Investigation Summary
The investigation centered on the 'FLCH SPD' (Flight Level Change Speed) autopilot mode. While attempting to increase the descent rate, the pilot flying (PF) selected a mode that initiated a climb because the aircraft was below the selected altitude. To counter this, the PF disconnected the autopilot and pulled the thrust levers to idle. This action transitioned the autothrottle into 'HOLD' mode, which stops the system from automatically adjusting thrust to maintain airspeed. The crew failed to monitor the airspeed decay, which dropped to 103 knots (34 knots below target) before the impact. Fatigue and over-reliance on automation were cited as significant factors in the crew's failure to recognize the deteriorating energy state.
Final Conclusions
The NTSB determined the probable cause was the flight crew's mismanagement of the descent, unintended deactivation of automatic airspeed control, and inadequate monitoring of airspeed. Contributing factors included the complexity of the Boeing 777's autothrottle/flight director systems, nonstandard communication between crew members, inadequate training on visual approaches, and flight crew fatigue.
Video Analysis
The Crash of Asiana Airlines Flight 214 — A detailed breakdown of the events leading to the crash of Asiana 214, focusing on the automation modes and pilot performance during the final approach.
Watch on YouTube ↗If playback is blocked, the owner has disabled embedding — use the link above.
Systems & Failure Modes
Autothrottle (A/T) HOLD Mode
A mode where the autothrottle servos are inhibited, allowing the pilot to set thrust manually but preventing the system from maintaining a target airspeed.
FLCH SPD (Flight Level Change)
An autopilot mode that changes altitude by using a programmed pitch to maintain a specific airspeed.
PAPI (Precision Approach Path Indicator)
Visual lights at the side of the runway that provide vertical guidance; four red lights indicate the aircraft is dangerously low.
Interesting Facts
- 01Three passengers died; two were ejected from the aircraft because they were not wearing seatbelts.
- 02One of the deceased passengers was accidentally run over by two firefighting vehicles during the emergency response.
- 03The aircraft was destroyed by impact forces and a post-crash fire that started in the right engine.
- 0498% of passengers successfully self-evacuated from the burning wreckage.
- 05The Pilot Flying was in the process of initial operating experience (IOE) training for the Boeing 777.
Safety Actions & Advisories
Autoflight System Design
Recommendations were made to Boeing to reduce the complexity of the 777's autoflight system and enhance documentation regarding mode transitions.
Manual Flight Training
Asiana Airlines was advised to increase manual flight training and emphasize visual approach planning for its pilots.
ARFF Training
Improved training for Aircraft Rescue and Firefighting (ARFF) personnel regarding the safety of passengers on the ground during emergency responses.