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Wed, Jan 10, 2007

NTSB Says 'Poor Airmanship' The Root Cause Behind 2004 Pinnacle Airlines Crash

Says Pilots Committed A Number Of Errors; Airline Failed To Properly Train Them

The National Transportation Safety Board determined Tuesday a laundry list of causes led to the October 14, 2004 "joyride" accident of Pinnacle Airlines flight 3701.

According to the NTSB, the probable causes of the crash -- which killed the two pilots ferrying the aircraft -- were as follows:

  • 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 the 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 (right). "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 (dba Northwest Airlink) departed Little Rock National Airport about 9:21 pm CDT en route to Minneapolis-St. Paul, MN for a repositioning flight.

The flight plan indicated the planned cruise altitude was 33,000 feet. At about 9:26 pm, 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 CRJ-200's maximum operating altitude of 41,000 feet. After the aircraft reached FL410, 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.

As Aero-News reported, in November 2006 the Board also issued a series of urgent safety recommendations, stating the FAA should require operators of CRJs equipped with CF34-1 or CF34-3 engines be well-versed in compressor stall, engine shutdown, and inflight restart procedures.

FMI: www.ntsb.gov

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