British Airways Flight 5390
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British Airways Flight 5390 was a flight from
Birmingham Airport Birmingham Airport , formerly ''Birmingham International Airport'', is an international airport located east-southeast of Birmingham city centre, west-northwest of Coventry slightly north of Bickenhill village, in the Metropolitan Borou ...
in England for
Málaga Airport Málaga Airport , officially Málaga–Costa del Sol Airport ( es, Aeropuerto de Málaga-Costa del Sol) since June 2011, is the fourth busiest airport in Spain after Madrid–Barajas, Barcelona and Palma de Mallorca. It is significant for Spa ...
in Spain. On 10 June 1990, the BAC One-Eleven 528FL suffered
explosive decompression Uncontrolled decompression is an unplanned drop in the pressure of a sealed system, such as an aircraft cabin or hyperbaric chamber, and typically results from human error, material fatigue, engineering failure, or impact, causing a pressure vesse ...
resulting in no loss of life. While the aircraft was flying over
Didcot Didcot ( ) is a railway town and civil parish in the ceremonial county of Oxfordshire and the historic county of Berkshire. Didcot is south of Oxford, east of Wantage and north west of Reading. The town is noted for its railway heritage, Di ...
, Oxfordshire, an improperly installed
windscreen The windshield (North American English) or windscreen (Commonwealth English) of an aircraft, car, bus, motorbike, truck, train, boat or streetcar is the front window, which provides visibility while protecting occupants from the elements. Mo ...
panel separated from its frame causing the captain to be sucked out of the aircraft. The captain was held in place through the window frame for twenty minutes until the first officer landed at
Southampton Airport Southampton Airport is an international airport located in both Eastleigh and Southampton, Hampshire in the United Kingdom. The airport is located north-north-east of central Southampton. The southern tip of the runway lies within the Sou ...
.


Aircraft and crew

The ''County of South Glamorgan'' was a
BAC One-Eleven The BAC One-Eleven (or BAC-111/BAC 1-11) was an early jet airliner produced by the British Aircraft Corporation (BAC). Originally conceived by Hunting Aircraft as a 30-seat jet, before its merger into BAC in 1960, it was launched as an 80-se ...
Series 528FL jet airliner, registered as The aircraft first flew on 8 February 1971, and was delivered to
Bavaria Fluggesellschaft Bavaria Fluggesellschaft was a West Germany, West German airline founded in 1957 and was merged with Germanair to become Bavaria Germanair in March 1977. History This airline was founded in 1957 as Bavaria Fluggesellschaft Schwabe & Co. In Janu ...
on 26 February 1971. It was later transferred to
Bavaria Germanair Bavaria Germanair was an airline that came into being following the merger of Bavaria Fluggesellschaft and Germanair on 1 January 1977. The airline's main area of activity was operating charter flights from German airports to European holida ...
in 1977,
Hapag-Lloyd Flug Hapag-Lloyd Flug (between 2005 and 2007 also marketed as ''Hapagfly'') was a German leisure airline headquartered in Langenhagen, Lower Saxony that was originally founded by Hapag-Lloyd and later became a subsidiary of TUI Group. It operated sch ...
in 1979,
British Caledonian British Caledonian (BCal) was a British private independent airline which operated out of Gatwick Airport in south-east England during the 1970s and 1980s. It was created as an alternative to the British government-controlled corporation airlin ...
in 1981, and finally to British Airways in 1988. The captain was 42-year-old Timothy Lancaster, who had logged 11,050 flight hours, including 1,075 hours on the BAC One-Eleven; the copilot was 39-year-old Alastair Atchison, with 7,500 flight hours, with 1,100 of them on the BAC One-Eleven. The aircraft also carried 4 cabin crew and 81 passengers.


Incident

Atchison handled a routine take-off at 08:20
local time Local time is the time observed in a specific locality. There is no canonical definition. Originally it was mean solar time, but since the introduction of time zones it is generally the time as determined by the time zone in effect, with daylight s ...
(07:20 UTC) then handed control to Lancaster as the plane continued to climb. Both pilots released their shoulder harnesses and Lancaster loosened his lap belt. At 08:33 (07:33 UTC) the plane had climbed through about over
Didcot Didcot ( ) is a railway town and civil parish in the ceremonial county of Oxfordshire and the historic county of Berkshire. Didcot is south of Oxford, east of Wantage and north west of Reading. The town is noted for its railway heritage, Di ...
, Oxfordshire, and the cabin crew were preparing for meal service.
Flight attendant A flight attendant, also known as steward/stewardess or air host/air hostess, is a member of the aircrew aboard commercial flights, many business jets and some government aircraft. Collectively called cabin crew, flight attendants are prima ...
Nigel Ogden was entering the cockpit when there was a loud bang and the cabin quickly filled with
condensation Condensation is the change of the state of matter from the gas phase into the liquid phase, and is the reverse of vaporization. The word most often refers to the water cycle. It can also be defined as the change in the state of water vapor to ...
. The left
windscreen The windshield (North American English) or windscreen (Commonwealth English) of an aircraft, car, bus, motorbike, truck, train, boat or streetcar is the front window, which provides visibility while protecting occupants from the elements. Mo ...
panel, on Lancaster's side of the flight deck, had separated from the forward fuselage; Lancaster was propelled out of his seat by the rushing air from the decompression and forced head first out of the flight deck. His knees were caught on the flight controls and his upper torso remained outside the aircraft, exposed to extreme wind and cold. The
autopilot An autopilot is a system used to control the path of an aircraft, marine craft or spacecraft without requiring constant manual control by a human operator. Autopilots do not replace human operators. Instead, the autopilot assists the operator' ...
had disengaged, causing the plane to descend rapidly. The flight deck door was blown inward onto the control console, blocking the throttle control (causing the aircraft to gain speed as it descended), flight documents and check lists were sucked out of the cockpit and debris blew in from the passenger cabin. Ogden rushed to grab Lancaster's belt, while the other two flight attendants secured loose objects, reassured passengers, and instructed them to adopt
brace position To assume a brace position or crash position is an instruction that can be given to prepare for a crash, such as on an aircraft; the instruction to "Brace for impact!" or "Brace! Brace!" is often given if the aircraft must make an emergency land ...
s in anticipation of an emergency landing. The plane was not equipped with oxygen for everyone on board, so Atchison began a rapid emergency descent to reach an altitude with sufficient air pressure. He then re-engaged the autopilot and broadcast a
distress call A distress signal, also known as a distress call, is an internationally recognized means for obtaining help. Distress signals are communicated by transmitting radio signals, displaying a visually observable item or illumination, or making a soun ...
, but he was unable to hear the response from
air traffic control Air traffic control (ATC) is a service provided by ground-based air traffic controllers who direct aircraft on the ground and through a given section of controlled airspace, and can provide advisory services to aircraft in non-controlled airs ...
because of wind noise; the difficulty in establishing two-way communication led to a delay in initiation of emergency procedures. Ogden, still holding on to Lancaster, was by now becoming exhausted, so purser John Heward and flight attendant Simon Rogers took over the task of holding on to the captain. By this time Lancaster had shifted several centimetres farther outside and his head was repeatedly striking the side of the fuselage. The crew believed him to be dead, but Atchison told the others to continue holding onto him, out of fear that letting go of him might cause him to strike the left wing, engine, or horizontal stabiliser, potentially damaging it. Eventually, Atchison was able to hear the clearance from
air traffic control Air traffic control (ATC) is a service provided by ground-based air traffic controllers who direct aircraft on the ground and through a given section of controlled airspace, and can provide advisory services to aircraft in non-controlled airs ...
to make an emergency landing at
Southampton Airport Southampton Airport is an international airport located in both Eastleigh and Southampton, Hampshire in the United Kingdom. The airport is located north-north-east of central Southampton. The southern tip of the runway lies within the Sou ...
. The flight attendants managed to free Lancaster's ankles from the flight controls while still keeping hold of him. At 08:55 local time (07:55 UTC), the aircraft landed at Southampton and the passengers disembarked using boarding steps. Lancaster survived with frostbite, bruising, shock, and fractures to his right arm, left thumb, and right wrist. Ogden had cuts and bruises to his arm, and later suffered from
PTSD Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a ...
. There were no other injuries.


Investigation

Police found the windscreen panel and many of the 90 bolts securing it near
Cholsey Cholsey is a village and civil parish south of Wallingford in South Oxfordshire. In 1974 it was transferred from Berkshire to Oxfordshire, and from Wallingford Rural District to the district of South Oxfordshire. The 2011 Census recorded Chol ...
, Oxfordshire. Investigators found that when the windscreen was installed 27 hours before the flight, 84 of the bolts used were too small in
diameter In geometry, a diameter of a circle is any straight line segment that passes through the center of the circle and whose endpoints lie on the circle. It can also be defined as the longest chord of the circle. Both definitions are also valid for ...
(
British Standards British Standards (BS) are the standards produced by the BSI Group which is incorporated under a royal charter and which is formally designated as the Standards organization#National standards bodies, national standards body (NSB) for the UK. The ...
A211-8C vs A211-8D, which are #8–32 vs #10–32 by the
Unified Thread Standard The Unified Thread Standard (UTS) defines a standard thread form and series—along with allowances, tolerances, and designations—for screw threads commonly used in the United States and Canada. It is the main standard for bolts, nuts, and a w ...
) and the remaining six were A211-7D, which is the correct diameter but too short (0.7 inch vs. 0.8 inch). The previous windscreen had also been fitted using incorrect bolts, which were replaced by the shift maintenance manager on a like-for-like basis without reference to maintenance documentation, as the plane was due to depart shortly. The undersized bolts were unable to withstand the
air pressure Atmospheric pressure, also known as barometric pressure (after the barometer), is the pressure within the atmosphere of Earth. The Standard atmosphere (unit), standard atmosphere (symbol: atm) is a unit of pressure defined as , which is equival ...
difference between the cabin and the outside atmosphere during flight. (The windscreen was not of the "plug" type – fitted from the inside so that cabin pressure helps to hold it in place – but of the type fitted from the outside so that cabin pressure tends to dislodge it.) Investigators found that the shift maintenance manager responsible for installing the incorrect bolts had failed to follow British Airways policies. They recommended that the CAA recognise the need for aircraft engineering personnel to wear corrective glasses if prescribed. They also faulted the policies themselves, which should have required testing or verification by another individual for this critical task. Finally, they found the local Birmingham Airport management responsible for not directly monitoring the shift maintenance manager's working practices.


Awards

First Officer Alastair Atchison and cabin crew members Susan Gibbins and Nigel Ogden were awarded the
Queen's Commendation for Valuable Service in the Air The Queen's Commendation for Valuable Service in the Air, formerly the King's Commendation for Valuable Service in the Air, was a merit award for flying service awarded by the United Kingdom between 1942 and 1994. It was replaced by the Queen’ ...
; Ogden's name was erroneously missed from the published supplement. Atchison was awarded a 1992
Polaris Award The Polaris Award is the highest decoration associated with civil aviation, awarded by the International Federation of Air Line Pilots' Associations (IFALPA) to airline crews in recognition for acts of exceptional airmanship Airmanship is skil ...
for outstanding airmanship.


Aftermath

The aircraft was repaired and returned to service, eventually being sold to Jaro International in 1993. It continued to operate with them until Jaro ceased operations in 2001; the aircraft was scrapped in 2002. Tim Lancaster returned to work after less than five months. He left British Airways in 2003 and flew with
EasyJet EasyJet plc (styled as easyJet) is a British multinational low-cost airline group headquartered at London Luton Airport. It operates domestic and international scheduled services on 927 routes in more than 34 countries via its affiliate airli ...
until he retired from commercial piloting in 2008. Alastair Atchison left British Airways shortly after the incident and joined
Channel Express Channel Express (Air Services) Limited was an airline with its head office in Building 470 at Bournemouth International Airport in Christchurch, Dorset, near Bournemouth. It operated scheduled services from Bournemouth to the Channel Islands a ...
, remaining there after it was rebranded as
Jet2 Jet2.com Limited is a British low-cost leisure airline offering scheduled and charter flights from the United Kingdom. As of 2022, it is the List of largest airlines in Europe, third-largest scheduled airline in the UK, behind EasyJet and Briti ...
until he made his last commercial flight on a Boeing 737-33A (registration: G-CELE) from
Alicante Alicante ( ca-valencia, Alacant) is a city and municipality in the Valencian Community, Spain. It is the capital of the province of Alicante and a historic Mediterranean port. The population of the city was 337,482 , the second-largest in t ...
to
Manchester Manchester () is a city in Greater Manchester, England. It had a population of 552,000 in 2021. It is bordered by the Cheshire Plain to the south, the Pennines to the north and east, and the neighbouring city of Salford to the west. The t ...
on his 65th birthday on 28 June 2015.


In popular culture

The accident was featured on season 2 of the Canadian documentary series ''
Mayday Mayday is an emergency procedure word used internationally as a distress signal in voice-procedure radio communications. It is used to signal a life-threatening emergency primarily by aviators and mariners, but in some countries local organiza ...
''. The episode is entitled "Blow Out".


See also

*
Sichuan Airlines Flight 8633 Sichuan Airlines Flight 8633 was a flight from Chongqing Jiangbei International Airport to Lhasa Gonggar Airport on 14 May 2018, which was forced to make an emergency landing at Chengdu Shuangliu International Airport after the cockpit windshield ...
, a similar incident * Southwest Airlines Flight 1380, an explosive decompression incident following an
uncontained engine failure A turbine engine failure occurs when a turbine engine unexpectedly stops producing power due to a malfunction other than fuel exhaustion. It often applies for aircraft, but other turbine engines can fail, like ground-based turbines used in power ...
that resulted in a passenger being partially sucked out of a window; the passenger later died from her injuries


References


External links

*
Air Accident Investigation Branch The Air Accidents Investigation Branch (AAIB) investigates civil aircraft accidents and serious incidents within the United Kingdom, its overseas territories and crown dependencies. It is also the Space Accident Investigation Authority (SAIA) ...

Report No: 1/1992. Report on the accident to BAC One-Eleven, G-BJRT, over Didcot, Oxfordshire on 10 June 1990
*
Final report

Transcript of Air Traffic Control communications during the incidentArchive

Summary of the Final ReportArchive

Database entryArchive

News article showing image of cockpit exterior after landing
{{International Airlines Group 1990 in England Airliner accidents and incidents caused by maintenance errors Aviation accidents and incidents in England Aviation accidents and incidents in 1990 5390 Airliner accidents and incidents caused by in-flight structural failure Airliner accidents and incidents involving in-flight depressurization Accidents and incidents involving the BAC One-Eleven June 1990 events in the United Kingdom Airliner accidents and incidents in the United Kingdom Airliner accidents and incidents caused by pilot incapacitation