Date: 22nd May 2010
Location: Mangalore, Karnataka, India
Aircraft: Boeing 737-800, registration VT-AXV
Flight Number: 812
Operator: Air India Express
Flight Route: Dubai (UAE) to Mangalore (India)
Passengers: 160
Crew: 6
Summary of Events
On 22nd May 2010, Air India Express Flight 812, a Boeing 737-800, crashed after overrunning the runway at Mangalore’s Bajpe Airport. The aircraft, carrying 160 passengers and six crew members, overshot the tabletop runway, crashed into a steep valley, and burst into flames. Out of the 166 people on board, only eight survived, making it one of the deadliest aviation disasters in India’s history. The flight had originated in Dubai and was on final approach to Runway 24 at Mangalore’s Bajpe Airport when the accident occurred.
Despite being a visual landing, the aircraft approached the runway at high speed and touched down late, leaving insufficient runway length to stop. The aircraft’s speed, the delayed touchdown, and the challenging geography of the hilltop airport contributed to the runway overrun. The aircraft plunged into the valley at the end of the runway, breaking apart on impact and catching fire.
Aircraft and Crew Information
The aircraft involved in the crash was a Boeing 737-800, a modern and widely used twin-engine narrow-body jetliner that is popular for short- to medium-haul routes. The aircraft, registration VT-AXV, had been delivered new to Air India Express in 2008 and was equipped with modern avionics and safety features, including enhanced terrain awareness and warning systems (TAWS). At the time of the crash, the aircraft had accumulated thousands of flight hours and was regularly maintained according to industry standards.
The flight crew consisted of an experienced captain and a first officer. The 55-year-old captain was a seasoned pilot with over 10,000 hours of flight experience, including over 7,000 hours on the Boeing 737. He had been recently transferred from Air India to Air India Express. The first officer, a 40-year-old Indian national, had around 3,000 hours of flight experience.
Despite the crew’s experience, issues with fatigue and decision-making under pressure emerged as contributing factors to the crash, particularly regarding the captain’s response to the fast approach and the late touchdown on the short runway.
Sequence of Events
Flight 812 departed from Dubai International Airport late in the night of 21st May 2010 and was scheduled to arrive at Mangalore’s Bajpe Airport early in the morning of 22nd May. The flight was routine until the aircraft began its approach to Mangalore. Bajpe Airport is known for its tabletop runways, which are located on a plateau with steep drop-offs at either end. While picturesque, these runways present unique challenges for landing, as there is little margin for error, and overshooting the runway can have catastrophic consequences.
As Flight 812 approached Runway 24 at Mangalore, the weather was clear, but the approach was fast. The aircraft crossed the runway threshold at an altitude higher than normal and touched down approximately 1,500 feet beyond the ideal touchdown zone, leaving only around 5,000 feet of runway remaining to stop the aircraft. Given the high approach speed, this was not enough runway to bring the aircraft to a safe stop.
Despite applying maximum braking and deploying the thrust reversers, the crew was unable to decelerate the aircraft in time. The Boeing 737-800 overran the end of the runway and plunged into the valley beyond the airfield’s perimeter. The impact caused the aircraft to break apart and ignite a massive fire, exacerbated by the aircraft’s full fuel tanks. Rescue efforts were hindered by the difficult terrain, but eight survivors were pulled from the wreckage, all of whom were seated in the rear of the aircraft.
Weather and Runway Conditions
At the time of the crash, the weather at Mangalore was clear, and visibility was good. Weather conditions were not considered a factor in the crash. However, the runway at Mangalore’s Bajpe Airport is a tabletop runway, which presents unique challenges. Tabletop runways are located on elevated terrain with steep drop-offs at either end. If an aircraft overruns the runway, it can fall into a valley or ravine, as occurred in this incident.
The runway at Bajpe Airport is 8,033 feet long, which is sufficient for Boeing 737 operations under normal circumstances. However, given that the aircraft touched down nearly halfway down the runway, there was insufficient space to bring the aircraft to a stop before it overran the runway’s end.
Investigation and Analysis
The investigation into the crash was conducted by the Directorate General of Civil Aviation (DGCA) of India, with assistance from Boeing and international aviation experts. The investigation focused on several factors, including the approach and landing speed, the actions of the flight crew, and the design of the airport’s runway.
Late Touchdown and Excessive Speed: The investigation determined that the aircraft approached Runway 24 at a higher-than-normal speed and altitude. The touchdown occurred approximately 1,500 feet beyond the usual touchdown point, significantly reducing the available runway length for braking. The captain failed to initiate a go-around when it became apparent that the approach was unstable, which would have been the appropriate action under such circumstances.
Pilot Fatigue: The investigation also looked into the issue of pilot fatigue. The captain had flown multiple long-haul international flights in the days leading up to the crash, raising concerns about his level of fatigue at the time of the landing. Fatigue is known to impair decision-making, reaction time, and the ability to assess critical situations accurately, all of which may have contributed to the captain’s failure to execute a go-around.
Tabletop Runway: The tabletop runway at Bajpe Airport was a major factor in the crash. While the runway length was sufficient under normal landing conditions, the steep drop-off at the runway’s end leaves little room for error. Once the aircraft overran the runway, there was no flat surface or safety area to prevent the aircraft from plunging into the valley below. The investigation highlighted the need for enhanced runway safety features at airports with tabletop runways, such as the installation of engineered materials arrestor systems (EMAS), which can stop overrunning aircraft safely before they exit the runway.
Crew Communication and CRM: The cockpit voice recorder (CVR) revealed that the communication between the captain and the first officer during the approach was not optimal. The first officer did not sufficiently challenge the captain when it became clear that the aircraft was coming in too fast and too high. The breakdown in cockpit resource management (CRM) meant that the first officer’s concerns were not adequately addressed, and the unstable approach was allowed to continue.
Conclusions
The crash of Air India Express Flight 812 was primarily caused by the flight crew’s failure to execute a go-around after an unstable approach to Mangalore’s Runway 24. The late touchdown, combined with the excessive landing speed, left insufficient runway length to stop the aircraft before it overran the runway. The challenging geography of the tabletop runway exacerbated the situation, as the aircraft fell into a valley after overrunning the runway, resulting in the total destruction of the aircraft and the loss of 158 lives.
The investigation also highlighted the role of pilot fatigue and the breakdown in communication between the captain and the first officer. The crash underscored the importance of adhering to standard operating procedures, particularly in challenging landing environments, and the need for enhanced runway safety measures at airports with difficult terrain.
Recommendations
Following the investigation, several key recommendations were made to improve aviation safety and prevent similar accidents in the future:
1. Improved Crew Resource Management (CRM) Training: Airlines should emphasise the importance of effective communication between flight crew members. CRM training should ensure that first officers feel empowered to challenge captains when necessary, particularly in situations where safety is at risk.
2. Mandatory Go-Around for Unstable Approaches: Airlines should enforce stricter policies requiring go-arounds when an approach is unstable, especially when aircraft are approaching at excessive speed or altitude. This policy would prevent landings under unsafe conditions.
3. Enhanced Runway Safety Measures: Airports with tabletop runways should consider installing engineered materials arrestor systems (EMAS) or similar technology to stop overrunning aircraft before they fall into dangerous terrain.
4. Pilot Fatigue Management: Airlines should review their scheduling practices to ensure that pilots are not overworked and fatigued before critical flights. Fatigue management programs should be implemented to monitor and address pilot fatigue.
Safety Lessons and Industry Impact
The crash of Air India Express Flight 812 was a sobering reminder of the dangers posed by unstable approaches and the challenges of operating at airports with difficult terrain. The incident highlighted the importance of strict adherence to standard operating procedures and the need for enhanced runway safety features at tabletop airports.
Since the crash, airports with similar runway designs have begun to adopt additional safety measures, and airlines have strengthened their policies regarding go-arounds and crew communication. The lessons learned from this tragedy continue to shape aviation safety practices worldwide.
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