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  • AT72, vicinity Budapest Hungary, 2016 (Synopsis: On 16 March 2016, an engine fire occurred to an ATR 72-200 departing Budapest and after declaring a MAYDAY, it was landed in the reciprocal direction on the departure runway without further event. The Investigation found that the failure had been initiated by the fatigue-induced failure of a single blade in the power turbine assembly but with insufficient evidence to ascribe a cause for this. A number of almost identical instances of engine failure initiated by failure of a single turbine blade were noted. Opportunities for both ATC procedures and flight crew response to mandatory emergency procedures were also identified.)
  • DH8C, vicinity Abu Dhabi UAE, 2012 (Synopsis: On 9 September 2012, the crew of a DHC8-300 climbing out of Abu Dhabi declared a PAN and returned after visual evidence of the right engine overheating were seen from the passenger cabin. The Investigation found that the observed signs of engine distress were due to hot gas exiting through the cavity left by non-replacement of one of the two sets of igniters on the engine after a pressure wash carried out overnight prior to the flight and that the left engine was similarly affected. The context for the error was identified as a dysfunctional maintenance organisation at the Operator.)
  • DH8B, en-route, west northwest of Port Moresby Papua New Guinea, 2017 (Synopsis: On 4 August 2017, a de Havilland DHC8-200 was climbing through 20,000 feet after departing Port Moresby when a sudden loud bang occurred and the aircraft shuddered. Apart from a caution indicating an open main landing gear door, no other impediments to normal flight were detected. After a return to the point of departure, one of the main gear tyres was found to have exploded causing substantial damage to the associated engine structure and releasing debris. The Investigation concluded that tyre failure was attributable to FOD damage during an earlier landing on an inadequately maintained but approved compacted gravel runway.)
  • B752, en-route, Northern Ghana, 2009 (Synopsis: On 28 January 2009 the crew of a Boeing 757-200 continued takeoff from Accra Ghana despite becoming aware of an airspeed discrepancy during the take off roll. An attempt to resolve the problem failed and the consequences led to confusion as to what was happening which prompted them to declare a MAYDAY and return - successfully - to Accra. The left hand pitot probe was found to be blocked by an insect. The Investigation concluded that a low speed rejected takeoff would have been more appropriate than the continued take off in the circumstances which had prevailed.)
  • B789, en-route, eastern Belgium, 2017 (Synopsis: On 29 April 2017, a Boeing 787-9 which had just reached cruise altitude after despatch with only one main ECS available began to lose cabin pressure. A precautionary descent and PAN was upgraded to a rapid descent and MAYDAY as cabin altitude rose above 10,000 feet. The Investigation found that aircraft release to service had not been preceded by a thorough enough validation of the likely reliability of the remaining ECS system. The inaudibility of the automated announcement accompanying the cabin oxygen mask drop and ongoing issues with the quality of CVR readout from 787 crash-protected recorders was also highlighted.)
  • A320, vicinity Perth Australia, 2015 (Synopsis: On 12 September 2015, an Airbus A320 autopilot and autothrust dropped out as it climbed out of Perth and multiple ECAM system messages were presented with intermittent differences in displayed airspeeds. During the subsequent turn back in Alternate Law, a stall warning was disregarded with no actual consequence. The Investigation attributed the problems to intermittently blocked pitot tubes but could not establish how this had occurred. It was also found that the priority for ECAM message display during the flight had been inappropriate and that the key procedure contained misleading information. These ECAM issues were subsequently addressed by the aircraft manufacturer.)