The Top 10 Leading Causes of Fatal General Aviation Accidents 2001-2011
1. Loss of Control Inflight
2. Controlled Flight Into Terrain
3. System Component Failure – Powerplant
4. Low Altitude Operations
5. Unknown or Undetermined
6. Other
7. Fuel Related
8. System Component Failure – Non-Powerplant
9. Midair Collisions
10. Windshear or Thunderstorm
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‘
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.
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.
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.
Scheduled 14 CFR Part 121: Air Carrier operation of UNITED AIR LINES INC
Accident occurred Friday, February 19, 2010 in Anchorage, AK
Probable Cause Approval Date: 02/23/2017
Aircraft: BOEING 747, registration: N173UA
Injuries: 1 Serious, 25 Minor, 236 Uninjured.
NTSB investigators used data provided by various entities, including, but not limited to, the Federal Aviation Administration and/or the operator and did not travel in support of this investigation to prepare this aircraft accident report.
On February 19, 2010, about 1452 Alaska standard time (AKST) (2352 UTC), United Airlines flight 897, a Boeing 747-400, N173UA, encountered severe turbulence during cruise descent between FL310 and FL300 about 100 miles west of Anchorage, Alaska. Of the 243 passengers and 19 crew members on board, 17 passengers and eight flight attendants (FA) received minor injuries and one FA received a serious injury. The airplane received minor damaged. The flight was operating under 14 Code of Federal Regulations (CFR) part 121 as a regularly scheduled international passenger flight from Dulles International Airport (IAD), Washington, DC, to Narita International Airport (NRT), Narita, Japan.
Prior to the turbulence encounter, the flight crew received pilot reports (PIREPs) of moderate to severe turbulence above FL340 and that it was less at FL300. According to the flight crew, about one hour late, the flight began to encounter a few “light bumps” or intermittent light “chop.” The sky conditions were clear with good visibility. The captain turned on the “fasten seat belt” sign and made a public address (PA) announcement to fasten seat belts. The flight crew requested a descent to FL300 and began to encounter moderate turbulence after starting the descent. The first officer then made a PA announcement directing the flight attendants to “take your seats.” The autopilot remained engaged throughout the turbulence encounter, which lasted less than one minute.
After encountering the turbulence, the crew assessed airplane damage and checked the number and severity of injuries to passengers and crew. The crew was assisted in assessing passenger and crew injuries by a U.S. Army Special Forces medic who stated that all of the injuries were considered minor. All the FAs indicated that they were able to perform their required emergency duties for the remainder of the flight.
After discussing the injuries and the available diversion airports with the FAs, company dispatch and the medic, the flight crew decided to continue on to NRT since there were sufficient diversion airports along the route if the situation worsened.
Upon arrival in NRT, 16 passengers and one FA were transported to hospitals for medical evaluation. All were released with only minor injuries, however, the FA was re-evaluated by her personal physician when she returned home with the further diagnosis of a fractured rib.
Both Airbus and Boeing say the designs for their litium-ion systems are safe, in spite of known risk of flames, explosion, smoke and leakage.
Those are some pretty hefty “known” risks.
Now ANA says that prior to the fire, it had replaced batteries on its 787 aircraft some 10 times because of low charges.
Now the Kanto Aircraft Instrument Co whose system monitors voltage, charging and temperature of lithium-ion batteries is also under scrutiny, in addition to GS Yuasa who makes the batteries.
The National Transportation Safety Board is conducting a chemical analysis of internal short circuiting and thermal damage of the battery.
NTSB ISSUES SIXTH UPDATE ON JAL BOEING 787 BATTERY FIRE INVESTIGATION
January 29, 2013
WASHINGTON – The National Transportation Safety Board today released the sixth update on its investigation into the Jan. 7 fire aboard a Japan Airlines Boeing 787 at Logan International Airport in Boston.
The examination of the damaged battery continues. The work has transitioned from macroscopic to microscopic examinations and into chemical and elemental analysis of the areas of internal short circuiting and thermal damage.
Examination and testing of the exemplar battery from the JAL airplane has begun at the Carderock Division of the Naval Surface Warfare Center laboratories. Detailed examinations will be looking for signs of in-service damage and manufacturing defects. The test program will include mechanical and electrical tests to determine the performance of the battery, and to uncover signs of any degradation in expected performance.
As a party contributing to the investigation, Boeing is providing pertinent fleet information, which will help investigators understand the operating history of lithium-ion batteries on those airplanes.
An investigative group continued to interpret data from the two digital flight data recorders on the aircraft, and is examining recorded signals to determine if they might yield additional information about the performance of the battery and the operation of the charging system.
In addition to the activities in Washington, investigators are continuing their work in Seattle and Japan.
August 27, 2012
WASHINGTON – The National Transportation Safety Board determined today that deteriorated locknut inserts found in the highly modified North American P-51D airplane that crashed during the 2011 National Championship Air Races in Reno, Nevada, allowed the trim tab attachment screws to become loose, and even initiated fatigue cracking in one screw. This condition, which resulted in reduced stiffness in the elevator trim system, ultimately led to aerodynamic flutter at racing speed that broke the trim tab linkages, resulting in a loss of controllability and the eventual crash.
On September 16, 2011, as the experimental single-seat P-51D airplane “The Galloping Ghost,” traveling about 445 knots, or 512 mph, in the third lap of the six-lap race, passed pylon 8, it experienced a left-roll upset and high-G pitch up. During the upset sequence, the airplane’s vertical acceleration peaked at 17.3 G, causing incapacitation of the pilot. Seconds later, a section of the left elevator trim tab separated in flight. The airplane descended and impacted the ramp in the spectator box seating area, killing the pilot and 10 spectators and injuring more than 60 others.
“In Reno, the fine line between observing risk and being impacted by the consequences when something goes wrong was crossed,” said NTSB Chairman Deborah A. P. Hersman. “The pilots understood the risks they assumed; the spectators assumed their safety had been assessed and addressed.”
Contributing to the accident were the undocumented and untested major modifications made to the airplane, as well as the pilot’s operation of the airplane in the unique air racing environment without adequate flight testing.
The nearly 70-year-old airplane had undergone numerous undocumented modifications. The modifications, designed to increase speed, included shortening of the wings, installation of a boil-off cooling system for the engine, increasing the elevator counterweights, modification of the pitch trim system, and changing the incidence of the horizontal and vertical stabilizers.
Although the Federal Aviation Administration required that a flight standards district office be notified in writing of any major changes made to The Galloping Ghost before it could be flown, investigators could find no records that such notifications were made except for the installation of the boil-off cooling system. The undocumented major modifications were identified through wreckage examinations, photographic evidence, and interviews with ground crewmembers.
In April, while the investigation was ongoing and after the NTSB’s investigative hearing in January on air race and air show safety, the NTSB issued 10 safety recommendations to the Reno Air Racing Association, the National Air racing Group Unlimited Division, and the FAA. These recommendations addressed:
Although no additional safety recommendations were issued today, the Board reclassified nine existing recommendations as described below:
A tenth safety recommendation, issued to the FAA, which addressed air race and course design guidance was reclassified as “Open—Acceptable Response” on July 25, 2012.
“It’s good news for the air races that so many of our recommendations have been addressed,” said Chairman Hersman. “We will continue to push for the full implementation of all of our safety recommendations.”
The National Transportation Safety Board makes the following recommendation to the Federal Aviation Administration:
Require repetitive inspection of Engine Components, Inc. cylinder assemblies produced between May 2003 and October 2009 (serial numbers 7709 through 52884) installed on Teledyne Continental Motors model 520 and 550 engines and removal of these cylinder assemblies once they reach the engine manufacturer’s recommended normal time (hours) in service between overhauls. (A-12-7)
