Aviation Accident Summaries

Aviation Accident Summary DCA96MA029

JAMAICA, NY, USA

Aircraft #1

N605FF

Boeing 747-136

Analysis

The captain initiated a takeoff on runway 4L, which was covered with patches of ice and snow. The wind was from 330 degrees at 11 knots. Before receiving an 80-knot call from the 1st officer, the airplane began to veer to the left. Subsequently, it went off the left side of the runway and collided with signs and an electric transformer. Investigation revealed evidence that the captain had overcontrolled the nosewheel steering through the tiller, then applied insufficient or untimely right rudder inputs to effect a recovery. The captain abandoned an attempt to reject the takeoff, at least temporarily, by restoring forward thrust before the airplane departed the runway. The current Boeing 747 operating procedures provide inadequate guidance to flightcrews regarding the potential for loss of directional control at low speeds on slippery runways with the use of the tiller. Current Boeing 747 flight manual guidance was inadequate about when a pilot should reject a takeoff following some indication of a lack of directional control response. Improvements in the slippery runway handling fidelity of flight simulators used for Boeing 747 pilot training were considered to be both needed and feasible. (See: NTSB/AAR-96-04 for detailed information.)

Factual Information

On December 20, 1995, at 1136 eastern standard time, a Boeing 747-136, N605FF, operated by Tower Air, Inc., sustained substantial damage during an aborted takeoff at the John F. Kennedy International Airport, Jamaica, New York. The two airline transport rated pilots and one flight engineer were not injured; nor were there injuries to eleven of the flight attendants or two cockpit jump seat occupants. One flight attendant received serious injuries. There were 24 minor injuries among the 441 passengers. Instrument meteorological conditions prevailed, and an IFR flight plan was filed for the flight, which was destined for Miami, Florida. The passenger/cargo flight was being conducted under 14 CFR Part 121. The airplane, Flight 41, was de-iced at the gate, prior to passenger boarding. It was towed from the gate about 1036, and de-iced again, prior to commencing taxiing. Flight 41 was cleared to taxi to runway 4L, which was the active runway for departures, while snow removal was in progress on runway 31. Flight 41 was cleared for takeoff at 1136. Shortly after initiating the takeoff, the pilot reported that the airplane veered to the left of centerline. He attempted to correct the change in direction with rudder and steering tiller, but the airplane continued to turn left. The airplane exited the left side of the runway about 2100 feet from the start of the takeoff roll. The pilot stated that he initiated an aborted takeoff before the airplane exited the side of the runway, by retarding the throttles to idle and applying maximum braking. After the airplane departed the runway, the number 4 engine impacted a concrete structure, containing electrical wires, and the entire pylon separated from the wing. As the airplane continued in soft terrain, the right wing landing gear and nose gear collapsed. The airplane came to rest between two taxiways, approximately 4800 feet from the start of the takeoff roll. The captain determined that there was no sign of fire and the injuries to passengers were not serious; therefore, he elected to not order an emergency evacuation. The removal of passengers was conducted in an orderly manner by airport personnel. Runway 4L had been plowed and sanded about 1.5 hours prior to the accident, and an estimated 22 aircraft had departed on that runway. The wind was reported from the control tower as 330 degrees at 11 knots, as Flight 41 was cleared for takeoff. The pilot reported that he was able to see the runway centerline during line-up, even though there was packed snow covering portions of the runway. Additional Persons (Continued) Michael Young Pratt & Whitney 400 Main Street M/S162-24 East Hartford, CT 06106 Mr. Chris Witkowski Association of Flight Attendants 1625 Massachusetts Ave., NW Washington, DC 20036-2212

Probable Cause and Findings

the captain's failure to reject the takeoff in a timely manner when excessive nosewheel steering tiller inputs resulted in a loss of directional control on a slippery runway. Inadequate Boeing 747 slippery runway operating procedures developed by Tower Air, Inc., and the Boeing Commercial Airplane Group and the inadequate fidelity of B-747 flight training simulators for slippery runway operations contributed to the cause of this accident. The captain's reapplication of forward thrust before the airplane departed the left side of the runway contributed to the severity of the runway excursion and damage to the airplane.

 

Source: NTSB Aviation Accident Database

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