Final accident report between firefighters and Airbus A320neo in Lima

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It was made public final accident report aroused among the firefighters of the Lima airport and a Airbus A320neo from LATAM Peru.

To begin with, it is important to indicate that in accordance with the provisions of the Annex 13 to the Convention on International Civil Aviation, “The sole objective of the investigation of accidents or incidents, it will be
the prevention of future accidents and incidents”.

Operational Safety Recommendations, resulting from the technical process of the investigation, They are not intended to create a presumption of guilt or responsibility.

Final LATAM Airbus A320neo accident report – firemen

The information presented here is the same as the final report published by the Peruvian authority..

Last 18 November 2022, an Airbus A320-200 aircraft, CC-BHB registration, operated by the company LATAM Peru, suffered a plane crash while it is detached from Lima, Peru on runway 16L towards Juliaca as flight LPE2213.

After the aircraft have moved 1,200 mts. ca.. and with 243 Km/hr o 131 knots, collides with the R3 Rescue Vehicle that entered the runway when it was moving quickly from the new Aeronautical Fire Station, in the execution of an ETR.

Product of the strong impact, the engine on the right side of the aircraft became detached from its mounting, The right main gear collapsed and the aircraft slid onto the runway on its right wing., fuel spilled and caught fire; in addition, The R3 Rescue Vehicle was destroyed.

The technical crew executed the takeoff interruption procedures and controlled the direction of the aircraft until it stopped.; The auxiliary cabin crew conducted the immediate evacuation of passengers and crew, after SSEI-LAP Rescue extinguished the fire. Due, two died (02) of three (03) Aeronautical firefighters who crewed the R3 Rescue Vehicle, leaving the third firefighter seriously injured.

The final investigation report, published on 29 September 2023 determined as the cause of the accident; “Collision of the LATAM Aircraft during the takeoff run, against a SSEI-LAP Rescue Vehicle, what entered the track of flight without having the Express Authorization of the CORPAC Control Tower, when carrying out a Response Time Recording Exercise from the new Aeronautical Fire Station of the Jorge Chávez International Airport. This chain of events originated from the lack of joint planning; poor coordination; and the non-use of communication and phraseology standardized by ICAO.

The investigation identified the following contributing factors to the accident:

1. Not having held a Briefing meeting after the 1st ETR between LAP/SSEILAP and CORPAC, to determine errors, deficiencies, discrepancies and material and procedural shortages in the development of the exercise, that would have allowed the analysis and provision of improvement actions in all the aspects found, as a basis for the optimal execution of the 2nd ETR.
2. CORPAC's acceptance without observations of the LAP proposal, to perform ETR from partially implemented and testing facilities, located in the new areas of the airport, that had not yet been officially handed over to CORPAC control.
3. No meetings have been held between the LAP SMS and CORPAC to identify hazards, risk management and mitigation actions, inherent to the programming and execution of ETR from the new areas and facilities of the airport.
4. Not having held a joint meeting between LAP and CORPAC to plan the execution of the 2nd ETR, that would have allowed the participating personnel to know more clearly the concept and details of it.
5. Failure to provide adequate training to SSEI-LAP personnel and Tower Controllers, for location familiarization, designation and operational operation of the new Aircraft Taxiways and Vehicular Routes.
6. The incorrect application of the principles of aeronautical communication (clarity and precision) among those involved in the prior coordination of the execution of the 2nd ETR, generated a wrong interpretation by the CORPAC Tower Controllers about its execution.
7. The Tower Controllers did not notice that, by authorizing the withdrawal of the Safety Cones from the SSEI-LAP, the only way was being freed (VSR4) for the direct entry of the convoy of Rescue Vehicles to the flight runway.
8. The wrong interpretation that the SSEI-LAP Rescue had, thinking that the confirmation that the Tower gave him for the start of the 2nd ETR, It also implied authorization to enter the flight runway.
9. Aerodrome and Tower Surface Controllers, They knew about the 2nd ETR, minutes before execution, situation that did not allow them to have the capacity to analyze the risks and appropriately prioritize air traffic management.
10. The normalized phraseology established by ICAO for communications and exchanges between the SSEI-LAP and the Tower Controller has not been properly used during the execution of the 2nd ETR.

On the airline side, No findings were found that contributed to the accident., its crew having been up to date with all legal requirements and having complied with all parameters for safe operation.

The full report composed of 162 pages are available on the CIAA website.

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