Pilots Engaged in Small Talk Before Botched Jet Takeoff

derg

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Pilots Engaged in Small Talk Before Botched Jet Takeoff

Federal crash investigators said Thursday that the pilots of a US Airways Express flight engaged in small talk and violated other basic safety rules before their jet barreled off the end a runway in January during a botched takeoff.

Nobody was hurt when US Airways Express Flight 2495, a commuter jet operated by PSA Airlines Inc., came to rest in a crushable concrete safety zone at the end of a Charleston, W.Va., runway on Jan. 19. But details of the investigation released by the National Transportation Safety Board, including transcripts of conversations between the two pilots, reveal carelessness and a breakdown in cockpit discipline before, during and after the event.

Federal Aviation Administration rules and airline procedures prohibit cockpit conversations not directly related to the aircraft during taxi, takeoffs, landings and other critical phases of flight.

PSA Airlines is a unit of US Airways Group Inc. It hasn't had a fatal accident or incident since it became part of US Airways, or what was then called US Air, in 1995.

The NTSB is likely to cite Flight 2495—including the crew's failure to deploy engine thrust-reversers while trying to stop on a mountainous runway located at the edge of a cliff—as part of its public session scheduled for later this year focusing on lapses in cockpit training and discipline.

According to transcripts of the cockpit-voice recorders, the pilots engaged in extensive small talk about sports cars and other personal matters before taking the runway at Yeager Airport in Charleston and failed to notice that the flaps, movable devices on the rear of the wings that provide extra lift, weren't properly set.

Captain Thomas Morrow, 38 years old, acknowledged during the course of the investigation that he failed to follow basic safety procedures during portions of the taxi and pre-takeoff checklist. He also never gave a clear command about aborting or rejecting the takeoff.

Capt. Morrow, who has 11 years of experience with PSA, told NTSB investigators he failed to verify that the flaps were deployed correctly before starting the takeoff roll. When the captain realized the mistake as the plane was speeding down the runway at roughly 90 miles an hour, he failed to follow normal procedure which required him to call for the takeoff to be stopped.

Instead, according to testimony to the NTSB, he quickly adjusted the flaps to solve "the stupid problem" of having previously overlooked the incorrect setting. The plane's flight-computers immediately issued a series of warnings—as they are designed to do when flaps are adjusted during takeoff—and the captain then decided to halt the takeoff.

The accident has been closely watched by air-safety experts partly because pilots consider it generally unsafe and quite unusual to adjust the flap settings during takeoff.

The captain told NTSB investigators that he reduced power, applied maximum pressure on the brakes but didn't end up engaging the thrust-reversers because the engine controls may not have been pulled back all the way back to idle.

The NTSB documents reveal that First Officer Robert Saltsgaver, 44, failed to call out speeds, as required, while the plane was decelerating. Officer Saltsgaver had to prompt the captain about whether he wanted the engines shut down to avoid fire dangers, as required after such an event. The captain's initial response was: "Yeah, guess so," according to the transcript.

Roughly two minutes later, as the pilots were talking about what happened and discussing if they had performed the proper checklist to turn off the Bombardier jet's systems, the captain said: "I don't even know what the [expletive] we're supposed to do now."

Both pilots were placed on administrative leave and taken off flying duties, which is normal after such an event.

Details of the investigation are likely to stoke criticism about the professionalism of some commuter-airline crews, at a time when federal air safety regulators already are calling for stepped-up pilot training and greater emphasis on cockpit discipline. The Charleston accident, for instance, is bound to focus more public attention on the issue of "sterile" cockpit rules, which prohibits discussion of extraneous topics during critical phases of flight and taxi.

The first officer told the investigators that "for the most part" PSA crews adhered to sterile cockpit rules, but that it was sometimes difficult to avoid comments. When investigators asked the captain if he had maintained a sterile cockpit before the accident, his response was, "probably not."

In its anticipated public session later this year, the safety board also is expected to examine pilot training at PSA for halting takeoffs in the middle of a roll.
 
That transcript is not good for anyone.

I cant believe he straight up confessed on the CVR about what happened.
 
Two comments:

#1 - sterile cockpit. We don't know if the parking brake was set for some of the talk.

Sterile cockpit does NOT apply when the parking brake is set

#2 - since when has it been required to call out speeds when the plane is decelerating? Is that a PSA thing?
 
Well, this certainly won't help the bad press airline pilots have been getting over the past year.

The only speed I ever called out on landing in the CRJ was the speed to stow the thrust reversers.
 
Well, this certainly won't help the bad press airline pilots have been getting over the past year.

The only speed I ever called out on landing in the CRJ was the speed to stow the thrust reversers.

We call 80 knots on slow down. But I'd hardly state that one "call" is "speeds".... it's one speed.
 
Uh... what happened to the takeoff config warning horn? Doesn't blow until x speed? What kind of system is that?? Everything I have flown that has a config horn has the horn activate with power-up, not at a specific speed.

and unless I read the transcript wrong, from the time of horn initiation to V1 is only a few seconds so the crew is faced with a damned if you go, damned if you abort. Bad set of choices.

Granted the crew screwed up but to hang it all on 'sterile cockpit' when there is an obvious system design flaw or failure seems like we are going back to the good old era when it was all 'pilot error'.
 
Uh... what happened to the takeoff config warning horn? Doesn't blow until x speed? What kind of system is that?? Everything I have flown that has a config horn has the horn activate with power-up, not at a specific speed.

Granted the crew screwed up but to hang it all on 'sterile cockpit' when there is an obvious system design flaw or failure seems like we are going back to the good old era when it was all 'pilot error'.

From reading the CVR, sounds like this CRJ was one equipped with a flaps 8 detent and flaps 20 detent. Both of these setting can be used for takeoff so there would be no config warning unless something changed, like in this accident. Someone realized the flaps were in the wrong detent (sounds like flaps 8) and they tried to lower the flaps to 20 while on the takeoff roll. THAT will give the config warning the crew heard.
 
From reading the CVR, sounds like this CRJ was one equipped with a flaps 8 detent and flaps 20 detent. Both of these setting can be used for takeoff so there would be no config warning unless something changed, like in this accident. Someone realized the flaps were in the wrong detent (sounds like flaps 8) and they tried to lower the flaps to 20 while on the takeoff roll. THAT will give the config warning the crew heard.

But in the CVR, the crew notes the flap setting. Which is used most often? 20? And out of CRW, would there be that much difference is performance between 8 and 20? Now we seem to be getting into more than just 'sterile cockpit'.

FWIW, I think the sterile cockpit rule is good but used too often as some trump card. The lesson I see is the small item of a delay throws the crew off its normal pacing. And it is a good idea to run the checklist two or three times when a less than normal progression occurs.
 
Granted the crew screwed up but to hang it all on 'sterile cockpit' when there is an obvious system design flaw or failure seems like we are going back to the good old era when it was all 'pilot error'.

Indeed.
 
From reading the CVR, sounds like this CRJ was one equipped with a flaps 8 detent and flaps 20 detent. Both of these setting can be used for takeoff so there would be no config warning unless something changed, like in this accident. Someone realized the flaps were in the wrong detent (sounds like flaps 8) and they tried to lower the flaps to 20 while on the takeoff roll. THAT will give the config warning the crew heard.


Either way they will probably use this to push for the Senate Bill S.3048? I bet that could have happened even if they weren't having a conversation... The things our governments self-career protecting politicians will do to appease the soccer mom nanny state majority... even at the expense of safety as this bill would push (people will start being hush about their comrade's simple mistakes kinda like they do if the FED's were in the jumpseat which would actually lower safety.)
 
I'm floored honestly..I can't believe that there is not an instantaneous ball busting head splitting loud horn if you advance the power levers to t/o thrust without the flaps set properly. I know I fly a measly old TP but man, this couldn't happen in a Dash.

My heart goes out to this crew. Sounds like it ended oaky, no body hurt. So I hope they keep their jobs and chalk it up as one learned. Makes me think about being extra vigilant with taxi/pre-t/o procedures.
 
But in the CVR, the crew notes the flap setting. Which is used most often? 20? And out of CRW, would there be that much difference is performance between 8 and 20? Now we seem to be getting into more than just 'sterile cockpit'.

FWIW, I think the sterile cockpit rule is good but used too often as some trump card. The lesson I see is the small item of a delay throws the crew off its normal pacing. And it is a good idea to run the checklist two or three times when a less than normal progression occurs.

If you notice, there is a discrepancy with the flap setting in the transcript...

As far as performance, it depends... weather, elevation, loads, etc. Generally flaps 20 will give you a shorter takeoff roll (CRW is 6300') as the V-speeds are generally lower (9E is about 10 knts lower on V1 for 20 over 8) than for flaps 8.

And again... both will give you a green T/O Config message on the EICAS. The airplane did exactly what it was supposed to do. It allowed the crew to make a choice of takeoff flap settings and showed the aircraft was configured for takeoff within those parameters.

I agree it is more than just a "sterile cockpit" issue. Looks like there is some checklist discipline (or lack of) issues as well.
 
I'm floored honestly..I can't believe that there is not an instantaneous ball busting head splitting loud horn if you advance the power levers to t/o thrust without the flaps set properly. I know I fly a measly old TP but man, this couldn't happen in a Dash.

My heart goes out to this crew. Sounds like it ended oaky, no body hurt. So I hope they keep their jobs and chalk it up as one learned. Makes me think about being extra vigilant with taxi/pre-t/o procedures.

Why?
Nothing in that transcript showed that either of them deserved their job.
Hell they didn't even know the circuit breaker to pull before telling the whole thing to a buddy on their cell phone.
Moving flaps while speeding down a runway? Are you kidding me?
 
I'm floored honestly..I can't believe that there is not an instantaneous ball busting head splitting loud horn if you advance the power levers to t/o thrust without the flaps set properly. I know I fly a measly old TP but man, this couldn't happen in a Dash.

Again...

The CRJ-200 will give you a green T/O Config message for BOTH flaps 8 and flaps 20. It is the responsibility of the crew to determine which setting is appropriate for the situation.
 
Blatantly armchair quarterbacking here, but I'm curious as to why he'd elect to perform a high-speed, post-V1 abort?
 
Blatantly armchair quarterbacking here, but I'm curious as to why he'd elect to perform a high-speed, post-V1 abort?

Here is something else to chew on Doug..

Not sure about PSA, but at 9E, our Flaps 8 V-speeds have V1=VR on all but a few speed cards. Even the ones that are different are only a 1 knot increase over V1. Basically a post V1 abort would also be a post VR abort...:crazy:
 
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