NTSB Board Meeting for Pinnacle 3701

[rausda27]

Interesting live webcast...


http://www.ntsb.gov/events/boardmeeting.htm#upcoming

The live webcast is currently discussing the core lock theory..

 

[Turtlesfly]

Did you see that commercial during the big game last night? Where the ref comes out and makes that fake "penalty" announcement where he says "I totally goofed - I totally blew it - but I'll make it up in the 2nd half by randomly penalizing the other team to make it even" . . . and then it says "This fresh moment brought to you by Subway" or something like that.

I just wish the people here would give us a fresh moment like that and say "This crew totally blew it and it's their fault. You are now all excused."

 

[rausda27]

Their #1 finding was "unprofessional crew behavior"

 

[Poahi]

This is by far the biggest event happening in the airline industry today and I'm surprised there hasn't been more reaction on this message board.
I didn't get a chance to catch all of it, but the conclusions I heard were not a much of a surprise. It was interesting that some of the NTSB board members didn't have even a basic understanding of how FOQA and ASAP worked. There were a couple of the board members actually wanted the FAA to force FOQA on all regionals (and majors as well).

I truly hope Jesse and Pete didn't die in vain. Hopefully there will be a genuine push for airlines to educate their pilots on the truth about high altitude areodynamics and find a way to create a cuture so our pilots fly professionally, even on part 91 flights.

I also hope GE starts determining the limits of their engines. I'm not excusing the way the airplane was operated, but from what I heard, no one knows precisely when the CF-34-3B1 engines will core lock and I would hate to find out the hard way. They owe it to all of us to test these engines and tell the airlines what to expect.

Anyone know when the blue cover report will be available? Let's learn from this.

Aloha.

 

[NoBathroom]

I agree with you that I hope Jesse and Peter didn't die in vain. The unfortunate truth is that most regionals don't have an instructor that knows or understands high altitude aerodynamics well enough to teach it. That is what I have been told by one of our head instructors here.

 

[erj-145mech]

I also hope GE starts determining the limits of their engines. I'm not excusing the way the airplane was operated, but from what I heard, no one knows precisely when the CF-34-3B1 engines will core lock and I would hate to find out the hard way. They owe it to all of us to test these engines and tell the airlines what to expect.

The engines were operated outside of their design envelope. The crew failed to maintain the minimum airspeed to keep the cores rotating. The crew failed to operate the aircraft in accordance with the flight manual.

http://www.aero-news.net/index.cfm?ContentBlockID=87917438-e0b9-44b5-bc65-f40f4e5957aa&

the pilots' unprofessional behavior, deviation from standard operating procedures, and poor airmanship, which resulted in an in-flight emergency from which they were unable to recover, in part because of the pilots' inadequate training
the pilots' failure to prepare for an emergency landing in a timely manner, including communicating with air traffic controllers immediately after the emergency about the loss of both engines and the availability of landing sites
and the pilots' failure to achieve and maintain the target airspeed in the double engine failure checklist, which caused the engine cores to stop rotating and resulted in the core lock engine condition.

 

[Rogue5]

I just wish the people here would give us a fresh moment like that and say "This crew totally blew it and it's their fault. You are now all excused."

Well, here you go:

************************************************************
NTSB PRESS RELEASE
************************************************************

National Transportation Safety Board
Washington, DC 20594

FOR IMMEDIATE RELEASE: January 9, 2007
SB-07-03

************************************************************

NTSB DETERMINES PILOTS' POOR AIRMANSHIP CAUSED 2004 PINNACLE
ACCIDENT IN JEFFERSON CITY, MISSOURI

************************************************************

Washington, DC -- The National Transportation Safety Board
determined today that the probable cause of the October 14,
2004 accident of Pinnacle Airlines flight 3701 was the pilots'
unprofessional behavior, deviation from standard operating
procedures, and poor airmanship, which resulted in an in-
flight emergency from which they were unable to recover, in
part because of the pilots' inadequate training; the pilots'
failure to prepare for an emergency landing in a timely
manner, including communicating with air traffic controllers
immediately after the emergency about the loss of both engines
and the availability of landing sites; and the pilots' failure
to achieve and maintain the target airspeed in the double
engine failure checklist, which caused the engine cores to
stop rotating and resulted in the core lock engine condition.

Contributing to the cause of this accident were the engine
core lock condition, which prevented at least one engine
from being restarted, and the airplane flight manuals that
did not communicate to pilots the importance of maintaining
a minimum airspeed to keep the engine cores rotating.

"This accident was caused by the pilots' inappropriate and
unprofessional behavior," said NTSB Chairman Mark V.
Rosenker. "Simply adhering to standard operating procedures
and correctly implementing emergency procedures would have
gone a long way to adverting this tragic accident."

On October 14, 2004, a Bombardier CL-600-2B19 (N8396A)
operated by Pinnacle Airlines (doing business as Northwest
Airlink) departed Little Rock National Airport about 9:21
p.m. central daylight time en route to Minneapolis-St. Paul,
Minnesota for a repositioning flight. The flight plan
indicated that the planned cruise altitude was 33,000 feet.
At about 9:26 p.m., the airplane was at an altitude of
about 14,000 feet and the flight crew engaged the autopilot.

A few seconds later, the captain requested and received
clearance to climb to the Commuter Regional Jet's maximum
operating altitude of 41,000 feet. After the aircraft
reached 41,000 feet, the airplane entered several stalls and
shortly thereafter had double engine failure. The crew
declared an emergency with the tower, informing them of an
engine failure. However, they failed to inform the tower
that both engines had failed while they made several
unsuccessful attempts to restart the engines. The crew also
continued to try to restart the engines after the controller
asked if they wanted to land.

The flight crew attempted to make an emergency landing at
the Jefferson City, Missouri airport but crashed in a
residential area about three miles south of the airport. The
airplane was destroyed by impact forces and a post crash
fire. The two crewmembers were fatally injured. There were
no passengers on board and no injuries on the ground.

The Safety Board issued eleven recommendations to the
Federal Aviation Administration, as a result of this
accident, dealing with pilots training and high altitude
stall recovery techniques.

On November 20, 2006, the Safety Board also issued the
following urgent safety recommendations, as a part of its
investigation into this accident:

To the Federal Aviation Administration

1. For airplanes equipped with CF34-1 or CF34-3
engines, require manufacturers to perform
high power, high altitude sudden engines
shutdowns; determine the minimum airspeed
required to maintain sufficient core
rotation; and demonstrate that all methods of
in-flight restart can be accomplished when
the airspeed is maintained.

2. Ensure that airplane flight manuals of
airplanes equipped with CF34-1 or CF34-3
engines clearly state the minimum airspeed
required for core engine rotation and that,
if this airspeed is not maintained after a
high power, high altitude sudden engine
shutdown, a loss of in-flight restart
capability as a result of core lock may
occur.

3. Require the operators of CRJ-100, -200, and
400 airplanes include in airplane flight
manuals the significant performance
penalties, such as loss of glide distance and
increase descent rate, that can be incurred
from maintaining the minimum airspeed
required for core rotation and windmill
restart attempts.

A synopsis of the Board's report, including the probable
cause and recommendations, is available on the Board's
website, www.ntsb.gov. The Board's full report will be
available on the website in several weeks.

Media Contact: Terry N. Williams [email protected]
202) 314-6100










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[ImbracableCrunk]

Does anyone know where an archive site of the video might be?

 

[Prop2Jet]

By I tell yah that is just sad. Not in a sarcastic way either. I lived in a town near the crash and could not believed what happened. If only they did not take it to 41,000 ft. You would think that there would be a margin above that altitude were the engines could still operate though.

 

[YourPilotFriend]

By I tell yah that is just sad. Not in a sarcastic way either. I lived in a town near the crash and could not believed what happened. If only they did not take it to 41,000 ft. You would think that there would be a margin above that altitude were the engines could still operate though.

Not likely, extra performance usually means more cost. It will only get worse from here on out, as manufactures try to save weight in such a fuel critical environment. I doubt these pilots would have done this with passengers aboard. With that being said, I think most of us here have pushed the limit at some point since being a pilot. I think this case is more attributed to bad luck rather than unprofessionalism.