WEBVTT

1
00:00:00.120 --> 00:00:03.919
<v Speaker 1>Picture the heat. It is July eleventh, eight point twenty

2
00:00:04.000 --> 00:00:06.440
<v Speaker 1>six in the morning in Jedda, Saudi.

3
00:00:06.080 --> 00:00:10.080
<v Speaker 2>Arabia, and the temperature has already crossed the thirty degrees

4
00:00:10.119 --> 00:00:11.439
<v Speaker 2>celsius by that point, right.

5
00:00:11.320 --> 00:00:14.720
<v Speaker 1>It's brutal. The sun is just baking the concrete, creating

6
00:00:14.759 --> 00:00:17.679
<v Speaker 1>those shimmering heat waves over the tarmac.

7
00:00:17.760 --> 00:00:20.079
<v Speaker 2>Yeah, that intense desert heat exactly.

8
00:00:20.600 --> 00:00:24.559
<v Speaker 1>And you are standing inside the massive Hodge Terminal. This

9
00:00:24.719 --> 00:00:29.879
<v Speaker 1>place is it's an absolute architectural marvel. It was built

10
00:00:30.000 --> 00:00:35.320
<v Speaker 1>specifically to handle the incredible influx of the annual Islamic pilgrimage.

11
00:00:35.359 --> 00:00:37.560
<v Speaker 2>I mean it can hold eighty thousand people at once.

12
00:00:37.439 --> 00:00:41.039
<v Speaker 1>Eighty thousand, and on this particular morning, you're watching a

13
00:00:41.039 --> 00:00:44.520
<v Speaker 1>group of two hundred and forty seven Nigerian pilgrims getting

14
00:00:44.520 --> 00:00:45.079
<v Speaker 1>ready to board.

15
00:00:45.320 --> 00:00:47.840
<v Speaker 2>These are people who have just completed the most profoundly

16
00:00:47.880 --> 00:00:50.320
<v Speaker 2>spiritual journey of their lives in Mecca, right.

17
00:00:50.200 --> 00:00:52.520
<v Speaker 1>And many of them are from rural villages. They've never

18
00:00:52.560 --> 00:00:54.240
<v Speaker 1>even been on an airplane before this trip.

19
00:00:54.320 --> 00:00:56.200
<v Speaker 2>Oh wow, so this is all completely new to them,

20
00:00:56.320 --> 00:00:57.039
<v Speaker 2>completely new.

21
00:00:57.159 --> 00:01:00.399
<v Speaker 1>They are exhausted, they are overjoyed, and they are you know,

22
00:01:00.840 --> 00:01:02.399
<v Speaker 1>finally going home to Sokoto.

23
00:01:02.679 --> 00:01:05.480
<v Speaker 2>It's just a beautiful, deeply human scene. You have this

24
00:01:07.000 --> 00:01:10.879
<v Speaker 2>intersection of ancient faith in modern technology. Yeah, because they

25
00:01:10.879 --> 00:01:13.159
<v Speaker 2>were walking out to Bordination Air flight twenty one to

26
00:01:13.200 --> 00:01:15.040
<v Speaker 2>twenty which is a DC eight.

27
00:01:15.000 --> 00:01:17.719
<v Speaker 1>And for context, I mean, the DC eight was essentially

28
00:01:17.799 --> 00:01:21.599
<v Speaker 1>the workhourse of the era. It's a massive, rugged, four

29
00:01:21.640 --> 00:01:23.920
<v Speaker 1>engine jet designed for long hauls.

30
00:01:24.319 --> 00:01:27.599
<v Speaker 2>Right, and looking at the flight logs, everything seems completely routine.

31
00:01:27.920 --> 00:01:30.040
<v Speaker 2>They are fueled up for the long flight across the

32
00:01:30.040 --> 00:01:30.879
<v Speaker 2>African continent.

33
00:01:31.000 --> 00:01:33.920
<v Speaker 1>But looking through these official investigator files and the black

34
00:01:33.959 --> 00:01:37.200
<v Speaker 1>box transcripts, it is just staggering to see the reality

35
00:01:37.200 --> 00:01:38.439
<v Speaker 1>of what was actually happening.

36
00:01:38.519 --> 00:01:39.239
<v Speaker 2>Yeah, that's chilling.

37
00:01:39.319 --> 00:01:41.840
<v Speaker 1>They were stepping into a machine that was already doomed.

38
00:01:42.760 --> 00:01:45.040
<v Speaker 1>And the mission for our deep dive today isn't just

39
00:01:45.079 --> 00:01:48.159
<v Speaker 1>to look at the mechanical failure. We're going to trace

40
00:01:48.200 --> 00:01:50.799
<v Speaker 1>the forensic clues back through the desert sand to find

41
00:01:50.799 --> 00:01:56.079
<v Speaker 1>out how a simple, almost mundane maintenance oversight destroyed this aircraft, a.

42
00:01:55.959 --> 00:01:58.959
<v Speaker 2>Flight that turned into one of the deadliest aviation disasters

43
00:01:59.000 --> 00:01:59.519
<v Speaker 2>in history.

44
00:02:00.120 --> 00:02:02.560
<v Speaker 1>Two hundred and sixty one lives in barely ten minutes.

45
00:02:03.159 --> 00:02:06.840
<v Speaker 1>And the craziest part is that the fatal blow was

46
00:02:06.879 --> 00:02:09.919
<v Speaker 1>struck before the wheels ever even left the ground.

47
00:02:10.240 --> 00:02:12.639
<v Speaker 2>So the timeline of the disaster really begins with the

48
00:02:12.680 --> 00:02:18.120
<v Speaker 2>geography of the airport itself. Jetta is a sprawling, massive facility.

49
00:02:18.759 --> 00:02:20.680
<v Speaker 2>For flight twenty one to twenty to get from the

50
00:02:20.759 --> 00:02:23.319
<v Speaker 2>terminal to the takeoff position on runway three four left,

51
00:02:23.719 --> 00:02:27.240
<v Speaker 2>they have to execute a grueling five kilometer taxi.

52
00:02:27.439 --> 00:02:30.080
<v Speaker 1>Five kilometers just driving on the ground exactly.

53
00:02:30.400 --> 00:02:33.560
<v Speaker 2>That is an enormous distance for a fully loaded heavy

54
00:02:33.599 --> 00:02:36.439
<v Speaker 2>aircraft to be rolling across sun baked asphalt.

55
00:02:36.599 --> 00:02:39.000
<v Speaker 1>I can't even imagine the heat radiating off that ground.

56
00:02:39.080 --> 00:02:41.560
<v Speaker 2>Oh, it's intense. And the sheer friction on the tires

57
00:02:41.639 --> 00:02:43.759
<v Speaker 2>during a taxi that long is immense.

58
00:02:44.039 --> 00:02:45.879
<v Speaker 1>So they finally get to the runway, they are cleared

59
00:02:45.919 --> 00:02:48.680
<v Speaker 1>for takeoff and they throttle up. First officer can't damage

60
00:02:48.680 --> 00:02:51.360
<v Speaker 1>is at the controls and they are accelerating hard.

61
00:02:51.400 --> 00:02:54.120
<v Speaker 2>But the cockpit voice recorder picks up something terrifying right

62
00:02:54.159 --> 00:02:55.719
<v Speaker 2>at ninety knods right.

63
00:02:55.520 --> 00:02:58.879
<v Speaker 1>There is this violent shimmy. The entire plane starts shaking,

64
00:02:58.960 --> 00:03:02.280
<v Speaker 1>sounding like they're driving over massive rumble strips.

65
00:03:02.800 --> 00:03:05.080
<v Speaker 2>Yeah, and you can actually hear the flight engineer ask

66
00:03:05.159 --> 00:03:05.520
<v Speaker 2>what's that.

67
00:03:05.879 --> 00:03:09.000
<v Speaker 1>But at ninety knots, they are in a rapidly shrinking

68
00:03:09.039 --> 00:03:10.000
<v Speaker 1>window of options.

69
00:03:10.199 --> 00:03:13.159
<v Speaker 2>They really are. They are approaching V one, which is

70
00:03:13.199 --> 00:03:16.080
<v Speaker 2>the critical threshold speed and commercial aviation.

71
00:03:15.879 --> 00:03:17.800
<v Speaker 1>The point of no return exactly.

72
00:03:17.919 --> 00:03:20.800
<v Speaker 2>The math is simple, right, once you cross that speed,

73
00:03:21.199 --> 00:03:24.199
<v Speaker 2>you literally do not have enough physical runway lest in

74
00:03:24.199 --> 00:03:26.680
<v Speaker 2>front of you to hit the brakes and stop safely

75
00:03:27.000 --> 00:03:28.520
<v Speaker 2>without overrunning the tarmac.

76
00:03:28.639 --> 00:03:29.960
<v Speaker 1>So you are fully committed.

77
00:03:30.039 --> 00:03:32.599
<v Speaker 2>You're committed. You have to fly the plane, diagnose the

78
00:03:32.639 --> 00:03:34.400
<v Speaker 2>problem in the air, and then try to land.

79
00:03:34.639 --> 00:03:37.719
<v Speaker 1>So, feeling this massive vibration, they hit V one and commit.

80
00:03:38.120 --> 00:03:40.280
<v Speaker 1>They pull back on the yoke, they lift off, and

81
00:03:40.319 --> 00:03:42.520
<v Speaker 1>the captain makes the standard call gear.

82
00:03:42.400 --> 00:03:46.000
<v Speaker 2>Up, and the second those landing gear doors open and

83
00:03:46.039 --> 00:03:48.199
<v Speaker 2>the wheels pull up into the belly of the plane,

84
00:03:48.719 --> 00:03:50.560
<v Speaker 2>the cockpit absolutely erupts.

85
00:03:50.719 --> 00:03:53.400
<v Speaker 1>The transcript from this moment is just pure chaos. It's

86
00:03:53.439 --> 00:03:55.719
<v Speaker 1>not a single warning light. It is a waterfall of

87
00:03:55.759 --> 00:03:59.960
<v Speaker 1>system failures. First, four low pressure lights flash on, which.

88
00:03:59.759 --> 00:04:04.599
<v Speaker 2>Tell the flight engineer they are losing cabin pressurization, right.

89
00:04:04.879 --> 00:04:08.439
<v Speaker 1>Which is incredibly alarming because they are barely a few

90
00:04:08.520 --> 00:04:10.919
<v Speaker 1>hundred feet in the air. The cabin shouldn't even be

91
00:04:10.960 --> 00:04:12.199
<v Speaker 1>fully pressurized yet.

92
00:04:12.639 --> 00:04:16.199
<v Speaker 2>But before the flight engineer can even voice that thought,

93
00:04:16.399 --> 00:04:18.959
<v Speaker 2>the spoiler light illuminates.

94
00:04:18.519 --> 00:04:21.560
<v Speaker 1>And spoilers are those large flat panels on the top

95
00:04:21.600 --> 00:04:23.680
<v Speaker 1>of the wings that pop up to kill lift and

96
00:04:23.759 --> 00:04:27.000
<v Speaker 1>act as air brakes. When a plane lands right.

97
00:04:27.040 --> 00:04:30.160
<v Speaker 2>And the pilots haven't touched the spoiler controls, but the

98
00:04:30.240 --> 00:04:34.240
<v Speaker 2>electrical system is screaming that they are deploying or malfunctioning,

99
00:04:34.360 --> 00:04:35.199
<v Speaker 2>And then.

100
00:04:35.199 --> 00:04:37.839
<v Speaker 1>Less than two minutes into the flight, the absolute worst

101
00:04:37.879 --> 00:04:41.319
<v Speaker 1>case scenario happens. They lose their hydraulics. I was reading

102
00:04:41.319 --> 00:04:43.680
<v Speaker 1>the flight manual for the DCA to understand this, and

103
00:04:43.759 --> 00:04:46.920
<v Speaker 1>losing hydraulics isn't like losing power steering in your car,

104
00:04:46.959 --> 00:04:49.279
<v Speaker 1>where the wheel just gets kind of heavy, not at all.

105
00:04:49.319 --> 00:04:52.240
<v Speaker 1>These control surfaces on the wings and the tail are

106
00:04:52.399 --> 00:04:55.439
<v Speaker 1>massive pieces of metal facing hundreds of miles an hour

107
00:04:55.480 --> 00:04:56.360
<v Speaker 1>of wind resistance.

108
00:04:56.720 --> 00:04:59.439
<v Speaker 2>Yeah, without the hydraulic fluid pushing the pistons to move

109
00:04:59.439 --> 00:05:02.399
<v Speaker 2>those surfaces, the pilots are suddenly having to rely on

110
00:05:02.560 --> 00:05:04.439
<v Speaker 2>manual mechanical cables.

111
00:05:04.759 --> 00:05:08.240
<v Speaker 1>They are literally using their own upper body strength to

112
00:05:08.519 --> 00:05:11.639
<v Speaker 1>wrestle this massive airliner through the sky.

113
00:05:11.839 --> 00:05:14.800
<v Speaker 2>All while dealing with a complete breakdown in communication with

114
00:05:14.879 --> 00:05:15.800
<v Speaker 2>air traffic Control.

115
00:05:15.920 --> 00:05:17.839
<v Speaker 1>Oh Man, the ATC nightmare.

116
00:05:18.199 --> 00:05:21.759
<v Speaker 2>Right, the controller in the Jetta tower is looking at

117
00:05:21.759 --> 00:05:25.600
<v Speaker 2>his radar, and by a tragic coincidence, there is a

118
00:05:25.720 --> 00:05:29.519
<v Speaker 2>Saudi seven thirty eight flight in the exact same airspace

119
00:05:30.040 --> 00:05:31.319
<v Speaker 2>at the exact same.

120
00:05:31.160 --> 00:05:34.800
<v Speaker 1>Moment, also reporting a pressurization issue. Exactly so the controller

121
00:05:34.839 --> 00:05:37.399
<v Speaker 1>thinks he's talking to the Saudi plane while the Nation

122
00:05:37.560 --> 00:05:40.680
<v Speaker 1>air pilots are screaming that they have a catastrophic emergency

123
00:05:40.680 --> 00:05:42.959
<v Speaker 1>and need to level off at two thousand feet.

124
00:05:43.079 --> 00:05:44.120
<v Speaker 2>It's total confusion.

125
00:05:44.399 --> 00:05:47.720
<v Speaker 1>Imagine your car's check engine light comes on, then your

126
00:05:47.759 --> 00:05:50.639
<v Speaker 1>brakes failed, then the steering wheel locks a ball while

127
00:05:50.680 --> 00:05:53.240
<v Speaker 1>someone on the radio is shouting driving directions meant for

128
00:05:53.279 --> 00:05:55.560
<v Speaker 1>a completely different car going to a different city.

129
00:05:55.680 --> 00:05:58.120
<v Speaker 2>It is complete sensory overload.

130
00:05:57.920 --> 00:06:01.120
<v Speaker 1>And the controller gives them headings to climb and turn left,

131
00:06:01.360 --> 00:06:03.439
<v Speaker 1>which actually steers them away from the airport.

132
00:06:03.720 --> 00:06:06.879
<v Speaker 2>Right, the flight path data shows them ending up thirteen

133
00:06:06.920 --> 00:06:08.639
<v Speaker 2>kilometers out flying the wrong.

134
00:06:08.439 --> 00:06:09.959
<v Speaker 1>Way, which just sounds so fatal.

135
00:06:10.160 --> 00:06:13.639
<v Speaker 2>But when investigators later ran the forensic simulations of this flight,

136
00:06:14.480 --> 00:06:18.560
<v Speaker 2>they found a fascinating, albeit grim reality.

137
00:06:18.639 --> 00:06:20.480
<v Speaker 1>Wait, really, what was it.

138
00:06:20.519 --> 00:06:21.959
<v Speaker 2>That radio mixer didn't kill them.

139
00:06:22.040 --> 00:06:22.519
<v Speaker 1>No.

140
00:06:22.519 --> 00:06:25.759
<v Speaker 2>No, Even if the controller had instantly realized the mistake,

141
00:06:26.040 --> 00:06:28.879
<v Speaker 2>cleared the airspace, and given them a perfect vector back

142
00:06:28.879 --> 00:06:31.199
<v Speaker 2>to the runway, the plane would not have made.

143
00:06:31.040 --> 00:06:33.720
<v Speaker 1>It because the structural failure was happening too fast.

144
00:06:33.920 --> 00:06:37.240
<v Speaker 2>Exactly, the real enemy was already inside the plane.

145
00:06:37.120 --> 00:06:40.360
<v Speaker 1>Right because the real emergency wasn't an instrument glitch. It

146
00:06:40.439 --> 00:06:43.160
<v Speaker 1>was happening in the passenger cabin. We know from the

147
00:06:43.160 --> 00:06:46.279
<v Speaker 1>files that the lead mechanic for the flight, Jean Paul Phillip,

148
00:06:46.399 --> 00:06:47.360
<v Speaker 1>was riding in the cabin.

149
00:06:47.480 --> 00:06:49.600
<v Speaker 2>Yeah, and he smells something incredibly wrong.

150
00:06:49.720 --> 00:06:51.240
<v Speaker 1>He walks to the back of the aircraft to check

151
00:06:51.279 --> 00:06:53.920
<v Speaker 1>it out, and he finds an absolute inferno.

152
00:06:54.120 --> 00:06:56.399
<v Speaker 2>He runs back toward the cockpit and reports that there

153
00:06:56.480 --> 00:06:58.720
<v Speaker 2>is smoke in the back quote real bad.

154
00:06:58.920 --> 00:07:01.560
<v Speaker 1>And the fire is earning with a ferocity that is

155
00:07:01.680 --> 00:07:05.759
<v Speaker 1>just hard to comprehend. The cabin is filling with thick, blinding,

156
00:07:05.959 --> 00:07:07.439
<v Speaker 1>toxic black smoke.

157
00:07:07.639 --> 00:07:09.839
<v Speaker 2>For the two hundred and forty seven passengers who are

158
00:07:09.879 --> 00:07:13.120
<v Speaker 2>just celebrating their pilgrimage, I mean, it turns into a

159
00:07:13.240 --> 00:07:14.079
<v Speaker 2>nightmare instantly.

160
00:07:14.439 --> 00:07:19.040
<v Speaker 1>The air is entirely displaced by smoke. The forensic reconstruction

161
00:07:19.279 --> 00:07:23.399
<v Speaker 1>details how the passengers surged forward, just a desperate stampede,

162
00:07:23.399 --> 00:07:27.079
<v Speaker 1>toward the cockpit, fighting for a single breath of oxygen.

163
00:07:27.480 --> 00:07:31.000
<v Speaker 2>But the fire is so intense, running directly beneath them

164
00:07:31.480 --> 00:07:34.560
<v Speaker 2>that it begins melting the actual floorboards of the cabin.

165
00:07:35.120 --> 00:07:36.560
<v Speaker 1>Melting the floorboards.

166
00:07:36.639 --> 00:07:40.120
<v Speaker 2>Yeah, And because those floorboards are melting, the structural ribs

167
00:07:40.160 --> 00:07:43.120
<v Speaker 2>of the aircraft's fuselage are turning to butter.

168
00:07:43.240 --> 00:07:45.439
<v Speaker 1>Which leads to a detail in the crash report that

169
00:07:45.560 --> 00:07:49.560
<v Speaker 1>is honestly difficult to even read. The aircraft is eleven

170
00:07:49.600 --> 00:07:52.240
<v Speaker 1>miles away from the airport, trying to turn back, and

171
00:07:52.319 --> 00:07:55.279
<v Speaker 1>its flight path takes it directly over the city of Jetta.

172
00:07:55.439 --> 00:07:58.439
<v Speaker 1>White over the city, the intense heat compromises the floor

173
00:07:58.519 --> 00:08:01.360
<v Speaker 1>so severely that the bottom of the aircraft simply gives way.

174
00:08:01.600 --> 00:08:02.399
<v Speaker 2>It's horrifying.

175
00:08:02.600 --> 00:08:05.680
<v Speaker 1>Debris pieces of the fuselage and passengers begin falling from

176
00:08:05.680 --> 00:08:07.720
<v Speaker 1>the sky, directly into the city and up.

177
00:08:07.560 --> 00:08:10.800
<v Speaker 2>In the cockpit, Captain Allen is violently pulling on controls

178
00:08:10.800 --> 00:08:12.519
<v Speaker 2>that are no longer attached to anything.

179
00:08:12.720 --> 00:08:15.519
<v Speaker 1>The fire has severed the manual control cables. You hear

180
00:08:15.600 --> 00:08:17.040
<v Speaker 1>him shout, I have no control.

181
00:08:17.319 --> 00:08:20.399
<v Speaker 2>He has lost his ailerons. Those are the flaps on

182
00:08:20.439 --> 00:08:22.480
<v Speaker 2>the back of the wings that let the plane roll

183
00:08:22.519 --> 00:08:25.639
<v Speaker 2>and turn right. And he has lost his elevators, which

184
00:08:25.680 --> 00:08:28.079
<v Speaker 2>are the flaps on the horizontal tail that make the

185
00:08:28.120 --> 00:08:29.160
<v Speaker 2>nose pitch up or down.

186
00:08:29.360 --> 00:08:32.240
<v Speaker 1>So he can't steer, he can't climb, he can't dive.

187
00:08:32.440 --> 00:08:36.919
<v Speaker 2>The aircraft is a burning, unguided missile at this point.

188
00:08:36.679 --> 00:08:39.480
<v Speaker 1>So, two miles out from the runway, desperate to create

189
00:08:39.519 --> 00:08:43.399
<v Speaker 1>some kind of aerodynamic stability, he pulls the lever to

190
00:08:43.559 --> 00:08:44.919
<v Speaker 1>lower the landing gear.

191
00:08:44.960 --> 00:08:48.200
<v Speaker 2>Which is a textbook last resort maneuver to create drag

192
00:08:48.360 --> 00:08:51.120
<v Speaker 2>and hopefully stabilize the flight pass. That makes sense, but

193
00:08:51.360 --> 00:08:54.720
<v Speaker 2>aerodynamically it was a death sentence for a compromise frame.

194
00:08:54.799 --> 00:08:55.360
<v Speaker 1>Why is that.

195
00:08:55.720 --> 00:08:58.600
<v Speaker 2>Think of the plane structure like an umbrella. When it's intact,

196
00:08:58.759 --> 00:09:02.679
<v Speaker 2>it easily handles the wind. But the fire has burned

197
00:09:02.720 --> 00:09:05.679
<v Speaker 2>through the aircraft's skeleton for ten minutes. Oh I see,

198
00:09:05.759 --> 00:09:09.320
<v Speaker 2>internal struts are melted and warped. When you drop massive,

199
00:09:09.360 --> 00:09:12.440
<v Speaker 2>heavy landing gear into a two hundred and forty nine slipstream,

200
00:09:12.840 --> 00:09:14.159
<v Speaker 2>you create immense drag.

201
00:09:14.279 --> 00:09:16.679
<v Speaker 1>Imagine driving eighty miles an hour and throwing all your

202
00:09:16.720 --> 00:09:17.799
<v Speaker 1>car doors wide open.

203
00:09:18.240 --> 00:09:22.559
<v Speaker 2>Exactly. The sheer aerodynamic violence of that drag acting on

204
00:09:22.600 --> 00:09:24.679
<v Speaker 2>a melted airframe was just too much.

205
00:09:24.759 --> 00:09:27.080
<v Speaker 1>The aircraft simply shattered in the sky.

206
00:09:27.320 --> 00:09:30.159
<v Speaker 2>Yeah, Flight twenty one to twenty crashes half a mile

207
00:09:30.200 --> 00:09:31.039
<v Speaker 2>short of the runway.

208
00:09:31.200 --> 00:09:34.360
<v Speaker 1>The impact and the remaining fuel create a fireball that

209
00:09:34.399 --> 00:09:38.000
<v Speaker 1>consumes whatever is left. Two hundred and sixty one people gone,

210
00:09:38.320 --> 00:09:40.200
<v Speaker 1>barely ten minutes after they took off.

211
00:09:40.480 --> 00:09:44.240
<v Speaker 2>The Canadian Transportation Safety Board the CTSB flies in to

212
00:09:44.320 --> 00:09:47.080
<v Speaker 2>assist because Nation Air was a Canadian carrier.

213
00:09:46.960 --> 00:09:49.279
<v Speaker 1>Right, and they walk into a debris field that makes

214
00:09:49.320 --> 00:09:50.320
<v Speaker 1>absolutely no sense.

215
00:09:50.360 --> 00:09:53.240
<v Speaker 2>At first glance, they find a massive impact crater and

216
00:09:53.320 --> 00:09:56.559
<v Speaker 2>a scorch mark four hundred meters long, right near the

217
00:09:56.639 --> 00:09:57.559
<v Speaker 2>runway threshold.

218
00:09:57.679 --> 00:10:00.879
<v Speaker 1>But as they start mapping the geographic coordinate of the wreckage,

219
00:10:00.919 --> 00:10:04.600
<v Speaker 1>they trace a horrific trail of debris stretching eleven miles

220
00:10:04.639 --> 00:10:06.399
<v Speaker 1>backward along the flight path.

221
00:10:06.600 --> 00:10:09.080
<v Speaker 2>My question when reading this was, how on earth do

222
00:10:09.200 --> 00:10:11.600
<v Speaker 2>you investigate a pile of ash? I mean, the plane

223
00:10:11.639 --> 00:10:13.000
<v Speaker 2>is essentially vaporized.

224
00:10:13.039 --> 00:10:15.000
<v Speaker 1>You can't just plug in a diagnostic tool and ask

225
00:10:15.080 --> 00:10:16.600
<v Speaker 1>the computer what broke exactly.

226
00:10:16.600 --> 00:10:18.240
<v Speaker 2>You have to look at the metallurgy.

227
00:10:17.759 --> 00:10:20.919
<v Speaker 1>And the CTSB experts find a massive clue on the

228
00:10:20.919 --> 00:10:22.279
<v Speaker 1>tail section of the plane.

229
00:10:22.600 --> 00:10:25.399
<v Speaker 2>Right, it is entirely coated in molten aluminum.

230
00:10:24.960 --> 00:10:28.440
<v Speaker 1>And aluminum doesn't melt until it hits about one hundred

231
00:10:28.480 --> 00:10:29.320
<v Speaker 1>degrees celsius.

232
00:10:29.480 --> 00:10:32.320
<v Speaker 2>Right. In a typical crash where the fire happens on

233
00:10:32.360 --> 00:10:35.559
<v Speaker 2>the ground after impact, the heat rises and the melting

234
00:10:35.559 --> 00:10:37.399
<v Speaker 2>metal drips straight down into puddles.

235
00:10:37.759 --> 00:10:41.639
<v Speaker 1>But this aluminum had melted and then the incredible force

236
00:10:41.639 --> 00:10:45.759
<v Speaker 1>of the airstream had blown it backward horizontally, plastering it

237
00:10:45.840 --> 00:10:46.639
<v Speaker 1>against the tail.

238
00:10:46.799 --> 00:10:49.799
<v Speaker 2>They call it a blow torch effect. Wow, it proved

239
00:10:49.799 --> 00:10:53.799
<v Speaker 2>definitively that an unimaginably hot fire was raging in the

240
00:10:53.840 --> 00:10:56.759
<v Speaker 2>mid section of the aircraft while it was flying at

241
00:10:56.840 --> 00:10:57.480
<v Speaker 2>high speed.

242
00:10:57.679 --> 00:10:59.799
<v Speaker 1>So they have hard proof of a mid air fire.

243
00:11:00.000 --> 00:11:02.840
<v Speaker 1>But instantly the corporate pr machines kick in.

244
00:11:02.960 --> 00:11:03.840
<v Speaker 2>Oh, of course they do.

245
00:11:04.440 --> 00:11:07.960
<v Speaker 1>Nation Air holds press conferences claiming that the Saudi runway

246
00:11:08.080 --> 00:11:11.159
<v Speaker 1>must have been littered with sharp metal debris which blew

247
00:11:11.200 --> 00:11:13.440
<v Speaker 1>a tire and sparked the disaster, and.

248
00:11:13.360 --> 00:11:17.399
<v Speaker 2>The Saudi Aviation authority fires back aggressively defending their airport,

249
00:11:17.559 --> 00:11:20.000
<v Speaker 2>claiming their tarmac was swept and spotless.

250
00:11:20.080 --> 00:11:22.639
<v Speaker 1>Wait, how can you trust either side. Here Nation Air

251
00:11:22.720 --> 00:11:25.360
<v Speaker 1>is trying to dodge liability for two hundred and sixty

252
00:11:25.360 --> 00:11:28.279
<v Speaker 1>one deaths, and the airport doesn't want to be blamed

253
00:11:28.279 --> 00:11:32.240
<v Speaker 1>for a dirty runway. Exactly how do investigators cut through

254
00:11:32.279 --> 00:11:33.399
<v Speaker 1>the pr spin.

255
00:11:33.879 --> 00:11:37.759
<v Speaker 2>Well, they ignore the press conferences and focus entirely on

256
00:11:37.799 --> 00:11:42.360
<v Speaker 2>the physical artifacts. The physical evidence can't lie right. Investigators

257
00:11:42.399 --> 00:11:45.679
<v Speaker 2>dig through the rubble and locate the landing gear bogie,

258
00:11:46.519 --> 00:11:49.879
<v Speaker 2>specifically the number two wheel on the left side.

259
00:11:49.600 --> 00:11:52.159
<v Speaker 1>And when they put that wheel rim under a microscope,

260
00:11:52.159 --> 00:11:54.440
<v Speaker 1>they see it hasn't just suffered impact damage.

261
00:11:54.480 --> 00:11:57.759
<v Speaker 2>The actual bare metal rim of the wheel has been

262
00:11:57.879 --> 00:12:01.440
<v Speaker 2>violently ground down, filed away by extreme friction.

263
00:12:01.919 --> 00:12:05.000
<v Speaker 1>It didn't strike a piece of debris and pop. It

264
00:12:05.039 --> 00:12:08.440
<v Speaker 1>was dragging and scraping directly on the concrete runway for

265
00:12:08.519 --> 00:12:10.480
<v Speaker 1>a significant distance, which means.

266
00:12:10.320 --> 00:12:12.840
<v Speaker 2>The tire was completely gone well before they ever left

267
00:12:12.840 --> 00:12:13.240
<v Speaker 2>the ground.

268
00:12:13.320 --> 00:12:16.200
<v Speaker 1>Something caused that tire to fail from within, and.

269
00:12:16.159 --> 00:12:18.399
<v Speaker 2>The smoking gun they find to explain this isn't a

270
00:12:18.399 --> 00:12:21.039
<v Speaker 2>piece of twisted metal or a scorched engine valve.

271
00:12:21.080 --> 00:12:22.720
<v Speaker 1>Here's where it gets really interesting.

272
00:12:23.000 --> 00:12:25.399
<v Speaker 2>It is a tiny, fragile piece of paper.

273
00:12:25.679 --> 00:12:28.679
<v Speaker 1>Investigator Bill Taylor is walking the perimeter of the desert

274
00:12:28.720 --> 00:12:31.840
<v Speaker 1>crash site, mapping debris, and he catches sight of a

275
00:12:31.840 --> 00:12:33.559
<v Speaker 1>piece of paper fluttering in the wind.

276
00:12:33.840 --> 00:12:37.120
<v Speaker 2>By some absolute miracle, it was blown clear of the

277
00:12:37.159 --> 00:12:37.960
<v Speaker 2>main fireball.

278
00:12:38.159 --> 00:12:40.559
<v Speaker 1>He picks it up and it's the handwritten a flight

279
00:12:40.600 --> 00:12:41.759
<v Speaker 1>inspection checklist.

280
00:12:41.960 --> 00:12:45.080
<v Speaker 2>This is the official maintenance log detailing the tire pressures

281
00:12:45.080 --> 00:12:46.279
<v Speaker 2>from the days leading up to the.

282
00:12:46.240 --> 00:12:48.799
<v Speaker 1>Flight, and he notices two different colors of ink on

283
00:12:48.840 --> 00:12:50.919
<v Speaker 1>the page. The numbers have been written over.

284
00:12:51.240 --> 00:12:55.159
<v Speaker 2>Yeah, whenever you see altered logs in an investigation, the

285
00:12:55.240 --> 00:12:58.960
<v Speaker 2>immediate question is intent. Was it a simple correction or

286
00:12:59.000 --> 00:12:59.559
<v Speaker 2>a cover up?

287
00:12:59.799 --> 00:13:03.440
<v Speaker 1>Right? So the Royal Canadian Mounted Police Forensics Lab takes

288
00:13:03.440 --> 00:13:06.679
<v Speaker 1>the document, runs an analysis on the ink layers and

289
00:13:06.879 --> 00:13:08.519
<v Speaker 1>uncovers the forgery.

290
00:13:08.600 --> 00:13:11.480
<v Speaker 2>Underneath the fresh inc The original numbers show that the

291
00:13:11.559 --> 00:13:15.279
<v Speaker 2>tires on that left landing gear were critically underinflated.

292
00:13:15.480 --> 00:13:19.240
<v Speaker 1>We're talking twenty to thirty psi below the absolute minimum

293
00:13:19.279 --> 00:13:20.200
<v Speaker 1>safe operating limit.

294
00:13:20.279 --> 00:13:21.720
<v Speaker 2>They falsified the safety logs.

295
00:13:21.759 --> 00:13:24.879
<v Speaker 1>Now, we know the mechanical failure incredibly low tire pressure.

296
00:13:25.000 --> 00:13:27.919
<v Speaker 2>But planes don't just crash because of a tire. They

297
00:13:27.960 --> 00:13:31.440
<v Speaker 2>crashed because the human systems surrounding that plane fail exactly.

298
00:13:31.799 --> 00:13:34.039
<v Speaker 1>We have to trace the timeline backward to figure out

299
00:13:34.080 --> 00:13:37.039
<v Speaker 1>the psychology of why a team of professionals allowed a

300
00:13:37.159 --> 00:13:38.679
<v Speaker 1>dangerous plane into the sky.

301
00:13:39.080 --> 00:13:42.639
<v Speaker 2>Four days before the crash in Jetta, this exact aircraft

302
00:13:42.720 --> 00:13:44.320
<v Speaker 2>was on the ground in Ghana.

303
00:13:44.480 --> 00:13:47.559
<v Speaker 1>The local mechanics doing the inspections saw the low tire

304
00:13:47.600 --> 00:13:49.080
<v Speaker 1>pressure on the left main gear.

305
00:13:49.320 --> 00:13:52.759
<v Speaker 2>The rubber was wearing unevenly, the PSI was dropping and

306
00:13:52.840 --> 00:13:55.559
<v Speaker 2>they pulled the replacement tires out. They were ready to

307
00:13:55.639 --> 00:13:56.120
<v Speaker 2>change them.

308
00:13:56.200 --> 00:13:58.440
<v Speaker 1>They had the personnel and they had the equipment, but

309
00:13:58.559 --> 00:14:02.000
<v Speaker 1>they lacked the authorization. The investigation reveals that a project

310
00:14:02.039 --> 00:14:06.200
<v Speaker 1>manager and executive overseeing the logistics of the trip sent

311
00:14:06.279 --> 00:14:08.399
<v Speaker 1>a direct facts to the maintenance crew.

312
00:14:08.639 --> 00:14:11.360
<v Speaker 2>The facts literally read forget it, we want us to

313
00:14:11.360 --> 00:14:11.840
<v Speaker 2>get going.

314
00:14:12.039 --> 00:14:15.559
<v Speaker 1>We have to understand the environment here. Nation Air isn't

315
00:14:15.600 --> 00:14:19.600
<v Speaker 1>a massive legacy carrier. They are a scrappy startup fighting

316
00:14:19.679 --> 00:14:21.000
<v Speaker 1>for every dollar right.

317
00:14:21.080 --> 00:14:24.080
<v Speaker 2>They take these intense charter contracts and if they delay

318
00:14:24.120 --> 00:14:27.399
<v Speaker 2>a flight, they bleed money and risk losing future contracts

319
00:14:27.399 --> 00:14:28.360
<v Speaker 2>to rival airlines.

320
00:14:28.480 --> 00:14:32.159
<v Speaker 1>It is the ultimate collision of production versus protection. The

321
00:14:32.399 --> 00:14:35.720
<v Speaker 1>executives prioritize the schedule over the safety manual.

322
00:14:35.639 --> 00:14:38.559
<v Speaker 2>The mechanics and Ghana are put in an impossible position.

323
00:14:39.080 --> 00:14:41.679
<v Speaker 2>If they ground the plane, they defy direct orders from

324
00:14:41.679 --> 00:14:43.559
<v Speaker 2>corporate and risk their livelihoods.

325
00:14:43.919 --> 00:14:47.919
<v Speaker 1>So, bowing to that pressure, someone takes a pen, crosses

326
00:14:47.960 --> 00:14:52.879
<v Speaker 1>out the dangerous PSI readings and writes in fake safe numbers.

327
00:14:52.600 --> 00:14:55.879
<v Speaker 2>That aircraft flew multiple legs over several days with those

328
00:14:55.919 --> 00:14:57.000
<v Speaker 2>falsified records.

329
00:14:57.320 --> 00:14:59.799
<v Speaker 1>Fast forward to the morning of July eleventh, and Jetta

330
00:15:00.679 --> 00:15:03.799
<v Speaker 1>lead mechanic Jean Paul Philip, who is about to board

331
00:15:03.840 --> 00:15:07.480
<v Speaker 1>this doom flight, knows those tires are critically low.

332
00:15:07.679 --> 00:15:10.720
<v Speaker 2>He isn't ignoring the problem, He's actively trying to fix it.

333
00:15:10.720 --> 00:15:14.240
<v Speaker 1>Before takeoff, he is frantically running around the tarmac trying

334
00:15:14.279 --> 00:15:16.120
<v Speaker 1>to find nitrogen to top up the tires.

335
00:15:16.240 --> 00:15:19.240
<v Speaker 2>They just to clarify, commercial aircraft tires are subjected to

336
00:15:19.320 --> 00:15:23.440
<v Speaker 2>extreme temperature swings from blistering runway heat to minus fifty

337
00:15:23.440 --> 00:15:25.000
<v Speaker 2>degrees at cruising altitude.

338
00:15:25.200 --> 00:15:28.480
<v Speaker 1>Right, So, regular compressed air contains moisture that freezes and

339
00:15:28.639 --> 00:15:30.840
<v Speaker 1>oxygen that expands dangerously When.

340
00:15:30.720 --> 00:15:34.360
<v Speaker 2>Heated nitrogen is inert it doesn't expand wildly, and crucially,

341
00:15:34.440 --> 00:15:36.799
<v Speaker 2>it won't fuel a fire. You cannot use regular air

342
00:15:36.840 --> 00:15:38.000
<v Speaker 2>in a jet tire safely.

343
00:15:38.159 --> 00:15:40.879
<v Speaker 1>But Philip checks the Nation Air nitrogen bottles and they

344
00:15:40.879 --> 00:15:41.960
<v Speaker 1>are completely empty.

345
00:15:42.159 --> 00:15:43.519
<v Speaker 2>The supply chain has failed them.

346
00:15:43.559 --> 00:15:46.559
<v Speaker 1>He is so desperate he runs over to another airline's

347
00:15:46.559 --> 00:15:50.360
<v Speaker 1>maintenance crew on the tarmac and begs to borrow their nitrogen, but.

348
00:15:50.320 --> 00:15:53.879
<v Speaker 2>Their bottles are empty too. The boarding process is finishing up,

349
00:15:54.240 --> 00:15:55.600
<v Speaker 2>the clock is ticking.

350
00:15:55.639 --> 00:15:59.879
<v Speaker 1>And the project manager, who lacks deep mechanical expertise, makes

351
00:16:00.200 --> 00:16:03.360
<v Speaker 1>the fatal administrative call forget the nitrogen.

352
00:16:02.960 --> 00:16:04.799
<v Speaker 2>Just fly, do not delay the takeoff.

353
00:16:04.879 --> 00:16:07.399
<v Speaker 1>And here we see the most catastrophic breakdown in the

354
00:16:07.639 --> 00:16:11.919
<v Speaker 1>entire system. In aviation, the captain is the ultimate authority.

355
00:16:12.120 --> 00:16:15.720
<v Speaker 2>Yes, if Captain Allen knew about the tires, he would

356
00:16:15.759 --> 00:16:18.919
<v Speaker 2>have instantly ordered the passengers off and grounded the aircraft.

357
00:16:18.960 --> 00:16:23.440
<v Speaker 1>But the forged logs looked perfect. The mechanics, afraid of management,

358
00:16:23.679 --> 00:16:24.360
<v Speaker 1>kept the secret.

359
00:16:24.600 --> 00:16:27.240
<v Speaker 2>The one person with the power to stop the disaster

360
00:16:27.759 --> 00:16:29.159
<v Speaker 2>was completely blind to it.

361
00:16:29.240 --> 00:16:31.799
<v Speaker 1>Okay, let's unpack this. We have the human error. We

362
00:16:31.840 --> 00:16:34.919
<v Speaker 1>see the pressure of the startup culture, the falsified logs,

363
00:16:35.279 --> 00:16:38.200
<v Speaker 1>the empty nitrogen tanks. Right, But we need to map

364
00:16:38.240 --> 00:16:42.240
<v Speaker 1>how a low tire morphs into an unstoppable floor melting

365
00:16:42.320 --> 00:16:45.759
<v Speaker 1>fire in just three minutes. How does the physics actually work.

366
00:16:46.039 --> 00:16:48.840
<v Speaker 2>It revolves around the design of the landing gear. The

367
00:16:48.919 --> 00:16:51.960
<v Speaker 2>DC eight uses a bogie system, which is a massive

368
00:16:51.960 --> 00:16:54.480
<v Speaker 2>strut with four wheels attached to it. Think of it

369
00:16:54.519 --> 00:16:57.080
<v Speaker 2>like carrying a heavy sofa with a friend. If your

370
00:16:57.120 --> 00:16:59.879
<v Speaker 2>friend suddenly trips and lets go, the entire weight of

371
00:16:59.879 --> 00:17:03.480
<v Speaker 2>the that sofa violently shifts onto your arms. Ah, because

372
00:17:03.519 --> 00:17:06.440
<v Speaker 2>one of those tires was underinflated by almost thirty pounds,

373
00:17:06.839 --> 00:17:10.000
<v Speaker 2>It was sitting low. It wasn't touching the ground with

374
00:17:10.119 --> 00:17:13.680
<v Speaker 2>enough force to carry its share of the aircraft's.

375
00:17:13.119 --> 00:17:16.839
<v Speaker 1>Weight, So the entire burden of that fully fueled, fully

376
00:17:16.839 --> 00:17:20.480
<v Speaker 1>loaded jet shifts onto its axle mate the tire right

377
00:17:20.559 --> 00:17:21.200
<v Speaker 1>next to it.

378
00:17:21.119 --> 00:17:24.359
<v Speaker 2>And they have to do that massive five kilometer taxi

379
00:17:24.559 --> 00:17:26.039
<v Speaker 2>across boiling concrete.

380
00:17:26.079 --> 00:17:29.480
<v Speaker 1>The adjacent tire is now carrying double its engineered load capacity.

381
00:17:29.920 --> 00:17:32.839
<v Speaker 2>As it rolls for eleven minutes across the hot tarmac,

382
00:17:33.119 --> 00:17:34.400
<v Speaker 2>it is overflexing.

383
00:17:34.759 --> 00:17:38.559
<v Speaker 1>The heavy nylon cords inside the sidewall are bending, heating up,

384
00:17:38.599 --> 00:17:40.799
<v Speaker 1>and starting to melt and pull apart from the inside

385
00:17:40.799 --> 00:17:41.400
<v Speaker 1>out as.

386
00:17:41.359 --> 00:17:44.559
<v Speaker 2>They accelerate down the runway and hit ninety knots that

387
00:17:44.720 --> 00:17:47.559
<v Speaker 2>overstressed adjacent tire simply detonates.

388
00:17:47.720 --> 00:17:50.599
<v Speaker 1>That was the violent shimmy and the loud sound the crew.

389
00:17:50.400 --> 00:17:53.079
<v Speaker 2>Heard, But they were at V one. They had to

390
00:17:53.160 --> 00:17:53.640
<v Speaker 2>keep going.

391
00:17:53.960 --> 00:17:57.160
<v Speaker 1>The moment that good tire blows, all that immense weight

392
00:17:57.359 --> 00:18:01.720
<v Speaker 1>instantly slams back down onto the severely underinflated tire, which

393
00:18:01.720 --> 00:18:02.920
<v Speaker 1>immediately blows out as.

394
00:18:02.880 --> 00:18:05.680
<v Speaker 2>Well, leaving nothing but the bare metal wheel rim.

395
00:18:05.759 --> 00:18:08.119
<v Speaker 1>The plane is traveling over one hundred miles an hour.

396
00:18:08.519 --> 00:18:11.880
<v Speaker 1>That metal rim is grinding directly against the concrete runway,

397
00:18:12.119 --> 00:18:14.000
<v Speaker 1>acting like a giant friction saw.

398
00:18:14.319 --> 00:18:17.240
<v Speaker 2>It sparks and superheats the shredded rubber of the blown

399
00:18:17.279 --> 00:18:18.480
<v Speaker 2>tires flapping around it.

400
00:18:18.640 --> 00:18:21.519
<v Speaker 1>The rubber gets so hot it spontaneously combusts.

401
00:18:21.759 --> 00:18:24.839
<v Speaker 2>So as the plane lifts off, Captain Allen calls gear up.

402
00:18:24.960 --> 00:18:27.279
<v Speaker 1>He thinks he's cleaning up the aero dynamics for the climb.

403
00:18:27.680 --> 00:18:31.519
<v Speaker 2>Instead, he is inadvertently pulling a raging rubber fire straight

404
00:18:31.599 --> 00:18:34.160
<v Speaker 2>up into the wheel well of his own airplane.

405
00:18:34.400 --> 00:18:37.680
<v Speaker 1>And this exposes a devastating design flaw in the DC eight.

406
00:18:37.799 --> 00:18:41.119
<v Speaker 2>Yeah, that wheel well is a cramped space packed tight

407
00:18:41.200 --> 00:18:45.599
<v Speaker 2>with highly flammable hydraulic fluid lines and miles of electrical wiring.

408
00:18:45.319 --> 00:18:48.119
<v Speaker 1>And tragically, the DC eight was manufactured without a single

409
00:18:48.119 --> 00:18:50.400
<v Speaker 1>heat or fire sensor inside those wheel wells.

410
00:18:50.640 --> 00:18:53.400
<v Speaker 2>The crew had zero warning until it was too late.

411
00:18:54.039 --> 00:18:57.359
<v Speaker 2>They had a massive fire burning inside the fuselage, and

412
00:18:57.400 --> 00:19:00.000
<v Speaker 2>the plane's computers had no way to tell them until

413
00:19:00.119 --> 00:19:02.880
<v Speaker 2>the fire physically melted through the wiring.

414
00:19:02.480 --> 00:19:05.920
<v Speaker 1>Harnesses, triggering the pressurization and spoiler alarms.

415
00:19:06.000 --> 00:19:08.759
<v Speaker 2>By the time those lights flickered on the dashboard, the

416
00:19:08.839 --> 00:19:11.119
<v Speaker 2>hydraulic lines had ruptured.

417
00:19:10.720 --> 00:19:13.359
<v Speaker 1>The fluid sprayed onto the rubber fire, acting as a

418
00:19:13.359 --> 00:19:16.720
<v Speaker 1>massive accelerant, and the flames just tore straight up through

419
00:19:16.759 --> 00:19:18.279
<v Speaker 1>the floorboards into the cabin.

420
00:19:18.400 --> 00:19:20.079
<v Speaker 2>It is absolutely gut wrenching.

421
00:19:20.240 --> 00:19:22.720
<v Speaker 1>The destruction of Flight twenty one twenty was borne from

422
00:19:22.759 --> 00:19:25.000
<v Speaker 1>a few strokes of a pen and a corporate culture

423
00:19:25.039 --> 00:19:27.039
<v Speaker 1>that refused to stop the clock.

424
00:19:27.160 --> 00:19:31.599
<v Speaker 2>When the investigation concluded, the finding sent shockwaves through the industry.

425
00:19:32.319 --> 00:19:35.039
<v Speaker 2>Nation air was exposed for a deep rooted culture of

426
00:19:35.039 --> 00:19:35.799
<v Speaker 2>cutting corners.

427
00:19:36.000 --> 00:19:39.839
<v Speaker 1>The public backlash was immediate, and the airline completely collapsed,

428
00:19:39.920 --> 00:19:42.079
<v Speaker 1>declaring bankruptcy in nineteen ninety three.

429
00:19:42.440 --> 00:19:44.640
<v Speaker 2>But the legacy of those two hundred and sixty one

430
00:19:44.720 --> 00:19:49.440
<v Speaker 2>lives changed the physical architecture of commercial airplanes forever.

431
00:19:49.200 --> 00:19:51.640
<v Speaker 1>Aviation regulations were completely overhauled.

432
00:19:51.920 --> 00:19:56.039
<v Speaker 2>Crucially, it is now strictly mandatory for all modern transport

433
00:19:56.079 --> 00:20:00.000
<v Speaker 2>aircraft to have smoke, fire and temperature sensors built directly

434
00:20:00.279 --> 00:20:01.160
<v Speaker 2>into the wheel wells.

435
00:20:01.559 --> 00:20:04.039
<v Speaker 1>A flight crew will never again pull a fire up

436
00:20:04.119 --> 00:20:07.640
<v Speaker 1>into their aircraft with alarms immediately sounding, giving them the

437
00:20:07.680 --> 00:20:10.200
<v Speaker 1>precious seconds they need to drop the gear and starve

438
00:20:10.240 --> 00:20:10.640
<v Speaker 1>the fire.

439
00:20:10.759 --> 00:20:12.759
<v Speaker 2>The technical takeaways are clear, but the.

440
00:20:12.839 --> 00:20:15.559
<v Speaker 1>Human element of this story is what really sticks with me.

441
00:20:16.039 --> 00:20:18.559
<v Speaker 1>Safety experts have a term for what happened in Ghana,

442
00:20:18.920 --> 00:20:20.960
<v Speaker 1>the normalization of deviants.

443
00:20:21.519 --> 00:20:24.519
<v Speaker 2>It's a heavy phrase, but the concept is simple. It's

444
00:20:24.559 --> 00:20:28.200
<v Speaker 2>what happens in any workplace, any hospital, any construction site,

445
00:20:28.480 --> 00:20:31.559
<v Speaker 2>or any office when we start letting the little rules slide.

446
00:20:31.720 --> 00:20:33.880
<v Speaker 1>You sign off on an inspection you didn't really do,

447
00:20:34.160 --> 00:20:36.599
<v Speaker 1>or you skip a safety check because you're running late,

448
00:20:36.799 --> 00:20:38.720
<v Speaker 1>and when nothing bad happens, you do it again the

449
00:20:38.720 --> 00:20:39.200
<v Speaker 1>next day.

450
00:20:39.799 --> 00:20:42.920
<v Speaker 2>You assume the system is robust enough to absorb your shortcuts.

451
00:20:43.519 --> 00:20:46.880
<v Speaker 1>Nation Air falsified those logs and the plane flew fine

452
00:20:46.960 --> 00:20:50.839
<v Speaker 1>for days. The deviance became normal until the exact wrong

453
00:20:50.880 --> 00:20:53.759
<v Speaker 1>set of variables aligned, a heavy load, a hot day,

454
00:20:54.079 --> 00:20:57.480
<v Speaker 1>a long taxi, and the system catastrophically snapped.

455
00:20:57.720 --> 00:21:00.200
<v Speaker 2>It is the trap of outcome bias. We think that

456
00:21:00.319 --> 00:21:03.759
<v Speaker 2>just because we survived the shortcut yesterday, the shortcut itself

457
00:21:03.799 --> 00:21:04.319
<v Speaker 2>is safe.

458
00:21:04.480 --> 00:21:08.000
<v Speaker 1>We forget that a compromise system doesn't always fail immediately.

459
00:21:08.359 --> 00:21:11.559
<v Speaker 1>Sometimes it just waits for the perfect moment. Exactly so,

460
00:21:11.920 --> 00:21:15.039
<v Speaker 1>think about the routines and the systems in your own life,

461
00:21:15.240 --> 00:21:17.799
<v Speaker 1>whether you are managing a team, running a business, or

462
00:21:17.880 --> 00:21:22.519
<v Speaker 1>just going through your daily responsibilities. What underinflated tires are

463
00:21:22.640 --> 00:21:26.200
<v Speaker 1>you or your organization ignoring right now, simply because you've

464
00:21:26.200 --> 00:21:27.680
<v Speaker 1>managed to get away with it so far.
