Runway Overrun During Rejected Takeoff in Bedford, MA 5/31/14.
Вставка
- Опубліковано 8 вер 2015
- This two-dimensional animated reconstruction shows the sequence of events in the accident, which occurred on May 31, 2014, about 2140 Eastern Daylight Time, when a Gulfstream Aerospace Corporation G-IV (N121JM), owned by SK Travel, LLC and operated by Arizin Ventures, LLC, crashed after it overran the end of runway 11 during a rejected takeoff at Laurence G. Hanscom Field, Bedford, Massachusetts.
The sequence of events were reconstructed based on information extracted from the airplane’s flight data recorder (FDR), the cockpit voice recorder (CVR) transcript, passive multilateration aircraft tracking data, ground scars, damage to airport structures, and aircraft performance data. For the purpose of visibility, the airplane is shown three times larger than actual size relative to the airport surroundings. The animation does not depict the weather or visibility conditions at the time of the accident.
The animated sequence of events is first shown at one-third actual speed and is then shown again at actual speed. The animation includes audio narration.
The animation begins as the airplane turns onto runway 11 at 2139:12 and ends at 2140:23 with the airplane coming to rest in a ravine formed by the Shawsheen River. The end of the animation transitions to two photographs. The first photograph shows the airport lighting, localizer antenna and airport perimeter fence that were struck by the airplane after it overran the runway. The second photograph shows the airplane at final rest in the ravine formed by the Shawsheen River. The airplane was destroyed by a post-crash fire.
In the animation, the upper portion of the screen shows an overhead view of the airplane as it moves down runway 11, across the paved safety area and into the grass. A scale indicates the distance along the runway in feet from the threshold to the end of the pavement. During the animation, red vertical marks and associated text callouts are used to locate specific events. The middle of the screen shows Eastern Daylight Time, airplane speed in knots, and the replay speed of the animation.
The lower left portion of the screen shows selected statements from the CVR transcript as text appearing at the time indicated in the transcript. The statements are attributed to either the Pilot-in-Command (PIC) or the Second-in-Command (SIC).
The lower right portion of the screen depicts selected indicators, which display parameters that were either recorded on the FDR or were calculated using the recorded data. The Engine Pressure Ratio is displayed in the center of the screen; the target Engine Pressure Ratio of 1.7 typically used by the pilots is highlighted with a green horizontal bar. On the far right side of the screen, from top to bottom, indicators shown are for activation of the autothrottle, flight power shutoff valve (FPSOV), brakes and thrust reversers.
Narration (one third speed)
The animation does not depict the night lighting conditions that existed at the time of the accident. Certain system parameters or settings are shown, but these displays are not intended to mimic the actual displays in the cockpit. Selected comments from the CVR transcript attributed to the pilot-in-command (PIC) and second-in command (SIC) appear as text at the time indicated in the transcript, on left side of the display area.
Based on a review of previous takeoff attempts, the flight crew likely targeted an Engine Pressure Ratio setting (or EPR) of 1.7, which is shown with a green horizontal bar. In addition, there are indications for activation of the Auto Throttle, Flight Power Shutoff Valve handle (or FPSOV), brakes, and thrust reversers
Note: Animation is available upon request to Office Record Management Division (CIO-40)
"Hey Bob, we have like five or six indications that the aircraft isn't configured correctly, what should we do?" "Hell Jim, I say we just go for it and sort it later. What could possibly go wrong?" Not to speak ill of those who lost their lives, but what in the hell were they thinking?
Bob and Jim will, fortunately, not be teaching others how to argue with gravity.
Gotta complete the take off and landing checklist all the way through every single time
I remember the time I took off as a solo student in a J3 Cub with two 2" x 4" boards gust locking the rudder. I made two touch an goes asking myself why I had such limited rudder authority before I landed and taxied back to the FBO to complain. Boy was I startled to see the long red removal ribbon flapping in the breeze, Never missed a check list for the next ten thousand hours.
You were really lucky that day!
@@NovejSpeed3 that is right
How did you manage to taxi?
@@Mr7o4 Planes steer their front wheel to taxi.
@@liesdamnlies3372 wrong. Differential braking in the aircraft mentioned.
No flight control check, not following checklist. Killed themselves.
Sounds like nice features to prevent a take off if theres something wrong. Very well thought out. Enough to stop it from leaving the ground, but not enough to stop the pilots from trying.
There is also a really effective feature called a "checklist" that most likely would have prevented this... that the pilots chose not to use.
they should have made the restriction lower like... maybe idle it shouldnt have allowed any past idle
@@googaagoogaa12345678 As an engineer I can say you really cant design any engineering control for stupid. To have this crash take place, the crew had to both not do the checklist and miss the fact that the gust lock was engaged, and then spend the better part of about half a minute ignoring the increasingly alarming signs that the controls were locked, even going as far as to call it out multiple times and not even bother to reject the take off for a good 15 seconds. Its basically like having your steering wheel lock suddenly engage in your car, but you continue to mash the gas pedal to the floor rather than immediately try to stop. To be fair, they were able to still attempt the take-off due to a design defect that allowed the manual throttles to be both pushed farther physically and overridden to levels beyond what was designed for. More zealous measures could be put in such as having the fuel controller shut down above taxi speed and kill the engines, but such measures can become as much of a hazard themselves if they malfunction on an otherwise perfectly flyable airplane. Im a firm believer in effective engineering controls, but at the end of the day, engineering controls are there to mitigate potential disaster when competent people have a momentary lapse of judgement and make a mistake, not protect against gross incompetence. Some times even the best intended prevention measures can fail with enough persistence, as happened here.
@@mysock351C Underrated comment about aggressive safety measures becoming a potential hazard themselves. Engineering is hard.
Wow... I guess more than anything, this is a lesson in habituation. Right from the start the PIC had an indication that the rudders were locked in place, which every pilot knows will almost certainly prevent a successful takeoff. In addition, if the person who was supposed to remove the rudder lock didn't remove the rudder lock, then very likely they also didn't remove the elevator lock (and possibly also aileron locks, depending on airplane). It is just amazing to watch the PIC and SIC notice things were wrong, yet *NOT* stop the takeoff roll... again and again and again. The *ONLY* force that I can imagine that would prevent anyone from acting in such a dangerous if not suicidal way is... *habituation.*
The PIC and SIC had taken off so many thousands of times before, and may never have stopped a takeoff ever before. Fact is, I never had to abort a takeoff either. But I just can't imagine that I would fail to immediately stop the takeoff at the first rudder-at-limit indication... and several times later too if I was dumb enough to continue beyond that point. It hurts to watch people hurt themselves, especially when nothing was forcing them to do so.
max bootstrap The gust lock system is controlled from within the cockpit and limits all control surfaces, it’s not something one removes like on a small single. Which of course makes you wonder why they didn’t check the gust lock lever? They also failed to do control checks on 98% of their previous flights. Also of note was that other Gulfstream gust locks failed to limit throttle movement as designed. Two pilot crew not using checklist is nuts.
"They also failed to do control checks on 98% of their previous flights." - why wasn't this caught before and them stopped? How many other pilots don't do control checks?
During retraining/upgrading do you have to perform aborts?
It’s like the pilots were in a dream…wanting things to be more normal…unable to instinctively reject the takeoff…. Perhaps years of trying to satisfy top management they were in a dream of get~off~itus
The first B-17 took off from Boeing Field in Seattle with the rudder gust lock in place killing test pilots and crew.
What’s sad about this accident was the four passengers on board who went to the slaughter like sheep having put their trust in strangers who did not take their duty and responsibility seriously, as the written NTSB accident investigation reveals.
It is easy to get complacent. If folks stopped doing stupid things the NTSB could concentrate on fixing mechanical issues.
There are just so many clues that that something was wrong and so many opportunities to stop the takeoff but they persisted until it was too late. When things are going wrong in aviation they rarely get better but it seems some crews like to keep pushing the envelope. Just a pity they take innocent passengers with them
Pester
Lovett
The braking starts about half of the usable runway after V1, like 3000 ft , and like 14 secs after V1...
Was the narrator at the dentist earlier?
I thought he was trying to pull a Sean Connery accent.
Ginigivitishhhhh
fxsrider - They are doing serious work here, not trying to win an award for “best short documentary.”
5:41 Sheems ash if the ShawSheen River shertainly shlowed the shpeeding shub-shonic Gulfshtream aircraft sho quickly shays the NTShhB report.
So sad, yet so preventable
If you reach V1, you *have* to take it to the air or you'll crash - that's what V1 means.
The inverse of that is: Don't go past V1 if you're not positive you can fly the thing. The PIC didn't even take 5 seconds between getting the error message (relayed by his SIC) and pushing the lever anyway. There is no way he actually thought about what the light meant - he just said "not now" and tried to take off...
"Hey captain, looks like we got a bunch of stuff not configured. A ton of warning lights and auto throttles won't function correctly. I say we go ahead, take off and sort it out later.". Captain: "Sounds like a plan. Take your foot and see if you can force the throttles up a little further". Seriously, God bless but what the heck was going through these guys' minds?
Did you make this comment, then come back 2 years later and make the same comment again? If you don't answer, don't worry I'll ask again in 2023.
I could/should write a book on all the events I have seen but a few highlights. Watched a Cub get airborne dragging a cynderblock tied to his tail. A Citation in ATL was taxing out with a towbar still hooked to the nose.Fyi its huge. Not holding brakes leading to yanking out ext power. To many wring rnw/taxiway and even wrong airports and incursions to list.
BTW- there is a vid of a large high wing twin possibly vintage that was painstakingly rebuilt and on its maiden went vert into a stall and nose in total loss die to gust locks being forgotten.
wow crazy i would buy/read that what was the vid
That video is a Buffalo I believe converted to turboprop power on an early flight in the program.
The cinderblock was just the Cub’s new tail hook.
@@Spyke-lz2hl Yeah, I think you're right if it's the one I'm thinking of. A DHC-5 Buffalo. Went straight up and straight back down, horrible.
It' is weird with no lights on....
Sad that they lost their lives but the pilots were at fault by not following pre-flight checklists, complacency leads to fatalities.
+Jeff Lebowski The NTSB report stated that the aircrew of this particular airplane failed to check the operation of the flight controls 98% of the time with over 176 take offs.
+Stranger Horse yes. they are lucky they didnt kill any passengers etc as well during the course of these failures
in every single failure pilots are always to blame, from super high attack angles that stall airplanes, to fighting the rudder between themselves, to even trying to fly manual at 40,000 ft, moronic in every episode
Why the hell did they leave the lock on and then attempt to rotate?
Can someone familiar with a G-IV tell us what was required to disengage gust locks while rolling?
All they had to do was lower a handle
ua-cam.com/video/R8OBO6vECug/v-deo.html
Nothing would disengage the lock in that situation.
Once the engines were started the hydraulic pressure won’t allow the gust lock to release. They had to shut down the engines to get the lock off. That’s why they incorrectly tried to turn off the hydraulics to the flight controls.
@@upurnose46 Nope.
Many times corporate pilots will do anything to avoid what they perceive as an embarrassment (go around, rejected takeoff, delay for deice, etc). Rather than reject, they try to shut off hydraulics to the flight controls to circumvent the gust lock? Then reject, way too late, when that doesn’t work? Just like the Teterboro Learjet, rather than go around, and admit they messed up, they try to sneak in into the circle and screw that up, luckily without pax or injuries on the ground. Also shows the lack of systems knowledge amongst corporate aviation. They should’ve known what the rudder limit light was telling them, and then should’ve know what it meant when they could’ve advance thrust. This isn’t Monday morning qb this is simple fact. I’ve flown about 7 years in corporate and 15 in the airlines and it is night and day difference.
Note to self: If offered a flight on someone’s corporate jet, go get a ticket on a normal airline instead.
So, you have a "rudder limit" message but you still advance power levers for T/O??? Can someone answer, does the GIV have a "Takeoff Config OK" message"?
Do operators randomly pull the tapes to verify their pilots are following procedure?
+johnfranks Yes, There's an automatic parameter indicator, FOQA, which records and highlights (sends a message) when specific speeds, flap settings, gear position and other configuration parameters are exceeded. Also company and FAA pilots routinely fly in the cockpit to observe procedural compliance. Also pilots train routine, as required by law, in simulators to practice emergency actions, new procedures and industry common issues. There's a lot to all of this, yet the cockpit environment is subject to many many many permutations in weather, weight, performance, personality, fatigue, flight hours, etc etc., so that there are many variables that affect the flight. Just the availability of approach modes of operation are complex choices with major and minor permutations that require focus and situational awareness on the part of both pilots.
+johnfranks I don't know about the major airlines, but this was a private corporate aircraft. The NTSB report stated that the aircrew of this particular airplane failed to check the operation of the flight controls 98% of the time with over 176 take offs. If I knew that about my pilots they would be fired : ) The question I have is how did they manage to pass their mandatory check rides? The NTSB also faulted the aircraft manufacturer for allowing the throttle lock position to advance power to take off speed with the gust lock engaged. The flight crew totally froze for too long (about 11 seconds) before aborting the take off. Besides engaging the autothrottle because the throttle levers wouldn't move past a certain degree (6 degrees?), they also tried to unlock the control surfaces instead of shutting it down. Very sad.
@@strangerhorse5209 i do have to wonder the outcome if they would have done reversers immediately with brakes
I would look into & recommend adjustment of the overall required continuing education requirements of licensed PIC's. Failing sequential events, such as these, MAY be greatly lessened by 'Critical Task Drill' requirements. In today's age, these can be conducted via zoom meeting, or during weekly-scheduled Safety Meetings. 'What If' Q & A sessions should be a welcome weekly practice. As a previously-licensed Master, on the water, these were are still are common SOP. #FoodForThought #SaveLives #SafetyFirst
Late at night after waiting at the airport for Mr Katz & co. to fly back to Philly. It's just a short flight and then home to bed, right? We've done it so many times it becomes routine. Everyone was probably tired and anxious to get home. I hope all the commenters can see how this sort of thing can happen. In the words of Mr Richard Bach "some days it is our own head that is carved of knotty pine"
Rushing in aviation is never a good thing.
would like an captain to break down pilots actions here
Is it bad that I knew that outcome but I still found myself saying "Abort! Just abort." "Abort Now idiot ABORT!" ..........?
look like they did not fly together and were not familiar with that plane
Dr Evil narrating?
What a load of crap. The pilots sucked at it!
Probable Cause: "The NTSB determines that the probable cause of this accident was the flight crewmembers’ failure to perform the flight control check before takeoff, their attempt to take off with the gust lock system engaged, and their delayed execution of a rejected takeoff after they became aware that the controls were locked. Contributing to the accident were the flight crew’s habitual noncompliance with checklists, Gulfstream Aerospace Corporation’s failure to ensure that the G-IV gust lock/throttle lever interlock system would prevent an attempted takeoff with the gust lock engaged, and the Federal Aviation Administration’s failure to detect this inadequacy during the G-IV’s certification."
When they say these were pilots, did they mean like real legit pilot-pilots, like the ones who fly airplanes? They were that kind of pilot?
G'day,
Yay Team !
Lovely Animation...
Verdict, "Pilot Error..." ; Failure to conduct an Adequate Pre-Flight Inspection, plus Failure to check the Real Answers to the Pre Take-Off Checks...
The Penalty is Death, with no "Right" of Appeal.
;-p
Ciao !
Shh
you get what you pay for....
OMG é Dhídd Thãý Déiđs ¿¿¿
dmmm,
Flight control checks are overrated /sarc
This or the crash of that learjet at Teterboro are competing for the prize of dumbest airplane crew ever.
You can always do worse (like BS 211 its crazy bad)
This guy has an appalling pronounciation.
At 160 knots they should have kept going and rotated.
That's the reason for them not being able to take of initially. They couldn't rotate.
Won't work with no functioning flight controls; the gust lock was left on.
DId you even listen to the video? You can't rotate with gust lock on.
Absolutely ignorant comment.