Ten Years Between Accidents & Ten More Years of Half-Measures

Once again, we have proof that the most dangerous part of the flight is during landing, when speed has to be reduced from about 130 mph to 10 mph to safely exit the runway. The latest evidence of this high-risk period comes from the landing overrun of an American Airlines twin jet at Kingston’s Norman Manley International Airport, Jamaica, on the rainy evening of 22 December.

The airplane’s wheels touched down, but speed was not appreciably abated and the B737-800 with 154 passengers and crew aboard roared off the end of the runway, ripped through a perimeter fence, split apart and came to a halt just a few feet from the ocean surf.

Ninety people were taken to hospitals with broken bones, contusions and bruises; four people were hurt seriously, although none of the injuries was considered life threatening. Injuries to crew are unknown.

Ten years ago, on 1 June 1999, the captain of an American Airlines MD-82 twin jet was killed in similar circumstances landing in a thunderstorm at Little Rock, Arkansas. The first officer was badly injured, as were a dozen or so passengers, some of whom escaped the wreckage though splits in the fuselage as the airplane ground to a halt just short of the Arkansas River.

The two cases, then and now, raise a simple question: what has the aviation industry learned in the intervening decade to prevent a repeat?

 

Kingston, Jamaica, 2009 -- going off the end of a wet runway and stopping just short of the ocean.

Kingston, Jamaica, 2009 -- going off the end of a wet runway and stopping just short of the ocean.

Little Rock, Arkansas, 1999 -- roaring off the end of a wet runway and stopping just short of the Arkansas River.

Little Rock, Arkansas, 1999 -- roaring off the end of a wet runway and stopping just short of the Arkansas River.

The following issues will doubtless be examined by the Jamaica Civil Aviation Authority, assisted by a team from the U.S. National Transportation Safety Board (some of whom, hopefully, were participants in the Little Rock crash investigation – their memory of the particulars of that crash will be especially pertinent):

— The role of the dispatcher. Every airline flight is a collaborative effort between the cockpit crew and the dispatcher at the airline’s flight operations center. Was this flight dispatched into an area of known thunderstorm activity? At certain U.S. airlines, it is policy to avoid thunderstorms entirely. The lack of such policy at American Airlines in 1999 had much to do with the set-up for the accident. If the dispatcher recommended delayed landing until the thunderstorm passed – say about 20 minutes – the accident might have been avoided as well. And of course there is the subject of alternate airports if the field at Kingston, Jamaica, was not usable because of severe thunderstorms.

— The utility of weather radar in the cockpit. In the 1999 crash investigation, questions were raised about the adequacy of the flight crew’s knowledge and training in the use of the airplane’s on board weather radar. The practice of “avoiding the red” on the radar display in the Little Rock crash was clearly insufficient. The areas depicted in red may show the most intense rainfall, but not necessarily the most turbulent convective activity.

— Time of day. As at Little Rock, the crash at Jamaica was late at night. Not only is poor visibility a factor, but also the matter of crew fatigue. At Little Rock, the captain was clearly fatigued, as evidenced from the cockpit voice recorder (CVR) indicating his non-responsiveness to the first officer (FO: “Want 40 flaps?” Captain: “Oh yeah, I thought I called it.”).

— Support from the tower. At Little Rock, the tower controller did not suspend operations, even though the airport was experiencing a Level 6 thunderstorm, considered “severe” on a six-point scale. The wind shear detectors at Little Rock were also not placed optimally for assessing the wind shear hazard.

— Touchdown point. Exactly how long is the runway at Kingston and where did the B737-800 touch down? Reportedly, the runway is 8,786 feet long, and the B737-800 landed long — about halfway down, due in part to a tailwind component. At Little Rock, the airplane touched down long on the runway. Given the circumstances of aircraft configuration, the airplane did not have enough paved length remaining to stop, no matter what procedures were employed by the crew.

— Configuration. At Little Rock, the crew had failed to arm the spoilers, so they did not deploy on landing. The spoilers kill lift and put maximum weight on the main landing gear. With about 95% of the airplane’s weight on the main landing gears, braking effectiveness is optimal. This wasn’t the case at Little Rock, where only 10% of the airplane’s 127,000 lb landing weight was on the wheels, and the airplane hydroplaned down the runway. Hydroplaning also occurred at Kingston, from early accounts.

— Reverse thrust. Did the crew at Kingston apply maximum reverse thrust to aid in deceleration? The flight data recorder (FDR) should reveal much. At Little Rock, the crew did not apply maximum reverse thrust. With a late touchdown, no spoilers, insufficient reverse thrust and delayed braking, plus hydroplaning, the Little Rock aircraft roared off the end of the runway at more than 100 mph. One passenger on the Kingston jet recalled, “The airplane did not seem to be slowing down when it landed. There was a loud sound, then a huge thud, and then we started to feel rain through the top.”

— Cabin safety. When the airplane landed hard at Kingston, overhead bins popped open, spilling carry-on bags and articles. The spillage contributed to the general sense of passenger confusion and frustration during the subsequent emergency evacuation. This bin spillage was a problem in the Little Rock crash, too. The flimsy overhead bin doors were a problem in 1999, and they’re still problematic in 2009, when passengers are carrying even more items aboard the aircraft. The locking mechanism on the doors needs to be strengthened. The manner in which ceiling panels are affixed also is an issue.

— What safety area? Every runway is supposed to have 1,000 feet of unpaved ground as a safety area off the end of the runway. This was not the case at Little Rock, where the Arkansas River floodplain was right off the end of the runway. The airplane hit runway lighting poles, which were not frangible, badly damaging the airplane but the poles helped stop it short of the water. At Kingston, the airplane was damaged by dunes, which had the effect of stopping it just 10 feet short of the ocean. At Little Rock, after the accident the airport authority installed an Engineered Materials Arresting System (EMAS), a porous form of concrete, to assist in stopping airplanes that cannot stop on the paved runway. The wheels bury themselves in the porous material and the airplane is quickly brought to a halt (without damaging the airplane itself and with only minor degradation to the landing gear). It is interesting that the Little Rock installation was hastily completed after the accident. Had EMAS been installed at Kingston, the airplane would have been stopped before plowing into dunes and splitting open, damaging the almost-new B737-800 beyond repair.

— The response. At Little Rock, the airport rescue and fire fighter (ARFF) response was delayed because of uncertainty about the crashed aircraft’s location. The fire fighters originally went to the wrong end of the runway. The Kingston airport ARFF response, however timely or not, will surely get close scrutiny. As at Little Rock, ARFF personnel were trying to locate a wrecked aircraft on a dark and stormy night.

So once again investigators will have issues to address that were not fully resolved in the ten years after the 1999 accident. And that raises an ugly question: why is the industry so tardy on correcting obvious, basic safety deficiencies? It could well take ten additional years to redress similar shortcomings revealed by the crash at Jamaica.