37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 1159646 |
Time | |
Date | 201403 |
Local Time Of Day | 0601-1200 |
Place | |
Locale Reference | ZZZ.Airport |
State Reference | US |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Make Model Name | B737-700 |
Operating Under FAR Part | Part 121 |
Flight Phase | Parked |
Component | |
Aircraft Component | Air Conditioning and Pressurization Pack |
Person 1 | |
Function | Captain |
Qualification | Flight Crew Air Transport Pilot (ATP) |
Experience | Flight Crew Last 90 Days 268 |
Events | |
Anomaly | Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor Flight Deck / Cabin / Aircraft Event Illness |
Narrative:
During the post deicing checklist; a significant amount of fumes from deicing fluid entered the cockpit after turning on the bleed switches one minute after completion of deicing. We quickly turned off the packs to stop the fumes from entering the cockpit and cabin. I became nauseous and developed a mild headache later in the flight and ended up being removed from the flight sequence in ZZZ. I was later placed on non-flying status via the oji process.we reviewed the company deicing procedures after we stopped the fumes/before starting the #1 engine and again while at cruise to see if we'd missed any steps. We noted that we hadn't since the before deicing checklist does not direct that the packs be turned off. Alas; when the bleeds are turned off one minute after completing deicing; the pack switch configuration allows any deicing fluid that has entered the APU bleed air ducting to be directed immediately to the left pack. The before deicing checklist should be amended to turn off the packs at the same time as the bleeds are turned off. The post deicing checklist should be amended to delay turning the packs back on until after each bleed source is used as a bleed source (e.g. APU for engine start or wing anti ice; engines for engine anti-ice or wing anti-ice). This would have air flow through the bleed ducts to remove any deicing fluid.
Original NASA ASRS Text
Title: A Captain became ill after deicing when the engine bleed air switches were turned ON with the engines off. Apparently deice fluid in the APU bleed air entered the left pack.
Narrative: During the Post Deicing Checklist; a significant amount of fumes from deicing fluid entered the cockpit after turning on the bleed switches one minute after completion of deicing. We quickly turned OFF the packs to stop the fumes from entering the cockpit and cabin. I became nauseous and developed a mild headache later in the flight and ended up being removed from the flight sequence in ZZZ. I was later placed on non-flying status via the OJI process.We reviewed the Company deicing procedures after we stopped the fumes/before starting the #1 Engine and again while at cruise to see if we'd missed any steps. We noted that we hadn't since the Before Deicing Checklist does not direct that the packs be turned off. Alas; when the bleeds are turned OFF one minute after completing deicing; the pack switch configuration allows any deicing fluid that has entered the APU bleed air ducting to be directed immediately to the left pack. The Before Deicing Checklist should be amended to turn OFF the packs at the same time as the bleeds are turned OFF. The Post Deicing Checklist should be amended to delay turning the packs back ON until after each bleed source is used as a bleed source (e.g. APU for engine start or wing anti ice; engines for engine anti-ice or wing anti-ice). This would have air flow through the bleed ducts to remove any deicing fluid.
Data retrieved from NASA's ASRS site and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.