Following a 767 crash in 2019, the FAA released a safety alert to highlight a potential 757/767 cockpit layout issue to all operators.

The FAA (Federal Aviation Administration) released this document, following the Atlas Air Flight 3591 crash. It happened in February 2019. The aircraft was on approach to Houston Airport (KIAH) in Texas. The NTSB released its report on the crash in July last year. And it showed that the Pilot-Flying (PF) misinterpreted an inadvertent Go-Around activation as a nose-up attitude. The dive that followed killed both pilots and a third, non-revenue pilot.

On the 20th of October, the FAA released a Safety Alert for Operators (SAFO), with regards to the 757/767 cockpit. The 757 and 767 share the same cockpit design and have a common type rating. The document provides more background on the inadvertent Go-Around mode activation, and related crew actions and procedures.


FAA Alerts 757/767 Operators

The First Officer was Pilot Flying. And on this occasion, the crew were descending with the speedbrakes/spoilers extended. In such a situation, the FAA explains that the Boeing 757/767 Flight Crew Training Manual (FCTM) recommends that the PF places a hand on the speedbrake lever. This is to ensure that pilots don’t forget the lever in the extended position. And this, in turn, is a lesson learned from an older crash, when pilots made such an error.

Possible 757/767 Cockpit Issue Gets FAA Attention

A 767 throttle quadrant, and the positions of the speedbrake lever and the Go-around switch. Image: NTSB

The Atlas Air standard operating procedures also called for its pilots to use this procedure. So the NTSB investigated how pilots might inadvertently hit the TOGA (Take-Off Go-Around) switch, while the speedbrake lever. There are two TOGA switches on the throttle levers. The FAA states that during light turbulence, the First Officer’s wrist could hit the left TOGA switch, in a 757/767.

The agency acknowledges that according to available data, this is a rare event. This is because pilots generally don’t reach for the lever from under the throttles. The FAA did not recommend that 757/767 change any specific procedures and practices, with relation to this issue. However, it highlights that pilots, operators and training providers should know the factors and circumstances of this tragic accident.

Possible 757/767 Cockpit Issue Gets FAA Attention

Reaching for the speedbrake lever from under the throttles, getting close to the Go-around switch. Image: NTSB


A Rare And Typically Benign Event

Additionally, it’s important to note that the FAA 757/767 safety report does not alter the conclusions of the NTSB investigation. The NTSB determined that the probable cause of this accident was the inappropriate actions of the first officer. And they followed this with a number of contributing factors. But these centred around hiring processes and a lack of ways for airlines to share pilot training information.

However, the inadvertent hitting of the TOGA switch was the triggering event in this accident. And what makes it unusual is that it is essentially a matter of ergonomics. However, the FAA and other regulators first approved the 757/767 cockpit design in the early 1980s. And it is rare for an ergonomics issue to become apparent nearly 40 years after its introduction.

But this illustrates the event’s own rarity, plus the fact that it wasn’t the cause of the crash. The NTSB calls it “a rare and typically benign event”. But as a technical matter, it is something that got special attention from authorities and airlines. Such events often influence the design of future aircraft, as well.