HBP$ HEC272

Volume 19
Issue 1
March 2021

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British Midland Flight 92 (A)
Case 1 prepared by Marine AGOGUÉ 2 and Chantale MAILHOT 3

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Crash of the British Midland Boeing 737-400
British Midland flight 92 was a scheduled service between London Heathrow and Belfast
International Airport. On January 8, 1989, there were 118 passengers and 8 crew members on board

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the Boeing 737-400. The aircraft took off at 7:52 p.m., but before it could reach its cruising altitude
of 35,000 feet, a fan blade in the left engine detached. This resulted in significant vibration and a
series of thuds, but the instruments gave no clear indication of the source of the problem.
Passengers seated toward the rear of the aircraft noticed “sparks,” “fire,” and “torching” coming
from the engine on the left wing, and this was accompanied by smoke and a burning smell, which
entered the cabin through the aircraft’s ventilation system.
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Captain Kevin Hunt immediately disengaged the plane’s autopilot. His understanding of the
aircraft’s air conditioning system led him to believe that the smoke coming from the passenger
cabin meant that the fault was in the right (No. 1) engine, not the left one. When Hunt asked his
co-pilot, First Officer David McClelland, which engine was malfunctioning, McClelland replied,
“It’s the le.... It’s the right one.”
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In earlier models of the Boeing 737, airflow and ventilation for the cabin was controlled mostly by
the right (No. 2) engine, but on Boeing’s new 737-400 model, some of the conditioned air for the
passenger cabin came from the left (No. 1) engine – the pilots were unaware of this change. When
Hunt and McClelland smelled smoke, they therefore believed it came from the right engine and
shut it down. They couldn’t see the engines from the cockpit, and the cabin crew did not inform
them that sparks and smoke had been seen coming from the left engine.
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After consulting British Midland’s operations department, the captain decided to land at the nearest
suitable airfield: East Midlands Airport, near Castle Donington in Leicestershire in central England.

After the pilots cut the right engine, they no longer perceived the vibration, and all evidence of
smell and smoke cleared from the flight deck, convincing them they had taken the correct action.
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1 Translation of the French by Debbie Blythe of case #9 40 2021 003A “Le vol 92 de la British Midland (A).”
2 Marine Agogué is an associate professor in HEC Montréal’s Department of Management.
3 Chantale Mailhot is a professor in HEC Montréal’s Department of Management.
© HEC Montréal 2021
All rights reserved for all countries. Any translation or alteration in any form whatsoever is prohibited.
The International Journal of Case Studies in Management is published on-line (http://www.hec.ca/en/case_centre/ijcsm/), ISSN 1911-2599.
This case is intended to be used as the framework for an educational discussion and does not imply any judgement on the
administrative situation presented. Deposited under number 9 40 2021 003AT with the HEC Montréal Case Centre, 3000, chemin
de la Côte-Sainte-Catherine, Montréal (Québec) H3T 2A7 Canada.
This document is authorized for educator review use only by Attique Rehman, Lahore University of Management Sciences until Nov 2023. Copying or posting is an infringement of copyright.
Permissions@hbsp.harvard.edu or 617.783.7860
 British Midland Flight 92 (A)

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But this was a coincidence: when the autothrottle was disengaged prior to shutting down the right
engine, the fuel flow to both engines was reduced, the flames disappeared, the smell of smoke and

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the vibration subsided, although cockpit instruments still indicated a problem.

The captain announced that there had been trouble with the right engine, which had produced some
smoke in the cabin, that the engine had been shut down, and that they would be landing at East
Midlands Airport in about ten minutes. Even damaged, the left engine would have been powerful

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enough to land the plane safely.

Needing more power to level the plane during their final approach, the pilots sent more fuel to the
damaged engine, but this led to an engine fire that caused it to cease operating entirely. They then
attempted to restart the right engine by windmilling (using the aircraft’s speed, or airflow entering
the engine), but the plane was by then flying too slowly for a restart. Deprived of all power, the
plane began to glide, and the captain raised the nose of the aircraft, narrowly avoiding the village

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of Kegworth. Just before crossing the M1 motorway, a few hundred metres short of the runway’s
paved surface, the aircraft’s tail and main landing gear struck the ground, and the aircraft bounced
back into the air and over the motorway, crashing on the far embankment and breaking into three
sections.

Result: 47 fatalities and 79 injured.

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2021-03-15

© HEC Montréal 2
This document is authorized for educator review use only by Attique Rehman, Lahore University of Management Sciences until Nov 2023. Copying or posting is an infringement of copyright.
Permissions@hbsp.harvard.edu or 617.783.7860