Aviation Accident Summaries

Aviation Accident Summary ATL96IA056

SAVANNAH, GA, USA

Aircraft #1

N936VV

McDonnell Douglas DC-9-32

Analysis

The flight was issued radar vectors for a visual approach to runway 36. The before landing checklist was completed, and all aircraft systems were operational for the landing. The flight crew reported that the airplane touched down approximately 2,500 feet from the threshold of the 7003 foot long concrete runway. During the landing roll, the first officer, who was flying the airplane, applied normal braking, but the airplane did not decelerate as expected. When the captain realized that the airplane was not decelerating, he took the flight controls and applied heavy braking; again, there was no noticeable deceleration. The airplane rolled off the departure end of runway 36 and stopped in approximately a foot of mud. A review of flight data recorder landing data revealed that the aircraft touchdown airspeed was 127 knots indicated airspeed. After touchdown, the airplane rolled 2500 feet before coming to a full stop 43 seconds later. According to the DC-9 aircraft operating manual, the target touchdown point is 1000 feet from the runway threshold. A witness reported that the airplane touched down approximately 4000 feet from the threshold. The prescribed landing airspeed for this flight was 127 knots.

Factual Information

HISTORY OF FLIGHT On February 28, 1996, at 1645 eastern standard time, a McDonnell Douglas DC-9-32 N936VV, operated as ValuJet flight 524, rolled off the departure end of runway 36 during a full stop landing at the Savannah international airport in Savannah, Georgia. The scheduled, domestic, passenger flight operated under the provisions of Title 14 CFR Part 121 and instrument flight rules. Visual weather conditions prevailed at the time of the incident. The airplane was not damaged, and none of the flight crew or passengers on board the flight were injured. The flight departed Atlanta, Georgia, at 1555. Upon arriving in Savannah, Savannah Approach issued the flight vectors for a visual approach to runway 36. The flight crew used the ILS runway 36 approach procedure as a backup for the visual approach. According to the captain, the before landing checklist was completed as the airplane turned onto the base leg of the traffic pattern. All aircraft systems were operational for the landing, and wing flaps were lowered to 50 degrees. According the flight crew, when the airplane was 600 feet above the ground, it was on the glide slope and on course; the indicated airspeed was Vref +10.knots until the airplane reached the runway threshold. According to the flight crew, as the airplane reached the runway threshold, the first officer initiated a flare and power reduction from the stabilized approach. The airplane "floated" longer than anticipated and touched down approximately 2,500 feet from the threshold of the 7,003 foot long concrete runway. The first officer, who was flying the airplane, applied normal braking, but the airplane did not decelerate as expected. When the captain realized that the airplane was not decelerating, he took the flight controls and applied heavy braking; again, there was no noticeable deceleration. The airplane rolled off the departure end of runway 36 and stopped in approximately a foot of mud; the runway surface was dry. AIRCRAFT INFORMATION Information on the airplane is included in this report on page 2 of this factual report under the data field labeled "Aircraft Information". PERSONNEL INFORMATION. Information about the flight crew included in this document on page 3 of the factual report under the data field labeled "First Pilot Information". The captain was hired by ValuJet on July 7, 1994, as a captain on DC-9 airplanes. The first officer was hired on October 2, 1995 as a DC-9 first officer. According to ValuJet officials the flight crew had completed all pre-employment requirements. The captain held an airline transport pilot (ATP) certificate with a multiengine land DC-9 type rating, According to the pilot's records, the captain had accumulated a total of 2,141 flight hours in the DC-9 of which 1087 flight hours were as a captain or pilot- in command. The first officer had accumulated a total of 5,200 flight hours of which 275 flight hours were in the DC-9 as a first officer. A review of flight operations information on the flight crew disclosed that the captain completed Crew Resource Management (CRM) training at his previous employer, Eastern Airlines. The first officer had completed CRM training at ValuJet Airlines. ValuJet flight training and CRM training were conducted at the Flight Safety International training facility in Miami, Florida. There was no record of the flight crew flying together before this flight. METEROLOGICAL INFORMATION Visual weather conditions prevailed at the time of the incident. Weather information is contained in this document on page 3 of the factual report under the data field labeled "Weather Information." The prevailing winds at the time of the incident were out of the west at 8 knots. The active runway was 36. WRECKAGE AND IMPACT INFORMATION. The aircraft was not damaged. The airplane was recovered from the mud without additional airframe damage. The examination of the airframe also failed to disclose a mechanical problem or malfunction of an aircraft system. ADDITIONAL INFORMATION Examination of the Digital Flight Data Recorder (DFDR) disclosed that the recorded data characteristics for cruise flight and normal landing were consistent with the incident landing data. A review of the landing data revealed that the airplane touched down at 127 knots indicated airspeed. After touchdown, the airplane rolled 2500 feet before coming to a full stop 43 seconds later. Approximately, eight seconds before the airplane came to a complete stop. ). The DFDR data also showed a uniform decrease in airspeed as the airplane decelerated to a complete stop. At Subframe Reference Number 2273, the DFDR recorded relatively large and rapid fluctuations in the aircraft vertical acceleration. The vertical acceleration at this point in the landing roll is consistent with the airplane rolling off the paved runway surface onto rougher terrain (see attached Digital Flight Data Recorder Study). According to the ValuJet DC-9 flight manual, the target touchdown point on the runway surface is 1000 feet from the runway threshold (see attached excerpts from airlines operation manual and the aircraft flight manual). A witness, located adjacent to the landing runway, reported that the flight touched down approximately 4000 foot from the threshold. According the DC-9 landing data card for 92,000 pounds landing weight, with 50 degrees of wing flaps, the landing airspeed should be 127 knots.

Probable Cause and Findings

the copilot's misjudgment of the landing touchdown point, and the pilot-in-command's inadequate supervision.

 

Source: NTSB Aviation Accident Database

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