Qantas Airways has updated its training for visual approaches following an incident in which the crew of an Airbus A330-200 misjudged an approach into Melbourne airport, resulting in warnings from the aircraft's enhanced ground proximity warning system (EPGWS).

The incident occurred in daylight hours during the early evening of 8 March 2013, and involved the aircraft registered VH-EBV, says the Australian Transport Safety Bureau (ATSB). The aircraft was inbound from Sydney with 11 crew and 211 passengers aboard at the time of the incident, which the ATSB categorises as “serious.”

The captain and first officer were at the end of a five day roster pattern, and had flown a Perth-Sydney service earlier that day. After being cleared for approach, the captain set an altitude target of 1,000ft, selected gear down, and 180kts as the target speed. At the aircraft descended through 1,800ft, the first officer told the captain the aircraft was low.

The captain reduced the rate of descent, but then the EPGWS issued “Terrain” alerts followed by the command to “Pull Up.” At this point the aircraft was at 1,400ft above sea level, but only 600ft above the ground – and 1,900ft below a normal three degree descent profile. The captain applied full power and conducted a go around before landing uneventfully.

“The ATSB found that during the visual approach the captain’s performance capability was probably reduced due to the combined effects of disrupted and restricted sleep, a limited recent food intake and a cold/virus,” it says. “The captain assessed the aircraft’s flight path using glide slope indications that were not valid. This resulted in an incorrect assessment that the aircraft was above the nominal descent profile.”

“In addition, the combination of the selection of an ineffective altitude target while using the auto-flight open descent mode and ineffective monitoring of the aircraft’s flight path resulted in a significant deviation below the nominal descent profile. The flight crew’s action in reducing the aircraft's rate of descent following their comprehension of the altitude deviation did not prevent the aircraft descending outside controlled airspace and the activation of the EGPWS.”

Qantas responded to the incident by updating training materials for visual approaches, and added questions for check pilots to help gauge crew proficiency. Visual approaches were also included as a discussion topic during crew route checks between 2013 and 2015.

“The ATSB stresses the importance of continually monitoring descent profiles, irrespective of the type of approach being flown and the level of automation being used. For flight crew, this occurrence illustrates the need to communicate their intentions and actions to ensure a shared understanding of the intended approach,” it adds.

At the time of the incident, the captain had 21,900hrs of flight experience, of which 2,270 was on the A330. The first officer had 10,030hrs experience, with 1,000hrs on the A330.

Source: Cirium Dashboard