Table of Contents

Contents
Table of Contents..................................................................................................................................1
Table of Images.....................................................................................................................................1
Ground Proximity Warning System.......................................................................................................2
Background........................................................................................................................................2
Modes of Operation..........................................................................................................................3
Enhanced Ground Proximity Warning System...................................................................................4
Flight Crew Interaction......................................................................................................................6
Components......................................................................................................................................7
System Interaction.............................................................................................................................8
System Failure...................................................................................................................................9
McDonnell Douglas DC-10...................................................................................................................10
The DC-10........................................................................................................................................10
Design..............................................................................................................................................10
American Airlines 96........................................................................................................................12
Service Bulletins...............................................................................................................................13
Turkish Airlines 981.........................................................................................................................14
Conclusion.......................................................................................................................................15
References...........................................................................................................................................16

Table of Images

Figure 1. TAD Typical Colour Representation (Thales, 2013).................................................................5

Figure 2. EGPWS on Airbus (KLM, 2015)................................................................................................6
Figure 3. Component Location on A330 (Thales, 2013).........................................................................7
Figure 4. GPWS Panel on A330 (Pete, 2021)..........................................................................................7
Figure 5. EGPWS System Inputs & Outputs on A330 (Thales,2013).......................................................8
Figure 6. Correct and Incorrect Latching of Door Mechanism (Bolai, 2010)........................................11
Figure 7. Rear Cargo Door on Landing of American Airlines Flight 96 (FAA, n.d).................................12
Figure 8. Illustration of Bent Torque Tube Allowing Locking Pins to Locate (Bolai, 2010)...................14
MECH40733 DL Introduction to Flight 20024962

Ground Proximity Warning System

Background

Controlled flight into terrain is defined as a serviceable, airworthy aircraft, under the control
of a pilot flown into the ground, water or an obstacle without intent. (Knowles, 2019). This
type of accident was such a common occurrence in aviation, research into the development
of a system that could warn of such hazards and reduce the number of controlled flight into
terrain incidents was launched in the 1960s. Late in the decade, a Canadian engineer
named Charles Donald Bateman successfully developed and gained accreditation for the
first Ground Proximity Warning System. The system gave the flight crew a warning, both
aural and visual, of any impending collision with the surrounding terrain, utilising aircraft
systems like the radio altimeter readings to compute a rise in the terrain below the aircraft.

Although this proved effective and reduced the number of controlled flight into terrain
accidents, an error was observed requiring modification, the system had a blind spot, as it
could only monitor the terrain below the aircraft and not in front of flight. As a result, the
ground proximity warning system went through multiple upgrades and development, as
aircraft technology and engineering advanced, one current version or variant that is utilised
today by aircraft worldwide is that of the Enhanced Ground Proximity Warning System. This
system incorporates added functions such as Forward-Looking Terrain Avoidance and
Terrain Clearance Floor.

The ground proximity warning system is deemed such a critical and vital asset that ICAO
decree no aircraft, turbine or piston engine, with a certified maximum take-off mass in
excess of 5,700Kg or authorised to carry more than nine passengers, shall be operated
without a ground proximity warning system which has a forward-looking terrain avoidance
function installed (ICAO, 2018).

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Modes of Operation

The ground proximity warning system has multiple modes of operation which allow it to
function successfully and accommodate for different factors encountered through flight, both
intentional and unintentional. As some flight paths require aircraft to encounter hazards or
obstacles in proximity, for example upon landing and take-off, the system can adapt its
warnings to acknowledge this. There are five basic modes of operation delivered by the
ground proximity warning system.

Mode 1. Excessive rate of descent.

This is in relation to the aircraft descending to the ground at a rate greater than
anticipated by the flight management computer, readings from the barometric
altimeter and radio altimeter are combined. An aural “SINK RATE” and amber
warning is initially issued when the descent exceeds the limit of the system, if this
descent fails to resolve or becomes more excessive, a red warning and “PULL UP” is
issued.

Mode 2. Excessive closure rate with terrain.

This is in relation to the ground approaching the height of the aircraft whilst the
aircraft is not descending. The radio altimeter gives reference for how rapidly the
height appears to be descending. 90 seconds before the aircraft flight path and
terrain cross, an amber “TERRAIN” warning is generated, if the path continues a red
“PULL UP” warning is issued 30 seconds prior to potential impact. There are 2 forms
of operation in mode 2, 2A and 2B.

2A offers the standard operation, flaps not in landing configuration and aircraft not on
glideslope centreline.

2B operates under a smaller alerting envelope to allow for landing manoeuvres close
to terrain, the mode is automatically selected when the flaps are in landing
configuration.

Mode 3. Descent after take-off.

Utilising the radio altimeter, an excessive altitude loss straight after take-off can be
highlighted to deliver the information to the flight crew. “DON’T SINK” and an amber
warning will be delivered if the altitude of the aircraft fails to rise within the initial 1000
feet above ground level after take-off.

Mode 4. Unsafe terrain clearance.

There are 2 sub modes in operation here, both provide the flight crew of the error in
the landing configuration, or lack of configuration as the terrain approaches and
aircraft speed decreases.

Mode 4A is during cruise and approach, landing gear and flaps not in landing
configuration. If the aircraft is too low and slow, “TOO LOW GEAR” will be aurally
stated with an amber warning.

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Mode 4B is again during cruise and approach but landing gear in landing
configuration OR flaps in landing configuration but landing gear not. “TOO LOW
FLAPS” will be the stated warning in this situation.

Mode 5. Descent below glide slope

A warning is given when the aircraft drops below the glide slope of the instrument
landing system. “GLIDESLOPE” is warned when the aircraft is below 1000 feet radio
altitude and has deviated below the glideslope beam. If the aircraft continues below
the beam and reaches 300 feet radio altitude, “GLIDESLOPE GLIDESLOPE” is
delivered every 3 seconds.

Enhanced Ground Proximity Warning System

In 1996, Enhanced Ground Proximity Warning System was introduced (Cardiff and Vale,
2014), as the modern aircraft evolved alongside engineering technology, so did the ground
proximity warning system. The enhanced ground proximity warning system supplements the
basic ground proximity warning system by looking more than just below the aircraft (Pete,
2021). The integration of such features as Forward-Looking Terrain Avoidance, Terrain
Clearance Floor and Terrain Alerting and Display was added to increase functionality and
capability.

Forward-looking terrain avoidance determines the position, ground speed and track of the
aircraft by utilising the global positioning system, this data, along with the altitude are fed into
the ground proximity computer (Benningfield, 2003). Within the computer is an amendable
database containing terrain, obstacles, and runways, this can be referenced against the
intended flight path of the aircraft to deliver a necessary warning of potential conflict.

Terrain clearance floor increases the terrain clearance envelope around airport runways, it
works as a complimenting element to mode 4. Analysing the aircraft current position, nearest
runway, and radio altitude, unnecessary warnings are then muted from surrounding hazards
due to the aircraft operating in a landing configuration.

Terrain alerting and display provides the crew with a visual representation of surrounding
terrain by using various colours and density to represent the terrain about the aircraft
altitude. The values of altitude represented by each colour can vary depending on airframe
size and style, helicopters and small aircraft differ from large commercial aircraft. Below is an
example of a large commercial aircraft terrain alerting and display representation.

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MECH40733 DL Introduction to Flight 20024962

Figure 1. TAD Typical Colour Representation (Thales, 2013)

The enhanced ground proximity warning system provides two extra modes of operation,
these add to the five basic modes of operation delivered under the original ground proximity
warning system.

Mode 6. Altitude and Bank Angle.

Call outs are delivered at altitudes set by the system, “FIVE HUNDRED” and “TWO
HUNDRED” feet for example as the aircraft reaches the radio altitude decision
height, “MINIMUMS MINIMUMS” is enunciated. The decision height is set by the
crew through flight.

If the aircraft begins to bank beyond a pre-set angle, dictated by aircraft manufacturer
in respect of type and size, a “BANK ANGLE” warning will be delivered. The angle of
acceptance alters continually as the aircraft approaches the ground level.

Mode 7. Windshear.

During take-off and approach, an excessive windshear will warn the crew.
“WINDSHEAR, WINDSHEAR, WINDSHEAR” will aurally sound if detected and the
aircraft is within 1500 feet above ground level radio altitude.

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Flight Crew Interaction

Enhanced ground proximity warning system provides the flight crew with a visual
representation of hazards and dangers, these are displayed on either the navigation display,
if the enhanced system is embodied, or an independent ground proximity warning system
display, depending on aircraft manufacture and type. A designated push button switch is
installed next to the navigation display screen, ‘Terrain on ND’, allowing the crew to choose
to display or not display the terrain around the aircraft. This is only on aircraft equipped with
the appropriate software state.

Figure 2. EGPWS on Airbus (KLM, 2015)

All modes provide an aural warning, this is through the flight warning system which means it
cannot be disabled or turned down by the crew. The only situation that disables the aural
warning is in the event of a stall warning or wind shear detection, these two scenarios hold a
higher warning priority. The flight warning system does this automatically through its internal
evaluation in the flight warning computer.

Master Caution and Master Warning annunciators are illuminated on the glare shield, these
can be cancelled by the crew if they choose, however they will re-illuminate and escalate if
they fail to rectify the situation. The modes independently dictate what level of warning is
required with respect to the aircraft position and terrain.

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Components

The central element of the system is the Ground Proximity Warning Computer, located in the
avionics bay, dependant on aircraft manufacture and type. It is the hub of all the information,
taking all the inputs, carrying out the computations and analysis, then distributing the
outputs.

Figure 3. Component Location on A330 (Thales, 2013)

The instrument panel on the flight deck contains multiple push button switches, these
switches allow the flight crew to turn elements of the system, or the whole system itself, off.
Cautions can also be cancelled down via these switches. The panel is generally located on
the overhead panel of the flight deck; however, this can vary with aircraft manufacture and
type.

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MECH40733 DL Introduction to Flight 20024962

Figure 4. GPWS Panel on A330 (Pete, 2021)

System Interaction

For the enhanced ground proximity warning system to operate at full effectiveness, it needs
to work with other systems on the aircraft, utilising data from such assets as the radio
altimeter, air data inertial reference unit, multi-mode receiver which hosts the instrument
landing system and weather radar. These systems provide inputs to the enhanced ground
proximity warning system, it also receives discreet digital inputs such as flap position,
landing gear position, aircraft landing configuration and flight path data. These numerous
inputs allow the enhanced ground proximity warning computer to carry out the required
internal calculations.

Outputs are fewer in number, the system only provides data to the audio management unit,
flight warning computer, system data acquisition concentrators, and the display management
computer. These are via discrete digital data outputs; these provide the crew with visual
representation and aural warnings.

Figure 5. EGPWS System Inputs & Outputs on A330 (Thales,2013)

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System Failure

There are no direct implications if the system malfunctions through flight, the aircraft can
continue its planned operation. The crew will however be solely responsible for observing
surrounding terrain as the functionality of the enhanced ground proximity warning system
and its modes of operation will not be working. The system can even be logged in the
acceptable deferred defects in accordance with the company minimum equipment list by
engineers on the ground, should the aircraft be required for operations before reactive
maintenance is granted an opportunity. Faults with the system can be confirmed by carrying
out tests through the aircraft multi-purpose control display unit, lights on the computer in the
avionics bay also highlight faults. The computer runs a power-up built-in test on the
application of aircraft power, then operates a continuous built-in test at periodic intervals.

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McDonnell Douglas DC-10

The DC-10

The DC-10 was a wide-body jumbo jet manufactured by McDonnell Douglas at the request
of American Airlines, who became the launch customer in the 1960s. It was built to compete
with the Boeing 747 and the yet to be released Lockheed L-1011 Tristar (Fielder, 1992), as a
long-haul carrier. This was a highly competitive market with Boeing already leading the way,
the race was on for McDonnell Douglas to beat Lockheed. The first DC-10 rolled down the
runway and into the skies on Saturday, August 19, 1970, in a test flight, with the first
deliveries to American and United Airlines on June 29, 1971 (Airways, 2014). The
introduction into commercial operation did not go as planned for the DC-10, as the first few
years saw a series of incidents and accidents, a couple of these were the result of a design
error, the rear cargo door.

Design

To speed up the design process and ensure they beat rival Lockheed Martin to the release
of the aircraft, McDonnell Douglas utilised designs from previous aircraft such as the DC-8
and DC-9. These were narrow-body airframes, immediately drawing questions to the
integrity of the structure and the ability to manage the extra load capacity that comes with a
wide-body frame. One particular element in a wide-body airframe requiring extra support in
comparison to a narrow-body airframe is the cabin floor, in 1970 Douglas ignored warnings
from high Dutch aviation officials that the DC‐10's floor was probably not designed to
withstand the explosive effect of sudden decompression (Sherrill, 1976). An influence in the
concern of the design of the floor was the lack of vents to help pressure equalise in a
decompression scenario.

As a weight-saving incentive, the cargo door mechanism was changed from a hydraulic
actuator to an electric one, this was a new venture for McDonnell Douglas (Beresnevicius,
2019). Hydraulic actuators have the advantage of ensuring constant pressure is applied to
the latching system, compared to electric actuators which only provide a positive exerted
pressure whilst switched on. In the event of an incorrectly closed door, the low pressure
would cause a failure when the pressure offsets the actuator force, meaning the aircraft
would ultimately not be able to pressurise and so would be forced to land. An electric
actuator would fail when the pressure is much greater and causes the lock mechanism to
force open (Wallace, 2019), this would be after the aircraft has achieved pressurisation.

The control cables and hydraulic piping on the DC-10 ran under the cabin floor, in between
the cabin and cargo hold, as opposed to other aircraft, for example, Boeing, which routed
them in the roof or under the cargo hold floor. This was a critical design decision when
coupled with the questionable cabin floor, it compromises the ability of the aircraft to function
if the cabin floor had a failure in an emergency.

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The DC-10, like most aircraft, opted for an outward opening cargo door design to utilise
maximum space in the hold, this option meant that the door would have pressure trying to
open it through flight rather than help secure it in place, as with a plug style door. To combat
this a heavy and reliable locking mechanism was required, McDonnell Douglas opted for
multiple ‘C’ hooks that would latch over a roller tube with an over centre linking arm. Locking
pins then secured the door in place by not allowing a restraining flange to pass over to the
opening position.

Figure 6. Correct and Incorrect Latching of Door Mechanism (Bolai, 2010)

During the testing phase of the DC-10, one of the forward cargo doors blew open on a
pressurisation test on the ground, raising concerns over the design and capability of the door
locking mechanism. Small modifications were introduced to the door design, including an
indicator to the ground crew the door was truly closed.

Following American Airlines 96, the Director of Product Engineering for Convair, the airframe
manufacturer, raised concerns over the fundamental safety of the cargo door (Wallace,
2019) to senior management via a memorandum. Not wanting to risk relationships with
McDonnell Douglas, Convair management did not act upon the information given to them.

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American Airlines 96

June 12, 1972, a DC-10 operated by American Airlines had a major incident when the rear
cargo door came open (Beresnevicius, 2019) The aircraft departed Detroit-Metropolitan
Airport and was climbing through 11,000 feet when a “thud” was felt by the aircrew,
simultaneously dust and dirt engulfed the crew and the rudder pedals moved to full left
rudder position (Ranter, n.d). A rapid decompression had occurred creating a pressure
differential between the cabin and the cargo hold, this caused the cabin floor to collapse,
jamming the rudder control cable and causing a full left deflection, however, the floor had
only partially collapsed and so did not severe all the hydraulic piping for the flying controls at
the rear of the aircraft. This allowed Pilot Bryce McCormick to still operate the aircraft,
although at great difficulty and limited functionality. It was only because Captain McCormick
had previously practised flying the aircraft in the simulator with a total hydraulic failure, he
was able to land with zero fatalities, using differential thrust steering to manage the DC-10 to
safety.

The National Transportation Safety Board determined that the probable cause of the
accident was the improper engagement of the latching mechanism for the aft cargo
compartment door (NTSB, 1973), a ground handler stated that extra force had to be applied,
but they managed to close and latch the door. This demonstrated the apparent closing of the
door when in truth, the locking mechanism latches were not fully engaged and the
restraining flange locking pins were falsely securing the door, the closed indication in the
flight deck represented a false situation.

This was possible due to the torque tube been forced out of position and bent, allowing the
locking pins to be seated with the flanges in the wrong position, thus giving the impression to
ground services that the cargo door was truly closed and latched and secure for flight.

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MECH40733 DL Introduction to Flight 20024962

Figure 7. Rear Cargo Door on Landing of American Airlines Flight 96 (FAA, n.d)

Service Bulletins

A Service Bulletin is a document issued by aircraft manufacturers detailing modifications and

works to be embodied on aircraft type, they offer a period in which to carry out the specified
work. An Airworthiness Directive is a mandatory document requiring immediate action,
detailing safety-critical issues preventing the operation of any aircraft under the specified
type from been operated until the work has been satisfied. Following American Airlines 96,
the Federal Aviation Authority did not issue an airworthiness directive but instead allowed
McDonnell Douglas to issue Service Bulletins, (Chittum, 2017).

Service bulletin 52-35 suggested the installation of a small viewing port directly above one of
the locking pins in the cargo door on all existing and all future DC-10 aircraft, this would
allow ramp services to visually check the locking pin was in place with the restraining flange
seated correctly. Confirming the door was truly closed and latched.

A second service bulletin, number 52-37 was also issued, this added a stiffener to prevent
bending of the torque tube on the cargo door, this would stop the locking pins been
incorrectly fitted and ensuring the restraining flange was not out of position.

DC-10 manufacture number, Ship 29, came off the production line three months after the
service bulletins were issued relating to the rear cargo door, it was not delivered to its
customer, Turkish Airlines, for a further three months, six months in total. The documentation
detailed that service bulletin 52-37 had been satisfied when in truth it had not, the door lock
mechanism could still be forced into a false latched position (Design News, 2009). Ship 29
was the aircraft used for Turkish Airlines 981.

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Turkish Airlines 981

March 3, 1974, a DC-10 operated by Turkish Airlines was performing a scheduled flight from
Istanbul to London Heathrow via Paris, having completed the first leg of the journey, the
aircraft took off to reach its destination of London Heathrow from Orly, Paris. Approximately
eight minutes into the flight, at an altitude of 9,000 feet, the rear cargo door of the aircraft
blew off causing the pressurized air in the cabin to explode through the opening. The rapid
decompression hurled six passengers still strapped in their seats out of the aircraft, the cabin
floor collapsed and in turn crushed the aircraft’s hydraulic system, leaving the DC-10
helpless (Sherrill, 1976). The aircraft began to descend and bank to the left as the control
cables for the rudder were severed. The pilot was left with no control of any of the DC-10’s
rear flying control surfaces and the aircraft continued to accelerate in a nose-down attitude.
Cockpit voice recorder transcripts show that Captain Berkoz demanded more thrust in an
attempt to bring the DC-10 back to level flight, this was unsuccessful, the aircraft crashed at
Ermenonville Forest just outside Paris, all three hundred and forty-six people on board were
killed. Investigation showed that the incorrect placement of the locking pins and insufficient
contact with the flanges meant the door was not fully latched in a closed position, this was
again possible due to the out of position torque tube (FSST, 1976).

Before flight, ramp services at Orly had used the rear cargo door for access during the
unloading and loading in between legs. The individual who closed the door was from Algeria,
they could read neither French nor English so did not understand the words on the decals
next to the viewport. They also had been taught to look at the lock pin through the viewing
port but did not know what it was for (DesignNews, 2009). Although the extra force was
required, the individual was able to close the rear cargo door.

Figure 8. Illustration of Bent Torque Tube Allowing Locking Pins to Locate (Bolai, 2010)

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MECH40733 DL Introduction to Flight 20024962

Conclusion

Rapid decompression is a common occurrence in aviation, it does not however normally

result in the demise of the aircraft, most scenarios result in the aircraft been handled
appropriately and landing safely, so why did the DC-10 perform so poorly in both the stated
incidents in this report. It can be easy to direct a single point of blame from the initial analysis
towards the cargo door, and in particular the locking mechanism, however, the problem lies
deeper than the obvious. As an aircraft developer, McDonnell Douglas in the desire to beat
Lockheed to the market, utilised old, narrow-body aircraft designs to build a wide-body
aircraft, questioning if the design of the DC-10 was truly developed or merely, adjusted and
made to fit. It was also the decision of McDonnell Douglas to route hydraulic lines under the
cabin floor, a critical design decision that proved pivotal in the crash of Turkish Airlines 981.

The testing phase of a new airframe is there to highlight potential issues, so is a critical
element for the introduction of the aircraft type into commercial life. A cargo door blowing out
during the testing raises great concern for both the locking mechanism design of the door
and the safety of the aircraft. Whilst an internal memorandum was written after the events of
American Airlines 96, this was too late in the development of the DC-10, concerns should
have been highlighted at the testing phase with greater authority and vigour.

There is a multitude of errors throughout the design, development and operation of the DC-
10 which simulate James Reason’s Swiss cheese model. All the errors aligned to allow such
a consequence to occur, prior warnings offered the opportunity for corrective preventative
action to be taken. Evidence shows us that designs were rushed, memos were written and
ignored, modifications were not ratified, service bulletins not actioned, and incorrectly trained
ground handling performed. Had any one of these actions occurred differently the alignment
would have no doubt been knocked out of sync, preventing either air incident from ever
occurring.

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Airliners, M. (2021) 'McDonnell Douglas DC-10', .
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Magazine, -02-17T13:00:30+00:00. Available at: https://airwaysmag.com/uncategorized/history-
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designNews (2009) Designed for Disaster: The DC-10 Airliner, Part 2. Available
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Pete. (2021) 'GPWS - A Definitive Guide | AviationMatters.co', aviation matters, January,.

Available at: /gpws-ground-proximity-warning-system/ (Accessed: Feb 3, 2021).
Ranter, H. ASN Aircraft accident McDonnell Douglas DC-10-10 N103AA Windsor, ON. Available
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