What happened
On January 22, 2001, a Boeing B767-400, registration CN-RMG, operating flight RAM 941, experienced two separate incidents involving smoke at Rome Fiumicino "Leonardo da Vinci" Airport. During the initial push-back, ground personnel observed thick smoke emanating from the number 2 engine while it was being started. Upon being notified, the crew halted the engine start sequence. Shortly thereafter, smoke became visible within both the cockpit and the passenger cabin, prompting cabin crew to open the aircraft doors to provide ventilation.
Following maintenance procedures that appeared to rectify the issue, the flight was rescheduled for departure later that evening. However, during the takeoff roll, the flight crew was forced to abort the takeoff because smoke reappeared in the cockpit and passenger cabin. Due to the presence of smoke, some passengers experienced respiratory difficulties and required medical assistance upon disembarking. There were no injuries or cases of intoxication reported among the 70 passengers or 9 crew members.
The investigation
Following the first incident, inspections of the hydraulic reservoirs revealed that the fluid levels in both systems were above the maximum limit. After the fluid levels were corrected, the issue appeared to be resolved. However, the recurrence of the smoke during the second departure attempt necessitated a more intensive fault investigation. This secondary inspection identified a specific mechanical failure within the hydraulic system.
Findings
- The investigation determined that the smoke was caused by a defective hydraulic pressurization module in the number 2 system.
- The initial attempt to fix the issue by merely adjusting fluid levels failed to address the underlying mechanical defect.