LE BOURGET, France -- A pilot facing faulty data and deafening alarms in an oversea thunderstorm pitched his plane sharply up instead of down as it stalled, then lost control, sending the Air France jet and all 228 people aboard to their deaths in the Atlantic Ocean in 2009.
The fatal move was part of a chain of events outlined in a report by French investigators yesterday that could change the way pilots around the world are trained to handle planes manually.
"I don't have control of the plane at all," the pilot said a minute before it crashed, according to the 224-page report.
Families of victims struggled to digest the report, the final of several studies into the crash by the French air accident investigation agency, the BEA. Some were disappointed that it didn't focus more on manufacturing problems and lay so much blame on the pilots.
The document is the result of a three-year investigation and makes sweeping recommendations for preparing pilots worldwide to fly high-tech planes when confronted with a crisis.
The Airbus 330 passenger jet flying from Rio de Janeiro to Paris crashed on June 1, 2009. Over-reliance on automated signals and inadequate training were repeatedly named as contributing to the crash, along with mounting stress in the cockpit.
Ice was the initial culprit. Ice crystals blocked speed sensors on the underbelly of the plane known as pitot tubes, said chief investigator Alain Bouillard.
Yesterday's report spelled out how the pitot problem led to other problems in the cockpit, where two co-pilots were guiding the plane through a storm while the captain was on a rest break.
The erroneous speed readings prompted the autopilot to disengage. Alarms started sounding in the cockpit.
The pilot at the controls couldn't tell if the plane was stalling or going too fast, the report said. One of the alarms was saying "Stall! Stall!" But the report says another alarm, ringing for 34 seconds straight, "saturated the aural environment within the cockpit" and confused the pilots.
Meanwhile, the plane's flight director system gave faulty, conflicting information. The flight director shows the pilot what movements of the controls he needs to make -- but the flight director relies on information from the pitots and other sensors. Investigators said the crew should have turned off the flight director at that point.
Instead, the pilot in control nosed the plane upward, thinking he was going too fast and the plane was in a dive, the report says. In fact, the plane was in an aerodynamic stall.