Fire On Japan Airlines Flight 516 – Some Systemic Issues

Air travel is known to be the safest mode of travel in the world. However, a system works only if its weakest link doesn’t give way. 

6 mins read
Japan Airlines' A350 airplane is on fire at Haneda international airport in Tokyo, Japan January 2, 2024. REUTERS/Issei Kato

The System

A Japan Airlines Airbus A350 plane operating Flight 516 which departed from Sapporo’s New Chitose airport at 16:00 local time (07:00 GMT) on 2nd January and was scheduled to land at Haneda (one of the two international airports in Tokyo) at 17:40 burst into flames on landing after an apparent collision with a smaller coastguard aircraft on the runway at Tokyo’s Haneda airport. The smaller cargo aircraft had been on the way to Niigata Airport base on Japan’s west coast, to deliver aid to those caught up in a massive earthquake that had occurred earlier.

All 379 passengers and crew on board were evacuated but five of the six crew on the coastguard plane died, according to a police report. The captain was injured. The Tokyo Fire department had reported that  at least 17 passengers and crew sustained injuries.

Until the accident investigation is complete and a report is issued, we cannot say for certain whether the accident was due to human error or communication or whether any technical issue was involved.  However, although it is still premature to prognosticate on specifics and we do not know details of this occurrence, some facts become instantly clear from an aviation perspective.  They incontrovertibly show how well the entire aviation system can successfully function in the operation of a flight.

Firstly, anyone seeing the monstrous ball of fame on impact would not imagine how 379 persons on board could get out of the aircraft without perishing.  The A350 is a state-of-the-art modern aircraft and is obviously endowed with an excellent design and an avionics system of precision.  One could safely conclude that the aircraft  had seemingly been designed and manufactured to facilitate quick evacuation.  Secondly, the flight crew and cabin crew had been excellently trained by the airline to handle the situation the way they did and save 379 SOB’s (Souls on Board). Simple Flying reported : “ considering the extent of the fire and how it gutted the aircraft’s fuselage, the crew must have enforced the airline’s evacuation procedures exceptionally”. Thirdly, the airport had been quick to respond with 70 fire trucks to curb the ravaging flames. Fourthly, the care given to the passengers was smoothly executed and the functioning of the airport conformed to the highest standards and best practices.  Finally, Japan’s impressive safety records in aviation in accordance with international standards had ensured that the entire system  operated smoothly and efficiently.

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The System Behind the System

A system can be defined as “ a set of things working together as parts of a mechanism or an interconnecting network; a complex whole” or in other words “ or “ a set of principles or procedures according to which something is done; an organized scheme or method”.  There is an implicit promise in the law of systems that a system which is operated according to acceptable standards is less likely to collapse than one which is haphazardly operated.  A flight is no exception.  Key players involved in a flight are the manufacturer ( for design and manufacturing the aircraft to ensure passenger safety and comfort and issue relevant procedures to be followed ; the airline ( to provide airworthy aircraft and training of crew); the airport (to provide all necessary facilities including emergency services); the air navigation services provider (to ensure safe and orderly navigation both in the air and on the ground); and the regulator (to provide standards, recommended practices and guidelines and procedures).

  1. Manufacturer

In the context under discussion, the main factor involved is whether the manufacturer had designed the aircraft and built it to ensure safe evacuation. The Royal Aeronautical Society in its Emergency Evacuation of Commercial Passenger Aeroplanes (Second Edition 2020) states that “the criteria for emergency evacuation originated in the early planning stages of the aeroplane design. The aeroplane manufacturer first determines the potential market for the aeroplane, the routes to be operated, the maximum flight duration, as well as the maximum number of passenger seats to be installed, including the potential for different classes of the passenger cabins. Among other things, this will determine: number, type and location of required emergency exits, and evacuation slides; minimum number of required cabin crew; requirements for portable emergency equipment; requirements for fixed systems, such as interphone and public address”.

At the international level this issue is addressed by the International Civil Aviation Organization (ICAO) which in Annex 6 to the Chicago Convention – Convention on International Civil Aviation (Operation of Aircraft) – sets out broad guidelines which suggest that aircraft should be designed to enable the swift evacuation of passengers and crew in emergency situations. The procedures for evacuation, which include indicating exit locations, must be clearly delineated and easily comprehensible. Stringent requirements exist for the maximum duration allowed to evacuate an aircraft under diverse emergency scenarios. The objective is to ensure the rapid and efficient exit of passengers and crew, even in challenging circumstances.

Adequate emergency lighting is essential in the cabin to guide occupants to exits in conditions of low visibility, such as darkness or cabins filled with smoke. Regulatory standards mandate that the number, size, and placement of exits meet specific criteria, facilitating the prompt and organized evacuation of passengers.

Furthermore aircraft manufacturers must perform evacuation tests to showcase adherence to regulatory requirements. Certification authorities scrutinize these tests and grant approval for aircraft operation if it meets predefined criteria. Certain regulations may necessitate manufacturers to utilize computer-based simulation models for assessing evacuation scenarios and demonstrating compliance with prescribed evacuation time limits.

Manufacturers are strongly encouraged to participate in research and development initiatives aimed at enhancing evacuation procedures and technologies.

Top of Form

Airbus is known to have excellent standards in design. For example, in 2006, an Airbus A380 successfully completed its passenger evacuation trial, clearing the path for certification. During the demonstration, a total of 873 individuals efficiently exited the aircraft and reached the ground within the specified 90-second timeframe. This marked the most rigorous evacuation ever undertaken and the inaugural one on a two-deck passenger plane. Notably, the trial was executed under low-light conditions.

These evaluations aim to showcase the aircraft’s capability to evacuate passengers within the mandated time frame set by regulatory authorities. Despite the assurance that participants’ lives are not at risk during these trials, the unpredictability of human behavior in a genuine panic scenario cannot be accurately accounted for. In a life-threatening emergency, the potential exists for not everyone to respond in a rational manner.

  1. Airline and Crew

Annex 6 to the Chicago Convention also  provides that   the carrier  must establish, to the satisfaction of the State of the Operator, the minimum number of cabin crew required for each type of aircraft, based on seating capacity or the number of passengers carried, in order to effect a safe and expeditious evacuation of the aircraft, and the necessary functions to be performed in an emergency or a situation requiring emergency evacuation. The operator must assign these functions for each type of aircraft. An operator must also establish and maintain a training programme, approved by the State of the Operator, to be completed by all persons before being assigned as a cabin crew member. Cabin crew must complete a recurrent training programme annually. These training programmes must ensure that each person is competent to execute those safety duties and functions which the cabin crew member is assigned to perform in the event of an emergency or in a situation requiring emergency evacuation. Annexes 1 (Personnel Licensing), 6 (Operation of Aircraft) and 8 (Airworthiness)  to the Chicago Convention become key elements of that training.

  1. Aerodromes

It is the responsibility of aerodrome operators to comply with the requirements of the aerodrome certification regulations. ICAO’s Manual on Aerodrome Certification (Doc 9774) provides that aviation safety at aerodromes depends primarily on voluntary adherence to the requirements  contained in the Manual tat detail   requirements by the aerodrome operators. Promoting compliance with the regulations through education, training and counselling is therefore of primary importance, and only when these efforts have failed should formal enforcement action be taken. Sanctions can be administrative or legal depending on the severity of the violation of the regulations and its impact on aviation safety. It is recognized that States may have their own policies for enforcement of their regulations. Rescue and fire-fighting training involve the checking of training records; random testing of the knowledge of firefighters; checking that the equipment is in position, is functional and meets the category requirements; conducting a time response drill; checking the alarm system; checking and examining proximity suits, other protective clothing and fire-fighting and rescue tools and supplies in the inventory.

The level of protection provided, expressed in terms of the category of the rescue and fire-fighting services, should be in accordance with the longest aeroplane normally using the aerodrome and the type and amounts of extinguishing agents normally available at the aerodrome.

My Take

Air travel is known to be the safest mode of travel in the world. However, a system works only if its weakest link doesn’t give way.  Whatever the outcome of the accident investigation report may reveal, the system seems to have held strong for the safety of the passengers on Flight 516.

Ruwantissa Abeyratne

Dr. Abeyratne teaches aerospace law at McGill University. Among the numerous books he has published are Air Navigation Law (2012) and Aviation Safety Law and Regulation (to be published in 2023). He is a former Senior Legal Counsel at the International Civil Aviation Organization.

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