37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 193730 |
Time | |
Date | 199111 |
Day | Thu |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : pit |
State Reference | PA |
Altitude | msl bound lower : 2600 msl bound upper : 10000 |
Environment | |
Flight Conditions | IMC |
Light | Dusk |
Aircraft 1 | |
Controlling Facilities | tracon : pit |
Operator | common carrier : air carrier |
Make Model Name | Medium Large Transport, Low Wing, 2 Turbojet Eng |
Navigation In Use | Other Other |
Flight Phase | cruise other cruise other descent other |
Route In Use | arrival other enroute : on vectors |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 200 flight time total : 12500 |
ASRS Report | 193730 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Events | |
Anomaly | non adherence : clearance other anomaly other anomaly other other spatial deviation |
Independent Detector | other flight crewa |
Resolutory Action | other |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
During descent from 10000 ft to 6000 ft, I either left mode control panel in the 'vertical speed' mode or it reverted from a 'level change' to a 'vertical speed' mode somewhere during descent. In any case, at approximately 8000 ft I noticed the IAS at 290 KIAS during autoplt descent. I immediately disconnected autoplt and corrected the deviation manually. After reestablished on correct profile, approach control set us up for a short turn in ILS 28L approach. Autoplt was being used, but localizer movement rate and angle exceeded capture capability and we drove through the localizer. We asked for a vector to reintercept. After another high aspect angle vector close in with same results, I manually flew aircraft to provide my own intercept and leveled off until established on approach. It became obvious we were going to intercept localizer inside FAF, so we went around and executed another ILS approach uneventfully. Contributing was over reliance on autoflt system and poor xchk. Fatigue and diet was also a factor. Situation occurred at end of 12 hour day with no time to eat and was preceded by 5 other rather brutal 12-13 hour day domestic short haul multiple leg duty periods.
Original NASA ASRS Text
Title: A DISPLAY OF FLC PLT BEHAVIOR INADEQUATE HUMAN RESOURCES WHEREIN PIC, PF, EXHIBITS A TEMPORARY LOSS OF MANUAL SKILLS DURING A SPD DEV AND HDG TRACK DEV.
Narrative: DURING DSCNT FROM 10000 FT TO 6000 FT, I EITHER LEFT MODE CTL PANEL IN THE 'VERT SPD' MODE OR IT REVERTED FROM A 'LEVEL CHANGE' TO A 'VERT SPD' MODE SOMEWHERE DURING DSCNT. IN ANY CASE, AT APPROX 8000 FT I NOTICED THE IAS AT 290 KIAS DURING AUTOPLT DSCNT. I IMMEDIATELY DISCONNECTED AUTOPLT AND CORRECTED THE DEV MANUALLY. AFTER REESTABLISHED ON CORRECT PROFILE, APCH CTL SET US UP FOR A SHORT TURN IN ILS 28L APCH. AUTOPLT WAS BEING USED, BUT LOC MOVEMENT RATE AND ANGLE EXCEEDED CAPTURE CAPABILITY AND WE DROVE THROUGH THE LOC. WE ASKED FOR A VECTOR TO REINTERCEPT. AFTER ANOTHER HIGH ASPECT ANGLE VECTOR CLOSE IN WITH SAME RESULTS, I MANUALLY FLEW ACFT TO PROVIDE MY OWN INTERCEPT AND LEVELED OFF UNTIL ESTABLISHED ON APCH. IT BECAME OBVIOUS WE WERE GOING TO INTERCEPT LOC INSIDE FAF, SO WE WENT AROUND AND EXECUTED ANOTHER ILS APCH UNEVENTFULLY. CONTRIBUTING WAS OVER RELIANCE ON AUTOFLT SYS AND POOR XCHK. FATIGUE AND DIET WAS ALSO A FACTOR. SITUATION OCCURRED AT END OF 12 HR DAY WITH NO TIME TO EAT AND WAS PRECEDED BY 5 OTHER RATHER BRUTAL 12-13 HR DAY DOMESTIC SHORT HAUL MULTIPLE LEG DUTY PERIODS.
Data retrieved from NASA's ASRS site as of July 2007 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.