France A320 at Point a Pitre on Feb 10th 2022, loss of visual reference in visual approach, minimum safe altitude warning

Last Update: April 3, 2024 / 16:03:03 GMT/Zulu time

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Photo of Air France F-HEPB, Airbus A320 — Air France F-HEPB, Airbus A320 (Photo credit: airlines470 / Flickr / License: CC by-sa)

Incident Facts

Date of incident
Feb 10, 2022

Classification
Incident

Airline
Air France

Flight number
AF-605

Departure
Fort de France, Martinique

Destination
Pointe-a-Pitre, Guadeloupe

Aircraft Registration
F-HEPB

Aircraft Type
Airbus A320

ICAO Type Designator
A320

Airport
Pointe-à-Pitre Le Raizet, Pointe-à-Pitre Le Raizet

Airport ICAO Code
TFFR

An Air France Airbus A320-200, registration F-HEPB performing flight AF-605 from Fort de France (Martinique) to Pointe-a-Pitre (Guadeloupe), was on visual approach to Pointe-a-Pitre's runway 12 in a right hand base when the captain lost visual reference of the airport due to a squall. The Minimum Safe Altitude Warning (MSAW) activated. The aircraft initiated a go around from about 450 feet, climbed to 3500 feet, positioned for another approach and landed safely on runway 12 about 20 minutes after the go around.

The French BEA reported the aircraft was on a right hand visual approach to runway 12 when on the base leg the captain lost visual sight of the runway due to a squall passing through. The MSAW activated. Coming out of the turn the aircraft was not aligned with the runway and went around. The French BEA rated the occurrence an incident and opened an investigation.

According to ADS-B data the aircraft was descending through 450 feet AGL (reaching a minimum of 425 feet AGL) when the aircraft went around. At that point the aircraft was still about 1nm off the extended runway center line and about 2.15nm from the runway threshold (measured along the extended runway centerline, 2.43nm direct line to the threshold) at a track of 100 degrees over the village of Destrellan.

On Aug 11th 2023 the French BEA released their final report in French only advising the English version will be released soon and concluding the probable cause of the incident were:

Contributing to the choice of a night visual approach under unfavourable weather conditions were:

- a desire to optimize trajectory and flight times
- the crew's desire to maintain non-automated flight training
- the frequent use of these trajectories in this flight sector

Contributing to the failure of the visual approach were:

- the threat, not identified by the approach briefing, posed by the pilot flying's seat position at the left hand for a right hand visual circuit
- underestimation of the risk of encountering low level clouds
- the choice of automatics (A/THR disengaged) resulting in a work load for the crew which in turn degraded both pilots' level of performance.

On Apr 3rd 2024 the BEA released their final report in English concluding the probable causes were:

The following factors contributed to the crew’s decision to follow a night visual approach path in weather conditions that were finally adverse:

- a wish to optimise the path and flight times;

- the crew’s desire to maintain flying skills without using automation;

- the frequent use of these flight paths in this flight sector.

The following factors contributed to the aborted visual approach:

- the threat, not identified during the approach briefing, due to the PF’s position (left seat) for a right-hand circuit;

- the underestimated risk of encountering low-height clouds;

- the decision to use the automation level corresponding to daylight conditions (A/THR switched off), which resulted in a heavy workload for the crew and degraded the performance level of both pilots.

The BEA summarized the scenario:

During the night descent, estimating that the weather conditions were favourable, the pilots requested a visual approach, which the controller cleared.

After starting to prepare the aeroplane, before turning onto the base leg, the PF disconnected the automation, including the A/THR. He asked the PM to “manage speed” in order to have the speed targets calculated by the FMS. The approach phase was not activated. The PM activated the approach phase via the MCDU.

He then carried out the actions associated with the landing gear extension (arming the ground spoilers, switching on the lights, announcing the imminent landing to passengers) before extending the flaps to position 3. Throughout this period, which lasted more than one minute, the PM’s workload did not allow him to monitor the path sufficiently.

Fifteen seconds after switching off the automation, the PF initiated a right turn towards the base leg and then the final. Faced with a few cloud banks and precipitation, the PF lost sight of the runway for a few moments. The initial bank angle of 15° finally increased to 28°. With this bank angle and a north-easterly wind, the aeroplane stayed within the desired path. In addition, the vertical speed increased to -2,000 ft/min. The erroneous path in the vertical and horizontal profiles and the high vertical speed were not detected.

When the controller announced and then repeated the information about the MSAW warning, the crew realised their mistake. They checked their position using the ND and, realising that the aeroplane was not aligned with the runway centreline, they decided to go around. After radar vectoring and an ILS approach, the landing took place without further incident.

Metars:
TFFR 110300Z AUTO 09010KT 9999 FEW031 BKN039 BKN052 23/22 Q1016 TEMPO 4000 SHRA SCT018TCU=
TFFR 110230Z AUTO 10008KT 9999 FEW013 BKN039 BKN047 23/22 Q1016 TEMPO 4000 SHRA SCT018TCU=
TFFR 110200Z AUTO 13004KT 9999 FEW018/// OVC080/// 23/22 Q1016 TEMPO 4000 SHRA SCT018TCU=
TFFR 110130Z AUTO 13006G17KT 100V160 9999 -RA SCT015 BKN022 BKN043 23/22 Q1016 TEMPO 4000 SHRA SCT018TCU=
TFFR 110100Z AUTO 10006KT 9999 FEW033 BKN044 BKN062 23/21 Q1015 TEMPO 4000 SHRA SCT018TCU=
TFFR 110030Z AUTO 11012KT 9999 FEW016 SCT031 BKN045 23/21 Q1015 TEMPO 4000 SHRA SCT018TCU=
TFFR 110000Z AUTO 10007KT 9999 FEW032 BKN060 BKN088 23/21 Q1015 TEMPO 3000 SHRA BKN018TCU=
TFFR 102330Z AUTO 09008KT 9999 FEW027 SCT034 OVC042 23/21 Q1015 TEMPO 3000 SHRA BKN018TCU=
TFFR 102300Z AUTO 08010KT 9999 FEW014 SCT040 BKN056 24/20 Q1014 TEMPO 3000 SHRA BKN018TCU=
TFFR 102230Z AUTO 08008KT 050V120 9999 FEW038 BKN046 BKN052 25/20 Q1014 TEMPO 3000 SHRA BKN018TCU=
TFFR 102200Z AUTO 07010KT 9999 -RA BKN036/// BKN047/// OVC068/// 26/21 Q1014 TEMPO 3000 SHRA BKN018TCU=
TFFR 102130Z AUTO 10008KT 070V130 9999 BKN035/// OVC056/// 27/19 Q1013 TEMPO 3000 SHRA BKN018TCU=
TFFR 102100Z AUTO 12010KT 9999 BKN037 BKN048 BKN060 27/19 Q1013 TEMPO 3000 SHRA BKN018TCU=