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Report: Hydraulic fluid mist and protective breathing equipment fire in A330 cabin
22 July 2016

An Airbus A330 was evacuated at Karachi Airport after the cabin filled with a hydraulic fluid mist and when a cabin crew member’s smoke hood caught fire, according to an investigation by the UAE GCAA.

On 4 October 2014, Emirates Airline flight EK609, from Jinnah International Airport, Karachi, Pakistan, to Dubai International Airport, the United Arab Emirates, with 14 crewmembers and 68 passengers onboard was operated by an Airbus A330 aircraft, registration A6-EAQ. As preparations for departure were completed the flight crew sensed an odor accompanied by a yellow hydraulic system low pressure indication on the electronic centralized aircraft monitoring (ECAM) system.

The odor was due to hydraulic fluid mist that entered the cabin and cockpit through the airconditioning system. The source of the hydraulic fluid mist was leakage from a fractured hose that provides hydraulic pressure to the rudder yellow system actuator. The leaking hydraulic fluid entered the auxiliary power unit (APU) from where it entered the airconditioning system. Examination of the hose concluded that the cause of the fracture was, most probably, fatigue failure of the metal braiding, followed by fracture of the hose PTFE core pipe.
The mist filled the cockpit and cabin and caused difficulty in breathing, throat discomfort, and eye irritation for some occupants.

In an attempt to determine the source of the mist, which was perceived as smoke, the cabin crewmember located at the L3 door handed a fire extinguisher and protective breathing equipment (PBE) to the cabin crewmember stationed at door L1A, and after the latter had donned the equipment and pulled the lanyard to activate the PBE oxygen generator, the PBE caught fire. The crewmember removed the PBE immediately and threw it on the floor next to the L3 door. This caused a localized fire that was suppressed by other crewmembers.

Based on initial information, the Commander decided to return the aircraft to the stand and disembark the passengers and crew using steps. The Commander requested information about the situation in the cabin from the L4 cabin crewmember, who stated that visibility in the cabin was now limited to four rows. On receiving this information, the Commander decided to order an evacuation while the aircraft was at its final pushback position.

The evacuation of the aircraft was well-managed with only minor injuries to some of the passengers. Following the evacuation, the passengers stayed close to the aircraft as they were not given directions as to what to do or where to go. On becoming aware of the evacuation of the aircraft, ATC did not issue any instruction to halt airside operations, and several aircraft and vehicles continued moving.

The Air Accident Investigation Sector (AAIS) determined that the cause of the dense mist was the failure of a yellow hydraulic system rudder servo hose that allowed leaking hydraulic fluid to enter the APU, become heated and atomized, and then to be fed into the aircraft airconditioning system. The cause of the hydraulic hose failure was not determined by the Investigation. The AAIS determined that it is probable that manufacturing defects in the PBE candle caused the candle to ignite abnormally when the cabin crewmember pulled the activation lanyard.
A contributing factor to the Incident was that the flight crew were unable to identify the source of the mist/smoke and decided to leave the APU running in case it became necessary to shutdown both engines.

Official accident investigation report
cover
investigating agency: General Civil Aviation Authority (GCAA) – United Arab Emirates
report status: Final
report number: AIFN/0016/2014
report released: 21 July 2016
duration of investigation: 1 year and 10 months
download report: AIFN/0016/2014