What happened
On 18 July 2013, a Boeing 737-8AS, registration EI-DWF, was operating a scheduled passenger service from Rome to Leipzig. During the climb through instrument meteorological conditions, the aircraft encountered sudden and unexpected severe turbulence approximately 48 km south of Perugia, Italy. At the time of the encounter, the cabin crew were preparing for in-flight service.
The turbulence was so intense that one cabin crew member, working in the rear galley, was thrown into the air, striking the ceiling before falling heavily to the floor. The crew member sustained a serious injury, later diagnosed as a fractured pelvis. While the other three cabin crew members and all 129 passengers remained uninjured, the aircraft experienced significant vertical accelerations, reaching a maximum of 1.95 g. Following the event, the flight crew managed the aircraft's climb and continued to the destination, with the injured crew member traveling back to Rome in a seated row.
The investigation
The AAIU investigation examined the flight crew's weather briefings, radar data, and the aircraft's flight parameters. The investigation established that the pre-flight weather charts did not indicate significant thunderstorm activity or high shear values in the area. While the flight crew had previously navigated around large cumulonimbus clouds, the specific severe turbulence encountered was not detected on the weather radar prior to the event.
Investigators also reviewed the crew's response to the incident. It was noted that while the flight crew addressed the medical needs of the crew member and coordinated with air traffic control for ground medical services, they did not notify ATC of the severe turbulence encounter, nor did they make a technical logbook entry regarding the event.
Findings
- The primary cause of the injury was the unrestrained movement of a cabin crew member during a period of sudden, unexpected severe turbulence.
- Weather forecasts and briefing materials failed to predict the turbulence or significant convective activity in the vicinity of the occurrence.
- The aircraft's flight crew did not record the encounter in the technical logbook, which resulted in a failure to perform a required maintenance inspection following the severe turbulence.
Safety action
The investigation led to safety recommendations for the operator to ensure flight crews are reminded of the necessity to notify air traffic control whenever turbulence is encountered. Additionally, the operator was advised to remind crews of the requirement to perform a maintenance inspection and complete a technical logbook entry following any encounter with severe turbulence.