37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 251772 |
Time | |
Date | 199309 |
Day | Wed |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : lax |
State Reference | CA |
Altitude | agl bound lower : 0 agl bound upper : 0 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | Widebody, Low Wing, 2 Turbojet Eng |
Navigation In Use | Other Other |
Flight Phase | ground : preflight ground other : taxi |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 30 flight time total : 12000 flight time type : 30 |
ASRS Report | 251772 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : commercial pilot : instrument |
Events | |
Anomaly | non adherence : far non adherence : published procedure other anomaly other |
Independent Detector | other other : unspecified |
Resolutory Action | none taken : detected after the fact |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | other |
Narrative:
There are 4 doors on the air carrier widebody transport. The 2 rear doors were not armed for emergency use from pushback at lax to blocking at iad. The first flight attendant did announce over the PA for flight attendants to arm their doors and xchk. The flight attendant responsible for door 2R did not hear either announcement and did not arm her door. Due to a mix-up and misunderstanding during the first flight attendant's briefing, door 2L was left unassigned! No flight attendant assumed responsibility for door 2L nor alerted the first flight attendant that the door was unassigned. 2 mins prior to takeoff the cockpit requested flight attendants prepare for takeoff over the PA system. The flight attendant responsible for door 2R either had forgotten she had not armed the door or did not exercise her responsibility to arm the door. She did not tell the first flight attendant or the cockpit that she had not received instructions to arm door 2R. The 2 rear doors were unarmed for the entire flight! It is apparent that there is no backup in case a flight attendant makes a mistake. There is no follow-up during flight to make sure all doors are still armed nor any check of door condition prior to landing. The unarmed condition was only discovered when the doors were checked to be disarmed at the conclusion of the flight. A confused and upset flight attendant came to the cockpit as my copilot and I were getting out of our seats and explained what had happened. I am astonished that this could happen! I am appalled that there isn't a fail safe arrangement to insure correct door condition for phase of flight. I view this incident as a serious safety lapse.
Original NASA ASRS Text
Title: AN ACR WDB CAPT RPTS THAT HE FLEW A TRIP WHEREIN THE FLT ATTENDANTS IN THE REAR CABIN DID NOT ARM THE 2 REAR DOORS.
Narrative: THERE ARE 4 DOORS ON THE ACR WDB. THE 2 REAR DOORS WERE NOT ARMED FOR EMER USE FROM PUSHBACK AT LAX TO BLOCKING AT IAD. THE FIRST FLT ATTENDANT DID ANNOUNCE OVER THE PA FOR FLT ATTENDANTS TO ARM THEIR DOORS AND XCHK. THE FLT ATTENDANT RESPONSIBLE FOR DOOR 2R DID NOT HEAR EITHER ANNOUNCEMENT AND DID NOT ARM HER DOOR. DUE TO A MIX-UP AND MISUNDERSTANDING DURING THE FIRST FLT ATTENDANT'S BRIEFING, DOOR 2L WAS LEFT UNASSIGNED! NO FLT ATTENDANT ASSUMED RESPONSIBILITY FOR DOOR 2L NOR ALERTED THE FIRST FLT ATTENDANT THAT THE DOOR WAS UNASSIGNED. 2 MINS PRIOR TO TKOF THE COCKPIT REQUESTED FLT ATTENDANTS PREPARE FOR TKOF OVER THE PA SYS. THE FLT ATTENDANT RESPONSIBLE FOR DOOR 2R EITHER HAD FORGOTTEN SHE HAD NOT ARMED THE DOOR OR DID NOT EXERCISE HER RESPONSIBILITY TO ARM THE DOOR. SHE DID NOT TELL THE FIRST FLT ATTENDANT OR THE COCKPIT THAT SHE HAD NOT RECEIVED INSTRUCTIONS TO ARM DOOR 2R. THE 2 REAR DOORS WERE UNARMED FOR THE ENTIRE FLT! IT IS APPARENT THAT THERE IS NO BACKUP IN CASE A FLT ATTENDANT MAKES A MISTAKE. THERE IS NO FOLLOW-UP DURING FLT TO MAKE SURE ALL DOORS ARE STILL ARMED NOR ANY CHK OF DOOR CONDITION PRIOR TO LNDG. THE UNARMED CONDITION WAS ONLY DISCOVERED WHEN THE DOORS WERE CHKED TO BE DISARMED AT THE CONCLUSION OF THE FLT. A CONFUSED AND UPSET FLT ATTENDANT CAME TO THE COCKPIT AS MY COPLT AND I WERE GETTING OUT OF OUR SEATS AND EXPLAINED WHAT HAD HAPPENED. I AM ASTONISHED THAT THIS COULD HAPPEN! I AM APPALLED THAT THERE ISN'T A FAIL SAFE ARRANGEMENT TO INSURE CORRECT DOOR CONDITION FOR PHASE OF FLT. I VIEW THIS INCIDENT AS A SERIOUS SAFETY LAPSE.
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.