The preliminary accident report on the August 9, 2024 crash of a Voepass ATR72 near Sao Paolo, Brazil has just been issued. John Goglia, Todd Curtis and Greg Feith apply their expertise to examine the findings and critical aviation safety issues.

The report has detailed facts, including a summary of the flight, but several key pieces of information are missing. One big issue – no detailed transcript of what was said in the cockpit during the flight.

The report focuses on the aircraft's deicing and anti-icing systems, including its apparent malfunctions. This system was first activated after the crew received an alert from the aircraft's ice detection system, and was turned off less than a minute later. 

The crew did not react appropriately after turning off the deicing system warning. Rather than leaving the altitude where the icing was occurring or disengaging the autopilot, the crew did neither.

Based on the portions of the crew's conversation during the flight in the report, John concludes that the crew was not paying enough attention to flying the airplane. They did not address warnings from the aircraft.

There is a potential conflict of interest that may impede getting all the details of this accident. The Brazilian Air Force runs CENIPA, the aviation accident investigative authority, and the Brazilian air traffic control organization. Greg and John share their firsthand experiences with investigators dealing with outside influences using the example of the 1994 Roselawn, Indiana ATR72 accident.

Key takeaway here: pilots, especially professional pilots, need to educate themselves about how icing affects their aircraft.

Related documents are available at the Flight Safety Detectives website.

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