Why the great escape on Japan Airlines’ A350 was no accident

And yet, despite the undeniable air of confusion and panic, each of the 367 passengers diligently followed the instructions of the onboard cabin crew, waiting in their seats until it was their turn to move forward and leaving everything behind but their phones and passports. The full evacuation of Flight JL516 took 18 minutes, with no casualties reported. The A350 went on to burn for over six hours as emergency crews attempted to subdue the flames.

A flight like any other

On 2 January 2024, at 5:47 pm, the Japan Airlines Airbus A350 touched down on Runway 34R at Haneda Airport, one hour and 20 minutes after taking off from New Chitose Airport, near Sapporo in the country’s north. In the middle of winter in Japan, the sun had set a full hour before landing, meaning the pilots relied on their instruments, landing strip lights, and air traffic control clearances to guide their way to the ground. Amid the sea of dark tarmac, the bright strip lights did little to illuminate anything outside of the pathway they represent. So, when an uncleared aircraft – a Japan Coast Guard Dash 8-300 – rolled onto Runway 34R, the smaller aircraft seemed largely invisible to the A350 pilots.

As JL516 touched down, the two planes collided in flames and smoke. The A350 finally stopped around 1,000 metres ahead of its touch-down point, veering off the right side of the runway. The Dash 8-300 had been on a mission to deliver supplies to Niigata in the country’s west, an area that suffered greatly amid the 7.6-magnitude earthquake that struck the country one day earlier. There were six people on board when the plane was struck, five of whom lost their lives in the accident. Investigations are ongoing into why an aircraft was standing on a blackened runway without clearance to do so. However, initial determinations have found that the pilots onboard the Dash 8 perhaps misinterpreted their clearance to enter a holding zone near the runway as confirmation to move onto the runway and prepare for their departure.

What astounded me, and many others, about this story was that despite what would be considered a catastrophic impact, despite the obvious signs of fire within the aircraft, despite the lack of functional lights or PA systems to convey critical safety information easily, and despite the ability to see through the growing smoke and fumes clearly, all 367 passengers onboard the damaged A350 were effectively evacuated before the plane succumbed to ash.

If you’ve read up on this case, you’ll know that experts have thanked a few key factors for this feat. Firstly, the advanced internal makeup of the Airbus A350 has been acknowledged as slowing down the plane’s burn rate, meaning the fire did not break through and into the cabin until after the full evacuation of the aircraft. Secondly, the cabin crew onboard, assisted by immensely compliant passengers, were regarded to be exceptionally calm, professional and proficient during the evacuation process. Today, we’ll delve a little deeper into these to determine what exactly contributed to the success of the mass evacuation of JL516 and what we can learn in the aftermath.

Advancements in aviation

Professor Arnold Barnett, an aviation safety expert, statistician and lecturer at the Massachusetts Institute of Technology, says that the outcome of this event is the result of decades of rigorous safety standards in aviation and improvements in the structural composition of aircraft. “Statistically speaking, Airbus and the A350 both have a fantastic safety record internationally,” he begins. “The A350 is an incredibly modern aircraft, by aviation standards. In the olden days, planes were built out of aluminium and alloys, whereas today, they are built of carbon fibre composites.”

Composites use a mix of metals and plastics to be lighter in weight, less wind resistant, cheaper to manufacture, and yet stronger overall. While composites have been around for a while, JL516 is essentially the first of its kind – a modern composite-built jet – to suffer such a cataclysmic event and fire. “JL516 was a bit of a testbed for our understanding of how this aircraft and others like it respond to fire, and this is the only event on record in which an A350 hull has been lost. The investigations will certainly tell us a lot about how these modern aircraft models work under pressure,” Barnett says.

While the plastics and resin involved in the makeup of carbon fibre composites are flammable, composites have a higher melting point than traditional aluminium. This essentially causes a ‘slow burn’ effect, which can help keep the cabin’s interior – as in the case of JL516 – intact for long enough to complete a full evacuation and keep an aircraft hull on fire for six hours despite numerous attempts to put it out. “These composites, in tandem with other fire-retardant materials that Airbus has used throughout and around the aircraft, all serve the process to slow down the speed at which a fire can spread, which buys immensely valuable time, as we saw in this case,” Barnett says. “If, in fact, the time it took for that plane to be utterly engulfed in flames had been, let’s say, eight minutes instead of 20 or 21, then I think we might have seen casualties into the triple digits. It was incredibly critical that everyone was able to get off that plane before that fire ripped through, and that is also thanks to the crew onboard.”

A cultural impact

The passengers and crew onboard JL516 certainly did not waste any of the extra time awarded to them by the well-designed A350. The fire onboard rendered multiple emergency exit doors unusable for the evacuation, meaning all passengers had to be moved to the front of the aircraft to escape. Multiple eyewitnesses testified to how ordered the evacuation was given the circumstances and how compliant the passengers were with the order not to bring their bags off the burning plane.Liz Simmons, a Griffith University PhD candidate and former Australian cabin crew member for nearly two decades, shared her thoughts with me on these reports. “We’ve seen plenty of catastrophic events in the last decade, where passengers evacuating have opted to take their bags off during an emergency, and that has sadly cost people their lives. An evacuation is only as strong as the weakest part of that evacuation,” she shares. “I’ve heard suggestions that the reason Flight JL516 was able to evacuate so efficiently was because the passengers were Japanese,” she says, alluding to the collectivist nature of the nation’s culture. However, if we let ourselves write off that part of the situation, we lose some valuable lessons from this whole evacuation. This was an international airline. Hundreds of passengers were onboard, and many nationalities – including Australians – were on that flight. So I don’t think that was the difference.”

Simmons highlighted several factors that could have contributed to this evac’s success. “Firstly, Japan Airlines’ safety demonstration video. If you haven’t seen it, it places a huge emphasis on safety, particularly the consequences of not following instructions. It says quite explicitly that if you take your bag with you during an emergency evacuation, you may be the reason someone else can’t get off the aircraft in time.” Other airlines have slightly altered the style of the traditional safety demonstration video to support brand awareness or available tourist destinations, she says. “However, as an industry, we should follow Japan Airlines and remember what purpose that video is supposed to serve. It is a safety briefing for passengers in the unlikely event of an emergency, and it contains a lot of very important information.”

Aviation’s first responders

Secondly, Simmons says the evacuation was such a success because it was textbook. “This was the end of a long day for this crew, and a catastrophic event occurred. And so they did what they are trained to do. They followed the procedure step by step.” Take-off and landing are the two more hazardous times in an aircraft and are, therefore, the times when crew need to be the most focused.

“Since 2005, following an incident much like Flight JL516 in which the actions of cabin crew led to a full evacuation, flight attendants have adopted the practice of a ‘silent review’ during take-off and landing,” she says. “You might notice during these times that the crew will sit, usually with their hands in their laps, and they might look like they’re focused on the wall. However, the silent review involved the crew going over, in their minds, all the safety procedures for incidents that could occur during take-off or landing. From the time the aircraft enters the runway until the gear is up, they have to be silently reviewing their safety drill and demands. At the time, they’re listening for changes in sound and smell in their environment. The same safety review occurs from when the gear goes down for landing to when an aircraft turns off the active runway. We know the Japan Airlines crew were preparing for a safety incident exactly as one began, after landing.”

A new way of learning

However, the difference between preparing for an emergency, in theory, and a plane catching alight in front of your very eyes is immense. So, how exactly do you train for a real-life incident and transition your knowledge from paper into actual emergency response? That is a question that Dr Mizuki Urano has worked for years to answer. Dr Urano is a former Japan Airlines cabin safety manager and trailblazer for new cabin safety training standards across the industry.

In the 10 years Dr Urano spent with Japan Airlines, she played a key role in rejuvenating the safety training practices for cabin crew both at the airline and internationally – practices which have now been proven on the world stage. “After joining Japan Airlines in 2013, I shortly became part of the cabin safety department,” Dr Urano shares. “During that time, I had a chance to work as a delegate member of the International Civil Aviation Organization (ICAO) Cabin Safety Working Group, where I met many safety experts from around the world and joined the discussion for developing its new cabin safety training manual.”

She references ICAO document 10,002, which focuses on redefining the “key competencies” of cabin crew and how we train and grade them. “The main aspect of ICAO’s work was the introduction of competency-based training and assessment or CBTA,” Urano reveals. This is essentially a new way of assessing cabin crew’s learning and capabilities, particularly during emergency drills, with a more hands-on approach than was used previously.

“The old school way for training cabin crew involves learning pages and pages of information, procedures and safety equipment. However, if you can’t put that knowledge into practice when it matters, then it isn’t that useful to you. So CBTA really challenges the old way of grading knowledge, and instead focuses on new drills, practical application of knowledge, group discussion, and ultimately a deeper understanding of drills and procedures.”

“Not every emergency scenario is going to unfold exactly the way one of the practice drills would unfold. Real life is much less predictable, like five out of eight exits being unusable because the flames are too bad. So CBTA trains you to think in the moment and make decisions.” I was particularly interested in Dr Urano’s mention of group discussion and the prominence it takes in this new understanding of crew training. “The thing with discussion is that it can open up the group to thinking about a situation differently. Or someone can ask a what if question that opens up a new avenue for learning.”

Thanks to Dr Urano, Japan Airlines has integrated CBTA training practices since 2020. “I was able to adopt the skills and knowledge I gained from the ICAO working group to internally develop Japan Airlines’ original competency-based training and assessment curriculum, which was introduced across the airline in 2020 and has been ongoing since,” Urano says.

“And it is clear that is what you can see being utilised here in the event of JL516. Even if some staff onboard were relatively new, they would understand how to apply their procedures in that situation because they’ve used CBTA throughout their training from the beginning.” While CBTA is not yet a mandatory aspect of global cabin crew certification, more and more airlines are embracing the difference. “The training standards for cabin crew internationally are very defined and very rigid,” Urano says.

“Cabin crew are far more than just your waiters in the sky. They are exceptionally well-trained and skilled first responders and safety professionals. Training is re-affirmed every 12 months to ensure that crew are current and competent in the face of an emergency. However, CBTA is not yet standard across the industry, so Japan Airlines is today going above and beyond what is expected internationally by including CBTA practices. Other countries, like Australia, are quite forward-thinking about CBTA – for pilots more so than cabin crew too – however, there are a lot of carriers throughout Asia and throughout Europe that aren’t yet considering the benefits of competency-based training in their curriculums.”

A safer future for flying

Wrapped together, new-age plane technologies, safety-focused regulations, new training practices, and ever-diligent cabin crews as safety professionals have led to not only the safe evacuation of this A350 but also unprecedented global safety standards in aviation. With that, I asked each of my three interviewees what they hoped would be the main takeaway for the travelling public in the aftermath of JL516.

Professor Barnett says passengers should be astounded by how safe it is to board and fly an aircraft in 2024. “Looking at the data, we can see that for every decade that goes by, the risk of getting killed in an air crash drops by a factor of two,” he says. “That’s exponential, so if you go back to the 1960s, the risk associated with flight has now dropped by a factor of 38. You would think that the safer the industry gets, the harder it is to continue to get safer at the same rate. And yet, even though the rate of this risk has gone down, down, down, we still seem to manage to cut it by a factor of two every decade – including the last! So, the overall record is wonderful, and while it’s always been safe to fly, it’s still never been safer than it is today.

Griffith University’s Liz Simmons responds, “If audiences take away anything, I think it should be a renewed sense of what cabin crew do daily onboard the aircraft. They are more than just greeters and waiters bringing you tea and biscuits. They are highly trained safety professionals, and listening to their instructions is important – not just during an emergency.” As for Dr Urano, she says more airlines should embrace CBTA training. “When I first saw the photos and the flames, I thought nobody could have survived. But then I learned that everyone onboard survived, and I immediately thought, ‘My goodness, what a miracle!’ But I later realised it wasn’t a miracle. It was simply a product of cabin crew doing exactly as they were trained, and aircraft doing exactly what it was built to do.

“Miracle is a strange word for a system that works just as intended when the worst occurs.”