ATSB final investigation report on ship fire off Newcastle

The ATSB has found that the engine room fire on board the general cargo ship Baltimar Boreas off Newcastle, on 9 February 2007, started after diesel oil leaking from a failed fuel hose on one of the ship's generator engines ignited.

The Australian Transport Safety Bureau investigation found that long term wear from chafing caused the flexible fuel hose to fail. Inadequate maintenance, use of longer than specified hoses and temporary repairs contributed to the poor condition of a number of hoses on the ship's generators. The length of the fuel hoses, as designed, was also not consistent with internationally-prescribed guidelines. The condition of the hoses had not been noticed during previous surveys, audits or inspections. The investigation also found that the ship's funnel ventilator closing arrangements were not in accordance with the intent of the relevant international regulations.

At 2305 on 8 February, the Bahamas registered Baltimar Boreas sailed from Newcastle with a cargo that included 945 tonnes of the industrial explosive, ammonium nitrate.

At 0250 on 9 February, the ship's fire detection system indicated a fire the engine room. On investigation, the second engineer found a large fire on number three generator. He quickly raised the alarm and stopped the engine room ventilation fans. The crew mustered quickly, operated systems to stop the engine room oil pumps and prepared to fight the fire. All the engine room ventilators were closed, except those at the top of the funnel which were inaccessible because of thick smoke and sparks issuing from them.

At 0305, Halon gas from the engine room fixed fire extinguishing system was released and the master then sent a distress message. A rapid response to the incident ashore was coordinated by the Australian Maritime Safety Authority. Baltimar Boreas was about five miles off the coast and a passing ship stood by to assist if necessary. A tug from Newcastle, with fire-fighting capability, was also sent to assist.

At 0340, the ship's crew determined that the fire was extinguished. There were no injuries but fire damage in the engine room had disabled the ship. By 1030, the tug had taken Baltimar Boreas in tow and the ship berthed in Newcastle for repairs later that day.

The ATSB has issued a number of recommendations and safety advisory notices with the aim of preventing similar incidents in the future.

Copies of the report can be downloaded from the ATSB's internet site.

Fatal level crossing collision at Moloney Road South Australia

The ATSB has found that a fatal collision between a Patrick Portlink freight train and a small passenger van occurred when the motorist drove into the path of the train at the Moloney Road level crossing near Virginia, SA.

The Australian Transport Safety Bureau report into the collision on 16 November 2007 concluded that the motorist's familiarity with the crossing and low expectation of encountering a train were probably factors that contributed to the collision Alternatively, the motorist may simply have had a lapse of concentration and failed to stop. Both occupants of the van were fatally injured in the collision.

The investigation established that had the motorist come to a halt at the 'Stop' sign as required he would have been able to clearly see the train, remain at stop and then proceed safely over the crossing when the train had passed.

On 27 June 2008 the ATSB released its final investigation report into another collision at the Moloney Road level crossing which included safety actions relevant to the current investigation.

The City of Playford Council is closing the Moloney Road crossing to prevent similar accidents in the future. Copies of the report can be downloaded from the ATSB's internet site at www.atsb.gov.au or obtained from the ATSB by telephoning 1800 020 616.

Derailment investigation report

An Australian Transport Safety Bureau (ATSB) investigation has found that a fatal level crossing accident at Back Creek in central western NSW at about 1830 on 10 March 2007 occurred when the semi-trailer driver drove into the path of an empty grain train. The driver sustained fatal injuries in the collision.

The ATSB today released a report regarding the collision. The semi-trailer was trapped under the leading locomotive and dragged onto the rail bridge over a watercourse adjacent to the level crossing. During the collision sequence, the leading locomotive and semi-trailer prime mover caught fire. The fire subsequently destroyed both vehicles and the other two locomotives that were hauling the train, and the timber members of the railway bridge over the watercourse.

The ATSB's investigation found that the semi-trailer driver was probably intending to perform a rolling stop, where the vehicle is slowed but not stopped at the level crossing Stop sign, and he may have only heard the locomotive horn at the last moment, if at all. The driver lived in the area and was very familiar with the crossing and probably did not expect to see a train given the low volume of rail traffic on the line.

The investigation also found that the semi-trailer driver's ability to see the train was probably impeded by glare from the sun given the time of day and the westerly direction he was driving as he approached the crossing.

The ATSB's investigation report also notes that there were no advance level crossing warning signs on an alternate road approach to the level crossing for heavy vehicles. However, given the semi-trailer driver's extensive local knowledge, the lack of this signage was not considered to have contributed to the collision.

Copies of the report can be downloaded from the ATSB's internet site or obtained from the ATSB by telephoning (02) 6274 7687 or 1800 020 616.

Qantas Boeing 747-400 depressurisation and diversion to Manila on 25 July 2008

The ATSB was advised on Friday 25 July of an accident involving a Qantas aircraft.

The aircraft, a Boeing 747-400 was operating a scheduled passenger service from Hong Kong to Melbourne Australia. At approximately 29,000 feet, the crew were forced to conduct an emergency descent after a section of the fuselage separated and resulted in a rapid decompression of the cabin. The crew descended the aircraft to 10,000 feet in accordance with established procedures and diverted the aircraft to Manila where a safe landing was carried out. The aircraft taxied to the terminal unassisted, where the passengers and crew disembarked. There were no reported injuries.

The ATSB is leading this safety investigation with the assistance of a number of other organisations and agencies, including the Civil Aviation Authority of the Philippines, The National Transportation Safety Board and the Federal Aviation Administration of the USA, the Civil Aviation Safety Authority of Australia and Qantas and Boeing.

The ongoing investigation has confirmed that there is one unaccounted for oxygen cylinder from the bank of cylinders that are located in the area of the breach. There are 13 oxygen cylinders in the bank that are responsible for supplying oxygen to the passenger masks and cabin crew.

Also recovered are a number of parts of components including part of a valve in the vicinity of the breach. However, it is yet to be determined whether these components are part of the aircraft system.

A number of passengers have reported that some of the oxygen masks appeared not to function correctly when they deployed from the overhead modules. The ATSB intends to examine the oxygen system including the oxygen masks.

The ATSB is also intending to interview the aircraft crew including the cabin crew and make contact with all passengers on the flight. All passengers will be surveyed, while those that had reported problems with mask deployment will be interviewed.

The passenger survey should be available in about two weeks.

The ATSB would like to request that any passengers that experienced issues during the flight, or those who photographed or videoed the incident contacts us via email at atsbinfo@atsb.gov.au.

The ATSB would also like to encourage passengers to write down their recollection of events that occurred. This will aid them with the completion of the passenger survey.

The aircraft flight data recorder and the cockpit voice recorder have arrived in Australia. The ATSB will download the recorders at its Canberra facilities over the next few days.

The ATSB will also be examining maintenance records for the aircraft. This will include any airworthiness directives or alert bulletins that may have been issued by the regulators or the manufacturers.

Level crossing collision at Moloney Road South Australia

The ATSB has found that a collision between the Indian Pacific passenger train and a tip truck occurred when the driver of the truck drove into the side of the train at the Moloney Road level crossing in SA.

The Australian Transport Safety Bureau has today released its final report into the collision which occurred on 13 December 2007. At the time of the accident road traffic at the crossing was controlled by 'Stop' signs and approach warning signs.

The investigation established that the truck did not come to a halt at the 'Stop' sign and concluded that the truck driver's familiarity with the crossing, low expectation of encountering a train and his possible increased propensity to take risks were factors that may have led to him failing to stop at the crossing.

The investigation concluded that had the truck driver come to a halt at the 'Stop' sign as required he would have been able to clearly see the train and then have been able to proceed safely over the crossing when the train had passed.

In the interest of enhancing future road/rail safety the ATSB has identified a series of opportunities to improve the road/rail interface risk at this location. The City of Playford Council is currently in the process of closing the road over the crossing as alternative access with active protection is close-by and available for public use. This action will eliminate the risk of any future collision at the level crossing.

Copies of the report can be downloaded from the ATSB's internet site.

Boeing 747 diversion to Manila

The Australian Transport Safety Bureau was advised this afternoon of a serious incident involving a Qantas aircraft.

The aircraft, a Boeing 747-400 was operating a scheduled passenger service from Hong Kong to Melbourne Australia. At approximately 29,000 feet, the crew were forced to conduct an emergency descent after a section of the fuselage separated and resulted in a rapid decompression of the cabin. The crew descended the aircraft to 10,000 feet in accordance with established procedures and diverted the aircraft to Manila where a safe landing was carried out. The aircraft taxied to the terminal unassisted, where the passengers and crew disembarked. There were no reported injuries.

Initial information indicates that a section of the fuselage has separated in the area of the forward cargo compartment.

The Australian Transport Safety Bureau is dispatching a team of four investigators to Manila to assist local authorities with the investigation.

Investigation into Boeing 747- 400 depressurisation and diversion to Manila, Philippines

The ATSB is leading this safety investigation with the assistance of a number of other organisations and agencies, including the Civil Aviation Authority of the Philippines, The National Transportation Safety Board and the Federal Aviation Administration of the USA, the Civil Aviation Safety Authority of Australia and Qantas and Boeing.

Yesterday the aircraft was moved to a hangar. This will provide a safer and more optimal working environment for the investigation team.

The remainder of the freight on the aircraft has been progressively examined and removed from around the area of the rupture. This has allowed the investigation team full access to the area. The team have also been examining and clearing the area adjacent to the disrupted right cabin door.

The investigation team are in the process of examining the interior of the cabin including the onboard oxygen system, the passenger masks and portable crew oxygen cylinders. The aircraft outer panels around the ruptured area have also been removed.

A number of components and parts of components are being retained for further examination and analysis at the ATSB engineering facilities in Canberra.

Last night the aircraft cockpit voice recorder (CVR), which records crew conversations, radio traffic and cockpit ambient sounds, was downloaded by ATSB specialists in Canberra. Unfortunately, the standard two hour recording which works on an endless loop principle did not contain the event. The oldest recording commences after the descent and diversion into Manila, so the event itself appears to have been overwritten. However, the information that has been captured on the CVR may provide valuable insights into the flight crew's handling of the situation following the depressurisation.

The aircraft flight data recorder (FDR), which nominally records 25 hours of data, is being downloaded today at the ATSB Canberra facilities. The specialist team should know in the next day or two if the recording contains valid data.

The investigation team plan to continue the examination and collection of evidence from the aircraft. ATSB investigators in Australia are gathering data from the operator. Interviews with both flight crew and cabin crew are being conducted today in Melbourne.

A reminder that the ATSB requests that any passengers that experienced issues during the flight, or those who photographed or videoed the incident, contacts us via email at atsbinfo@atsb.gov.au

Investigation of collision between sewage truck and The Ghan

The ATSB has found that a collision between The Ghan passenger train and a loaded sewage truck occurred when the driver of the truck drove into the path of the train at a private road level crossing at 'Murrow Farm' near Two Wells in SA.

The Australian Transport Safety Bureau has today released its final investigation report into the collision which occurred on 6 August 2007 seriously injuring the truck driver. At the time of the accident road traffic at the level crossing was controlled by 'Stop' signs.

The ATSB found that the truck driver did not stop and did not see the train until he was on the level crossing. However, vegetation adjacent to the crossing had grown to the point where the truck driver could not see the approaching train even if he had stopped as required. Had the vegetation been adequately maintained, the truck driver would have been able to clearly see The Ghan, stop and then proceed safely over the crossing when the train had passed.

As a result of this investigation, the ATSB has identified safety issues primarily related to maintenance practices for the control of vegetation in the rail corridor which require action to reduce the risk of future collisions at this and other level crossings. Six safety recommendations have been issued. The ATSB also acknowledges safety action already undertaken by the Australian Rail Track Corporation in response to identified safety issues. Copies of the report can be downloaded from the ATSB's internet site at www.atsb.gov.au or obtained from the ATSB by telephoning 1800 020 616.

Depressurisation, 475 km north-west of Manila, Philippines, 25 July 2008, Boeing Company 747-438, VH-OJK

Today the Australian Transport Safety Bureau is releasing its Preliminary Factual report on the depressurisation of Boeing 747-438, VH-OJK, 475 km northwest of the Philippines, while being operated on a scheduled passenger flight from Hong Kong to Melbourne on 25 July 2008.

It is important to note that the information contained in the preliminary factual report, as the name suggests, is limited to preliminary factual information that has been establish in the initial investigation of the accident. Caution should be exercised that there is the possibility that new evidence may become available that alters the circumstances as depicted in the report.

To date, the Australian Transport Safety Bureau investigation, assisted by a number other organisations and agencies, including the Civil Aviation Authority of the Philippines, the National Transportation Safety Board and the Federal Aviation Administration of the USA, the Civil Aviation Safety Authority of Australia, Qantas and Boeing, has determined that about 55 minutes after departure from Hong Kong, and after the aircraft was established at its cruising altitude of 29,000 ft, the captain and first officer reported hearing a 'loud bang or cracking sound' with an associated airframe jolt. At that time, the autopilot disconnected, and the first officer, who was the pilot flying at the time, assumed manual control of the aircraft. Multiple warning messages were displayed in the cockpit, including warnings regarding the R2 door status and cabin altitude - that is the altitude corresponding to the air pressure inside the aircraft cabin. After donning oxygen masks the crew completed the 'cabin altitude non-normal' checklist. Approximately 20 seconds after the event, the captain reduced the thrust on all four engines and extended the speed brakes. The first officer commenced the descent, while the captain declared a MAYDAY on the Manila flight information region (FIR) radio frequency.

About 5 and a half minutes later, the aircraft reached and was levelled at an altitude of 10,000 ft, where the use of supplementary oxygen by passengers and crew was no longer required. After reviewing the aircraft's position, the flight crew elected to divert and land at the Ninoy Aquino International Airport, Manila. Landing preparations were subsequently commenced, including the jettisoning of excess fuel to ensure the aircraft's landing weight was within safe limits. The flight crew reported that many system failure messages were displayed, including all three instrument landing systems (ILS), the left VHF omni-directional radio-range (VOR) navigation instrument, the left flight management computer (FMC) and the aircrafts anti-skid braking system.

The cabin crew reported that shortly after the bang was heard, oxygen masks fell from most of the personal service units in the ceiling above passenger seats and in the toilets. Most passengers started using the oxygen masks soon after they dropped. All the cabin crew, who were engaged in passenger service activities at the time, immediately located oxygen masks to use. Some crew located a spare passenger mask and sat in between passengers, while others went to a crew jump-seat at an exit, and one used a mask in a toilet.

The flight crew reported that at all times during the ensuing descent into Manila, they were able to maintain the aircraft in visual flight conditions. With radar vectoring assistance from Manila air traffic control, the captain, who had assumed the pilot flying role, conducted an uneventful approach and landing on runway 06, with a smooth touchdown, full reverse thrust and minimal braking. Emergency services were in attendance after the aircraft was stopped on the runway, after which intercom contact was made with a ground engineer and the aircraft verified as being safe to tow to the airport terminal and disembark the passengers via a terminal airbridge.

None of the passengers or crew aboard the aircraft reported any physical injuries to the cabin crew immediately following the depressurisation event, or to the operators staff upon arrival in Manila.

An initial inspection of the external aircraft surfaces on the ground in Manila revealed the complete loss of the right wing forward leading edge-to-fuselage fairing, with separation occurring along the lines of interconnection between the fairing and fuselage skins. In the area exposed by the fairing loss, was an inverted T-shaped rupture in the fuselage skin, with several items from within the forward cargo hold partially protruding from the rupture.

Following removal of all cargo materials and lowering of the hold right-side curtain panels, it was found that the fuselage rupture was aligned with the nominal position of the number 4 passenger emergency oxygen cylinder; (slide2) one of seven such cylinders in a bank along the right side of the hold. The number 4 cylinder was missing from the bank.

On the basis of the physical damage to the aircraft's forward cargo hold and cabin, it was evident that the number 4 passenger oxygen cylinder sustained a failure that allowed a sudden and complete release of the pressurised contents. The rupture and damage to the aircraft's fuselage was consistent with being produced by the energy associated with that release of pressure. Furthermore, it was evident that as a result of the cylinder failure, the vessel was propelled upward, through the cabin floor and into the cabin space. Damage and impact witness marks found on the structure and fittings around the R2 cabin door showed the trajectory of the cylinder after the failure.

The following graphics illustrate the likely trajectory of the cylinder, based on the observed damage:

(slide 3) This graphic represents a cross-sectional view through the aircraft at the position of the R2 main cabin door - you will note here the oxygen bottle in situ in the cargo hold, the main deck floor, the R2 door and handle, the bustle that contains the escape slide and the overhead storage bins.

(slide 4) It is apparent that the cylinder failed towards its lower end, allowing a sudden and complete release of the pressurised contents that had sufficient energy to rupture the fuselage. It is likely that the lower part of the cylinder exited the aircraft through the rupture at this time, while the bulk of the bottle, complete with valve was propelled upward through the cabin floor. You can see the hole punched through the main cabin floor by the cylinder here, as viewed from within the cargo hold.

(slide 5) The cylinder then impacted the R2 door frame and the internal door handle - you can see in these photographs green paint transfer from the cylinder on the partition, vertically oriented scoring of the door escape slide shroud (bustle), impact damage on the door frame and the internal door handle rotated approximately 80% towards the open position. However, the door handle shaft had failed, as it is designed to do if an attempt is made to open the door in flight, so the position of the door handle is not representative of the position of the door lock mechanism or the security of the door. The investigation has confirmed that the door latches were still engaged. The portable walk-around oxygen cylinder that was normally located in an alcove just inside the R2 door was not present, and was not accounted for in a subsequent search of the aircraft.

(slide 6) It is apparent that the impact with the door frame broke off the cylinder valve and caused the cylinder to invert, while continuing to travel upward. Various items of debris were found around the aircraft cabin in the vicinity of the R2 door. Of note, that included fragments of the number-4 oxygen cylinder valve handle, the valve pressure relief assembly and the valve body itself. A fragment of the valve body was also recovered from within the damaged area on the door frame. However, a thorough search of the cabin and overhead ceiling void space failed to locate any part of the number-4 oxygen cylinder itself.

(slide 7) The cylinder then impacted the overhead panelling end on, producing the circular cut-out type damage observed in these photographs. The diameter of the cut-out region closely matched that of the passenger oxygen cylinder, as can bee seen in the lower photograph.

(slide 8) The still rotating cylinder then produced crushing damage adjacent to the cut-out opening. The semi-circular area of crushing damage to the partitioning panel was of a similar diameter to the cut-out section. A light fitting, normally present in the overhead panels had sustained upward crushing damage and presented clear green paint smears of a similar colouration to the marks on the partition panel and door bustle.

(slide 9) The cylinder then fell to the cabin floor, back through the hole into the cargo hold and exited the aircraft through the ruptured fuselage.

The investigation to date has also identified other damage to the aircraft, including severing and damage to numerous electrical cables and cable bundles, routed through the lower aircraft fuselage near the point of rupture. In addition, both right side (first officer's) aileron control cables, routed along the right side of the fuselage above the passenger oxygen cylinders, were fractured during the rupture event. However, the aircraft control systems have a redundancy arrangement whereby the first officer's aileron control cables are duplicated by the captain's system, the cables from which were routed along the opposite (left) side of the forward cargo hold. Interlinks between the aileron systems provided the necessary redundancy in this instance, ensuring the continued safety of flight after the event.

(slide 10) In terms of cabin safety issues, Investigators conducted a comprehensive walk-through examination of the aircraft's cabin and a survey of the safety systems; in particular, the status of the passenger oxygen masks and equipment. Preliminary observations included that:

  • there were 353 passenger seats in the aircraft
  • 476 passenger oxygen masks had deployed from their overhead compartments
  • 426 passenger oxygen masks were pulled down (i.e. activated for use) - you will note in this photograph arrowed a number of those that dropped, but were not activated, and
  • forward crew rest and customer support manager station masks had not deployed.

Cabin safety investigation aspects are ongoing and will examine the serviceability and functionality of the cabin oxygen apparatus and other cabin safety equipment, cabin crew actions, and passenger actions and problems. The investigation has interviewed all 16 of the cabin crew about their experiences, and a review of cabin crew procedures will be conducted.

The investigation is also conducting a survey of all passengers on the flight. The results of this survey will help the investigation determine what occurred and enable the investigation to document passenger and crew actions, equipment issues, and whether there were any resulting injuries. The effects of the damage sustained by the oxygen system on its capacity to function adequately and for a sufficient period will also be investigated. The survey will also help determine if any improvements in equipment design or crew procedures are needed to enhance safety. The survey has been emailed or posted to passengers where the ATSB could locate contact details. Passengers who have not received a survey but who would like to receive one are requested to provide an email or postal address to the ATSB, and this can be done through 1800 020 616 or to email.

The ongoing engineering investigation into the apparent oxygen cylinder failure will focus on (but not be limited to):

  • cylinder design, manufacturing methods and type testing procedures
  • manufacturing quality control processes and results
  • modes and mechanisms of cylinder failure
  • historical oxygen and pressurised cylinder failure experiences, civil and military, aviation and industrial.
  • cylinder degradation mechanisms
  • the adequacy and efficacy of inspection, maintenance and repair processes, procedures and equipment prescribed by the manufacturer and implemented by maintenance organisations, and
  • cylinder filling processes and procedures.

As the failed cylinder was not recovered, the ATSB is currently working with the aircraft manufacturer, other aircraft operators and the oxygen cylinder manufacturer, to obtain samples of cylinders from the same manufacturing batch as the failed item, to facilitate the ongoing investigation of all relevant issues.

Examination of cockpit voice recorder, flight data recorder and quick access recorder information is ongoing and will include the

  • Analysis of CVR audio regarding crew actions, aircraft handling and crew/cabin communications during the approach and landing at Manila
  • Analysis of FDR data to produce a detailed sequence of events and assist in identifying secondary damage from the oxygen cylinder failure and the effects of that damage to aircraft systems and aircraft handling.

A number of safety actions have already been taken by the operator. On 27 July (2 days following the VH-OJK event), the aircraft operator, in agreement with the Civil Aviation Safety Authority (CASA), commenced a fleet-wide program of detailed visual inspections of its Boeing 747 oxygen system installations. The ATSB was advised that those inspections were completed by 1 August.

The operator has also completed a preliminary internal review of the event, addressing the crew and passenger response, the emergency passenger oxygen system operation, supplementary passenger oxygen requirements, and the functionality of the depressurisation emergency announcement system operation.

The ATSB has also considered, in consultation with the NTSB, US FAA, Boeing and CASA, the need for any immediate safety action. It is important that any corrective or precautionary action undertaken in response to a safety occurrence should be justifiable in terms of established or probable facts. However, in view of the nature of the depressurisation event and the implication of a possible mechanism or condition that could affect the structural integrity and safety of other oxygen cylinders used in the aviation environment, the ATSB has released a number of safety advisory notices on the basis of prudence, until such time that the mechanism/s contributing to the cylinder failure are established and understood.

Those safety advisory notices encourage all organisations performing inspection, testing, maintenance and repair activities on aviation oxygen cylinders, to note the circumstances detailed in the ATSB's preliminary report, with a view to ensuring that all relevant procedures, equipment, techniques and personnel qualifications satisfy the applicable regulatory requirements and established engineering best-practices. The ATSB also encourages other operators of transport category aircraft fitted with pressurised gaseous oxygen systems, to note the circumstances detailed in the preliminary report, with a view to ensuring that all oxygen cylinders, and cylinder installations, are maintained in full accordance with the relevant manufacturers requirements, statutory regulations, and established engineering best practices.

The investigation is ongoing and the ATSB continues to work closely with representatives from the US NTSB and FAA, Boeing, CASA and Qantas. It is always difficult to predict how long an investigation such as this will take. While it is likely to take some months, should any critical safety issues emerge that require urgent attention, the ATSB will immediately bring such issues to the attention of the relevant authorities who are best placed to take prompt action to address those issues.

Qantas Airbus Incident Media Conference

The Australian Transport Safety Bureau was advised yesterday afternoon of an occurrence involving an Airbus A330-300 aircraft while on a flight from Singapore to Perth, operating as Qantas Flight 72. The aircraft, which had 303 passengers and 10 crew on board, was in normal level flight at 37,000 ft about 110 nautical miles north of Carnarvon and 80 nautical miles from Learmonth near Exmouth in north-western Australia, when the pilots received electronic centralised aircraft monitoring messages in the cockpit relating to some irregularity with the aircraft's elevator control system. The aircraft is reported to have departed level flight and climbed approximately 300 ft, during which time the crew had initiated non-normal checklist/response actions. The aircraft is then reported to have abruptly pitched nose-down. During this sudden and significant nose-down pitch, a number of passengers, cabin crew and loose objects were thrown about the aircraft cabin, primarily in the rear of the aircraft, resulting in a range of injuries to some cabin crew and passengers.

The crew made a PAN PAN emergency broadcast to air traffic control, advising that they had experienced flight control computer problems and that some people had been injured, and they requested a clearance to divert to and track direct to Learmonth. A few minutes later the crew declared a MAYDAY and advised ATC of multiple injures including broken bones and lacerations. The aircraft landed at about 1330 local time, about 40 minutes after the start of the event.

The ATSB understand that there were 14 people with serious but not life-threatening injuries, which included concussion and broken bones who were taken by air ambulance to Perth. In addition, up to 30 other people attended hospital with possible concussion, minor lacerations and fractures, with up to a further 30 or so people with minor bruises and stiff necks etc who did not need to attend hospital. However, these casualty figures are subject to further clarification and confirmation. All passengers have been now been transported to Perth. Given the nature of injuries, the occurrence is defined as an accident in accordance with the International Civil Aviation Organization definition.

The ATSB has initiated a safety investigation and two investigators from the ATSB's Perth office travelled to Learmonth yesterday evening and commenced initial on-site investigation activities, which included securing the aircraft's Flight Data and Cockpit Voice recorders. A further five ATSB investigators are due to arrive in Learmonth early this afternoon Western Australia time.

An officer from the Civil Aviation Safety Authority with a type rating on the A330 has joined the ATSB team. In addition, le Bureau d'Enquetes et d'Analyses, or BEA of France, the French counterpart of the ATSB has assigned an accredited representative as the State of Design and Manufacture of the aircraft, to provide assistance to the ATSB investigation. An investigator who is a flight control specialist from the aircraft manufacturer Airbus, is currently travelling to Australia and will also assist the investigation team.

It is obviously very early in the investigation and too soon to draw any conclusions as to the specific cause of this accident. The ATSB investigation will explore all aspects of the operation of the aircraft, including through detailed examination of the Flight Data and Cockpit Voce recordings, aircraft systems and maintenance history, Air Traffic Control radar and audio recordings, and weather conditions. The ATSB will also be conducting a range of interviews with the pilots and cabin crew, and will also speak with passengers to examine the cabin safety aspects.

It is always difficult to predict how long an investigation such as this will take. While it is likely to take some number of months, the ATSB will release a Preliminary Factual report within about 30 days. Furthermore, should any critical safety issues emerge that require urgent attention, the ATSB will immediately bring such issues to the attention of the relevant authorities who are best placed to take prompt action to address those issues.

Without pre-empting any findings in relation to cabin safety issues and the wearing of seatbelts, this accident serves as a reminder to all people who travel by air of the importance of keeping seatbelts fastened at all times when seated in an aircraft.