印度民航部飛行事故調查局正式發布了6月12日印航423航班空難事故的第一版事故調查報告。

一般空難的第一版事故調查報告往往比較概略，很難有細節，但這次的報告卻有非常多且重要的細節，悲劇的迷霧被驅散了很多，事故原因變得很具體了。

目前來看，飛機在起飛前一切正常，一切都發生在飛機離開地面后的

31秒里

世界協調時2025年6月12日8時7分33秒，飛機收到起飛許可。
8時7分37秒，飛機開始滑跑。
8分39秒，飛機離地。
8分42秒～43秒，飛機兩臺發動機的燃油開關被關閉，一名飛行員問“為什么關閉燃油開關？”另一名回應“我沒有。”
8分47秒，兩臺發動機轉速低至怠速以下，飛機最后的應急動力-空氣沖壓渦輪自動釋放并工作。
8分52秒，一號發動機燃油開關被重新打開。
8分56秒，二號發動機燃油開關被重新打開。
兩臺發動機相繼點火成功但無力逆轉空速下降。
9分5秒，飛行員呼報mayday。
9分11秒，飛機墜毀。機上230名乘客中的229人，10名空乘，2名飛行員和地面19人喪命。

什么是發動機燃油開關？

顧名思義，它是控制油泵向發動機輸送燃油的開關。在波音787上，兩個開關并排，位于駕駛艙中部控制臺油門桿的后方，是兩個蘑菇頭型的開關，向前推是開位，向后撥是閉位。

為了防止誤操作，這兩個開關都有限位裝置，飛行員必須先向上提起蘑菇頭，再前后撥動。

兩個開關的距離大約是10厘米。此前也發生過飛行員袖口勾掛這個開關造成的誤操作事件，所幸沒有釀成事故。但是一秒之內兩個開關相繼被誤操作，是什么情況下發生的？接下來還要更多的調查才能還原這兩個開關被關閉的真相。

想看更多細節的朋友，我下面翻譯了報告的事故回顧部分，大家可以參考一下。

Accident Flight

事故航班

On 12th June 2025, Air India’s B787-8 aircraft bearing registration VT-ANB arrived at Ahmedabad airport operating flight AI423 from Delhi. The aircraft touched down at 05:47 UTC (11:17 IST) and was parked at the bay 34.
2025年6月12日，印度航空一架注冊號為VT-ANB的波音787-8飛機執飛AI423航班從德里飛抵艾哈邁達巴德機場。飛機于協調世界時（UTC）05:47（印度標準時間11:17）著陸，并停靠在34號停機位。

The crew of the previous flight (AI423) had made Pilot Defect Report (PDR) entry for status message “STAB POS XDCR” in the Tech Log. The troubleshooting was carried out as per FIM by Air India’s on duty AME, and the aircraft was released for flight at 06:40 UTC.
前一航班（AI423）的機組人員在技術日志中記錄了飛行員故障報告（PDR），故障信息為“STAB POS XDCR”。印度航空當班維修工程師按照故障排除手冊（FIM）進行了檢修，飛機于06:40 UTC獲準放行。

The aircraft was scheduled to operate flight AI171 from Ahmedabad to Gatwick with ETD 07:40 UTC (13:10 IST). The flight was to be operated by the flight crew comprising an ATPL holder PIC, a CPL holder Co-pilot along with ten cabin crew. Both pilots were based at Mumbai and had arrived at Ahmedabad on the previous day. They had adequate rest period prior to operating the said flight. The co-pilot was Pilot Flying (PF), and the PIC was Pilot Monitoring (PM) for the flight.
該飛機計劃執行AI171航班，從艾哈邁達巴德飛往蓋特威克，預定起飛時間為07:40 UTC（13:10 IST）。機組由一名持有航線運輸飛行員執照（ATPL）的機長和一名持有商用飛行員執照（CPL）的副駕駛，以及10名客艙乘務組成。兩名飛行員常駐孟買，前一天已抵達艾哈邁達巴德，并在起飛前獲得了充分休息。此次飛行由副駕駛執行操縱任務（PF），機長負責監控（PM）。

The crew of flight AI171 arrived at the airport and underwent preflight Breath Analyzer test at 06:25 UTC and were found fit to operate the flight. The crew is seen arriving at the boarding gate in the CCTV recording at about 07:05 UTC (12:35 IST).
AI171航班的機組人員于06:25 UTC抵達機場，并接受了飛行前的酒精呼氣測試，結果顯示適合執飛任務。閉路電視錄像顯示，機組人員于約07:05 UTC（12:35 IST）抵達登機口。

There were 230 passengers on board, out of which 15 passengers were in business class and 215 passengers were in economy class including two infants.
機上共有230名乘客，其中15人在商務艙，215人在經濟艙（含兩名嬰兒）。

Fuel on board was 54,200 Kgs and as per the load and trim sheet of the flight, the Take-off Weight was 2,13,401 Kgs (Max. allowed - 2,18,183 Kgs). The take-off weight was within allowable limits for the given conditions. There was no ‘Dangerous Goods’ on the aircraft.
機上燃油為54,200公斤，根據該航班的載重和配載單，起飛重量為213,401公斤（最大允許為218,183公斤），在當時條件下屬正常范圍。機上未裝載危險品。

The calculated V speeds with available conditions at Take-Off were V? - 153 Kts, V? - 155 Kts, V? - 162 Kts.

起飛條件下計算的V速如下：

V?（決斷速度）：153節

V?（抬輪速度）：155節

V?（安全爬升速度）：162節

The A-SMGCS replay of the flight was also carried out after the accident. The aircraft was observed departing from the bay 34 at 07:48:38 UTC. The taxi clearance was received at 07:55:15 UTC and the aircraft taxied from the bay at 07:56:08 UTC. The aircraft taxied to Runway 23 via Taxiway R4, backtracked and lined up. The take-off clearance was issued at 08:07:33 UTC. The aircraft started rolling at 08:07:37 UTC.
事故后回放了A-SMGCS（高級地面移動引導和控制系統）記錄。飛機于07:48:38 UTC從34號停機位推出。07:55:15 UTC收到滑行許可，07:56:08 UTC開始滑行，通過R4滑行道前往23號跑道，掉頭并對正跑道。08:07:33 UTC收到起飛許可，08:07:37 UTC開始滑跑。

As per the EAFR data, the aircraft crossed the take-off decision speed V? and achieved 153 kts IAS at 08:08:33 UTC. The V? speed (155 kts) was achieved as per the EAFR at 08:08:35 UTC. The aircraft air/ground sensors transitioned to air mode, consistent with liftoff at 08:08:39 UTC.
根據EAFR（增強型飛行數據記錄）數據，飛機于08:08:33 UTC通過V?決斷速度（153節），08:08:35 UTC達到抬輪速度V?（155節）。08:08:39 UTC，空地傳感器狀態切換為“空中模式”，表明飛機已完成起飛。

The aircraft achieved the maximum recorded airspeed of 180 Knots IAS at about 08:08:42 UTC and immediately thereafter, the Engine 1 and Engine 2 fuel cutoff switches transitioned from RUN to CUTOFF position one after another with a time gap of 01 sec. The Engine N1 and N2 began to decrease from their take-off values as the fuel supply to the engines was cut off.
飛機于08:08:42 UTC達到最大記錄空速180節。緊接著，1號和2號發動機的燃油切斷開關在1秒間隔內相繼從“RUN”位置切換至“CUTOFF”位置，導致N1與N2轉速下降，說明燃油供應被切斷。

In the cockpit voice recording, one of the pilots is heard asking the other why did he cutoff. The other pilot responded that he did not do so.
駕駛艙語音記錄中，一名飛行員問另一人為何切斷燃油，另一人回應自己沒有這么做。

The CCTV footage obtained from the airport showed Ram Air Turbine (RAT) getting deployed during the initial climb immediately after lift-off (fig. 15). No significant bird activity is observed in the vicinity of the flight path. The aircraft started to lose altitude before crossing the airport perimeter wall.
機場監控錄像顯示，飛機在起飛后初始爬升階段即部署了沖壓空氣渦輪（RAT）（見圖15）。飛行路徑周圍未發現明顯鳥類活動。飛機在尚未越過機場圍墻前就開始失去高度。

Figure 15 CCTV screenshot of RAT Deployment

圖15：閉路電視截圖顯示沖壓空氣渦輪（RAT）展開

As per the EAFR data both engines N2 values passed below minimum idle speed, and the RAT hydraulic pump began supplying hydraulic power at about 08:08:47 UTC.
根據增強型飛行數據記錄（EAFR）數據，兩臺發動機的N2值降至最低怠速以下，沖壓空氣渦輪（RAT）液壓泵約在08:08:47 UTC開始供給液壓動力。

As per the EAFR, the Engine 1 fuel cutoff switch transitioned from CUTOFF to RUN at about 08:08:52 UTC.

根據EAFR記錄，1號發動機的燃油切斷開關約在08:08:52 UTC從“CUTOFF”切換至“RUN”狀態。

The APU Inlet Door began opening at about 08:08:54 UTC, consistent with the APU Auto Start logic.
輔助動力裝置（APU）進氣門約在08:08:54 UTC開始打開，與APU自動啟動邏輯一致。

Thereafter at 08:08:56 UTC the Engine 2 fuel cutoff switch also transitions from CUTOFF to RUN.
隨后在08:08:56 UTC，2號發動機的燃油切斷開關也從“CUTOFF”切換至“RUN”。

When fuel control switches are moved from CUTOFF to RUN while the aircraft is inflight, each engine’s full authority dual engine control (FADEC) automatically manages a relight and thrust recovery sequence of ignition and fuel introduction.
當飛機在空中時，燃油控制開關從CUTOFF切換至RUN，發動機的全權限雙通道電子控制系統（FADEC）會自動執行重新點火與推力恢復的程序，包括點火與燃油重新引入。

The EGT was observed to be rising for both engines indicating relight.
觀察到兩臺發動機的排氣溫度（EGT）上升，表明點火成功。

Engine 1’s core deceleration stopped, reversed and started to progress to recovery.
1號發動機的核心轉速減速趨勢停止，隨后逆轉并開始恢復。

Engine 2 was able to relight but could not arrest core speed deceleration and re-introduced fuel repeatedly to increase core speed acceleration and recovery.
2號發動機雖然重新點火成功，但未能阻止核心轉速下降，只能反復注入燃油以促使加速與恢復。

The EAFR recording stopped at 08:09:11 UTC.
EAFR記錄在08:09:11 UTC停止。

At about 08:09:05 UTC, one of the pilots transmitted “MAYDAY MAYDAY MAYDAY”.
約在08:09:05 UTC，一名飛行員發出了“MAYDAY MAYDAY MAYDAY”緊急呼叫。

The ATCO enquired about the call sign. ATCO did not get any response but observed the aircraft crashing outside the airport boundary and activated the emergency response.
空管員（ATCO）詢問呼號，但未收到回復，隨后觀察到飛機在機場圍界外墜毀，并立即啟動了應急響應程序。

At 08:14:44 UTC, Crash Fire Tender left the airport premises for Rescue and firefighting.
08:14:44 UTC，機場的應急消防車離開機場執行救援與滅火任務。

They were joined by Fire and Rescue services of Local Administration.
地方政府的消防與救援部門隨后也加入了行動。

不管是何種原因，及時、嚴謹、透明的事故調查，都能成為讓系統更加安全的保障。