Report Says She Failed To Account For Crosswind On Landing
The National Transportation Safety Board today determined the
probable cause of the crash on landing of a FedEx cargo aircraft
was the first officer's failure to properly apply crosswind landing
techniques to align the airplane with the runway centerline and to
properly arrest the airplanes descent rate before the airplane's
touchdown.
Additionally, the captain's failure to adequately monitor the
first officer's performance and command or initiate corrective
action during the final approach and landing contributed to the
accident, the Board said.
On December 18, 2003, Federal Express Corporation flight 647
crashed while landing at Memphis International Airport.
Following the crash, the right main landing gear of the Boeing
MD 10 -10F collapsed, and there was a post-crash fire. There were
two crewmen and five nonrevenue FedEx pilots aboard the airplane.
The first officer and one nonrevenue pilot received minor injuries
during the evacuation.
"This accident highlights the need for proper training," said
NTSB Acting Chairman, Mark Rosenker. "If the accident
crewmembers had applied techniques in accordance with their
training, the landing would have been uneventful, he added.
The investigation found that the first officer had demonstrated
unsatisfactory performance during proficiency checkrides at a
previous employer and at Federal Express.
During her career at FedEx, she had two unsatisfactory
proficiency checkrides. Although the first officer's
proficiency checkrides demonstrated deficiencies in multiple areas,
the investigation was unable to directly link her previous
deficiencies to her actions on the day of the accident. During the
accident flight, the captain was serving as both check airman and
pilot in command; he was expected to continually monitor the first
officer's performance while at the same time being responsible for
the overall safe conduct of the flight.
After the flight 647 accident and as a result of several other
accidents and incidents, the FedEx Flight Operations Directorate
developed its Enhanced Oversight Program (EOP) to improve air
safety through early identification of pilots who exhibit
deficiencies during training or checkrides.
After the Memphis
accident plane came to a rest and as the right wing was on fire,
flightcrew and jumpseaters attempted to evacuate the airplane via
the L1 door slide; however, the slide separated from the airplane
during the inflation sequence. Therefore, everyone aboard the
aircraft was forced to exit the airplane using the cockpit
window. During the evacuation and while persons were still
aboard the plane at least 13 pieces of personal baggage were thrown
from the airplane. FedEx issued additional guidance following
this accidents requiring its pilots involved in an accident to
evacuate in the most expeditious manner possible, without salvaging
their baggage.
As a result of this accident, the Safety Board made the
following recommendations:
To the Federal Aviation Administration:
1. Require all Part 121 air carrier operators to establish
programs for flight crewmembers who have demonstrated performance
deficiencies or experienced failures in the training environment
that would require a review of their whole performance history at
the company and administer additional oversight and training to
ensure that performance deficiencies are addressed and
corrected.
2. Amend the emergency exit training information contained in
the flight crew and cabin crew sections in Federal Aviation
Administration Order 8400.10 (Air Transportation Aviation
Inspector's Handbook) to make the emergency exit door/slide
training described in the flight crew section as comprehensive as
the cabin crew emergency training section of the principal
operations inspector handbook.
3. Verify that all Part 121 operators' emergency door/slide
trainers are configured to accurately represent the actual airplane
exit door/slide and that their flight crew emergency exit
door/slide training provides the intended hands-on emergency
procedures training as described in 14 Code of Federal Regulations
Section 121.417, to include pulling the manual inflation
handle.
4. Inform all air traffic control tower controllers of the
circumstances of this accident, including the need to ensure that
aircraft rescue and firefighting (ARFF) vehicles are not delayed
without good cause when en route to an emergency and the need to
relay the number of airplanes.