Risk Management of Technology and Maintenance Failures in the Context of Aviation Industry
Occasionally, an accident is so unique and overwhelming that it sends shock waves through the industry. These “watershed events” provide a change in focus and are major catalysts for change. One of the more famous “watershed events” occurred in 1988, when an Aloha Airlines B737-200 suffered structural fuselage failure and subsequent decompression. On April 28, 1988, Aloha Airlines flight 243, a Boeing 737-200, experienced an explosive decompression during climb out at cruise altitude About 5.5 m of the pressure cabin skin and supporting structure aft of the cabin entrance door and above the passenger floorline separated from the aircraft (see photograph in Appendix). Amazingly, the damage did not result in disintegration of the aircraft, and a successful emergency landing was made. The aircraft had been manufactured in 1969 and had since accumulated 35,496 airframe flight hours and 89,680 landings (Aircraft Accident Report, Aloha Airlines, Flight 243, 1989). Owing to the short distance between destinations on some Aloha Airlines routes, the maximum pressurization differential was not reached in every flight. Thus the number of equivalent full pressurization cycles was significantly less than 89,680. Nevertheless, the aircraft was nearly 19 years old. On the other hand, It was also operating with long-term access to warm, humid, maritime air effecting in critical corrosion risk. Probable Cause: fuselage, attachment fatigue and separation Contributing Factors: 1) Maintenance: improper inspection of aircraft, low Supervision, inadequate Company/operator management 2) Inadequate surveillance of operation from FAA (organization) side 3) Aircraft/equipment, inadequate airframe Manufacturer Investigation showed the large loss of pressure cabin skin was caused by rapid link-up of many