Passengers of an Azul Airbus A320neo which aborted take-off at Cuiaba evacuated the aircraft while its engines were still running, after the cabin crew failed to understand the pilots’ instructions.
The aircraft came to a halt on runway 35 after the low-speed abort at 90kt – triggered by a hydraulic system warning – while attempting to depart for Sao Paulo on 25 November 2021.
Brazilian investigation authority CENIPA states that, a few seconds after the jet stopped, the captain instructed passengers and cabin crew to await further instructions.
“According to statements collected, this message was not understood by the flight attendants, possibly due to initial unrest among some passengers who believed there was fire outside the aircraft,” says CENIPA’s newly-published findings.
It states that tyre friction smoke from heavy braking combined with the effect of red and white strobe lights “may have given the impression” of an external fire. Passenger testimony indicates that remarks about fire and a possible explosion could have triggered panic.
Less than 30s after the captain’s announcement, the lead flight attendant opened the forward left-hand door, without any command from the cockpit and without verifying the conditions that would warrant an evacuation. The inquiry says this decision was partly due to an incorrect perception that passengers had already opened an overwing exit.
The captain attempted an emergency call on the interphone to contact cabin crew, after hearing screams, but was unsuccessful.
“For the flight attendants, the emergency call was not an expected procedure in that situation,” says the inquiry. “From their perspective, when triggered directly by the emergency alert, it was interpreted as ‘the worst-case scenario’.”
Upon seeing the initial forward door opened, other flight attendants opened the remaining three doors. Passengers activated the four overwing exits afterwards.
At the time the aircraft’s CFM International Leap-1A engines were still running, albeit at idle thrust.
Some 40s after the aircraft had stopped, the first officer observed passengers walking on the runway next to the aircraft, but neither pilot remembered that the engines were still operating.
Cabin crew were “unable to hear” the engine noise, owing to confusion in the passenger cabin, but they “observed the slides swinging”. The engines were eventually shut down about 4min after the evacuation began.
Fifteen passengers were injured during the evacuation, one of them seriously. The aircraft had been carrying 152 passengers and six crew members.
Investigators determined that the hydraulic system warning which led to the abort was caused by a small component of a sensor which had detached and fallen into the oil reservoir. “It was, therefore, an indication issue, with no actual leakage,” the inquiry says.
