Air Emergency (2003–…): Season 14, Episode 4 - Choosing Sides - full transcript
Drama recreation of the Kegworth air disaster on 8 January 1989 when British Midland Flight 92, a Boeing 737-400, crashed onto the embankment of the M1 motorway near Kegworth, UK. Of the 126 people aboard, 47 died and 74, sustained serious injuries.
A 737 vanishes from radar
over one of the most remote jungles on earth
The crash pushes investigators to the limit.
On the first day, we had 8 snake-bites,
3 broken legs and one cardiac arrest
It is the worst accident in history of Panama.
A commercial aircraft
just don't fall out of the sky
Dark theories emerge
Drug runner airplanes out there?
What about a bomb
They saw a big ball of fire
It was highly suspicious
An entire nation is demanding answers
With this massive spreads of parts
that made no logical sense
Only one stunning conclusion can explain it
It was a big surprise to everybody
Air Crash Investigation
Season 14, Edition 04
This is a true story
It is based on official reports
and eyewitness accounts
SIDESWIPED
Tocumen International Airport in Panama City
V1
Copa Airlines Flight 201
takes off for a short flight to Cali, Colombia
Gear up
Captain Rafael Chial is Copa's most senior pilot
Today, he is monitoring the instruments
First Officer Cesareo Tejada is flying the plane.
40 passengers are on board,
mostly business travellers heading to Colombia
The flight usually takes about an hour.
But tonight,
there is a hitch that could add some time.
We got some heavy weather
moving in from the Gulf.
Flight 201 is heading straight for a storm
In Panama, out over the water 8 or 10 miles out
because over the Gulf, there is a lot of
convective activity and thunderstorms.
The weather was unusually terrible
It was a big big storm,
It looks like we have to take the long way around
If you fly through a powerful thunderstorm,
there are up and downdrafts
They can overcome the airplane
so, you don't fly through them.
The pilots need to find a way
to fly around the bad weather
you look at the weather
and you decide if you can do it
If you can't,
you ask for a vector around the thunderstorms,
Panama CENTER
Copa 201,
we'd like to get around these weather,
requesting a new heading for 090
Copa 201, copy that
we are clear to heading 090
Cleared to heading 090.
Ladies and gentlemen, we are going to take
a short detour to avoid some bumpy weather
It may delay our arrival in Cali,
I will keep you posted.
The new flightpath will take the 737 East
around the storm
before heading South again to Cali.
Panama CENTER, Copa 201.
It has been 12 minutes since take off
The Captain tells controllers
he has reached cruising altitude, 25.000 ft.
Minutes later,
the plane disappears from radar.
The Controller tries the radio,
but gets no response.
If you are close to thunderstorms
a lot of rain will be static on the radio
and sometimes
you may not be able to talk for a few minutes.
Garcia Orcana is one of the Controllers on duty.
The flight was leaving Panama airspace,
entering Colombian airspace.
When the signal disappeared from the radar,
I was worrying what happened
The plane's last known location
was over Panama's remote Darién Gap
The plane has vanished
over an almost impenetrable jungle
If Copa 201 crashed here,
just getting to the crash site
will be a huge struggle.
Graciela Ocana reports the missing flight
to aviation authorities
Then comes the news she has been dreading.
Early in the morning,
I received a call from a radio station in Darién
Witnesses on the ground
have reported a terrifying site.
During the night,
they saw a big ball of fire
falling from the sky.
We had to find out where the aircraft was
and if there was any one alive
they could save.
The next day,
searchers make their way to the crash site,
but all 47 people on board
are dead.
Even if it is one person,
it is a big loss
and it is a plane full of passengers.
It is really terrible
In Panama City, air-crash investigators
set up a command post at a local flight school.
Panama's Deputy Director of civil aviation,
Jorge Rodriguez,
is under enormous pressure
to figure out what happened.
The loss of such a large aircraft
has left his country in shock.
At that time, it was the first big accident
of an air carrier of Panama.
We lost 47 people on board,
all dead.
The bad weather leads to
immediate speculation
that the Copa pilots may have been overcome
by a deadly storm.
They reported nasty weather
in the Gulf of Panama that time.
I want any weather-data
for this entire area.
In the Darien Province,
Panamanian firemen say a prayer
for the 47 people who died aboard flight 201.
The search to understand why they died
brings NTSB investigator Tom Haueter
to Panama City.
It is a lot of pressure in all investigations
in terms of the cause of the accident
We want to know what happened, and why
and we want to prevent another accident
That is our main mission.
Tom Haueter, NTSB
How do you do?
But there is added pressure on Haueter,
because of the type of plane
involved in the tragedy
a Boeing 737.
I'd really like
to get a look at the rudder on this one.
The rudder
is a critical control surface in the tail
that helps to turn the plane.
The NTSB suspects a rudder failure
caused a recent crash of another 737
United Airlines Flight 585.
There had previously been an accident
with a 737 at Colorado Springs
It was on approach, when it suddenly rolled over
and dove into the ground at high speed
killing all aboard.
A possible connection
between the two crashes
makes it critical to figure out
what brought down Flight 201.
Because that was an unsolved accident
we were very anxious to know
Is there other evidence out there
that will help us solve that case?
If rudder failure brought down both flights
there could be a fatal flaw in every 737,
the most popular airliner in the sky.
Passengers all over the world could be at risk.
In Panama's Darien Province,
investigators begin the painstaking task
of try to find all the wreckage of Copa Flight 201
The dense vegetation makes it almost impossible
to spot small pieces from the air
The team must search on foot
with the help of local guides.
It wasn't laid out as we
normally see in a crash
where the airplane
comes in and you know:
here is the nose, here is the
CENTER section, here is the tail
it turned out there were parts all over.
we were trying to determine where they were
and so it became a major search
They need to find as much of the plane as they can
but they quickly realize
it is going to be a daunting task.
The Darien jungle is probably the remotest
section of Latin America you can think of
The Pan American highway does not go through there
There are no roads, nothing.
It is like one of the worst jungles in the world
I probably saw insects
that National Geographic hasn't even seen yet
It was just very tough.
On the first day, we had 8 snake bites,
3 broken legs and one cardiac arrest.
As they work,
they map the location of
every fragment of the plane
Tracking where the pieces landed
could hold clues about why the plane crashed.
Most of the pieces are small
but a trail of scorched vegetation
leads to the first large piece of the plane.
There was a large cleared area
there was a fire that took place from the fuel
This is the CENTER section of the wing
the main landing gear is right there below you
feet down the hill
It is an important find
but many more parts are still missing,
including the rudder, and the cockpit.
The wreckage is spread across
more than a 100 mile²
For investigators,
the large area is a critical clue
There had been some type of high speed event
where the airplane had broken up
it rained parts down on the jungle
Because the break up, we didn't know,
so we did take a look at the wreckage
and tried to determine
how all these pieces of the puzzle fit.
The crash site's proximity to the Colombian border
suggests an obvious theory
It is an air-corridor for drugs
It is a busy one.
The Darien jungle is right on the
border between Panama and Columbia
and there is a fair amount of drug activity
coming back and forth across the jungle.
The remote jungle of the Darien Gap
is a haven for drug-cartels
flying illicit merchandise,
North from secret air-strips
In that gap, we don't have no radar
to patrol the route of the drug-smuggle
Drug-runners usually fly at night
when they are less likely to be spotted.
Unlike commercial crews,
smuggles avoid radar detection
by switching OFF their radar transponder
and they never check in with Air Traffic Control.
If he does not report,
who will know that they are there?
It is really dangerous,
especially if there is not good visibility.
Cleared heading 090
We will let you know
when we are getting clear from this weather
Perhaps the unsuspecting pilots
suddenly crossed paths with drugs runners
It would have been
the last thing they ever saw.
We thought at drug running
who were going out there
Everything was open for consideration.
If Flight 201 did hit another aircraft,
investigators should be able to find some trace
of the 2nd plane among the wreckage.
If a red airplane hits a blue airplane,
the paint is going to transfer
from the one to the other
They scrutinize each piece carefully
hunting for any speck of paint
that could have come from a covert drug plane,
But they come up empty.
Even more telling,
there is no wreckage that
could have come a 2nd plane
We didn't find any other wreckages ,
old or new
and looking at the wreckage we found
from the Copa airplane
we didn't find any evidence
of a mid air collision.
There is another possibility:
What about a bomb?
Flight 201 was bound for Cali, Colombia,
home of a violent drug cartel.
Investigators know that a bomb on board could
explain the eye-witness reports of fire in the sky
Certainly, we were interested in
the possibility of an explosion
we brought an FAA explosive expert with us
a possible bomb went off
and caused to break up of the airplane
We needed to take a look at everything.
Commercial aircraft just don't fall out of the sky
so those individuals put in a team together
felt that it was highly suspicious
and might be something in my area of expertise
Explosive expert Calvin Walbert begins his
search for evidence of an on board bomb
There is a tremendous amount of pressure
because everybody wants that answer yesterday
He is looking for signature blast marks,
caused by the superheated gasses from an explosion
There are indicators that you look for,
that will tell you that this is
caused from an explosive event
it is not caused from just a fire
or fuel erupting or something like that
If there were a bomb, the tell tale marks
will most likely be found on metal debris.
On something like aircraft aluminium, you
would be looking for pitting and cratering
like the surface of the moon
He carefully examines each piece.
He finds burn marks , evidence of a fire
but there is no sign of an explosive detonation.
The bomb theory is looking less likely
but it cannot be ruled out completely
until they carry out one final test.
Transport to Panama city
where the bodies will be X Rayed
to check for embedded shrapnel
I am looking for something
that would be foreign to human remains
that is not part of the aircraft
that is not part of the personal facts
that is something
that would indicate that it was a bomb.
Base camp, come in, please
A call from the jungle search team
brings some much needed good news
We got the black boxes.
The exhausting effort has paid off:
they found Flight 201's Black boxes
This could be the break through
investigators need.
At least we got something to analyze
what was the cause of the accident
Without those Black boxes
you are blind, you don't get nothing.
There is no lab in Panama,
equipped to analyze the recorders.
They need to go to the NTSB in Washington DC.
We were anxious to look at the FDR
The Flight Data Recorder is the only data we have
from the flight up to the time of the break up.
NTSB technicians work quickly to download
the information, stored on the two recorders.
The FDR tracks information
like airspeed and heading.
The CVR captures the sound
of the pilots' conversation in the cockpit.
We are hoping with the CVR
we get more information in terms of what
the crew was saying, what was happening
right at the time of impact
The FDR is in good condition...
...but the same can not be said for the CVR.
It was a big surprise to everybody
Somehow, the tape has snapped
and come unspooled
My God, what a mess.
the tape was broken completely
like black spaghetti.
Jorge had a ball of Mylar tape.
Investigators won't know
what answers the tape holds
unless they can somehow repair it.
If the people of the NTSB
can not put that tape to work
there was no way.
Battling a 120° F heat in the Panamanian jungle
investigators struggle to learn what they can
from the wreckage of Copa Flight 201.
Another big find could be a crucial lead
in two investigations
They have recovered a key part from the rudder:
the PCU
The PCU is a hydraulic ram
that moves the rudder back and forth.
It is the same part investigators suspect may have
failed during the recent crash of a UA 737
If there is a failure mode out there
that is affecting thousands of airplanes
we want to document
what happened
work with the FAA, the main factories to correct
the problem, so the accident cannot happen again.
If they find evidence
that the critical component malfunctioned
it will send shock-waves
through the entire industry
The Boeing company will stop all those airplanes
They will not be flying.
Investigators test the mechanism.
They need to know if it jammed in flight
a failure
that could easily put a 737 into a sudden dive,
but it is another dead end.
There is no evidence of pre existing damage
it appeared to be working normally
The team hopes
the engines will provide a better lead
In rare cases,
turbine engines have been known to overheat
and catch fire.
If you got a fire in the engine,
there is a lot of things that you can do about it
If there was an engine fire on Flight 201
investigators should be able to find scorch-marks
on fan blades and other internal parts.
But again, their inspection turns up nothing.
There wasn't a problem at all with the engines
that flight
The engines were working normally
when the plane broke apart.
Investigators are still no closer to understand
what happened in the skies over Panama
Medical X Rays eliminate yet another theory
All of the victim's remains were X Rayed
to see if there is any evidence of an explosion.
The images show no sign of any foreign debris
that could have come from an explosion on board
There is nothing that I saw or that I observed
that would indicate to me
that there was a device on board Copa flight 201.
Investigators now believe the flames witnesses saw
ignited after the plane broke apart.
It wasn't a bomb.
There is enormous pressure on the investigation.
Panamanians want to know what caused
their nations deadliest air disaster.
How could that happen, we could not imagine
We needed an answer.
In Washington, there is renewed hope
of finding answers in the CVR
Technicians have managed
to repair the broken tape
Well, it took a lot of effort,
but they slowly found an end and straight it out
rolled it back up, get it on a reel
Rodriguez can finally listen to the sounds,
captured in the cockpit.
Copa 4129, you are cleared for take off
But what he hears reveals a stunning new problem
Cleared for take off, 4129
OKAY, here we go
The recording is not from flight 201
It is from a flight, days earlier.
It seems that the tape was already broken
when Flight 201 took off.
The tape was broken 7 days before that accident.
and that was the reason
that the recorder wasn't working at all.
It is very unusual that it does not operate.
I flew the airplane for many years
I don't recall ever having a CVR not working
The first funeral
is for one of the 5 flight attendants
Many mourners are asking
the same questions as investigators:
'Why did this tragedy happen?'
It was like a nightmare that you wish
you could wake up
You do not expect that to happen
at least not in your country
The flight data
is finally in the hands of investigators
It paints a terrifying picture
Flight 201 suddenly went into a catastrophic dive.
The airplane coming from 25,000 ft
until it disintegrate at 9,195 ft
10,000 ft /min
The extreme speed of the dive
solves the mystery of the mid-air break up
It is not designed for flying inverted
with speeds approaching the speed of sound
And so, we were trying to understand
how it got from a level flight to be inverted
coming down at high speeds.
That few seconds
is really the focus of the investigation.
The fierce weather over the Gulf of Panama
may have been a factor
We had reports that the storm extended
more than 100 miles from East to West.
If the Copa crew flew into a severe storm
there is a chance that the pilots were confused
by what experts call spatial disorientation.
Flying in bad weather at night, thunderstorms
can be disorienting.
You can't really trust your own senses
The inner ear will not lead you
to the right conclusion
the G-forces you are feeling may lead you think
you are turning left while you are turning right.
Investigators use radar information,
captured in the tower to plot Flight 201's path.
They want to compare it
to the path of the storm.
We could go back and look at the weather data
and the long range radar data
We knew where the storm was
we knew where the airplane was, by the impact
and so we could piece together their flight path
and where they were going.
The results are conclusive:
Flight 201 wasn't anywhere near the storm.
I said that the weather wasn't an issue
in that accident.
Investigators still can't explain
what happened to Copa Flight 201.
They need a better approach.
The data we had, the take off,
the climb out, the cruise,
everything looked like a normal flight
They delved deeper
into the last 2 minutes of flight data
and discover some very unusual flight manoeuvres
Tom Haueter:
OKAY, it looks like it turned right, and then left
and then right again
until they spiralled into a dive.
It doesn't make any sense.
The flight data seems completely baffling.
Could it hold the key to explaining
why 47 people died?
Investigators zero in on the final 2 minutes
They create an animation of the flight data...
That was normal,
That was abrupt
...hoping it will shed some light on how the 737
could have made such strange manoeuvres...
Tom H.
It should be correcting, it is not correcting
What the heck is going on?
...but it only adds to the mystery.
We saw the aircraft roll over into a bank angle
then a sudden snap back to level vice versa.
The strange motion is unlike anything
an airliner usually does during flight
It is strange to understand
how can the airplane manoeuvre the way it is doing
That was causing quite a bit of problems,
because we couldn't make a fit.
The aircraft is normally flown very gentle
As if your grandmother is in the back
and she does not like to fly
because you are trying to make a happy customer
and make them come back and fly with you again.
Could the pilots have been incapacitated
by drugs or a medical emergency?
We've got to find that cockpit.
There is no way to answer that question
unless they can find the pilots' bodies
and carry out forensic tests.
That was one of the main parts
of the investigation
We have to get the cockpit.
Investigators are prepared for the hunt.
Before going into the jungle, they examine the 737
just like the one that crashed.
We hurry and go to the jungle
looking for parts and pieces
it might be nice to see
what they look like intact
So, we came across in the jungle
we had an idea what we were really seeing.
The meticulous search finally pays off.
We found the cockpit in the base of the big tree.
Like it hit the tree
and stopped there.
In Panama City, pathologists examine the bodies.
During the autopsies,
we found no evidence of heart seizure at that time
or any medical event with eyes of the pilots
at the time of the impact
Toxicology tests also confirm
that neither pilot was impaired by drugs
There must be another explanation
for the bizarre manoeuvres
We are trying to understand what happened here,
the cause of the upset
It was quite a mystery for a long time.
With little else to go on
investigators focus on the cockpit debris.
It provides some intriguing details
about the last moments of the flight
We certainly did piece together what may have
been going on in the cockpit at the time
The delicious food makes up for the long hours.
The First Officer is flying the airplane,
the Captain is back from the controls
He is having his meal,
everything seems like a very normal flight.
Investigators study the flight instruments
and cockpit controls that pilots rely on.
The position of a switch
raises an immediate red flag.
The vertical GYRO-switch affects
the most important flight instrument:
The attitude indicator
Each pilot has his own attitude indicator.
It shows him how the plane is positioned
with respect to the horizon
The attitude indicator is like a ball
It shows bank angle, it shows pitch
It is the sole control of the aircraft
And without it, it would be very,
very difficult to fly the airplane.
Each attitude indicator is connected
to its own sensor, called a vertical gyro
Or VG
The gyros constantly measure the plane's attitude
If the gyro's don't match,
the pilots get a warning.
Normally, you will have the captain's
attitude indicator powered by one gyro,
and the First Officer's attitude indicator
powered by another gyro.
If there is a problem with one gyro,
the pilots can switch both
indicators onto the other one.
If one gyro goes bad, you don't want to have
a pilot looking at bad data
So you switch them both over to the good data.
It appears that is what happened:
the gyro control switch has been positioned
to feed both indicators from VG1,
the Captain's gyro.
It is like
they are having troubles with the FO's gyro
Both of them
are reading data from the same gyro source
which make you think that at some point
either it was selected that way
or they didn't realize it was selected that way
but they are both feeding data
from the same source, which is unusual.
Investigators could be on the verge
of an important break-through
but they won't know for sure,
until they can test the flight-instruments
for any kind of malfunction.
We removed all the components from the cockpit
and shipped those back to the U.S. for examination
This could be their last chance
to understand what happened to Flight 201.
Investigators need to know if a faulty
cockpit instrument was giving the crew
misleading data about the position of their plane.
What we were going to look at:
Is there anything here
that would show us what happened
Is there a failure on one of the gyros
or the failure is added to the indicator
They test the displays
and the gyros that feed them.
This one seems to work fine.
There is nothing wrong
with the First Officer's instrument.
They run the same test
on the Captain's attitude indicator.
At first,
the Captain's instrument seems fine, too
We put them on a bench, we powered them up
they actually worked quite well.
Then, they notice something odd.
Hang on, it seems to be stuck
Occasionally,
the display momentarily freezes in place.
The attitude indicator stops moving
even though the gyro is still in motion
Yeah, there it goes,
now it is circling.
Investigators need to know
what is causing the failure.
They test every wire,
connecting the display to the gyro.
Finally, they find the culprit.
This wire is hanging by a thread
We found a break in the wire
Intermittent, it was close enough:
Sometimes it touches and sometimes it won't.
The discovery gives new meaning to
the bizarre rolling motion, captured by the FDR
The Captain's instrument and the Flight recorder
are both fed by the same gyro.
The way the airplane is wired is:
what the Captain is seeing on his indicator
is what is been recorded on the FDR
Since the Captain's gyro was broken,
it was sending faulty roll data to the recorder.
Copa 201 didn't really make
any quick rolling manoeuvres at all.
OKAY, let us see what the plane is really doing.
By carefully analyzing
other parameters on the FDR,
they managed to calculate its actual movements
and reveal the plane's true motion.
Making it visual, we could see
what the data is showing and the plane is doing.
That is extraordinary helpful.
The red image shows the bad data
the pilots were seeing,
while the solid image shows
how the Copa 201 was actually flying.
They were trying to level the plane,
but they are making it worse.
You have the attitude indicator here, stuck
Now, the airplane is going in the other direction
and sends suddenly
the attitude indicator is powered to unstuck
it goes back and moves the airplane again
The pilots' ability to troubleshoot the problem
was likely complicated by
the intermittent nature of the failure.
If they are totally confused
by their attitude indicator
they are making improper control inputs.
When it sticks,
the pilot is trying to correct that problem
so, he is trying to get
that airplane 'level' again
and he doesn't realize
that he is going in the wrong direction
He is looking at an instrument providing bad data,
and unfortunately in the period of time,
he lost control of the aircraft.
The plane rolls so far to the right,
it becomes unrecoverable.
Though the pilots don't know it,
they are now falling from the sky.
When they got to this point,
they didn't have a chance.
But a puzzling question remains
It was the Captain's gyro
that failed in flight
and started sending bad data.
So, why did the pilots select it?
The question is:
why they believed
the Captain's gyro is the good one?
Why is it switched to that position?
Because of that mistake,
both pilots were seeing the wrong information.
The accident wouldn't have happened
had they've been on VG-2
What could have led the pilots
to make such a lethal error?
You want to know,
how are they trained for unusual events?
What is their level of skill?
How would they handle an unusual situation?
are they trained for gyro failures?
OKAY, let us start
Investigators go into the type of flight-simulator
the Copa crew used for their 737 training.
Climb to 25,000 ft and turn right.
They recreate the flight of Copa 201
Now, trigger the failure.
Including the malfunction
of the Captain's attitude indicator.
Tom Haueter:
How do you make the switch?
Wait a minute, let me see that
That is not the same switch that was on Copa 201
Two different configurations
for one small control-switch
has overwhelming implications
for the investigation.
This is the gyro switch from the simulator
where the Captain was trained
Next slide, please
And this is the gyro-switch from Copa 201
Can we get it closer, please?
Alright, now let's see both
Well, that is completely different
The cockpit and the simulator weren't similar
and so it is possible to get confused
thinking you are going to independent gyro-source
when you weren't.
In the simulator, flipping the toggle to the left
switches the Captain's instrument to an AUX gyro,
independent of the other two.
On Flight 201,
flipping the switch to the left puts both
instruments on the Captain's malfunctioning gyro.
With no CVR from the cockpit of Copa 201
investigators will never know for certain
who flipped the switch the wrong way.
But they finally collected
enough evidence
to build a compelling theory of
how the flight went so horribly wrong
After diverting around the storm,
the crew of Copa Flight 201
needs to turn right to get back on course.
The delicious food makes up for the long hours.
As the plane levels out,
an error flag warns there is a problem
with the Captain's attitude indicator.
They fall back on their training
and flip the gyro switch to the left,
thinking they are switching to the AUX gyro.
You may revert to your training
and do something inappropriate
because, that is what you are trained to do.
Now, they are both on the bad gyro,
neither of them knows about it.
The gyro malfunction
causes the AUTOPILOT to switch off.
First Officer Tejada must now fly by hand.
He turns his wheel to level the wings.
His frozen instrument makes it look
like the plane isn't responding.
So, he continues to turn the controls
sending the plane further and further to the left.
He is trying to correct the problem
He is actually making the problem a lot worse.
The pilots have no way of sensing their error.
It is too dark to see anything outside
that could help orient them.
In the middle of the night,
you don't have the horizon.
You loose the horizon,
you don't know where you are.
As the short circuit cuts in and out,
the instruments start working
then suddenly stops again.
Now, he thinks they are banking left
he is trying to correct it by banking right
In the cabin, there is little sign of trouble.
The barrel move manoeuvre was fairly smooth
with 1 G
I doubt the passengers really
realized the impending danger
until the airplane inverted
and started to come through
and then it would have happened very quickly.
Altitude
Pull up, pull up!
In-between the two pilots,
there is a 3rd standby attitude indicator,
fed by its own independent gyro.
By comparing the 2 main indicators
to the standby
pilots can quickly determine
which one of the main indicators is faulty.
The standby indicator
should have giving them the correct indication.
Why the pilots didn't use the standby,
remains a mystery.
Had they looked at the standby,
they knew there was something really wrong here
By the time
the pilots realized they were in a dive...
Left, left, left!
I am trying, Captain
...it is too late.
It is extraordinary dis-concerning
you've gone from a few degrees to the left
to multiple degrees to the right.
Once a usual attitude get out of hand
it is much more difficult to recover.
This airplane got so much nose low
and at such a high speed
I can imagine in the cockpit what is going on.
In seconds,
massive G forces incapacitated passengers and crew
As the airplane gets faster,
components are being over-stressed
and you will start breaking off
parts of the aircraft.
In the dive, the airplane got fire
because that rupture of the tank...
...and exploded.
We were so sorry...
...that the end was the worst.
It is the worst accident in the history of Panama,
and I hope I never run through one again.
Jorge Rodriguez spends months,
helping prepare the final report on Copa 201
for Panama Civil Aviation Authority.
It is very important that you analyze
and find out what was the cause of the accident.
Copa Airlines responds
with a major overhaul of its fleet,
standardizing the layout of cockpit controls.
Their fleet is fully harmonized,
it is a completely different airline
that it was at that time.
Copa also revamps pilot training
to make sure its crews are prepared
for any instrument malfunction.
I have been 4.5 years with them
and their training is the best I've seen
We will respect them for that.
For the airline industry,
Copa 201 is a reminder of how even small problems
can result in catastrophe.
A minor flaw can result in a tragedy,
and so we always have to look for these flaws
we have to train for them
we have to challenge ourselves to be the best
whether it is the guy
who makes the component on the bench
to the people who maintain the aircraft
to the pilots
It takes everybody working together.
Narrator
Jonathan Aris
Subtitles
Rein Croonen
over one of the most remote jungles on earth
The crash pushes investigators to the limit.
On the first day, we had 8 snake-bites,
3 broken legs and one cardiac arrest
It is the worst accident in history of Panama.
A commercial aircraft
just don't fall out of the sky
Dark theories emerge
Drug runner airplanes out there?
What about a bomb
They saw a big ball of fire
It was highly suspicious
An entire nation is demanding answers
With this massive spreads of parts
that made no logical sense
Only one stunning conclusion can explain it
It was a big surprise to everybody
Air Crash Investigation
Season 14, Edition 04
This is a true story
It is based on official reports
and eyewitness accounts
SIDESWIPED
Tocumen International Airport in Panama City
V1
Copa Airlines Flight 201
takes off for a short flight to Cali, Colombia
Gear up
Captain Rafael Chial is Copa's most senior pilot
Today, he is monitoring the instruments
First Officer Cesareo Tejada is flying the plane.
40 passengers are on board,
mostly business travellers heading to Colombia
The flight usually takes about an hour.
But tonight,
there is a hitch that could add some time.
We got some heavy weather
moving in from the Gulf.
Flight 201 is heading straight for a storm
In Panama, out over the water 8 or 10 miles out
because over the Gulf, there is a lot of
convective activity and thunderstorms.
The weather was unusually terrible
It was a big big storm,
It looks like we have to take the long way around
If you fly through a powerful thunderstorm,
there are up and downdrafts
They can overcome the airplane
so, you don't fly through them.
The pilots need to find a way
to fly around the bad weather
you look at the weather
and you decide if you can do it
If you can't,
you ask for a vector around the thunderstorms,
Panama CENTER
Copa 201,
we'd like to get around these weather,
requesting a new heading for 090
Copa 201, copy that
we are clear to heading 090
Cleared to heading 090.
Ladies and gentlemen, we are going to take
a short detour to avoid some bumpy weather
It may delay our arrival in Cali,
I will keep you posted.
The new flightpath will take the 737 East
around the storm
before heading South again to Cali.
Panama CENTER, Copa 201.
It has been 12 minutes since take off
The Captain tells controllers
he has reached cruising altitude, 25.000 ft.
Minutes later,
the plane disappears from radar.
The Controller tries the radio,
but gets no response.
If you are close to thunderstorms
a lot of rain will be static on the radio
and sometimes
you may not be able to talk for a few minutes.
Garcia Orcana is one of the Controllers on duty.
The flight was leaving Panama airspace,
entering Colombian airspace.
When the signal disappeared from the radar,
I was worrying what happened
The plane's last known location
was over Panama's remote Darién Gap
The plane has vanished
over an almost impenetrable jungle
If Copa 201 crashed here,
just getting to the crash site
will be a huge struggle.
Graciela Ocana reports the missing flight
to aviation authorities
Then comes the news she has been dreading.
Early in the morning,
I received a call from a radio station in Darién
Witnesses on the ground
have reported a terrifying site.
During the night,
they saw a big ball of fire
falling from the sky.
We had to find out where the aircraft was
and if there was any one alive
they could save.
The next day,
searchers make their way to the crash site,
but all 47 people on board
are dead.
Even if it is one person,
it is a big loss
and it is a plane full of passengers.
It is really terrible
In Panama City, air-crash investigators
set up a command post at a local flight school.
Panama's Deputy Director of civil aviation,
Jorge Rodriguez,
is under enormous pressure
to figure out what happened.
The loss of such a large aircraft
has left his country in shock.
At that time, it was the first big accident
of an air carrier of Panama.
We lost 47 people on board,
all dead.
The bad weather leads to
immediate speculation
that the Copa pilots may have been overcome
by a deadly storm.
They reported nasty weather
in the Gulf of Panama that time.
I want any weather-data
for this entire area.
In the Darien Province,
Panamanian firemen say a prayer
for the 47 people who died aboard flight 201.
The search to understand why they died
brings NTSB investigator Tom Haueter
to Panama City.
It is a lot of pressure in all investigations
in terms of the cause of the accident
We want to know what happened, and why
and we want to prevent another accident
That is our main mission.
Tom Haueter, NTSB
How do you do?
But there is added pressure on Haueter,
because of the type of plane
involved in the tragedy
a Boeing 737.
I'd really like
to get a look at the rudder on this one.
The rudder
is a critical control surface in the tail
that helps to turn the plane.
The NTSB suspects a rudder failure
caused a recent crash of another 737
United Airlines Flight 585.
There had previously been an accident
with a 737 at Colorado Springs
It was on approach, when it suddenly rolled over
and dove into the ground at high speed
killing all aboard.
A possible connection
between the two crashes
makes it critical to figure out
what brought down Flight 201.
Because that was an unsolved accident
we were very anxious to know
Is there other evidence out there
that will help us solve that case?
If rudder failure brought down both flights
there could be a fatal flaw in every 737,
the most popular airliner in the sky.
Passengers all over the world could be at risk.
In Panama's Darien Province,
investigators begin the painstaking task
of try to find all the wreckage of Copa Flight 201
The dense vegetation makes it almost impossible
to spot small pieces from the air
The team must search on foot
with the help of local guides.
It wasn't laid out as we
normally see in a crash
where the airplane
comes in and you know:
here is the nose, here is the
CENTER section, here is the tail
it turned out there were parts all over.
we were trying to determine where they were
and so it became a major search
They need to find as much of the plane as they can
but they quickly realize
it is going to be a daunting task.
The Darien jungle is probably the remotest
section of Latin America you can think of
The Pan American highway does not go through there
There are no roads, nothing.
It is like one of the worst jungles in the world
I probably saw insects
that National Geographic hasn't even seen yet
It was just very tough.
On the first day, we had 8 snake bites,
3 broken legs and one cardiac arrest.
As they work,
they map the location of
every fragment of the plane
Tracking where the pieces landed
could hold clues about why the plane crashed.
Most of the pieces are small
but a trail of scorched vegetation
leads to the first large piece of the plane.
There was a large cleared area
there was a fire that took place from the fuel
This is the CENTER section of the wing
the main landing gear is right there below you
feet down the hill
It is an important find
but many more parts are still missing,
including the rudder, and the cockpit.
The wreckage is spread across
more than a 100 mile²
For investigators,
the large area is a critical clue
There had been some type of high speed event
where the airplane had broken up
it rained parts down on the jungle
Because the break up, we didn't know,
so we did take a look at the wreckage
and tried to determine
how all these pieces of the puzzle fit.
The crash site's proximity to the Colombian border
suggests an obvious theory
It is an air-corridor for drugs
It is a busy one.
The Darien jungle is right on the
border between Panama and Columbia
and there is a fair amount of drug activity
coming back and forth across the jungle.
The remote jungle of the Darien Gap
is a haven for drug-cartels
flying illicit merchandise,
North from secret air-strips
In that gap, we don't have no radar
to patrol the route of the drug-smuggle
Drug-runners usually fly at night
when they are less likely to be spotted.
Unlike commercial crews,
smuggles avoid radar detection
by switching OFF their radar transponder
and they never check in with Air Traffic Control.
If he does not report,
who will know that they are there?
It is really dangerous,
especially if there is not good visibility.
Cleared heading 090
We will let you know
when we are getting clear from this weather
Perhaps the unsuspecting pilots
suddenly crossed paths with drugs runners
It would have been
the last thing they ever saw.
We thought at drug running
who were going out there
Everything was open for consideration.
If Flight 201 did hit another aircraft,
investigators should be able to find some trace
of the 2nd plane among the wreckage.
If a red airplane hits a blue airplane,
the paint is going to transfer
from the one to the other
They scrutinize each piece carefully
hunting for any speck of paint
that could have come from a covert drug plane,
But they come up empty.
Even more telling,
there is no wreckage that
could have come a 2nd plane
We didn't find any other wreckages ,
old or new
and looking at the wreckage we found
from the Copa airplane
we didn't find any evidence
of a mid air collision.
There is another possibility:
What about a bomb?
Flight 201 was bound for Cali, Colombia,
home of a violent drug cartel.
Investigators know that a bomb on board could
explain the eye-witness reports of fire in the sky
Certainly, we were interested in
the possibility of an explosion
we brought an FAA explosive expert with us
a possible bomb went off
and caused to break up of the airplane
We needed to take a look at everything.
Commercial aircraft just don't fall out of the sky
so those individuals put in a team together
felt that it was highly suspicious
and might be something in my area of expertise
Explosive expert Calvin Walbert begins his
search for evidence of an on board bomb
There is a tremendous amount of pressure
because everybody wants that answer yesterday
He is looking for signature blast marks,
caused by the superheated gasses from an explosion
There are indicators that you look for,
that will tell you that this is
caused from an explosive event
it is not caused from just a fire
or fuel erupting or something like that
If there were a bomb, the tell tale marks
will most likely be found on metal debris.
On something like aircraft aluminium, you
would be looking for pitting and cratering
like the surface of the moon
He carefully examines each piece.
He finds burn marks , evidence of a fire
but there is no sign of an explosive detonation.
The bomb theory is looking less likely
but it cannot be ruled out completely
until they carry out one final test.
Transport to Panama city
where the bodies will be X Rayed
to check for embedded shrapnel
I am looking for something
that would be foreign to human remains
that is not part of the aircraft
that is not part of the personal facts
that is something
that would indicate that it was a bomb.
Base camp, come in, please
A call from the jungle search team
brings some much needed good news
We got the black boxes.
The exhausting effort has paid off:
they found Flight 201's Black boxes
This could be the break through
investigators need.
At least we got something to analyze
what was the cause of the accident
Without those Black boxes
you are blind, you don't get nothing.
There is no lab in Panama,
equipped to analyze the recorders.
They need to go to the NTSB in Washington DC.
We were anxious to look at the FDR
The Flight Data Recorder is the only data we have
from the flight up to the time of the break up.
NTSB technicians work quickly to download
the information, stored on the two recorders.
The FDR tracks information
like airspeed and heading.
The CVR captures the sound
of the pilots' conversation in the cockpit.
We are hoping with the CVR
we get more information in terms of what
the crew was saying, what was happening
right at the time of impact
The FDR is in good condition...
...but the same can not be said for the CVR.
It was a big surprise to everybody
Somehow, the tape has snapped
and come unspooled
My God, what a mess.
the tape was broken completely
like black spaghetti.
Jorge had a ball of Mylar tape.
Investigators won't know
what answers the tape holds
unless they can somehow repair it.
If the people of the NTSB
can not put that tape to work
there was no way.
Battling a 120° F heat in the Panamanian jungle
investigators struggle to learn what they can
from the wreckage of Copa Flight 201.
Another big find could be a crucial lead
in two investigations
They have recovered a key part from the rudder:
the PCU
The PCU is a hydraulic ram
that moves the rudder back and forth.
It is the same part investigators suspect may have
failed during the recent crash of a UA 737
If there is a failure mode out there
that is affecting thousands of airplanes
we want to document
what happened
work with the FAA, the main factories to correct
the problem, so the accident cannot happen again.
If they find evidence
that the critical component malfunctioned
it will send shock-waves
through the entire industry
The Boeing company will stop all those airplanes
They will not be flying.
Investigators test the mechanism.
They need to know if it jammed in flight
a failure
that could easily put a 737 into a sudden dive,
but it is another dead end.
There is no evidence of pre existing damage
it appeared to be working normally
The team hopes
the engines will provide a better lead
In rare cases,
turbine engines have been known to overheat
and catch fire.
If you got a fire in the engine,
there is a lot of things that you can do about it
If there was an engine fire on Flight 201
investigators should be able to find scorch-marks
on fan blades and other internal parts.
But again, their inspection turns up nothing.
There wasn't a problem at all with the engines
that flight
The engines were working normally
when the plane broke apart.
Investigators are still no closer to understand
what happened in the skies over Panama
Medical X Rays eliminate yet another theory
All of the victim's remains were X Rayed
to see if there is any evidence of an explosion.
The images show no sign of any foreign debris
that could have come from an explosion on board
There is nothing that I saw or that I observed
that would indicate to me
that there was a device on board Copa flight 201.
Investigators now believe the flames witnesses saw
ignited after the plane broke apart.
It wasn't a bomb.
There is enormous pressure on the investigation.
Panamanians want to know what caused
their nations deadliest air disaster.
How could that happen, we could not imagine
We needed an answer.
In Washington, there is renewed hope
of finding answers in the CVR
Technicians have managed
to repair the broken tape
Well, it took a lot of effort,
but they slowly found an end and straight it out
rolled it back up, get it on a reel
Rodriguez can finally listen to the sounds,
captured in the cockpit.
Copa 4129, you are cleared for take off
But what he hears reveals a stunning new problem
Cleared for take off, 4129
OKAY, here we go
The recording is not from flight 201
It is from a flight, days earlier.
It seems that the tape was already broken
when Flight 201 took off.
The tape was broken 7 days before that accident.
and that was the reason
that the recorder wasn't working at all.
It is very unusual that it does not operate.
I flew the airplane for many years
I don't recall ever having a CVR not working
The first funeral
is for one of the 5 flight attendants
Many mourners are asking
the same questions as investigators:
'Why did this tragedy happen?'
It was like a nightmare that you wish
you could wake up
You do not expect that to happen
at least not in your country
The flight data
is finally in the hands of investigators
It paints a terrifying picture
Flight 201 suddenly went into a catastrophic dive.
The airplane coming from 25,000 ft
until it disintegrate at 9,195 ft
10,000 ft /min
The extreme speed of the dive
solves the mystery of the mid-air break up
It is not designed for flying inverted
with speeds approaching the speed of sound
And so, we were trying to understand
how it got from a level flight to be inverted
coming down at high speeds.
That few seconds
is really the focus of the investigation.
The fierce weather over the Gulf of Panama
may have been a factor
We had reports that the storm extended
more than 100 miles from East to West.
If the Copa crew flew into a severe storm
there is a chance that the pilots were confused
by what experts call spatial disorientation.
Flying in bad weather at night, thunderstorms
can be disorienting.
You can't really trust your own senses
The inner ear will not lead you
to the right conclusion
the G-forces you are feeling may lead you think
you are turning left while you are turning right.
Investigators use radar information,
captured in the tower to plot Flight 201's path.
They want to compare it
to the path of the storm.
We could go back and look at the weather data
and the long range radar data
We knew where the storm was
we knew where the airplane was, by the impact
and so we could piece together their flight path
and where they were going.
The results are conclusive:
Flight 201 wasn't anywhere near the storm.
I said that the weather wasn't an issue
in that accident.
Investigators still can't explain
what happened to Copa Flight 201.
They need a better approach.
The data we had, the take off,
the climb out, the cruise,
everything looked like a normal flight
They delved deeper
into the last 2 minutes of flight data
and discover some very unusual flight manoeuvres
Tom Haueter:
OKAY, it looks like it turned right, and then left
and then right again
until they spiralled into a dive.
It doesn't make any sense.
The flight data seems completely baffling.
Could it hold the key to explaining
why 47 people died?
Investigators zero in on the final 2 minutes
They create an animation of the flight data...
That was normal,
That was abrupt
...hoping it will shed some light on how the 737
could have made such strange manoeuvres...
Tom H.
It should be correcting, it is not correcting
What the heck is going on?
...but it only adds to the mystery.
We saw the aircraft roll over into a bank angle
then a sudden snap back to level vice versa.
The strange motion is unlike anything
an airliner usually does during flight
It is strange to understand
how can the airplane manoeuvre the way it is doing
That was causing quite a bit of problems,
because we couldn't make a fit.
The aircraft is normally flown very gentle
As if your grandmother is in the back
and she does not like to fly
because you are trying to make a happy customer
and make them come back and fly with you again.
Could the pilots have been incapacitated
by drugs or a medical emergency?
We've got to find that cockpit.
There is no way to answer that question
unless they can find the pilots' bodies
and carry out forensic tests.
That was one of the main parts
of the investigation
We have to get the cockpit.
Investigators are prepared for the hunt.
Before going into the jungle, they examine the 737
just like the one that crashed.
We hurry and go to the jungle
looking for parts and pieces
it might be nice to see
what they look like intact
So, we came across in the jungle
we had an idea what we were really seeing.
The meticulous search finally pays off.
We found the cockpit in the base of the big tree.
Like it hit the tree
and stopped there.
In Panama City, pathologists examine the bodies.
During the autopsies,
we found no evidence of heart seizure at that time
or any medical event with eyes of the pilots
at the time of the impact
Toxicology tests also confirm
that neither pilot was impaired by drugs
There must be another explanation
for the bizarre manoeuvres
We are trying to understand what happened here,
the cause of the upset
It was quite a mystery for a long time.
With little else to go on
investigators focus on the cockpit debris.
It provides some intriguing details
about the last moments of the flight
We certainly did piece together what may have
been going on in the cockpit at the time
The delicious food makes up for the long hours.
The First Officer is flying the airplane,
the Captain is back from the controls
He is having his meal,
everything seems like a very normal flight.
Investigators study the flight instruments
and cockpit controls that pilots rely on.
The position of a switch
raises an immediate red flag.
The vertical GYRO-switch affects
the most important flight instrument:
The attitude indicator
Each pilot has his own attitude indicator.
It shows him how the plane is positioned
with respect to the horizon
The attitude indicator is like a ball
It shows bank angle, it shows pitch
It is the sole control of the aircraft
And without it, it would be very,
very difficult to fly the airplane.
Each attitude indicator is connected
to its own sensor, called a vertical gyro
Or VG
The gyros constantly measure the plane's attitude
If the gyro's don't match,
the pilots get a warning.
Normally, you will have the captain's
attitude indicator powered by one gyro,
and the First Officer's attitude indicator
powered by another gyro.
If there is a problem with one gyro,
the pilots can switch both
indicators onto the other one.
If one gyro goes bad, you don't want to have
a pilot looking at bad data
So you switch them both over to the good data.
It appears that is what happened:
the gyro control switch has been positioned
to feed both indicators from VG1,
the Captain's gyro.
It is like
they are having troubles with the FO's gyro
Both of them
are reading data from the same gyro source
which make you think that at some point
either it was selected that way
or they didn't realize it was selected that way
but they are both feeding data
from the same source, which is unusual.
Investigators could be on the verge
of an important break-through
but they won't know for sure,
until they can test the flight-instruments
for any kind of malfunction.
We removed all the components from the cockpit
and shipped those back to the U.S. for examination
This could be their last chance
to understand what happened to Flight 201.
Investigators need to know if a faulty
cockpit instrument was giving the crew
misleading data about the position of their plane.
What we were going to look at:
Is there anything here
that would show us what happened
Is there a failure on one of the gyros
or the failure is added to the indicator
They test the displays
and the gyros that feed them.
This one seems to work fine.
There is nothing wrong
with the First Officer's instrument.
They run the same test
on the Captain's attitude indicator.
At first,
the Captain's instrument seems fine, too
We put them on a bench, we powered them up
they actually worked quite well.
Then, they notice something odd.
Hang on, it seems to be stuck
Occasionally,
the display momentarily freezes in place.
The attitude indicator stops moving
even though the gyro is still in motion
Yeah, there it goes,
now it is circling.
Investigators need to know
what is causing the failure.
They test every wire,
connecting the display to the gyro.
Finally, they find the culprit.
This wire is hanging by a thread
We found a break in the wire
Intermittent, it was close enough:
Sometimes it touches and sometimes it won't.
The discovery gives new meaning to
the bizarre rolling motion, captured by the FDR
The Captain's instrument and the Flight recorder
are both fed by the same gyro.
The way the airplane is wired is:
what the Captain is seeing on his indicator
is what is been recorded on the FDR
Since the Captain's gyro was broken,
it was sending faulty roll data to the recorder.
Copa 201 didn't really make
any quick rolling manoeuvres at all.
OKAY, let us see what the plane is really doing.
By carefully analyzing
other parameters on the FDR,
they managed to calculate its actual movements
and reveal the plane's true motion.
Making it visual, we could see
what the data is showing and the plane is doing.
That is extraordinary helpful.
The red image shows the bad data
the pilots were seeing,
while the solid image shows
how the Copa 201 was actually flying.
They were trying to level the plane,
but they are making it worse.
You have the attitude indicator here, stuck
Now, the airplane is going in the other direction
and sends suddenly
the attitude indicator is powered to unstuck
it goes back and moves the airplane again
The pilots' ability to troubleshoot the problem
was likely complicated by
the intermittent nature of the failure.
If they are totally confused
by their attitude indicator
they are making improper control inputs.
When it sticks,
the pilot is trying to correct that problem
so, he is trying to get
that airplane 'level' again
and he doesn't realize
that he is going in the wrong direction
He is looking at an instrument providing bad data,
and unfortunately in the period of time,
he lost control of the aircraft.
The plane rolls so far to the right,
it becomes unrecoverable.
Though the pilots don't know it,
they are now falling from the sky.
When they got to this point,
they didn't have a chance.
But a puzzling question remains
It was the Captain's gyro
that failed in flight
and started sending bad data.
So, why did the pilots select it?
The question is:
why they believed
the Captain's gyro is the good one?
Why is it switched to that position?
Because of that mistake,
both pilots were seeing the wrong information.
The accident wouldn't have happened
had they've been on VG-2
What could have led the pilots
to make such a lethal error?
You want to know,
how are they trained for unusual events?
What is their level of skill?
How would they handle an unusual situation?
are they trained for gyro failures?
OKAY, let us start
Investigators go into the type of flight-simulator
the Copa crew used for their 737 training.
Climb to 25,000 ft and turn right.
They recreate the flight of Copa 201
Now, trigger the failure.
Including the malfunction
of the Captain's attitude indicator.
Tom Haueter:
How do you make the switch?
Wait a minute, let me see that
That is not the same switch that was on Copa 201
Two different configurations
for one small control-switch
has overwhelming implications
for the investigation.
This is the gyro switch from the simulator
where the Captain was trained
Next slide, please
And this is the gyro-switch from Copa 201
Can we get it closer, please?
Alright, now let's see both
Well, that is completely different
The cockpit and the simulator weren't similar
and so it is possible to get confused
thinking you are going to independent gyro-source
when you weren't.
In the simulator, flipping the toggle to the left
switches the Captain's instrument to an AUX gyro,
independent of the other two.
On Flight 201,
flipping the switch to the left puts both
instruments on the Captain's malfunctioning gyro.
With no CVR from the cockpit of Copa 201
investigators will never know for certain
who flipped the switch the wrong way.
But they finally collected
enough evidence
to build a compelling theory of
how the flight went so horribly wrong
After diverting around the storm,
the crew of Copa Flight 201
needs to turn right to get back on course.
The delicious food makes up for the long hours.
As the plane levels out,
an error flag warns there is a problem
with the Captain's attitude indicator.
They fall back on their training
and flip the gyro switch to the left,
thinking they are switching to the AUX gyro.
You may revert to your training
and do something inappropriate
because, that is what you are trained to do.
Now, they are both on the bad gyro,
neither of them knows about it.
The gyro malfunction
causes the AUTOPILOT to switch off.
First Officer Tejada must now fly by hand.
He turns his wheel to level the wings.
His frozen instrument makes it look
like the plane isn't responding.
So, he continues to turn the controls
sending the plane further and further to the left.
He is trying to correct the problem
He is actually making the problem a lot worse.
The pilots have no way of sensing their error.
It is too dark to see anything outside
that could help orient them.
In the middle of the night,
you don't have the horizon.
You loose the horizon,
you don't know where you are.
As the short circuit cuts in and out,
the instruments start working
then suddenly stops again.
Now, he thinks they are banking left
he is trying to correct it by banking right
In the cabin, there is little sign of trouble.
The barrel move manoeuvre was fairly smooth
with 1 G
I doubt the passengers really
realized the impending danger
until the airplane inverted
and started to come through
and then it would have happened very quickly.
Altitude
Pull up, pull up!
In-between the two pilots,
there is a 3rd standby attitude indicator,
fed by its own independent gyro.
By comparing the 2 main indicators
to the standby
pilots can quickly determine
which one of the main indicators is faulty.
The standby indicator
should have giving them the correct indication.
Why the pilots didn't use the standby,
remains a mystery.
Had they looked at the standby,
they knew there was something really wrong here
By the time
the pilots realized they were in a dive...
Left, left, left!
I am trying, Captain
...it is too late.
It is extraordinary dis-concerning
you've gone from a few degrees to the left
to multiple degrees to the right.
Once a usual attitude get out of hand
it is much more difficult to recover.
This airplane got so much nose low
and at such a high speed
I can imagine in the cockpit what is going on.
In seconds,
massive G forces incapacitated passengers and crew
As the airplane gets faster,
components are being over-stressed
and you will start breaking off
parts of the aircraft.
In the dive, the airplane got fire
because that rupture of the tank...
...and exploded.
We were so sorry...
...that the end was the worst.
It is the worst accident in the history of Panama,
and I hope I never run through one again.
Jorge Rodriguez spends months,
helping prepare the final report on Copa 201
for Panama Civil Aviation Authority.
It is very important that you analyze
and find out what was the cause of the accident.
Copa Airlines responds
with a major overhaul of its fleet,
standardizing the layout of cockpit controls.
Their fleet is fully harmonized,
it is a completely different airline
that it was at that time.
Copa also revamps pilot training
to make sure its crews are prepared
for any instrument malfunction.
I have been 4.5 years with them
and their training is the best I've seen
We will respect them for that.
For the airline industry,
Copa 201 is a reminder of how even small problems
can result in catastrophe.
A minor flaw can result in a tragedy,
and so we always have to look for these flaws
we have to train for them
we have to challenge ourselves to be the best
whether it is the guy
who makes the component on the bench
to the people who maintain the aircraft
to the pilots
It takes everybody working together.
Narrator
Jonathan Aris
Subtitles
Rein Croonen