Pilot Initiated Fuel Transfer, But Failed To Notice As
Tank Ran Dry
What happens when you
don't properly plan for a flight? Sometimes, the very worst... and
the NTSB says that's what happened in the case of an Air Tahoma
Convair 580 that went down near Cincinnati in August, 2004.
Investigators found the plane's pilot, Bruno Pichelli of
Welland, Ontario, spent most of the flight doing fuel-weight
calculations that should have been completed before takeoff. The
investigation also found Pichelli initiated a crossfeed fuel
transfer about 50-minutes into the flight -- then let it continue
unmonitored, while he attended to his calculations.
The fuel shut-off valve was left open during the transfer. As a
result, investigators say, the left tank ended up dry. The engines
quit, because they were both feeding off the left tank.
As Aero-News reported, the
1950s-era twin-turboprop (file photo of type, below) -- which was
carrying cargo for DHL -- went down on a golf course near Florence
early in the morning August 13, 2004. Copilot Michael Gelwicks of
Southaven, MS was killed in the crash.
"Here again we see the tragedy that can result when time-tested
procedures are not respected," said NTSB Acting Chairman Mark V.
Rosenker. "The accident also points up the severe consequences that
can follow when the operator of an aircraft, or any other vehicle,
The NTSB's finding of probable cause lists as factors the
captain's inadequate preflight planning, his subsequent distraction
during the flight, and his late initiation of the in-range
checklist." In addition, "the flight crew's failure to monitor the
fuel gauges and to recognize that the airplane's changing handling
characteristics were caused by fuel imbalance."
The Board also recommended that the FAA issue a flight standards
information bulletin to familiarize Convair 580 operators with the
circumstances of the Air Tahoma accident, including the importance
of closing the fuel tank shutoff valve for the tank not being used
during crossfeed operations.
Noting that additional details about the flight crew's actions
after the loss of engine power would have aided the investigation,
the Board also reiterated a previous recommendation to the FAA
(A-99-16), which called for retrofitting airplanes with
independently powered cockpit voice recorders.