Aviation Accident Summaries

Aviation Accident Summary NYC96LA063

JAMAICA, NY, USA

Aircraft #1

N11060

Airbus Industrie A-300B4-605R

Analysis

The aircraft was pushed back from the gate, and both engines were started. The pneumatics were shifted from the auxillary power unit to the engines. Shortly thereafter, smoke was observed in the cockpit and cabin. The flightcrew donned smoke masks, and the captain commanded an emergency evacuation. During evacuation, 2 passengers were seriously injured, and 32 passengers received minor injuries. An investigation revealed that the source of the smoke was a hydraulic check valve failure, which allowed hydraulic fluid into the engine pneumatic duct. Investigation also noted that the 3R door evaucation slide did not deploy. Further investigation determined that the door did not fully open. Although, when manually pushed during the investigation, the door went fully open, and the slide deployed and inflated.

Factual Information

On February 20, 1996, at 0710 eastern standard time, an Airbus Industries A300B4-605R, N11060, operated by American Airlines as Flight 587, conducted an emergency evacuation at John F. Kennedy Airport, Jamaica, New York. The airplane was not damaged. Two passengers received serious injuries, and 32 passengers received minor injuries. The remaining 153 passengers, cockpit crew of 2, and 8 flight attendants were not injured. Visual meteorological conditions with rain prevailed. An instrument flight rules (IFR) flight plan had been filed, but not activated for the flight which was conducted under 14 CFR Part 121, and was destined for Santo Domingo, Dominican Republic. Prior to engine start, cabin air was being supplied through the air cycle machines which were using bleed air from the APU. After the airplane was pushed back onto the ramp, and the engines were started, the bleed air source was changed from the APU, to the engines. Smoke was then observed in both the cockpit and cabin. In addition, the flight crew received a smoke warning on the ECAM, and a aural warning tone. The captain then commanded an evacuation. The slide at door 3R failed to inflate either automatically, or manually, after the door was opened. In addition, the flight attendants at doors, 1L, 1R, 4L, and 4R, reported that the power assist on their doors did not operate as they had been trained. the flight attendants at doors 2 L/R reported no problems with slide inflation, and that their doors operated the same as the door simulators they had been trained on. Examination of the airplane revealed that a hydraulic fluid check valve on the left engine had failed. Hydraulic fluid was found in the left engine pneumatic duct and left side air cycle machine. The slide at door position 3R was examined at the overhaul facility, and the examination was inconclusive as to why it failed to inflate. Two inflation tests were accomplished on the 1R door. On both tests, there was a momentary pause after the door cleared the latches, and the girth reached full extension. After about 3 to 5 seconds, the door then continued to full open position, followed by slide inflation. A review was made of the video tapes of 10 certification deployment test of Air Cruiser slides/rafts positioned at doors 1L and 1R from the initial certification of the A300-600. Three doors paused during opening while others opened with no hesitation. All doors, including the doors that paused, opened within the time limits specified for certification. The slides at doors 1 L/R, 2 L/R, and 4 L/R were dual lane slide/rafts, and used the same size packboard, and decorative covers. The slides at doors 2 L/R were 5 feet shorter, and compressed into a smaller pack size. Examination of the American Airlines A300 flight attendant handbook disclosed that the flight attendants were instructed to push on the door in the event of a "power assist" failure; however, there was no information on how to determine if the door is pausing momentarily, or there has been a power assist failure. Additionally, according to American Airlines flight attendants, the A300 door simulator at the American Airlines flight attendant training center did not pause on opening, once it has cleared the latches.

Probable Cause and Findings

unsuccessful use of the evacuation slides by passengers during an emergency evacuation of the aircraft. The hydraulic valve failure, subsequent hydraulic leak, and resultant smoke were related factors.

 

Source: NTSB Aviation Accident Database

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