Hendricks NTSB Prelim report

[ultrarunner]

<http://www.ntsb.gov/ntsb/brief.asp?ev_id=20041104X01760&key=1>

Well, this is interesting. Assuming they had DME, MDA is 1340 MSL. 1220 WX was 600 over and 5 (1525 msl). This looks like a no brainer had they actually decended to MDA. But this quote from the prelim indicates they never decended to MDA prior to reaching it:

"...During the final segment, the airplane showed a gradual descent and leveled at 2,600 feet, in the vicinity of the missed approach point..."

No mystery why the never saw the airport.


Hmmm......OK, so, maybe NO DME...in which case they were timing the approach, and MDA goes to 1520 msl. This would have put them right in the ceiling. Good vis. They likely would have had some ground contact.

But they kept on flying and decending. Not sure where they were in relation to the runway????


NO CVR, so I suspect there won't be anything new to add to this prelim.

By the way, they were second in line for the approach and did a turn in holding. Did the plane in front of them miss or land?

 

[Dr Pokenhiemer]

After reading the NTSB report, it looks like they lost track of where they were. They went down to 2600 and leveled off until they passed the airport, then started on down to MDA. It should've been 2600 to the marker then down to MDA. It aslo says they crossed the marker at 3900 where it should've been 2600 or above. True--3900 is above 2600.

I am in no way flaming on the crew. I look at the NTSB reports to see why these planes go down. We can learn alot from this--Doesn't matter how many hours you have or what types of acft you have flown, lose situational awareness just once or for a minute and it can bite us when we least expect it.

God Bless the crew and pax! All were good people.

 

[ultrarunner]

It's not hard to understand them crossing Bales at 3900 since they were directed to hold there at 4000. It appears they only did one turn, as during the outbound let they were cleared for the approach.

It would be difficult to believe they lost situational awareness this early in the game, but it is possible.

Turning inbound, they were likely going 160kts or so. You would have expected gear down and flaps approach at the beacon, and with the plane fully loaded, maybe about 130 kts. Thats just over 2 miles a minute. The had to loose nearly 2700 feet in FIVE miles to even have a shot, and that would have been for a circle. For a straight-in, assuming configured at 1 mile from the threshold, that's 4 miles to get to MDA. AT 2 miles a minute, they would have had to decend at over 1300 feet a minute to even get close.

I would have expected the crew to plan on a straight-in, since they didn't have circling minimums. If this is a reasonalble assumption, then the fact that they were holding at 4000 really put them into a situation that would likely have resulted in not even going visual prior to the MAP.


I tend to agree with Dr. Poken, that they just were not sure of their position. Had they KNOWN where they were, I can't imagine they wouldn't have busted butt to get to MDA. As it was they just slowly decended to 2600, then further down to 1800 beyond the airport.

It's possibly they were the GPS unit, even though it wasn't certified. But even if they had the GPS 30 approach up there, it's got basically the same descent profile.

 

[ultrarunner]

And WHY, when cleared for the approach, when established did they not decend to 2600. ATC turned them loose..

Having a CVR would sure help here, as it might have revealed how they briefed the approach.

 

[Bandit60]

Ultrarunner.. You asked if the aircraft in front of them made it in. Well the answer to that question is YES.

 

[ultrarunner]

I suspected...based on the WX.

 

[Oakum_Boy]

It's not hard to understand them crossing Bales at 3900 since they were directed to hold there at 4000. It appears they only did one turn, as during the outbound let they were cleared for the approach.

It would be difficult to believe they lost situational awareness this early in the game, but it is possible.

For a straight-in, assuming configured at 1 mile from the threshold, that's 4 miles to get to MDA. AT 2 miles a minute, they would have had to decend at over 1300 feet a minute to even get close.


I tend to agree with Dr. Poken, that they just were not sure of their position. Had they KNOWN where they were, I can't imagine they wouldn't have busted butt to get to MDA. As it was they just slowly decended to 2600, then further down to 1800 beyond the airport.

It's possibly they were the GPS unit, even though it wasn't certified. But even if they had the GPS 30 approach up there, it's got basically the same descent profile.

Firstly, it's REALLY hard for me to understand why they would even consider themselves ready for the final approach segment. They were 2400' high for the next stepdown fix and had only 3.2 miles to get down. All that was needed were 2 turns in holding before going inbound. Being cleared for the approach while in a hold means do it when you're ready, that airspace is yours until you call me on the ground. Secondly, anyone who has any clue knows a professional wouldn't be "busting butt" on something as serious as a non-precision approach. Thirdly, you say they should have been "configured" at 1 mile from the threshold. Okay, that's a six degree gradient to reach the runway from MDA. At their two miles per minute, that's 1200 fpm. Totally unstabilized.

It seems they didn't have an understanding of this approach. It is possible they didn't even brief the thing, having gotten approach clearance almost immediately after entering holding. Bottom line? This was a simple procedure any competent pilot could have done. It's hard to believe two professionals could have let this happen. I tell you, if ever unsure of your position- descending will kill you...

 

[enigma]

It looks like this is one accident that we'll never find the cause. We know now that they descended late, but why is not, nor is likely to be known.

I almost never have an opportunity to fly anything other than radar vectors to an ILS, but you can bet that I will remember this the next time I get an non-precision. I can't bring those guys back, but I can resolve to honor them by thinking hard about every non-precision approach from now on.

With that said, Stuff like this is one of the reasons I left corporate flying. What in the world was a Hendrick aircraft doing with a VFR gps? I'm pretty certain that Jeff Gordon gets the best equipment that Rick Hendricks' money can buy for his car, yet Hendrick is flying himself and his family around in an airplane that does not have the best equipment. What's up with that? How could the aviation department manager NOT equip the aircraft with at LEAST an IFR certified GPS?

I can only surmise that most corporate aviation department managers are yes men. Men who are more concerned with their own stature with the boss, than they are concerned with the safety of their pax. I've seen it first hand. These people want to be seen as someone who can "get the job done", and would rather operate on the negative side of safe than they would go to the boss and say, "Boss, It takes money to run this department. I need to spend X number of dollars to intstall the latest nav equipment and that equipment is essential to safe flight. We either install it, or limit our flying to conditions that do not require instrument navigation". Instead, they roll the dice and peoples lives hang in the balance.

Does anyone think that Rick Hendrick would pay $50G's to keep his brother, son, and nieces alive? I bet he would. I also bet the he wishes that his aviation guy had informed him that they needed better equipment and the training to properly us it.

God bless the families of those who died on the alter of cheap operations.

enigma

 

[SiuDude]

With that said, Stuff like this is one of the reasons I left corporate flying. What in the world was a Hendrick aircraft doing with a VFR gps? I'm pretty certain that Jeff Gordon gets the best equipment that Rick Hendricks' money can buy for his car, yet Hendrick is flying himself and his family around in an airplane that does not have the best equipment. What's up with that? How could the aviation department manager NOT equip the aircraft with at LEAST an IFR certified GPS?


enigma

This was their back-up aircraft. It sat in the back of the hangar at JQF all the time and very rarely used.

 

[Oakum_Boy]

C'mon Enigma, you know as well as anyone that an IFR GPS would have done them ZERO good. If you can't fly a localizer approach, then you certainly won't do better with a GPS. Are you saying they needed moving map to figure out where they were? No way. Competent people have been flying without that stuff since the beginning. Now, if you're talking about EGPWS or TAWS, now that's an investment worth considering. If you do get off course, or descend too early on an approach, that equipment may save your arse. On the flip side, maybe they should have invested in some better pilots or pilot training. Where was that King Air accident a few years ago, where the Captain sometimes wore his American Eagle jacket to work, bragging about it. After the accident, it turned out he hadn't lasted through training with them before being released for inadequate performance. Makes you wonder....

 

[Dep676]

Yeah remember "old school" before GPS? Not sure what an IFR GPS would have done in this case.

 

[Bandit60]

It looks like this is one accident that we'll never find the cause. We know now that they descended late, but why is not, nor is likely to be known.

I almost never have an opportunity to fly anything other than radar vectors to an ILS, but you can bet that I will remember this the next time I get an non-precision. I can't bring those guys back, but I can resolve to honor them by thinking hard about every non-precision approach from now on.

With that said, Stuff like this is one of the reasons I left corporate flying. What in the world was a Hendrick aircraft doing with a VFR gps? I'm pretty certain that Jeff Gordon gets the best equipment that Rick Hendricks' money can buy for his car, yet Hendrick is flying himself and his family around in an airplane that does not have the best equipment. What's up with that? How could the aviation department manager NOT equip the aircraft with at LEAST an IFR certified GPS?

I can only surmise that most corporate aviation department managers are yes men. Men who are more concerned with their own stature with the boss, than they are concerned with the safety of their pax. I've seen it first hand. These people want to be seen as someone who can "get the job done", and would rather operate on the negative side of safe than they would go to the boss and say, "Boss, It takes money to run this department. I need to spend X number of dollars to intstall the latest nav equipment and that equipment is essential to safe flight. We either install it, or limit our flying to conditions that do not require instrument navigation". Instead, they roll the dice and peoples lives hang in the balance.

Does anyone think that Rick Hendrick would pay $50G's to keep his brother, son, and nieces alive? I bet he would. I also bet the he wishes that his aviation guy had informed him that they needed better equipment and the training to properly us it.

God bless the families of those who died on the alter of cheap operations.

enigma

I fly corporate and I can tell you that my equiptment will rival any airliner out there today. We use the most up to date technology and also go above and beyond what is required of us by the regs. My company is not alone. I know many others that have the best of the best and dont cut corners.
I also remember lots of airline aircraft not to long ago flying around with just a vor and dme.

My point is that you shouldn't paint the corporate field with one color brush.

 

[satpak77]

not second guessing two dead brother pilots, and we do not know if instrument/avionics malfunction/error is involved, etc, but I read the report and made a note-to-self that

1. The approach was not extremely complicated. 2600 to BALES then you need to loose 1300 feet in the next 5 miles to get to MDA, not an incredibly impossible task in the B-200. The report indicates they were cleared for the approach and crossed abeam BALES at 3900 feet.

2. Straight in MDA barely met mins, based on reported weather. Obviously we can "shoot it and try it" whenever we want, however the plane CRASHED at 12:20. The 12:00 WX was 600/5 and the 11:40 WX was 400/1.25. I wonder what WX for this airport when they departed. It was an 80 mile trip, so who knows.

3. Even "VFR GPS" can be used for situational-awareness "advisory" information. I wonder if the GPS was being used at all for just this purpose. This may have enhanced safety.

4. Male Captain and Female CP. Only speculation, and I admit that, but I wonder if any "nah, I can get us in here" by the CPT occured.

5. Danville, 33 miles away, offers a nice ILS. New reports (accuracy =???) claim that 20 other airplanes went to Danville. He11, if 20 other professional pilots elected to NOT go where I am going, and instead they ALL went to an ILS airport 33 miles away, uh, maybe I should to. I am not Chuck Yeager. Tell the NASCAR Pax how "all the race teams are going to Danville, we should all be together" or some other BS if you need to articulate it from a non-pilot standpoint.


again, we have two dead people here. So lets analyze what happened (commonly called "second guessing") and try to learn from it. The above are my observations, nothing more, nothing else

later

 

[Bandit60]

satpak77...

I understand that you are just looking for the cause in order that it never happens again, but let me clarify something you probably didn't know.

You talk how other professionals went to other airports. That is true, but most of them went to the other airports earlier in the morning when the weather was much worse than it was at the time of the accident. Many of the airplane, including the one that landed before the Hendrick's plane did go to an alternate and then decide the weather was better and headed to Martinsville.

 

[Bandit60]

oops double post

 

[CatYaaak]

It looks like this is one accident that we'll never find the cause. We know now that they descended late, but why is not, nor is likely to be known.

I almost never have an opportunity to fly anything other than radar vectors to an ILS, but you can bet that I will remember this the next time I get an non-precision. I can't bring those guys back, but I can resolve to honor them by thinking hard about every non-precision approach from now on.

With that said, Stuff like this is one of the reasons I left corporate flying. What in the world was a Hendrick aircraft doing with a VFR gps? I'm pretty certain that Jeff Gordon gets the best equipment that Rick Hendricks' money can buy for his car, yet Hendrick is flying himself and his family around in an airplane that does not have the best equipment. What's up with that? How could the aviation department manager NOT equip the aircraft with at LEAST an IFR certified GPS?

I can only surmise that most corporate aviation department managers are yes men. Men who are more concerned with their own stature with the boss, than they are concerned with the safety of their pax. I've seen it first hand. These people want to be seen as someone who can "get the job done", and would rather operate on the negative side of safe than they would go to the boss and say, "Boss, It takes money to run this department. I need to spend X number of dollars to intstall the latest nav equipment and that equipment is essential to safe flight. We either install it, or limit our flying to conditions that do not require instrument navigation". Instead, they roll the dice and peoples lives hang in the balance.

Does anyone think that Rick Hendrick would pay $50G's to keep his brother, son, and nieces alive? I bet he would. I also bet the he wishes that his aviation guy had informed him that they needed better equipment and the training to properly us it.

God bless the families of those who died on the alter of cheap operations.

enigma

Spoken like someone who doesn't know much about corporate flying, corporate ops, or corporate aviation managers in general let alone this specific operation. Your cliche'd "root-digging" extrapolation from what seems to be a botched appoach is nothing less than an accusation and judgement that the aviation department manager killed the crew and pax. Frankly, you don't know f@$k-all about who that is or what the policy with regards to safety in that operation are.

Instead of "surmising" about that which you obviously know nothing about, stick to flying those radar vectors to ILSs in the airline world womb. Hopefully you'll never be out tooling around in a perfectly good King Air 200 with nobody holding your hand, and if you think flying a loc approach without the benefit of an approach-certified GPS presents some great challenge, then I think some remedial training is in order for you. Btw, what was the captain's background? The prelim NTSB report lists 8,600 hours of Beech 1900 time, and his last review was in the 1900 last May.

 

[enigma]

C'mon Enigma, you know as well as anyone that an IFR GPS would have done them ZERO good.

Maybe, maybe not. My point is not that an IFR certified box would have helped, it is that this high dollar operation was flying around with less than the best equipment.

If you can't fly a localizer approach, then you certainly won't do better with a GPS.

I'll disagree. (not that I'm defending the inability to fly a LOC approach) A certified GPS (with current database) doesn't get LOST. A momentarily distracted pilot can get lost when attempting a LOC approach.

Are you saying they needed moving map to figure out where they were? No way.

No, I'm saying (again) that they were not flying with the best available equipment. I'd understand if the airplane belonged to Kirk Shelmerdine. Kirk has a shoestring budget and probably can't even afford a single VOR receiver; but we're talking about Hendrick Motorsports, the most successful business in stock car racing the last ten or fifteen years. Hendrick most certainly could afford to put his people in the best. Yet he was flying them around in less the the best. Why?

 

[enigma]

This was their back-up aircraft. It sat in the back of the hangar at JQF all the time and very rarely used.

I'm not sure I get your point. So what if the aircraft was a "backup". A "backup' bird can (and did) kill as easily as the primary bird.

enigma

 

[enigma]

I fly corporate and I can tell you that my equiptment will rival any airliner out there today.

I'm sure that your aircraft are much better equipped than the Maddogs I herd around every day. However, I'm not talking about me, nor you. I'm talking about a highly successful racing team that failed to utilize the best technology.

We use the most up to date technology and also go above and beyond what is required of us by the regs. My company is not alone. I know many others that have the best of the best and dont cut corners.

So do I, but that still doesn't explain why Hendrick Motorsports choose not to use the most up to date technology.

I also remember lots of airline aircraft not to long ago flying around with just a vor and dme.

I know of airlines today flying around with only a VOR, DME, and ADF. But in the airline business, equipment levels are dictated by the Feds. In the corporate business, equipment levels are dictated by the value the owner places on his OWN life. I understand completely (notice I didn't say I agree, only understand) why an airline might fly with less than the best. They are a "for profit" business. Corporate departments exist only for the benefit of the owner. I guess that I just don't understand owners who intentionally choose to fly with less than the safest technology.

My point is that you shouldn't paint the corporate field with one color brush.

OK, I shouldn't paint with a broad brush. In my experience, way too many corporate operators hire department managers who are not adequate for the job. Hows that? Is that too broad?

enigma

 

[satpak77]

Enigma

Ease up there my man. You said "GPS doesnt get lost" however that is exactly what happened when a perfectly good AA B-757 crashed into the mountains in Colombia in 1995 (or so).

In todays world of EFIS, EVS, TAWS, GPWS, and TCAS, who would think that a LOC approach to an airport with 600/5 WX reported would be impossible with an old analog ADF, and analog/"standard old fashioned" localizor needles?

I mean before the technology discussed above, I guess these approaches were impossible, right?

not busting ba11s, but just wanted to throw that out there. Nor am I the NTSB Chairman or have a Phd in Accident Investigation, however, I would be of the opinion that this accident due to lack of SA

Fly Safe

 

[CatYaaak]

I'm not sure I get your point. So what if the aircraft was a "backup". A "backup' bird can (and did) kill as easily as the primary bird.

enigma

So let's see. First, in your view it was the aviation manager caused this accident..now you're saying that a certified, functioning aircraft on a garden-variety, flight-checked approach "kills".

Tell me, does a crew's responsibility to be able to read and understand an approach plane, "stay on the lines", and maintain situational awareness (especially during critical phases of flight during IMC) fall anywhere into your equation? Staying on a published approach is THE most basic skill we as professionals are supposed to know, inside and out, even with basic instruments. "Getting lost" on an approach is NOT an option, and especially with two-crew ops, should NEVER happen. About 10 years ago there was a similar CFIT accident in Anniston (I think) involving a commuter turboprop. Descended outbound on a Loc, thinking they were still inbound if I recall correctly. The transcript provides interesting reading.

And let's not forget the CFIT accident up in Hibbing MN involving a NW arilink jestream about that time where they descended straight through the MDA at about 2,300 fpm. I was aquainted with the new-hire F/O on that one, and remember well how the ALPA version of the accident blamed mngment, lack of equipment, and even the still-on-probation, apprentice F/O.....pretty much everyone and everything but the Captain who made the decisions and was flying the ship (of course, I think he was on the MEC so that's not suprising, is it?). I believe ALPA's version said the Captain was put in the "impossible position" (impossible! even though thousands of pilots do it every day) of flying an approach "during IMC, in icing conditions, with no GPWS". According to ALPA...it didn't matter that the PIC didn't need to slam dunk through the icing because the aircraft had already been fitted with mods that made it uneccesary....or that Capt distracted the F/O away from his SOP duty to monitor his flying on the approach....or that the Capt in question had a history of intimidating F/Os to the point of yelling and screaming and hitting them on the headset in flight....or that he had additional history of giving passengers purposely rough rides in order to "get back at management". Highly professional, not.

Yes, there's a long (and in this case published) track record in the airline pilot view of things to blame everything BUT the pilot for a botched approach. Kind of like what you're doing here.


About 15 years ago I was doing pre-employment flight checks for a Part 135 company, and would take the applicants (ATP rated, 1500+ hours of flight time) out to fly. Under the hood, we'd go to a non-radar environment airport and shoot LOC, or VOR, or NDB full approaches. After giving them a couple of vectors and being cut loose by Center , I'd ask them to point to the spot on the approach plate where they were, and you wouldn't believe how many didn't know. I mean, they'd point to a NW quadrant and we were actually SE of the field..things like that. Gross situational awareness errors. I found that very scary given the level of experience they claimed. Not only that, some would even keep on truckin'...descending regardless of what the MSA was.

THAT's the kind of stuff that kills....practically every time, and if you call yourself a professional, has nothing to do with aviation managers or what extra toys you have in the cockpit.

 

[enigma]

Spoken like someone who doesn't know much about corporate flying, corporate ops, or corporate aviation managers in general let alone this specific operation. Your cliche'd "root-digging" extrapolation from what seems to be a botched appoach is nothing less than an accusation and judgement that the aviation department manager killed the crew and pax. Frankly, you don't know f@$k-all about who that is or what the policy with regards to safety in that operation are.

Instead of "surmising" about that which you obviously know nothing about, stick to flying those radar vectors to ILSs in the airline world womb. Hopefully you'll never be out tooling around in a perfectly good King Air 200 with nobody holding your hand, and if you think flying a loc approach without the benefit of an approach-certified GPS presents some great challenge, then I think some remedial training is in order for you. Btw, what was the captain's background? The prelim NTSB report lists 8,600 hours of Beech 1900 time, and his last review was in the 1900 last May.

Sorry dude. We'll never know who can piss the furtherest.

I can only say that my profile is correct. The Lear rating and an appreciable amount of time was garnered in corporate ops. I've got more years of corporate service than airline flying.

As far as remedial training for me, maybe I need it, maybe not. You'll never know.

I don't really know if an IFR certified GPS would have saved them, I do know that we'll never know, because apparently THEY DIDN'T have one. Why not?

OBTW, I have never flown an approach with an IFR certified GPS. Every non-precision I fly is either LOC, VOR, or ADF. My ops specs don't allow for GPS approaches. I am forced to go raw data, even though the FMS could fly the approach. I'm as likely to screw up as the Hendrick crew. If I do, I hope that someone has the guts to point out that we had the technology, but were not allowed to use it.

If you sensed some disdain for some corporate managers, you would be correct. If you sensed disdain for Hendricks manager, you would be wrong. I have no idea who he/she is; I don't blame them, I just can't imagine why they were flying a KingAir with a VFR nav box.

enigma

 

[enigma]

Enigma

Ease up there my man. You said "GPS doesnt get lost" however that is exactly what happened when a perfectly good AA B-757 crashed into the mountains in Colombia in 1995 (or so).

In todays world of EFIS, EVS, TAWS, GPWS, and TCAS, who would think that a LOC approach to an airport with 600/5 WX reported would be impossible with an old analog ADF, and analog/"standard old fashioned" localizor needles?

I mean before the technology discussed above, I guess these approaches were impossible, right?

not busting ba11s, but just wanted to throw that out there. Nor am I the NTSB Chairman or have a Phd in Accident Investigation, however, I would be of the opinion that this accident due to lack of SA

Fly Safe

The AA accident was not a GPS approach. They were navigating with their FMC and put in the wrong identifier for an enroute to approach transition fix. If they had been on a pure GPS approach, they fixes would have been built into the database and the GPS unit would have guided them from point to point. I would not have gotten lost. I don't even like GPS based nav, because I'd rather have a needle pointing to something on the ground. But I have to accept and admit that a navigational computer which uses GPS as it's position source is a very precise piece of equipment. They just don't get lost.

I certainly respect the ability of a pilot to execute a precise, raw-data non-precision approach, but I don't see why they must, when better guidance is available. This has nothing to do with pilot skills. I still can't understand why a highly successful organization like Hendrick would not have the latest and greatest equipment.

That my friends is the thrust of my arguments. I'm not trying to say that the best equipment would have made a difference, or that the pilots were incompotent. I'm only trying to say that it is inconceivable that they didn't have the best. It's sort of like sending an oceanliner out into the icefields without radar, yes it should be possible for lookouts to find the bergs, but why would you not install the radar?

I'm starting to tangle my responses, so after this I'm done. I'll end with this. The best equipment was not installed (if we can believe the NTSB) and if I were Rick Hendrick, I'd dang sure want to know why, and who made the decision.

enigma

 

[enigma]

Yes, there's a long (and in this case published) track record in the airline pilot view of things to blame everything BUT the pilot for a botched approach. Kind of like what you're doing here.

OK, now I get your perstpective. It's always the pilots fault. Sorry dude, I don't buy that, nor am I willing to let others take that position without a challenge.

I agree that pilots make mistakes. However, I want to know the underlying causes for those mistakes. Saying that the pilots screwed up just doesn't cut it for me. I know of times where I was not strong enough of an individual to stand up to a strong boss. I took chances because I was too scared to say no. I learned (I hope) and will not make those mistakes now. But back in the day, If I let the boss talk me into landing where I knew better, and I ended up in a pile of twisted metal, I believe that the boss would have been partially responsible. I know it makes a managers job easy to just blame the pilots, but it just aint that easy.

I think that the NTSB agrees with me, btw. I believe that human factors are a large part of any accident investigation. If the pilots screw up, the NTSB attempts to decipher why. The NTSB agrees that outside factors can influence pilots and lead to mistakes, why can't you?

enigma

 

[falcon20driver]

Pay attention and stay alive, or don't pay attention and die. There is a safe way to fly every approach.

 

[CatYaaak]

Sorry dude. We'll never know who can piss the furtherest.

I can only say that my profile is correct. The Lear rating and an appreciable amount of time was garnered in corporate ops. I've got more years of corporate service than airline flying.

As far as remedial training for me, maybe I need it, maybe not. You'll never know.

I don't really know if an IFR certified GPS would have saved them, I do know that we'll never know, because apparently THEY DIDN'T have one. Why not?

OBTW, I have never flown an approach with an IFR certified GPS. Every non-precision I fly is either LOC, VOR, or ADF. My ops specs don't allow for GPS approaches. I am forced to go raw data, even though the FMS could fly the approach. I'm as likely to screw up as the Hendrick crew. If I do, I hope that someone has the guts to point out that we had the technology, but were not allowed to use it.

If you sensed some disdain for some corporate managers, you would be correct. If you sensed disdain for Hendricks manager, you would be wrong. I have no idea who he/she is; I don't blame them, I just can't imagine why they were flying a KingAir with a VFR nav box.

enigma

You said before that a corporate aircraft flying around without the latest nav equipment is "rolling the dice hanging people's lives in the balance". Well, there's no reason why this wouldn't apply to flying approaches in a airliner either. Since you say you fly only raw data approaches, you must think that every approach you fly is "rolling the dice". That attitude is kind of troubling, since I take it you still fly what you consider to be "chance-y" approaches anyway.

But you're behind the times, because even though I'm fortunate enough to fly stand-alone, fully-IFR certified GPS-approach dual FMS-equiped aircraft now, perhaps I should refuse to fly IFR approaches until we have HUD and EVS installed?

 

[KeroseneSnorter]

I'm starting to tangle my responses, so after this I'm done. I'll end with this. The best equipment was not installed (if we can believe the NTSB) and if I were Rick Hendrick, I'd dang sure want to know why, and who made the decision.

enigma

Personally, I would do a review of the training department and crew procedures. Barring any as yet unknown equipment failures, it is beginning to look like two trained, current, and competent pilots flew a fully functioning airplane into a mountian. That usually points to a failure in training or procedures, or a complete loss of brain power in the airplane.


Years ago a simple burned out gear light caused 3 airline pilots to forget to fly the airplane while screwing with it, and ended up stuffing an L-1011 into the ground. This was probably something just as simple. A minor problem that interrupted their flow, and they lost S.A.

The biggest problem I have seen in the corporate world is not the equipment, it is the CRM and standardization. Very seldom do you see two corporate crews from the same company do the same callouts or briefs. And face it, The CRM and standards that F/S or Simuflt and all the rest train is very very weak. Mostly it is left to the individual operators, and never gets addressed.

 

[AA717driver]

Falcon20's got it right.

This is one of those "I hope I'd do it better" and "I wish they'd done it better" situations.

Let's all try to learn from this.TC

 

[CatYaaak]

OK, now I get your perstpective. It's always the pilots fault. Sorry dude, I don't buy that, nor am I willing to let others take that position without a challenge.

I agree that pilots make mistakes. However, I want to know the underlying causes for those mistakes. Saying that the pilots screwed up just doesn't cut it for me. I know of times where I was not strong enough of an individual to stand up to a strong boss. I took chances because I was too scared to say no. I learned (I hope) and will not make those mistakes now. But back in the day, If I let the boss talk me into landing where I knew better, and I ended up in a pile of twisted metal, I believe that the boss would have been partially responsible. I know it makes a managers job easy to just blame the pilots, but it just aint that easy.

I think that the NTSB agrees with me, btw. I believe that human factors are a large part of any accident investigation. If the pilots screw up, the NTSB attempts to decipher why. The NTSB agrees that outside factors can influence pilots and lead to mistakes, why can't you?

enigma

I don't believe it's always the pilots fault. I believe the NTSB does a great job and absolutely; human factors contribute greatly to accidents as they determine by them, and in this day and age of reliabilty play a much larger role than equipment failures, etc. I believe that things like bad Mx, management, etc, can and do become factors in accidents. I think that sometimes mechanical things come unglued and have seen ATC screwing up to the point where blind luck prevented a disaster. The ALPA report I cited ran counter to these "human factor" findings of the NTSB, however, in order to exonerate their own.

If "back in the day" you got pressured to land somewhere you knew you shouldn't and ended up in a pile of metal, well that's your own fault, not your ignorant boss's. No matter what his emotional state at the time, you're being paid to act and decide things as the flying professional, not him. Flying is your venue, not his. I'm glad you got over your weakness, but you're wrong about him being partially responsible.

Whitewashing basic piloting errors and decisions we make by blaming everything else runs counterproductive to safety, and finding and studying contributing factors, for us, should serve to help us recognize when WE are prone to errors in judgement or skill, or recognize when we're in the middle of a chain of events (caused by us or someone else is irrelevant at that moment) leading to potential disaster.

Sometimes technology makes this problem of losing the big picture worse. In the Cali incident, before plugging in the wrong fix and long before relaizing they were lost, the flight crew accepting a direct routing off the airway (which didn't really mean a shortcut anyway) while at the same time beginning a descent into mountainous terrain below probably lowered their SA because on their FMS screen would have wiped out the routing on the flight plan which included the reporting point they got confused if they had passed or not. Raw data SA was obviously not there, and the snowball got bigger by accepting straight in approach meaning steeper descent, etc. etc. Charlie Foxtrot.

Loss of SA can happen to anyone for many reasons. Rarely, however, does it happen to BOTH pilots in a two-person crew without at least one of them realizing something is amiss, even if they don't know exactly what that something is. If it happens at altitude it's embarrasing and might cost you a beer or a violation or perhaps your job until things get sorted out...but everyone lives. If the loss of SA happens while descending, HUGE friggin' alarm bells should be going off in at least one person's head because it's usually fatal if things continue towards terra firma. The DOMAIN where these alarm bells go off, how easily they are vocalized, and how to respond to them is the pilot's, no matter what got you to that point.

We're paid to remember these basics, especially when workload is high or conditions not severe clear daytime. The reason there has been such an effort to counter CFIT accidents involving perfectly good airplanes in the recent years is because unlike things like rudder-hardovers, in many cases it's the basics that get us in trouble. Shooting approaches is basic to what we do. Unfortunately, it seems that we must re-learn them all the time and IMO things like an self-serving ALPA "official" findings that ignores these basics only creates and re-inforces the notion that nothing can ever be a pilot's fault even if they disregard them. Attitude, more than anything else, determines the level of safety of any flight.

 

[prpjt]

This is Long

There is a great deal of truth in the CatYaak's fourth paragraph. Be very aware of what is plugged into our 'magic' boxes.This can happen to any of us, and this discussion should just heighten our awareness in our own particular operations.

First, I believe I read where someone stated they were attempting an approach below or right at mins. At the time of the attempted approach the wx was being reported as almost 200 feet above mins for the S30/dme localizer approach. Why wouldn't they try it.

Please don't read this as speculation, it is not to guess what happened in this particular tragedy.This professional crew could have had their hands full with any number of things. It is however to reply to those barking "how in the world could they not know where they were", and to give a heads up to those using GPS (certified or not) on approaches.

How many pilots back up a LOC approach by putting fixes in the GPS. Plenty. Let's take this case as an EXAMPLE. Plug Bales and the airport into the GPS.

You want 5-10 mile legs and you have Bales as your go to point. Cross Bales and turn outbound. Maybe run a checklist and start setting up the approach.Localizer front course inbound, identify station..... A few minutes later you are cleared for the approach. You start turning inbound and ask the NFP how far out you are. Now be honest with yourselves, how many of you would not look at the GPS?

The GPS says 6 dme. Sounds plausible. A little wind aloft and getting established in a hold. You're busy.You start a descent and watch the miles click down.You have Bales set in the unit.

You descend to 2600 until the miles get to '0.0" and begin final descent. Since this is an introspective post, ask yourself, do you ALWAYS verify what your DME is reading off of. This goes for GPS and VHF. Depending on what type of GPS you have, you may have to change pages to see the name of the fix.

The problem here is that about 5 minutes ago, upon crossing the initial holding fix, your GPS auto sequenced to the airport. Now, while you were reading this, did you throw up your hands when I wrote "The GPS says 6 dme. Sounds plausible". If not, you got sucked in too.

As the previous poster suggested, these events should make us think.

Again, this is not to speculate on what happened. It is an example to those who are saying how in the world. It's only a scenario. It is a hot point for me becauase this type scenario took the life of someone I knew. I've also seen it in the training environment with all levels of experience.

Be careful and verify what's in that black box.