Aviation Accident Summaries

Aviation Accident Summary LAX02LA252

Big Bear City, CA, USA

Aircraft #1

N50BK

Cessna S550

Analysis

On a final approach to runway 26 the flight crew was advised by a flight instructor in the traffic pattern that a wind shear condition existed about one-quarter of the way down the approach end of the runway, which the flight crew acknowledged. On a three mile final approach the flight crew was advised by the instructor that the automated weather observation system (AWOS) was reporting the winds were 060 degrees at 8 knots, and that he was changing runways to runway 08. The flight crew did not acknowledge this transmission. The captain said that after landing smoothly in the touchdown zone on Runway 26, he applied normal braking without any response. He maintained brake pedal pressure and activated the engine thrust reversers without any response. The copilot said he considered the approach normal and that the captain did all he could to stop the airplane, first applying the brakes and then pulling up on the thrust reversers twice, with no sensation of slowing at all. Considering the double malfunction and the mountainous terrain surrounding the airport, the captain elected not to go around. The aircraft subsequently overran the end of the 5,860 foot runway (5,260 feet usable due to the 600 displaced threshold), went through the airport boundary fence, across the perimeter road, and came to rest upright in a dry lakebed approximately 400 feet from the departure end of the runway. With the aircraft on fire, the five passengers and two crew members safely egressed the aircraft without injuries before it was consumed. Witnesses to the landing reported the aircraft touched down at midfield, was too fast, porpoised, and was bouncing trying to get the gear on the runway. Passengers recalled a very hard landing, being thrown about the cabin, and that the speed was excessive. One passenger stated there was a hard bang and a series of smaller bangs during the landing. Federal Aviation Regulations allowed 3,150 feet of runway for a full stop landing. Under the weather conditions reported just after the mishap, and using the anticipated landing weight from the load manifest (12,172.5 pounds), the FAA approved Cessna Flight Manual does not provide landing distance information. Post-accident examination and testing of various wheel brake and antiskid/power brake components revealed no anomalies which would have precluded normal operations.

Factual Information

HISTORY OF FLIGHT On August 13, 2002, at 1120 Pacific daylight time, a Cessna S550 Citation twin-engine jet, N50BK, was destroyed while landing at the Big Bear City Airport (L35), Big Bear, California. The airplane was registered to Melita Eagle Inc., of Wilmington, Delaware, and was operated by Corporate Flight International, of Las Vegas, Nevada. The airline transport rated pilot, commercial pilot, and their five passengers were not injured. Visual meteorological conditions prevailed, and an instrument flight rules (IFR) flight plan was filed for the 14 CFR Part 135 on-demand air-taxi flight. The cross-country flight originated from the McCarran International Airport (LAS), Las Vegas, Nevada, at 1038. After departing LAS, the flight, operating as Vegas 850, climbed to FL220 for the 137 nautical mile trip. At 1101 and 43 nautical miles northeast of L35 (elevation 6,748 feet), the aircraft began a descent to 14,000 feet. At 1107 and 8 nautical miles north-northeast of L35, the pilot reported the airport in sight. Air Traffic Control (ATC) instructed the aircraft to squawk 1200 and change to the advisory frequency. The aircraft continued descending and turned to the east, then back to the west for a landing on runway 26. At 1110:45, the aircraft was at 9,400 feet mean sea level, 7 nautical miles from the airport and heading west toward L35. The last radar return at 1111:57, 3 nautical miles from the airport, indicated the aircraft descended to 7,700 feet mean sea level at an average rate of descent of 1,478 feet per minute and at an average groundspeed of 156 knots. Approaching the airport, the Citation crew called for local traffic advisories. A certified flight instructor, who was in the traffic pattern practicing landings with a student to Runway 26, reported that he advised the Citation crew that a wind shear condition existed approximately one-quarter of the way down the approach end of the runway. The flight instructor said the Citation crew confirmed his transmission. On his downwind to runway 26 the instructor further advised the Citation crew that he would extend his downwind leg and let the Citation land first. The Citation crew acknowledged his radio call, confirming that they [the Citation] would land first. While the instructor pilot was downwind he stated that he observed the east and mid-field wind socks were indicating winds out of the east. He checked the Automatic Weather Observing System and noted the winds were 060 degrees at 8 knots. When the Citation was on an approximately 2 to 3 mile final approach to Runway 26, the instructor said he radioed the Citation crew that the winds had changed to 060 degrees at 8 knots and that he was changing to runway 08. The Citation crew did not acknowledge this transmission. The aircraft subsequently landed on Runway 26 (5,260 feet usable) and overran the departure end of the runway. After overrunning the runway, the aircraft went through the airport boundary fence, across an airport perimeter road, and came to rest upright in a dry lakebed approximately 400 feet from the departure end of Runway 26. A post-impact fire ensued, after which all occupants exited the aircraft successfully through the main cabin door. According to a statement supplied to the NTSB investigator-in-charge (IIC), the captain reported that prior to departure he and his first officer had determined that the flight could be made. The captain stated that during the descent the landing performance data was updated, he entered downwind for runway 26, and the approach was stable on the 4-degree glide path. The captain related that the airplane landed "smoothly" in the touchdown zone, normal braking was applied without any response, and that he maintained brake pressure and activated the engine thrust reversers, but there was no response. The captain said he manipulated the thrust reverse handles, placing them in the closed position and confirming the throttles were in the idle position, then applied thrust reverse for a second time while applying brake pressure, still with no response. The captain said he immediately decided that aborting was not an option, given the double malfunction, the terrain surrounding the airport, the airport's elevation of nearly 7,000 feet, his five male passengers, and a temperature of between 78 and 80 degrees Fahrenheit. The captain stated that he applied reverse thrust a third time about two-thirds of the way down the runway, again with no response. The captain further said he opted not to activate the emergency brakes due to the steep runway shoulders and having no asymmetrical control or anti-skid capabilities. The captain reported the airplane went off the runway, up an embankment and hitting a fence which ripped into the wings resulting in a post-impact fire. The captain said he and the first officer assisted the five passengers out of the airplane and that there were no serious injuries. In a statement provided to the IIC, the first officer reported that prior to landing the crew had figured their landing weight at just under 12,000 pounds, temperature of between 78 degrees and 80 degrees Fahrenheit, with a headwind of 9 to 16 knots, and 3,100 feet of runway required to land. The first officer said he considered the captain's approach "very normal," and that he was responsible for the speed brakes upon touching down. The first officer stated that he believed the captain did all he could to stop the airplane, first by applying the brakes, and then by pulling up on the thrust reversers. The first officer further stated that while the captain was "standing on the brakes," they had no sensation of slowing and he was pushing back on the speed brake hoping this would help them stop. The first officer said there was a 75-foot dirt overrun and then a fence about 8 feet tall off the end of the runway, and that the airplane probably caught on fire after hitting the fence. After the airplane came to a stop the first officer said he opened the door and everyone escaped. Four of the five passengers submitted a Passenger Statement form (NTSB form 6120.9) to the IIC: Passenger #1 reported that the flight was uneventful prior to the accident, but on approach over the top of the trees another passenger shouted "hang on guys." The passenger stated that there was a very hard bang and he hit his head to his left. He continued by saying another passenger seated behind him was thrown about more than anyone, and at one point "his head banged into my right upper arm, giving me a big black and blue mark." The passenger reported that after the first "bang" there was a series of "smaller bangs" and then a much harder "crash". He further stated that there was another series of smaller crashes before they stopped. Passenger #2 reported that another passenger yelled out "we are going to miss the runway." He continued by saying the airplane slammed into a fence and bounced along until it came to a stop in a field. The passenger stated that after the co-pilot opened the door and exited the plane, the passengers evacuated in an orderly fashion. Passenger #3 reported that he recalled a very hard landing and being thrown about the cabin because his seat belt was loose. After the airplane had stopped, he said he believed the airplane was on fire. The passenger reported that other passengers later told him that the wings had caught on fire when the plane went through the fence at the end of the runway. Passenger #4 reported the landing appeared "regular" as they approached the runway, but when the wheels touched down the aircraft jerked to the left significantly, but then appeared to come back in line with the runway as they began to roll. The passenger stated the speed seemed fast for the landing and it didn't decrease immediately. The passenger related "we slowed somewhat, but the speed was clearly excessive and was not decreasing as rapidly as one might expect. I was observing the entire landing from my seat through the cockpit window. I noticed that the end of the runway was fast approaching and noticed a black truck moving down the road perpendicular to the end of the runway. The pilot seemed to be trying to control the speed of the aircraft, but it was clear we were going too fast to stop. I told everyone to brace as soon as it was clear we were not going to stop at the end of the runway. We crashed through the fence and appeared to be launched over the roadway, which was about 30 yards beyond the fence at the end of the runway. We bounced violently and did a 'belly flop' on the fuselage as we skidded to a stop." The passenger also stated that the pilot touched down after approximately one-third of the runway had gone by. He also stated "it was difficult to tell if the wheels were actually on the ground or if we were still flying just above the runway. The pilot appeared to be having difficulty controlling the plane." Seven witnesses to the accident provided statements to the IIC: Witness #1, a certified airframe and power plant mechanic, reported that he and his wife were talking while standing in front of their hangar. The witness stated, "When the aircraft attempted to land on runway 26 he still had a very high rate of speed, and on touchdown the aircraft began to porpoise. Total number of cycles I did not count. The aircraft continued down the runway not slowing down at all. The TRs (thrust reversers) did not deploy until the last 1,000 feet of the runway. At that time they cycled at least 3 times, opened and closed. I don't believe they stayed open at the end of the last cycle." The witness reported the aircraft went off the end of the runway and through a fence where it exploded in flames, coming to a stop on the west side of the perimeter road. Witness #2, the wife of witness #1, reported that she and her husband were standing in front of their hangar and that it was a perfect day with a warm, light breeze. The witness stated that when they heard the airplane approach they turned to watch. "We were facing east when the Cessna began landing. He touched down at midfield - he porpoised down the runway past our hangar very fast. At this point my husband yelled 'he won't make it' and ran. He grabbed the fire extinguisher and truck. I dialed 911 as the aircraft hit the fence and went across the road." Witness #3, a certified flight instructor who was in the traffic pattern conducting an instructional flight with a student, reported that his first contact with the crew of the Citation was that he would be making a touch-and-go landing on runway 26, which the Citation crew acknowledged. The instructor stated that after completing the touch-and-go there was a wind shear approximately one-quarter of the way down the approach end of the runway. The wind sheared from the east to the west. On the downwind leg the instructor radioed and informed the Citation crew of the wind shear condition. The Citation crew acknowledged this transmission while they were on a long final approach and informed the instructor that he could land first. The instructor then informed the Citation crew that he would extend his downwind leg and let the Citation land first, which the Citation crew acknowledged. While on the downwind leg to runway 26, at the mid-field position, the instructor checked the windsocks. The east and mid-field windsocks were indicating winds out of the east. The instructor then checked the Automatic Weather Observing System (AWOS) and the winds were 060 degrees at 8 knots. The instructor reported that at this time the Citation was on an approximately three mile final when he radioed that the winds had changed to an east wind and that he was changing to runway 08. The instructor stated there was no acknowledgement from the crew of the Citation. After the instructor completed a 180-degree turn for downwind to runway 08, he noticed the Citation was on a short final for runway 26, and seemed extremely fast. The instructor stated, "His touchdown point was about mid-field and appeared to be faster than normal. It appeared that he was going to try to turn left at the west taxiway but was too fast. The aircraft skidded off the end of the runway, through a fence, across the road and stopped in the dry lakebed. The fire started at the road and followed the aircraft to a stop." Witness #4, a certified airframe and powerplant mechanic, reported that he was sitting in a pickup facing the runway when he observed an airplane landing. The witness stated the touchdown was at mid-field and the aircraft was bouncing trying to get the gear on the runway, with the engines throttled back and the thrust reversers not out "due to the gear not fully on the runway." The witness reported the aircraft ran off the end of the runway, through a fence, across a two lane road, blew up and was on fire, with the rear one-third of the left wing fully on fire and the right wing just starting to burn. The witness further reported that the aircraft came to rest upright facing the direction of intended landing. Witness #5, a pilot, reported seeing the airplane landing on runway 26. The witness stated "....when it was two thirds down the runway [I]saw it was going way too fast to stop and way too slow to go around. At this point it was not fully on the runway and the engines were not spooled up for thrust reversal. My mechanic and I drove to where he went off the end to assist." Witness #6, a backhoe operator, reported that he observed the airplane on final approach and "it looked to me that he was awful high and fast." The witness further stated that the aircraft proceeded to touch down past midfield, approximately at the "2nd turn" and began to porpoise up and down. The witness reported "I continued to observe the airplane and was listening for his reversers to engage and thought I heard them about the same time I saw the dust at the end of the runway. Seconds later I could see smoke." Witness #7, an FAA Support Center Manager, reported that he observed a Cessna Citation landing on Runway 26 with full flaps extended, the landing gear down, and in a nose down attitude. The witness stated the it first crossed his mind that the Citation was too far down the runway to land and needed to execute a go-around. The witness further stated that approximately one-half to two-thirds of the way down the runway the airplane flared for landing, which caused it to climb, then the pilot pointed the nose of the aircraft down in what appeared to be an effort to force the landing. The witness said he then lost sight of the airplane as it went further down the runway, but heard the sound of reverse thrusters being applied. He then heard over the radio that the aircraft had overshot the runway, at which time he looked to the west end of Runway 26 and saw a black cloud of smoke rising. PERRSONNEL INFORMATION The captain held an airline transport pilot certificate with a rating for multiengine land, and commercial privileges for airplane single engine land. Additionally, the captain received his Citation type rating on October 22, 1997. The captain reported his total flight experience as 3,900 hours, 800 of which were in the Citation 550. He also reported that he accumulated 150 hours in the Citation 550 in the last 90 days. The captain's most recent Federal Aviation Administration (FAA) first class medical certificate was issued on April 1, 2002, with no restrictions. The captain was hired by the company in January of 2001. He completed his Cessna S550 airman competency/proficiency check on March 8, 2001, during which he received a "satisfactory" for all maneuvers and procedures demonstrated, as well as comments in the remarks section stating "excellent airmanship and situational awareness." His most recent competency check was performed on April 26, 2002 at Simu Flite, during which he received a "satisfactory" for all maneuvers and procedures demonstrated. The first officer held a commercial pilot certificate with ratings for airplane and multiengine land and instrument airplane. The first officer's most recent first class medical certificate was issued on January 23, 2001, with no restrictions. The first officer report

Probable Cause and Findings

The pilot's failure to obtain the proper touchdown point which resulted in an overrun. Contributing factors were the pilot's improper in-flight planning, improper use of performance data, the tailwind condition, failure to perform a go-around, and the pilot-induced porpoising condition.

 

Source: NTSB Aviation Accident Database

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