Aviation News, Headlines & Alerts
 
Category: <span>NTSB</span>

Category: NTSB

National Transportation Safety Board

Boeing, NTSB, TWA, Video

NTSB Denies Petition on 1996 Crash of TWA Flight 800

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The National Transportation Safety Board today denied a petition for reconsideration of its findings in the investigation of the 1996 crash of TWA flight 800.

The petition was filed in June 2013 by a group called The TWA 800 Project. Petitioners claimed a “detonation or high-velocity explosion” caused the crash.

“Our investigations are never ‘closed’,” said Acting Chairman Christopher A. Hart. “We always remain open to the presentation of new evidence.”

Before responding to the petition, NTSB staff met with the petitioners’ representatives and listened to an eyewitness who described what he saw on the night of the accident. After a thorough review of all the information provided by the petitioners, the NTSB denied the petition in its entirety because the evidence and analysis presented did not show the original findings were incorrect.

Black Box

Part 1

Black Box

Part 2

Alaska Airlines, NTSB, USA

Alaska Passenger Jet Almost Collided with Cargo Plane Over Fire Island

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AlaskaAccording to the National Transportation Safety Board (NTSB), a passenger jet and a cargo plane had a ‘near miss’, after they were recorded to be less than a quarter mile apart over Fire Island, New York, on May 27.

The Alaska Airlines Boeing 737 was about to land at the runway #15 of the Ted Stevens Anchorage International Airport at about 3:08 p.m. when the air traffic controllers asked the pilot to ‘go-around’. The instruction was given to avoid a Sand Point-bound Ace Air Cargo Beechcraft 1900, which was taking off from the airport.

The passenger jet swerved off towards right; the cargo plane also took off and turned in the same direction. Above Fire Island, the aircrafts crossed each other at the same elevation within a quarter mile distance.

The Alaska airlines flight 135 landed without incident and all 143 passengers and 5 crew members remained unharmed.
NTSB has launched an investigation, led by a senior air traffic control specialist, based in Washington D.C. According to NTSB spokesperson Clint Johnson, “He’s going to be reviewing radar data, he’s going to be reviewing the conversations between the two pilots, the two flight crews and air traffic control and also looking at policies and procedures to look and document the circumstances that led up to this incident.”


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FAA, NTSB, USA

The ‘Near Midair Collision’ at the Newark Airport Prompts FAA to Take Action

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The April 24’s incident where two passenger planes were noticed to be in a near-collision situation midair at Newark Liberty International Airport, New Jersey, has led to changes in the landing and takeoff protocols of the airport.

The Federal Aviation Administration said in recent statement, “The FAA has investigated the recent air traffic incident at Newark and has taken steps to prevent similar incidents from occurring in the future.”

According to the new rules administered by the FAA, the east-west Runway 29 will not be used for arrivals simultaneously with another plane taking off from north-south Runway 4R.

On April 24, a United flight and an ExpressJet flight came at a distance of 200 feet horizontally at the intersection of these two runways. The NTSB’s initial report termed the incident as ‘a near midair collision’.

This post is an update of: Two Passenger Planes ‘Nearly Collided’ Midair in New Jersey Says NTSB’s Report


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Boeing, Embraer, ExpressJet, NTSB, United Airlines, USA

Two Passenger Planes ‘Nearly Collided’ Midair in New Jersey Says NTSB’s Report

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According to a preliminary report released by the NTSB, two passenger planes ‘nearly collided’ mid-air last month near Newark Liberty Airport, New Jersey.

The incident happened on April 24 when a Boeing 737-800 aircraft, registered to United Airlines was about to land at the airport while an Embraer ERJ145 aircraft belonging to ExpressJet flight was taking off. At about 3pm, the distance between the two planes was recorded to be only 200 feet laterally, and 400 feet vertically.

The report revealed that “The local controller recognized that the spacing was insufficient and instructed the B737 to go around. He provided traffic advisories to both the B737 and the ERJ145 pilots and instructed the ERJ145 pilot to maintain visual separation from the B737. The ERJ145 pilot responded that he was going to keep the aircraft’s nose down. The B737 overflew the ERJ145 at the intersection of runways 29/4R”.

There were 47 passengers and 3 crew members aboard the ExpressJet flight while the United flight was flying with 155 passengers and 6 crew members on board.


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Crash, NTSB, STEARMAN, USA

NTSB Releases Details of Travis Air Show Plane Crash

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The NTSB has issued the preliminary investigation report on May 4’s Stearman biplane crash at Travis Air Force Base in Fairfield, California.

The plane crashed when the 77 year old pilot, Edward Andreini, was attempting a ribbon cutting stunt during the Thunder Over Solano air show.

According to the report, “The planned maneuver consisted of a total of three passes…The first two passes were successful, but on the third pass, the airplane was too high, and did not cut the ribbon. The pilot came around for a fourth pass, and rolled the airplane inverted after aligning with the runway. The airplane contacted the runway prior to reaching the ribbon, slid inverted between the ground crew personnel holding the poles, and came to a stop a few hundred feet beyond them.”

The report also revealed that within 50 seconds of coming to rest, the plane’s right side was completely engulfed by flames but the firefighters took 3 to 4 minutes before they arrived at the scene to extinguish the fire.

This post is an update of ‘Biplane Crashed during Thunder Over Solano Air Show in California; Pilot Killed‘


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Air Safety, Editorial, FAA, NTSB

When Lady Luck Turns Away

Incidents and Accidents.

Behind every accident, there are many incidents. Accidents may be defined as involving fatalities and incidents as those many smaller events seemingly unconnected from any others. The importance of incidents has gotten little respect but for two obscure references. The industry recognized Heinrich Pyramid says “…. for every accident that causes a major injury, there are 29 accidents that cause minor injuries and 300 accidents that cause no injuries.”

A 2005 Rand Report drawing attention to NTSB databases said “…(there is) poor control of information, part of resolving more complex accidents depends upon a thorough knowledge of prior incidents, the number of major airline incidents the FAA reported in 1997 was ten times the number of major accidents, (there is) neither oversight nor an emphasis on accuracy in the collection and maintenance of NTSB records, as a result, the accuracy of most of the NTSB data sources was rated as “poor” and although the NTSB does examine a significant number of major incidents, only a small portion of the NTSB’s aviation resources are focused on incident events.”

Rand report Link >
http://www.rand.org/content/dam/rand/pubs/monograph_reports/2005/MR1122.pdf

See page 38 –40.

Key Public Databases – NTSB and FAA. Gaps Compromising Safety Assessments.

The NTSB’s most public source of records is the accident/incident database.

It is cited in the FAA Accident/Incident Data System (AIDS), Airworthiness Directives (ADs), risk/analysis studies, and in DOT/GAO Reports to congress.

In my various surveys along major safety issues (uncontained engine explosions, un-commanded rudder movements, shutdowns due to engine main bearing failures, or smoke/fire incidents, the NTSB data contains about 20 % of what is found in SDR data or other counterpart investigative agencies.

Gaps in NTSB data are further compounded by similar gaps in SDR data. From
1992 to 2002 four NTSB Safety Reccommendation Letters and the GAO had complained of such gaps. In 2010 and regarding data on windshield fires, an article said the “FAA said it was aware of 11 cases of fires in the planes over the past 20 years. However, Boeing has said it is aware of 29 incidents involving fire or smoke over the past eight years.’ Source link >
http://www.news24.com/World/News/FAA-orders-Boeing-inspection-20100710 – bottom of article.

1994. In 1994, The Department of Transportation Inspector General reported that between “46 and 98 percent of the data fields of inflight ‘service difficulty’ records are missing data.” From GAO/AIMD-95-27. 02/08/95. Data
Problems Threaten FAA Strides on Safety Analysis
Source Link >
http://www.gao.gov/archive/1995/ai9527.pdf

From the House Hearing Electrical Safety. (Ref report 106-112, Thursday, October 5, 2000, Testimony of Alexis M. Stefani, assistant IG for auditing), said; “Third, of most concern to us is the health of this SDR system, itself. While the new rule (coding for wire issues) was intended to improve the data in the system, FAA must also insure that the reports that are provided to it are timely, and follow the guidance. We found, however, that the SDR system is not robust, and over the years, it has suffered from budget cuts with staffing going from twelve full-time to three full-time people. Weakness in this system reduces the reliability and usefulness of the data, and can impact FAA’s ability to do trend analysis.”
Source Link >
http://commdocs.house.gov/committees/Trans/hpw106-112.000/hpw106-112_1.HTM
Page 47

From a June 8, 2006 U.S./Europe International Aviation Safety Conference, FAA’s Flight Standards Service, Jim Ballough.spoke of “FAA’s growing concern over numerous reports of smoke/fumes in cockpit/cabin and that FAA data analysis indicates numerous events not being reported.” Source Link >
http://www.faa.gov/news/conferences/2006_us_europe_conference/ See ‘Presentation
’ by Jim Ballough.
650 Records Of “Smoke In The Cockpit” A Lack of Concern.

Gary Stoller at USA Today did a good piece on “smoke in the cockpit”
reports. Of some 650 records, the FAA/NTSB has but a fraction. The story highlights included; (that the) “issue happens roughly four times a month.

Some experts say the problem is under-reported. FAA says there is “no safety benefit” to requiring systems to remove cockpit smoke. Smoke in a plane’s cockpit from electrical or other failures is reported an average of four times each month, a USA TODAY analysis finds.” Further that “In-flight fires left unattended “may lead to catastrophic failure and have resulted in the complete loss of airplanes,” the FAA warned. A flight crew “may have as few as 15-20 minutes to get an aircraft on the ground if the crew allows a hidden fire to progress without intervention.” USA Today

Source http://www.usatoday.com/story/news/nation/2013/10/30/cockpit-smoke-airline-faa/3316429/

33 records Of Insulation Blankets Fires. – How They Start.

From my catalog of 78 Records of fire from 1983 to 2012 sourced from the NTSB, AAIB (Danish & UK), French BEA, FAA’s SDR databases, and a few media reports of records of accidents and incidents of fire. There is no central repository. There are 33 records where acoustic insulation (blankets) were specifically mentioned are listed. The issues of self-igniting and flammable wire insulations and of flammable blankets were now are co-mingled.

Three modes of ignition are seen here: wire shorting/arcing, molten metal sprayed from faulting electrical relays and heating tapes. Most reports lack necessary detail, but seven incidents were seen from wires shorting/arcing.
Some involved only a few wires; one powering coal closet lights. Molten Metal (spatter) comprised another 8. More importantly, within those reports were references to another 19 (but without details) and that the NTSB said; the relays involved were not “substantially different from the receptacles used on other transport-category airplanes.”

Ignition from faulting heating tapes/ribbons was seen in another 4 reports – but there were more. In a November 14, 2002 Letter to the FAA, the Canadian Transport Safety Board (TSB) advised that; “heater ribbons are used extensively in transport category aircraft, including Boeing 707, 727, 737, 747, 757 and 767 series and Boeing (Douglas) DC-9, DC-10, and MD-11 aircraft. ” From a TSB report of such fires on 747s and a 767, four other reports were disclosed. The TSB added; “The standard Boeing 767 incorporates 26 heater ribbons. Between June 1985 and June 2002, operators of Boeing aircraft made a total of 67 reports to Boeing of heater ribbon failures where thermal degradation was evident.” From one Delta MD-88 fire in 1999, the NTSB said; “DAL conducted a fleet wide examination of their MD-88/MD-90 fleet to ascertain the condition of their static port heaters. Eight heaters were found with evidence of thermal damage on their wires and or connectors.” There are 8 ADs, and 24 additional SDRs describing burn marks or fire damage. (ref King Survey ‘History Heater Blanket/Tape Fires’.)

In 2002, the FAA concluded that “in-flight Fires In Hidden Areas are a risk to aviation safety – most hidden fires are caused by electrical problems – non-compliance with Safety Regulations have been uncovered. Fire safety problems and improvements are in various stages of correction and study” and that “it is impossible to predict the relative risk of serious fires occurring in Hidden Areas or Locations”. Source Link >
http://www.caasd.org/atsrac/meeting_minutes/2002/2002_01_Fire-Safety-in-Hidden-Inaccessible-Areas.pdf

Dense, Continuous Smoke in the Cockpit.

In June 2013 a GAO Report to Congress cited but one record of ‘Dense, Continuous Smoke in the Cockpit’ (in 1973). The input came from the NTSB and the FAA. Contrary to that, a Specialist Paper by the Royal Aeronautical Society detailed seven. Only two were in the NTSB databases – but with no mention of ‘continuous smoke.’

Links > GAO-13-551R, Jun 4, 2013. FAA Oversight of Procedures and Technologies to Prevent and Mitigate the Effects of Dense, Continuous Smoke in the Cockpit.
http://www.gao.gov/products/GAO-13-551R

Link > Royal Aeronautical Society – Smoke, Fire and Fumes in Transport Aircraft. Second Edition 2013, Part 1, Past History, Current Risk, And Recommended Mitigations. A Specialist Paper prepared by the Flight
Operations Group of the Royal Aeronautical Society. March 2013

http://flightsafety.org/files/RAESSFF.pdf

In Lady Luck We Trust ? – Those ‘Lucky’ Ground Incidents.
Often heard whenever the safety of our air transportation system is questioned is that we have an enviable safety record due to the industry, the FAA and the NTSB’s efforts. That is true if only actual deaths are counted.

This boiler-plate response comes whenever issues of safety are raised, but something else is left unspoken: its conditional nature. It includes just the U.S. carriers, and is based on the records kept. However, there have been no less than 6 events where fires occurred on the ground and caused significant damage, or loss of the airframes. Fire departments intervened in five.

What if, instead, over 900 lives had been lost over the past 12 years ?
For example:

(1) Aug 8, 2000, AirTran DC-9-32 – fire and blistering of aircraft skin, 63 on board.

(2) Nov 29, 2000, a DC-9-32 by AirTran (97 on board).

(3) Same Day, Nov 29, 2000, a DC-9-82, American Airlines (66 on board) ,
blankets burned, emergency evacuation on taxiways – 97 on board”.

(4) June 28, 2008, ABX 767 freighter burned through the fuselage and was destroyed at the gate, (“The risk of an in-flight fire and the propagation of a fire in those areas is essentially the same whether the airplane is equipped to fly passengers or cargo” says the FAA). Approximate 767 capacity is 190 people.

(5) July 29 2011, Egypt Air 777, fire erupted and burned a cockpit-widow
sized hole through the fuselage. Emergency services put the fire out – 291 passengers were evacuated.

(6) On October 14, 2012, a Corendon Airlines 737-800 had “substantial damage” from fire in the cockpit on the gate. 196 on board were evacuated. Had these fires broken at altitude or during the trans-oceanic crossing, all on board may have been lost.

For the sum each of these fires found in the NTSB’s accident/incident database, over 900 lives were not lost. A more honest assessment and the credit for this remarkable safety record of no fatalities was not the FAA and industry abilities to manage and ‘mitigate risks’ – but rather the kindness of Lady Luck. But what can happen when lady Luck turns away ?

Cessna, Crash, NTSB, USA

Engine Fault Caused Palatka Plane Crash: NTSB

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PalatkaThe National Transportation Safety Board has released the preliminary report on Palatka plane crash incident that happened on March 21.

According to the report, the pilot was preparing to land when he saw other planes passing by. So he altered the plane’s position in order to provide sufficient space between his and other planes heading to the runway. However, when he finally attempted to go around and screwed the throttle in, the engine stopped working.

The Cessna LC41-550FG was carrying two persons: the 73 year old pilot Richard Carrara and 71 year old Malcolm Clevenstine. Clevenstine died March 22, while the pilot has survived with serious injuries.

This post is an update of ‘ Private Cessna Airplane Crashes near Jacksonville‘


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Boeing, FAA, McDonnell Douglas, NTSB

MCDonnell Douglas MD 11 Recommendations

    From the NTSB to the FAA to an MD-11 near you:

    • Work with Boeing to (1) assess the effectiveness of flare cueing systems to assist MD-11 pilots in making timely and appropriate inputs during the landing flare
    • (2) provide a formal report on the findings of the assessment, and
    • (3) if the assessment shows that flare cueing systems could be useful to MD-11 pilots, provide copies of the report to all US operators of MD-11 airplanes and encourage them to install such a system on these airplanes.
    • Work with Boeing to (4) assess methods for providing weight-on-wheels cueing to MD-11 pilots to enhance pilot awareness of bounced landings and facilitate proper pilot reaction and effective control inputs when bounced landings occur,
    • (5) provide a formal report on the findings of the assessment, and
    • (6) if the assessment shows that the weight-on-wheels cueing methods could be useful to MD-11 pilots, provide copies of the report to all US operators of MD-11 airplanes and encourage them to provide a means for weight-on-wheels cueing for these airplanes. (A-14-005)
    • Work with Boeing to (7) evaluate the effect of brief power increases on simulated MD-11 landing distances, adjust the values in published MD-11 landing distance tables accordingly, andprovide the adjusted values to MD-11 operators. (A-14-006)

Asiana Airlines, Boeing, Crash, NTSB, USA

Asiana Airlines Plane Crash Update: Plane was Flying too Slow

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sanfranciscoRecent documents released by the federal investigators reveal Asiana Airlines’ stance on the San Francisco plane crash that happened on July 6, last year.

The documents are a part of the report submitted by Asiana Airlines to the National Transportation Safety Board (NTSB). In the report, the airline has acknowledged that the slow speed of plane was probably a cause of accident, and the irregularities in the Boeing 777-200ER’s autothrottle contributed to some extent. The plane’s navigation equipment was showing the autothrottle to be upholding the set speed, when in fact the equipment had disabled the minimum airspeed protection function of the aircraft.

Boeing has maintained in their report submitted to the NTSB that all the components and functions of the aircraft were working properly and did not contribute to the crash.

The incident happened when the flight was en route from Taipei to San Francisco. Three lives were lost while 200 were injured.

Recently Asiana Airlines admitted the pilot was flying too slowly.

The post is an update of:
Breaking News: Asiana Airlines Crash in San Francisco
NTSB Issues Investigative Update on Crash of Asiana Flight 214
Before Crash, Asiana Airlines Told to Revamp
Update on Asiana Crash
Asiana Crash Updated
Asiana Flight 214 Investigative Hearing Postponed
Automated Cockpit Props up Undertrained Pilots

Crash, FAA, NTSB, USA

Single Engine Plane Crashes Near Montrose

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Reservoir

Five people are feared dead after a single engine plane crashed in Ridgeway Reservoir Colorado.

The incident happened in the south of Montrose at 1:50 pm on March 22, 2014. The plane was on its way to Montrose regional airport from Oklahoma. Investigators believe that none of the five passengers survived, although no victims have been found yet.

Rescue and search efforts are still in progress, whereas a team of divers is recovering the parts of plane from water. NTSB and FAA will be investigating the incident.


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Malaysia Airlines, NTSB

Former MD, NTSB Criticizes Malaysia’s Handling of Airplane Disappearance Crisis

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According to Peter Goelz ,former managing director of the United States National Transportation Safety Board (NTSB), Malaysia has not abided by the protocols of the Convention on International Air Transportation, in handling the Malaysia Airlines’ (MAS) MH370 disappearance crisis.

In a recent interview, he regarded Malaysia’s conduct in this case as ‘the worst he has ever seen’.

Boeing, NTSB

NTSB Report Blames Clear Air Turbulence for United Airline Flight Injuries

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The National Transportation Safety Board (NTSB) has released the preliminary investigation report on the February 17 incident of United Airlines Flight 1676, flying from Denver-to-Billings, which suddenly started to jolt, injuring many passengers.

According to the report, the airplane was in cruise flying mode at an altitude of 34,000 feet, when it ran into extreme clear air turbulence and resulted in several injuries. The report further elaborates that among 114 passengers and flight crew, 2 were seriously injured while 9 were hospitalized with minor injuries.

The Boeing 737-700 was also damaged and was taken to United maintenance facility in Houston.

Airbus, Crash, hearing, NTSB, Official Report, UPS, USA, Video

Automation at Fault?

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Here’s the question: do pilots rely too much on automation? This question has been on my mind since hearing the parallels between the UPS Cargo jet crash and the Asiana passenger jet crash. This is on my mind not only as one who works toward aviation safety but also as a very frequent flyer. You can only imagine how my work carries me into international situations. I don’t fly as frequently as a pilot, but sometimes I fly internationally several times a month. I am on these planes frequently. I rely on them.

So I find it disturbing that the NTSB’s hearing Thursday revealed parallels between the crash of UPS Flight 1354 and Asiana Filght 214. While I don’t know the answers, I can only hope the investigation shines light on ways to deal with this problem. What is the solution? Less reliance on Automation? Better training for pilots?

On the other side of the coin, some parties will want even more automation, but I am reluctant to go in that direction. The idea of even more reliance on automation is anathema to me because the engineers and advocates of reliance on even more automation will not be on those even-more automated planes. While the technology and/or training will be on the chopping block, their actual necks won’t be.

What I don’t find disturbing is the professionalism of the hearings. The webcast is well worth watching.

The hearing webcast is recorded here: http://ntsb.capitolconnection.org/022014/ntsb_archive_flv.htm

Note the NTSB cautions participants in the hearing not to engage the media and to stick to the facts.

Or the recorded captions (unformatted) are here.
https://airflightdisaster.com/wp-content/uploads/2014/02/ntsb022014.htm.pdf

bio docket: https://airflightdisaster.com/wp-content/uploads/2014/02/biodocket.pdf


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Event, Expo, Helicopter, NTSB

Safety First: Aviation Lessons Learned

 

We at Air Flight Disaster are always trying to learn from our mistakes, and your mistakes and everyone’s mistakes. Which is why we would applaud the following Helicopter Expo event “Lessons Learned from Helicopter Accident Investigations” even if Air Safety wasn’t our business.

Pilots and interested parties wanting to learn lessons from recent helicopter accidents should pay attention to the following event:

2014 HAI Rotor Safety Challenge

Event: Lessons Learned from Helicopter Accident Investigations

Date/Time: Monday, February 24, 8:00 am to 12:00 p.m. (PST)

Location: Anaheim Convention Center (Ballroom C, Level 3), 800 W Katella Ave, Anaheim, CA 92802

Participants: Vice Chairman Christopher Hart and NTSB senior air safety investigators

Senior investigators from the National Transportation Safety Board will hold a training session about the lessons that have been learned from several recent helicopter accident investigations at the 2014 Helicopter Association International’s Heli-Expo in Anaheim, Calif., next week.
Investigators will present case studies that emphasize NTSB safety recommendations related to helicopter maintenance, flight simulators, and flight recorders. The case studies will be followed by industry-led panel discussions on best practices in the industry. NTSB Vice Chairman Christopher Hart will provide opening remarks for the session.

The preliminary schedule is posted below:


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NTSB, press release

Media Availability with NTSB Chairman Deborah A.P. Hersman

 

NTSB Chairman Deborah A.P. Hersman will take questions from the media after today’s investigative hearing on the crash of UPS Airlines Flight 1354, which crashed on approach to Birmingham-Shuttlesworth International Airport on Aug. 14, 2013.
Date/Time: Thursday, Feb. 20, 2014 at 5:45 p.m.EST

Location: Hearing Room A/B, next to the NTSB Boardroom where the hearing is taking place.
Address: 429 L’Enfant Plaza, SW
Washington, DC 20594

Participant: NTSB Board Chairman Hersman

Airbus, Aviation Attorney, Crash, hearing, NTSB, Official Report, Public Statement, USA

UPS Flight 1354 Agenda and Media Logistics for Investigative Hearing

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The National Transportation Safety Board today released the agenda for the investigative hearing on the ongoing investigation into the Aug. 14, 2013 crash of UPS Airlines flight 1354, an Airbus A300-600, on approach to Birmingham-Shuttlesworth International Airport in Birmingham, Ala.

The hearing will be held February 20 at the NTSB’s Board Room and Conference Center at 429 L’Enfant Plaza SW in Washington and begins at 8:30 a.m.

Hearing witnesses, including representatives of the Federal Aviation Administration, Airbus, UPS Airlines, Independent Pilots Association and the Transport Workers Union will testify and answer questions from NTSB Board members, technical staff, and parties about non-precision approaches, human factors and flight dispatch issues. The agenda, list of panel witnesses, biographies and other related information is available at the hearing event page at http://www.ntsb.gov/news/events/2014/ups1354_hearing/index.html

Investigative exhibits for the hearing will be placed in the electronic docket at the start of the hearing and will also be available on the hearing event page once the hearing begins.

NTSB Chairman Deborah A.P. Hersman will be available to answer questions from the media at the conclusion of the hearing. Additional details about the availability will be included in an advisory on Wednesday.

Television coverage of the proceedings will be by network pool provided by CNN. Escorted cutaway for video media will be permitted for brief periods throughout the hearing. Still photographers will be permitted in the seating area of the Board Room and by escort to areas in front of the witness panels.

Because of construction at and around L’Enfant Plaza, satellite and other media trucks will have to check in for parking and running cable through the construction zone. Please RSVP to eric.weiss@ntsb.gov by Feb. 19. Media access to the Board Room is available beginning at 7:30 a.m.

A media room is also available with tables, chairs and an audio mult box. Generally-accepted media credentials will be required for access to the media room. In addition, a fully equipped overflow room has been established and will serve as a storage area for video equipment during the hearing.

Seating for the general public in the Board Room is on a first-come, first-served basis. The hearing will be webcast live. Access to the webcast can be found at www.ntsb.gov.

===
The National Transportation Safety Board has scheduled an investigative hearing on February 20 into the crash of a UPS Airbus A300-600 on approach to Birmingham-Shuttlesworth International Airport in Birmingham, Ala., on Aug. 14, 2013.

The two flight crew members were killed and the airplane was destroyed when it impacted the ground less than a mile short of Runway 18. The cargo flight had originated from Louisville, Ky. Runway 18 was being used because the main runway at the airport was closed for repairs at the time of the airplane’s arrival.

The one-day hearing will examine:

Execution of non-precision approaches, including initial and recurrent training, adherence to standard operating procedures, and proficiency
Human factors issues associated with effective crew coordination and resource management applicable to this accident, including decision-making, communication, fatigue and fitness for duty, as well as monitoring and cross-checking, policies, standard operating procedures, guidance, and training provided to UPS crewmembers.
Dispatch procedures, including the training, evaluation, roles and responsibilities of UPS dispatchers and the limitations of dispatch-related software.
The investigation is ongoing and this hearing will develop additional facts to support the investigation. The hearing will be held in the NTSB Board Room and Conference Center in Washington, D.C. A detailed agenda and a list of attendees will be forthcoming.

Parties to the hearing will include the Federal Aviation Administration, UPS, Airbus, the Independent Pilots Association and the Transport Workers Union. The accredited representative from the French Bureau d’Enquêtes et d’Analyses pour la sécurité de l’aviation civile (BEA) will participate on the technical panels.

The determination of the probable cause of the crash will be released when the investigation is complete. Just prior to the start of the hearing, the public docket will be opened. Included in the docket are photographs, interview transcripts and other documents.

____________________________________________________________________________________________

NTSB public events are also streamed live via webcast. Webcasts are archived for a period of three months from the time of the meeting. Webcast archives are generally available by the end of the event day for public Meetings, and by the end of the next day for Technical conferences.

If you wish to obtain a copy of NTSB meetings, please contact the NTSB Records Management Division at (202) 314-6551 or 800-877-6799. You may also request this information from the NTSB web site or write the following: National Transportation Safety Board, Records Management Division (CIO-40), 490 L’Enfant Plaza, SW,Washington, DC 20594.


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Airbus, Crash, NTSB, press release, USA

NTSB to Hold Investigative Hearing Into August 2013 UPS A300 crash in Birmingham, Ala.

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NTSB to Hold Investigative Hearing Into August 2013 UPS A300 crash in Birmingham, Ala.

Jan. 30, 2014
WASHINGTON – The National Transportation Safety Board has scheduled an investigative hearing on February 20 into the crash of a UPS Airbus A300-600 on approach to Birmingham-Shuttlesworth International Airport in Birmingham, Ala., on Aug. 14, 2013.
The two flight crew members were killed and the airplane was destroyed when it impacted the ground less than a mile short of Runway 18. The cargo flight had originated from Louisville, Ky. Runway 18 was being used because the main runway at the airport was closed for repairs at the time of the airplane’s arrival.
The one-day hearing will examine:
• Execution of non-precision approaches, including initial and recurrent training, adherence to standard operating procedures, and proficiency
• Human factors issues associated with effective crew coordination and resource management applicable to this accident, including decision-making, communication, fatigue and fitness for duty, as well as monitoring and cross-checking, policies, standard operating procedures, guidance, and training provided to UPS crewmembers.
• Dispatch procedures, including the training, evaluation, roles and responsibilities of UPS dispatchers and the limitations of dispatch-related software.
The investigation is ongoing and this hearing will develop additional facts to support the investigation. The hearing will be held in the NTSB Board Room and Conference Center in Washington, D.C. A detailed agenda and a list of attendees will be forthcoming.
Parties to the hearing will include the Federal Aviation Administration, UPS, Airbus, the Independent Pilots Association and the Transport Workers Union. The accredited representative from the French Bureau d’Enquêtes et d’Analyses pour la sécurité de l’aviation civile (BEA) will participate on the technical panels.
The determination of the probable cause of the crash will be released when the investigation is complete. Just prior to the start of the hearing, the public docket will be opened. Included in the docket are photographs, interview transcripts and other documents.


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Crash, Embraer, LAM Linhas Aéreas de Moçambique., Mozambique, Nambia, NTSB

Slow ID in November 2013 LAM Crash

 

Identification of the remains of those aboard the LAM Embraer-190 that crashed en route from Maputo to Luanda is moving at a snails pace. Sixteen of the 33 fatalities have been identified, mostly, according to police reports, by fingerprint evidence.

The scientists who are making the identification are working with fragments.

I am not a scientist, and it does not appear that the scientists in this case are using DNA identification. But I did uncover an article here where a forensic scientist explicitly lists the time it takes for DNA identification. This reference might prove useful in providing some kind of framework to the families who are waiting for remains of their recently lost family members to be identified if the Mozambique investigation turns to DNA identification. The families have been waiting since the date of the crash, 29 November 2013.

The cockpit voice recorder (CVR) and the flight data recorder (FDR), were recovered from the crash site within four days of the crash. But the preliminary report only says:

NTSB Identification: DCA14RA018
Accident occurred Saturday, November 30, 2013 in Rundu, Namibia
Aircraft: EMBRAER ERJ190 – UNDESIGNAT, registration:
Injuries: 33 Fatal.
This is preliminary information, subject to change, and may contain errors. The foreign authority was the source of this information.

The Namibia Ministry of Works and Transport (MWT) has notified the NTSB of an accident involving an Embraer ERJ-190 that occurred on November 30, 2013. The NTSB has appointed a U.S. Accredited Representative to assist the MWT investigation under the provisions of ICAO Annex 13 as the State of Manufacturer and Design of the engines.

All investigative information will be released by the MWT.

Read more

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Boeing, Japan Airlines, NTSB

NTSB PARTICIPATING IN JAPAN’S INVESTIGATION OF B-787 BATTERY SMOKE EVENT

A maintenance crew observed a Japan Air Lines Boeing 787-8 Dreamliner at Tokyo-Narita Airport with white smoke coming from the lithium-ion batteries when one of eight cells started leaking. The euphemism used by the media was “venting gas.” No passengers were aboard and the plane was parked undergoing maintenance when it occurred but 158 passengers scheduled to fly on it were provided a different plane.

Press Release
The National Transportation Safety Board will participate in the investigation of a smoke event involving the main battery of a Japan Airlines B-787 that occurred while the aircraft was parked at Tokyo’s Narita Airport on Jan. 14.

The investigation is being led by the Japan Civil Aviation Bureau. NTSB aircraft systems investigator Mike Bauer will travel to Japan to assist with the investigation.

Boeing, fire, Lithium Ion battery, NTSB

NTSB PROVIDES UPDATE ON BOEING 787 BATTERY FIRE INVESTIGATION



WASHINGTON – The investigative work into the Jan. 7, 2013, fire aboard a Japan Airlines Boeing 787 at Logan International Airport in Boston, is estimated to be completed by the end of March, the National Transportation Safety Board said today. The analytical and report writing phase of the investigation will follow the completion of the investigative activities. The final report is expected to be presented to the Board at a public meeting in Washington in the fall.

Members of the investigative team have been conducting work in the United States, Japan, France, and Taiwan. As the investigation has progressed, the NTSB has been working closely with Boeing, the Federal Aviation Administration, the Japan Transport Safety Bureau, the French BEA, and technical advisors from Japan and France.

Some of the investigative activities include:

– Completed disassembly and documentation of the individual cells of the incident battery.

– Completed examinations of exemplar batteries and battery cells for baseline reference and comparison to the incident battery. These examinations were conducted at NTSB and independent laboratories and included computed tomography scans, non-destructive soft short testing, and destructive evaluation and analysis of the batteries and cells.

– Awarded a contract to Underwriter’s Laboratories to assist the NTSB in defining and performing system-level tests of the Boeing 787 battery and charging system. The testing includes characterization of the thermal and electrochemical properties of the battery and oscillatory testing and is expected to be completed in February.

– Radiographic studies, which included over 200,000 CT scan images, were conducted to examine and document the internal configuration of individual cells from the incident and exemplar batteries.

– Conducted interviews with FAA, Boeing, Thales, and GS Yuasa personnel to review and document key steps, personnel roles and responsibilities, data and information flow, design artifacts, and approvals in the certification process for the battery and charging system.

– Evaluated and documented the process for the battery system safety assessment, including a review of the supporting tests and analysis performed and the safety analysis standards relevant for lithium-ion batteries.

– Conducted on-site survey of battery manufacturing facility in Japan including a review of design, engineering, and production documentation, as well as manufacturing processes, procedures, and training for personnel involved in the manufacture of the battery.

The date of the Board meeting at which the findings of the investigation will be released, including the probable cause of the battery fire, will be announced later in the year.


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NTSB, Public Statement, USA

NTSB ISSUES FIVE NEW GENERAL AVIATION SAFETY ALERTS

 


The National Transportation Safety Board issued five new Safety Alerts last week that provide general aviation (GA) pilots with mitigating strategies for preventing accidents. These Safety Alerts follow five that were issued in March at a Board Meeting that focused on the most frequent types of general aviation accidents.

“Knowing these accidents, which sometimes include entire families, can be prevented is why ‘General Aviation Safety’ is on our Most Wanted List of transportation safety improvements,” said NTSB Chairman Deborah A.P. Hersman. “At a time when many people are putting together their list of resolutions for the coming year, these five Safety Alerts remind pilots, mechanics and passengers of basic safety precautions to add to their checklists to ensure a safe flight for all on board.”

A Safety Alert is a brief information sheet that pinpoints a particular safety hazard and offers practical remedies to address the issue.

The five Safety Alerts issued last week are:

• Check Your Restraints
• Engine Power Loss Due to Carburetor Icing
• “Armed” for Safety: Emergency Locator Transmitters
• All Secure, All Clear (securing items in the aircraft cabin)
• Proper Use of Fiber or Nylon Self-Locking Nuts

The NTSB is charged with investigating about 1,500 aviation accidents annually. Each year, about 475 pilots and passengers are killed and hundreds more are seriously injured in GA accidents in the United States.

Asiana Airlines, Boeing, California, Crash, Editorial, NTSB, USA, Video

Automated Cockpit Props up Undertrained Pilots

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The Asiana investigation continues.

Back in July, the pilot who was insecure about making a visual approach in a 777 crashed at San Francisco International Airport on a visual approach in Asiana Flight 214’s Boeing 777. Specifically, he told NTSB investigators “it was very difficult to perform a visual approach with a heavy airplane.” The glideslope was not working at the San Francisco airport, and that was an instrument the (*undertrained) pilot was relying on. The plane came in so low the tail struck the seawall and broke off. The video below shows the plane rotate 360 degrees and catch fire by the runway.

New Asiana Crash Video

Video with news commentary

Before impact, the relief pilot in the jump seat repeated several times “sink rate” trying to warn the pilots at the controls that the jet was too quickly losing altitude. One of the pilots said “It’s low.” Then there was a stick shaker alert (which occurs when the plane is about to stall from flying too slowly. I once had a pilot do a presentation that included the disturbing grinding of the stick shaker alarm as it violently vibrated the control yoke. It’s an alarming direction to the pilots to increase thrust.)

When the stick shaker went off, the instructor called for a go around. It went off four seconds before impact. It was too late.

Both the instructor and the captain were relying on the auto throttle, and both were unaware it was off.

In George’s Point of View

I do not know how anyone can watch the surveillance video of the Asiana crash and not marvel that of the three hundred and seven people aboard the plane, there were only three deaths.

I’m not discounting the wounds of the injured, nor those three deaths, nor the tragedy of one of the teen victims being run over by an airport crash tender. (That’s a whole tragedy by itself—who knows if she might have survived but for being so obscured by foam that she was not visible to crash responders—through the firemen who carried her out surely must have known she was there.)

A dozen critically injured, a hundred-sixty-nine injured, but only three deaths.

It’s nothing short of a miracle. Especially on inspecting the condition of the burned out shell of the hull. Especially on reviewing the just-released surveillance video that shows the plane splintering after impacting the firewall, cartwheeling like a crippled gymnast down the runway and dissolving into a cloud of dust and flame. No jet fuel fire here——leaking oil ignited as it poured on to a hot engine.

The Kazan crash (Tatarstan Airlines Flight 363) from November 17th is fresh in my mind. Everyone aboard–fifty people (forty-four passengers and six crew) all died. The plane just fell from the sky while landing at an impossible 75-degree-nose-down attitude, piloted by a pilot whose license is apparently fake. Everyone in that crash died. (Tatarstan surveillance below.)

Of course one can see the physics—that everyone on the Tatarstan flight received the full direct impact, versus how the rolling of the Asiana plane dispersed some of the impact energy. Still, there is tremendous force in a crash.

I know I should be talking about pilot training, because this is yet another crash that appears to be due to pilots becoming too dependent on technology. But I will focus on that another day. Right now, I am overwhelmed after looking at the crash tape.

Asiana—Cartwheeling Catastrophe
I am surprised that I have neither heard or seen choruses of amazement that all but three people survived the rolling catastrophe in San Francisco. Some credit should perhaps go to the rescue crew, quick actions of the cabin crew, performance of the emergency slides, and maybe even the aerodynamics of the 777 whose seats are required to withstand 16g of dynamic force.

Sure, there was error involved in this crash, but when you look at the survival rate, some credit is due to the 5.5 billion Boeing put into research, development and safety of the 777.

Asiana Airlines, Boeing, NTSB

Asiana Flight 214 Investigative Hearing Postponed


Asiana Flight 214 Investigative Hearing Rescheduled

The National Transportation Safety Board’s Investigative Hearing into the crash landing of Asiana Airlines Flight 214 originally scheduled for December 10, has been postponed due the government closing because of inclement weather in the Washington DC area.

The agenda for the previously scheduled two-day hearing has been slightly revised so that the hearing can be completed in one day. It is expected that the hearing will run until 8:00 p.m.

The hearing will be held at the NTSB’s Board Room and Conference Center at 429 L’Enfant Plaza SW in Washington. Directions to the Board Room are available at www.ntsb.gov/about/conference_center.html.

The revised agenda can be found below:


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FAA, NTSB, USA

Training! Training! Training!

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The NTSB was discussing safety measures in late October, especially pilot training before stalls. The new rule has been a long time coming. Earl Weener, a member of the National Transportation Safety Board, talked about the serious history of pilots wrongly pulling the plane’s nose up till the plane fell to the ground. If training is part of the problem, then at least that is a lack that can be amended.

Only twenty-six percent of pilots train for high altitude stalls, but according to a NASA study, twenty-eight percent of stalls are high altitude stalls. Seventy-one percent of stalls happen while autopilot is on.

In early November we heard how the FAA unveiled a rule about pilot training to avoid stalling airliners. It came about because of four crashes: Those crashes were Colgan 3407 in 2009, Air France 447 in June 2009, Pinnacle Airlines 3701 in October 2004 and USAir 427 in September 1994. (Too bad there have to be stall issues before stall training came to the attention of officials.) In the February 2009 crash of Colgan Air, it was determined that the pilots–as in the three other flights–in the midst of a blizzard in Buffalo pulled up on the nose of the plane, causing the crash. A meeting of air safety leaders in late November has jump-started the plans. Though something that has taken so long in the works can hardly said to be jump—started.

The powers that be sound positive about the new rule.

The FAA speculates training will save nearly seven million because of prevention—at a program cost of $274 million. Within five years this will mean:

  • Better ground and flight recovery training
  • Better pilot flight monitoring each other
  • Better runway safety protocols
  • Better crosswind training.

I have been beating a drum for a long time about obvious solutions to obvious problems. Yes, things may fail, but why not implement preventative measures where available? So now rather than my usual battle-cry: Maintenance! Maintenance! Maintenance! Maybe I will be saying Training! Training! Training! I am looking forward to increased safety brought about by this new rule.

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