37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 302930 |
Time | |
Date | 199504 |
Day | Sun |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | atc facility : enl airport : mvn |
State Reference | IL |
Altitude | msl bound lower : 2800 msl bound upper : 2800 |
Environment | |
Flight Conditions | Marginal |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zkc |
Operator | general aviation : personal |
Make Model Name | Cessna 210 Centurion / Turbo Centurion 210C, 210D |
Operating Under FAR Part | Part 91 |
Flight Phase | cruise other |
Route In Use | enroute airway : zkc |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : single pilot |
Qualification | pilot : commercial pilot : instrument pilot : cfi |
Experience | flight time last 90 days : 100 flight time total : 1150 flight time type : 300 |
ASRS Report | 302930 |
Person 2 | |
Affiliation | government : faa |
Function | controller : radar |
Qualification | controller : radar |
Events | |
Anomaly | aircraft equipment problem : critical inflight encounter other other anomaly other |
Independent Detector | aircraft equipment other aircraft equipment : unspecified |
Resolutory Action | controller : provided flight assist flight crew : overcame equipment problem flight crew : became reoriented flight crew : declared emergency other |
Consequence | Other |
Supplementary | |
Primary Problem | Aircraft |
Air Traffic Incident | other |
Narrative:
What occurred at this point is unclr. In my memory, I remember not being able to find the approach plates, even though they were on the floor beside me. I had both an approach certified GPS, RNAV and moving map and yet I was confused as to where I was going. I advised center that I would turn toward the airport when I could set my GPS and take some time to sort out where I was. I tried 3 times to set kmvn into the GPS in the rough air -- even though both it and the moving map offered a 'karest' function -- which I never thought to use. I was clearly confused as to what to do and panic began to set in. I advised ATC that I was going to proceed GPS direct to the airport and I believed that I could obtain a visual, cancel IFR and proceed VFR, if that didn't work I'd go to plan B. During this exchange a commuter was held from departure. Fortunately at 2800 ft MSL, I was able to acquire the airport visually at 10 O'clock and 3 mi and complete this approach visually. I was completely confused and temporarily wasn't thinking clearly. I could have completed a full VOR approach. I had both a GPS approved receiver and approach plates, but I couldn't seem to tune the GPS, much less think through what was happening. Upon landing, I discovered my carbon monoxide detector was jet black. I now suspect that I may have been suffering disorientation as a result of carbon monoxide exposure. My aircraft is subject to an exhaust check at each 50 hours, and I am just at that point with this flight for a rechk. If that is not the cause, then I am baffled. I did suffer dizziness and mild disorientation during the flight, which I though might be because I missed breakfast. Just prior to the incident, I had encountered unexpected sleet, icing and moderate to severe turbulence, perhaps all that combined to overwhelm me. Callback conversation with reporter revealed the following information: this is a classic case of carbon monoxide poisoning. The detector in the aircraft was black, indicating carbon monoxide presence and the effects on the pilot were symptomatic. The reporter said that he felt extreme fatigue, confusion, irritability and inability to concentrate or to even complete the simple tasks. His aircraft, a cessna turbo 210, has several notices regarding carbon monoxide leaks in the heater system. This heater fits around the exhaust shroud. The local FBO checked the aircraft for carbon monoxide leakage, but none was found. The pilot suspects that the turbulence he was experiencing at the time may have caused some of the flexible duct joints to open allowing carbon monoxide to be ingested into the cabin air heater. The pilot is going to have more extensive tests performed. He has now recovered from the fatigue and nausea that he experienced that day.
Original NASA ASRS Text
Title: ACFT EQUIP PROB -- PLT BECAME DISORIENTED UNDER THE EFFECTS OF CARBON MONOXIDE POISONING.
Narrative: WHAT OCCURRED AT THIS POINT IS UNCLR. IN MY MEMORY, I REMEMBER NOT BEING ABLE TO FIND THE APCH PLATES, EVEN THOUGH THEY WERE ON THE FLOOR BESIDE ME. I HAD BOTH AN APCH CERTIFIED GPS, RNAV AND MOVING MAP AND YET I WAS CONFUSED AS TO WHERE I WAS GOING. I ADVISED CTR THAT I WOULD TURN TOWARD THE ARPT WHEN I COULD SET MY GPS AND TAKE SOME TIME TO SORT OUT WHERE I WAS. I TRIED 3 TIMES TO SET KMVN INTO THE GPS IN THE ROUGH AIR -- EVEN THOUGH BOTH IT AND THE MOVING MAP OFFERED A 'KAREST' FUNCTION -- WHICH I NEVER THOUGHT TO USE. I WAS CLRLY CONFUSED AS TO WHAT TO DO AND PANIC BEGAN TO SET IN. I ADVISED ATC THAT I WAS GOING TO PROCEED GPS DIRECT TO THE ARPT AND I BELIEVED THAT I COULD OBTAIN A VISUAL, CANCEL IFR AND PROCEED VFR, IF THAT DIDN'T WORK I'D GO TO PLAN B. DURING THIS EXCHANGE A COMMUTER WAS HELD FROM DEP. FORTUNATELY AT 2800 FT MSL, I WAS ABLE TO ACQUIRE THE ARPT VISUALLY AT 10 O'CLOCK AND 3 MI AND COMPLETE THIS APCH VISUALLY. I WAS COMPLETELY CONFUSED AND TEMPORARILY WASN'T THINKING CLRLY. I COULD HAVE COMPLETED A FULL VOR APCH. I HAD BOTH A GPS APPROVED RECEIVER AND APCH PLATES, BUT I COULDN'T SEEM TO TUNE THE GPS, MUCH LESS THINK THROUGH WHAT WAS HAPPENING. UPON LNDG, I DISCOVERED MY CARBON MONOXIDE DETECTOR WAS JET BLACK. I NOW SUSPECT THAT I MAY HAVE BEEN SUFFERING DISORIENTATION AS A RESULT OF CARBON MONOXIDE EXPOSURE. MY ACFT IS SUBJECT TO AN EXHAUST CHK AT EACH 50 HRS, AND I AM JUST AT THAT POINT WITH THIS FLT FOR A RECHK. IF THAT IS NOT THE CAUSE, THEN I AM BAFFLED. I DID SUFFER DIZZINESS AND MILD DISORIENTATION DURING THE FLT, WHICH I THOUGH MIGHT BE BECAUSE I MISSED BREAKFAST. JUST PRIOR TO THE INCIDENT, I HAD ENCOUNTERED UNEXPECTED SLEET, ICING AND MODERATE TO SEVERE TURB, PERHAPS ALL THAT COMBINED TO OVERWHELM ME. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THIS IS A CLASSIC CASE OF CARBON MONOXIDE POISONING. THE DETECTOR IN THE ACFT WAS BLACK, INDICATING CARBON MONOXIDE PRESENCE AND THE EFFECTS ON THE PLT WERE SYMPTOMATIC. THE RPTR SAID THAT HE FELT EXTREME FATIGUE, CONFUSION, IRRITABILITY AND INABILITY TO CONCENTRATE OR TO EVEN COMPLETE THE SIMPLE TASKS. HIS ACFT, A CESSNA TURBO 210, HAS SEVERAL NOTICES REGARDING CARBON MONOXIDE LEAKS IN THE HEATER SYS. THIS HEATER FITS AROUND THE EXHAUST SHROUD. THE LCL FBO CHKED THE ACFT FOR CARBON MONOXIDE LEAKAGE, BUT NONE WAS FOUND. THE PLT SUSPECTS THAT THE TURB HE WAS EXPERIENCING AT THE TIME MAY HAVE CAUSED SOME OF THE FLEXIBLE DUCT JOINTS TO OPEN ALLOWING CARBON MONOXIDE TO BE INGESTED INTO THE CABIN AIR HEATER. THE PLT IS GOING TO HAVE MORE EXTENSIVE TESTS PERFORMED. HE HAS NOW RECOVERED FROM THE FATIGUE AND NAUSEA THAT HE EXPERIENCED THAT DAY.
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.