![]() When Air Canada Flight 143 was being refuelled, the procedures for refuelling had recently been changed. That process has quite a lot of room for error, which is why there are numerous checkpoints in the procedure to reduce the risk of those errors. When you’re refuelling an aircraft, you work out how much fuel you’ll need for your flight, and then put in that much plus a bit extra as a safety margin, to keep the weight down. This is because fuel is heavy, and you don’t want to haul more weight through the sky than you have to. One big difference is that you deliberately don’t fill the fuel tanks up completely unless you really have to. Refuelling an aircraft is a very different proposition from refuelling a car. That doesn’t mean that the decision to make the change was wrong usually in life, there isn’t a completely risk-free option, which is why professionals in the field think in terms of risk management and risk reduction rather than risk elimination. Sooner or later, someone would use the wrong units, and something would go horribly wrong. To anyone familiar with complex systems and human factors, it was a disaster waiting to happen. In 1983, when this happened, transition from Imperial to metric units was a live issue. So how do you manage to run out of fuel at 41,000 feet? It’s a classic example of what’s known as a normal accident. Images from Wikipedia details with attributions at the end of this article Even by the standards of movies about fictional aircraft in jeopardy, it’s quite a story. Nobody died everyone walked away, with feelings of disbelief and massive relief. The pilot landed successfully, largely because he happened to know a lot about flying gliders. The co-pilot recommended an emergency landing at Gimli airfield, which he knew from his days in the Royal Canadian Air Force. At that point, it became the world’s largest glider. ![]() It’s the true story of an airliner that ran out of fuel at 41,000 feet, because of a misunderstanding about whether it had been fuelled in litres or in pounds of fuel. If the name gives you surreal images of a Middle-Earth dwarf wielding an axe in a sailplane, you might be relieved to learn that the reality is very different, though equally surreal in some ways. It’s a feel-good true story, for days when a person needs a feel-good true story it’s invaluable as a case study for my students it’s also good for putting problems into perspective on a hard day. ![]()
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