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Kalitta B747 209F crash EBBR 2505 2008
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Excellent report, by my view.
Engine 3 ingested a Kestrel. Makes you wonder what possible prey was found in number 4. That one was a tough call by the Capt. GB |
The crash is not due to an engine failure, but the history of engine incidents, as well as the personal experience of the pilot with this aircraft could have had an influence on the reactions of the crew. The pilot furthermore stated he did not take a breakfast that morning. This could possibly influence the reaction rate of a person owing to a lowered blood glucose level |
V1 Calculation
The report says:
Statistics indicate that rejected takeoffs at V1 are very seldom successful. |
Don't forget this t/o was rejected 12 knots beyond v1, while departing with 300m less runway than their performance calculations allowed for!
seems a clear conclusion that rejects beyond V1 are not done. |
Seems also that with this company if the handling pilot is the co pilot and the take off is rejected say within 1 knot of V1 the captain will then take control selecting his own reverse thrust and spoilers etc.:}
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In reality, a feckup of the highest order, on the FD, on the day in question.
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Don't forget this t/o was rejected 12 knots beyond v1, while departing with 300m less runway than their performance calculations allowed for! The takeoff was rejected seven seconds past V1. Four seconds until the compressor stall, and the actual reject two seconds after that. The reject took place at 150 knots, which is the 12 knots above V1 to which you refer. Bear in mind that a typical 4-6 knot error in the cockpit indication on these airplanes means that the pilot may or may not have seen that much over V1, and his decision was predicated on the basis of feeling that the aircraft wasn't accelerating properly. The captain had briefed a reject after V1 if the aircraft didn't seem capable of flight, and later stated that in his opinion the aircraft wasn't accelerating; it was at this point, with two seconds of decision time after the compressor stall, that he elected to reject the takeoff. That two seconds includes reaction and action time. Seems also that with this company if the handling pilot is the co pilot and the take off is rejected say within 1 knot of V1 the captain will then take control selecting his own reverse thrust and spoilers etc. |
page 49 in the report:
"These performances showed a take-off margin of 300m, but this distance takes the whole runway length into consideration. In reality, the aircraft lined up at the B1 intersection, shorter by 300m. The crew was under the impression they started with a positive take-off margin, while this margin was reduced to zero." So they performed calculations for the whole runwaylength, but lined up at an intersection. |
That kestrel really made his exit with a bang....and still they were kinda lucky avoiding the 20 meter drop down to the railway tracks
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So they performed calculations for the whole runwaylength, but lined up at an intersection. |
Some interesting learning points here - luckily only metal was bent in the process.
From the report: The accident was caused by the decision to Reject the Take-Off 12 knots after passing V1 speed. The following factors contributed to the accident; o Engine Nr 3 experienced a bird strike, causing it to stall. This phenomenon was accompanied by a loud bang, noticed by the crew. o The aircraft line up at the B1 intersection although the take-off parameters were computed with the full length of the runway. o The situational awareness of the crew, o Less than maximum use of deceleration devices. o Although the RESA conforms to the minimum ICAO requirement, it does not conform to the ICAO recommendation for length. It may be safer to reject a takeoff when approaching V1 only if there is doubt of the aircraft’s ability to maintain flight. The problem may be more safely handled as an in-flight problem than as a rejected takeoff. At or after V1, unless a malfunction occurs that renders the aircraft uncontrollable, do not reject the takeoff. Statistics indicate that rejected takeoffs at V1 are very seldom successful. The noise analysis showed further that the engine appeared to be recovering immediately after the engine stall. There was no damage found during the engine examination that would indicate otherwise. Furthermore, a 4-engine aircraft is certified to be able to continue the take-off with the total failure of one of its engines. In reality, the aircraft lined up at the B1 intersection, shorter by 300m. The crew was under the impression they started with a positive take-off margin, while this margin was reduced to zero. We recommend to modify the training program of the flight crew (initial and recurrent), and related documentation, to highlight the risks involved in rejecting TO around V1, as well as the importance of respecting procedures. ...they also briefed about an abort take-off after V1 if there was a dangerous situation that would not allow the airplane to fly. |
I understand from previous posts by 747 guys that a max TOM will not fly with two out. They say if you do not abort you simply crash at a higher speed somewhere else.:)
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Originally Posted by SNS3Guppy
(Post 5054888)
The takeoff was rejected seven seconds past V1. Four seconds until the compressor stall, and the actual reject two seconds after that. The reject took place at 150 knots, which is the 12 knots above V1 to which you refer. Bear in mind that a typical 4-6 knot error in the cockpit indication on these airplanes means that the pilot may or may not have seen that much over V1, and his decision was predicated on the basis of feeling that the aircraft wasn't accelerating properly. The captain had briefed a reject after V1 if the aircraft didn't seem capable of flight, and later stated that in his opinion the aircraft wasn't accelerating; it was at this point, with two seconds of decision time after the compressor stall, that he elected to reject the takeoff. That two seconds includes reaction and action time. Regardless of any possible airspeed indication error, a significant amount of time has elapsed since the V1 call(4 seconds is significant) leaving a lot less runway and undoubtedly an increase in speed. |
There's no doubt what happened, and what errors occurred. The airline in question has been teaching this and pushing it hard before the incident occurred, and after...and continues to do so. The captain himself briefed what would take place, then disregarded his own brief, rejected the takeoff, didn't include the crew in the reject, didn't follow the reject procedure he had briefed and that the company provided (and trained), and ultimately lost the airplane. This much is known, and has been known all along at the company...and has been taught all along at the company.
This is not in question. The assertion that the aircraft departed contrary to predicted performance and that it didn't have enough runway available, is in error. It did. What could not be predicted was a rejected takeoff contrary to procedure and so late in the game. The ability to stop with a failure up to V1 was correctly planned and available. The ability to stop after that time was not available. I understand from previous posts by 747 guys that a max TOM will not fly with two out. They say if you do not abort you simply crash at a higher speed somewhere else. |
The entire crew spooked by a compressor stall.
It's hard to comprehend why a 15000hrs captain with 3000hrs on type didn't remove his paw and didn't keep his paw off the thrust levers by V1; it's an instinctive motion that's learned and practiced over and over in the sim.
Furthermore, the absentmindedness by an experienced captain of not selecting reverse thrust [which precluded auto spoiler deployment] and the forgetfullness by the F/E of not manually pulling the spoiler handle is stupefying. |
Furthermore, the absentmindedness by an experienced captain of not selecting reverse thrust [which precluded auto spoiler deployment] and the forgetfullness by the F/E of not manually pulling the spoiler handle is stupefying. The accident speaks for itself, together with the actions of the crew concerned. |
You have some particular insight into the company, do you?
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On October 20, 2004, Kalitta Air Boeing 747 (N709CK), with five crew members onboard, experienced mechanical difficulties with one of the four engines and diverted to land safely at Detroit Metropolitan Airport. No one was injured. It was discovered after landing that the number 1 engine had separated from the airplane as it climbed through 16,000 feet over Lake Michigan.[8] The engine was later recovered for inspection.
On May 25, 2008, a Boeing 747-209F/SCD (N704CK serial number 22299/462)[11][12] from the company's fleet overran runway 20 at Brussels Airport. The plane broke in three and came to a complete stop in a field bordering the runway. There were four crew members and one passenger onboard and no injuries have been reported. [13][14] The aircraft was loaded with 76 tons of goods, half of it being diplomatic mail, and was supposed to take off to Bahrain.[15] On December 23, 2008, Belgian investigators announced that the cause of the accident was the ingestion of a Kestrel bird into engine 3 [16 ENG08IA022 NTSB Identification: ENG08IA022 Scheduled 14 CFR Part 121: Air Carrier Kalitta Air Incident occurred Saturday, April 19, 2008 in Newark, NJ Probable Cause Approval Date: 6/22/2009 Aircraft: BOEING 747, registration: N704CK Injuries: 5 Uninjured. The cargo airplane experienced an in-flight engine fire in the No. 3 engine during climb. The flight crew declared an emergency, shut down the engine, discharged two engine fire suppression bottles to extinguish the fire, and dumped fuel in preparation for landing. The aircraft landed without incident and there were no reported injuries. Examination of the airplane and engine revealed that heat distress and fire damage localized in an area of the engine's accessory raceway where various oil, fuel, and hydraulic lines and hoses were located. The lines and hoses were pressure tested to isolate the source(s) of the flammable fluid leak and three tubes were found to leak. Those three tubes were sent to the manufacturer for further evaluation; however, due to the extensive fire damage, it could not be determined which of the three tubes was the original source of the flammable fluid leak. There were no life limit or required pressure tests in place for any of the three tubes. The National Transportation Safety Board determines the probable cause(s) of this incident as follows: An engine fire in the No. 3 engine due to the failure of, and subsequent flammable fluid leak from, one of three fuel or hydraulic lines located in the engine's accessory raceway that ignited when the fluid came in contact with the hot engine cases. Contributing to the incident were the lack of adequate inspection and test requirements and appropriate life limit or inspection interval requirements by the manufacturer. Full narrative available On July 7, 2008, a Boeing 747-209B (N714CK serial number 22446/519) crashed shortly after departing from El Dorado International Airport in Bogotá at 3:55 am. The plane was en route to Miami, Florida, with a shipment of flowers. After reporting a fire in one of the engines, the plane attempted the return to the airport but crashed near the village of Madrid, Colombia. The plane's empennage hit a ranch house, killing a 50-year-old man and his 13-year-old son who lived there (a report of this crash on AirDisaster.Com indicated a third fatality on the ground). The crew of eight survived with light to serious injuries.[17][18][19 |
You have some particular insight into the company, do you? With a very few exceptions, I have never seen so many misfits gathered together in one company. Most reasonable folks, had a close look, and gave it a very firm pass. Not likely to change, either. I say once again, the BRU accident speaks volumes. Poor operational control, poor training, poor management. A bad combination. GlueBall said it best... Furthermore, the absentmindedness by an experienced captain of not selecting reverse thrust [which precluded auto spoiler deployment] and the forgetfullness by the F/E of not manually pulling the spoiler handle is stupefying. |
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