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37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
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Halfway between gum and hnl, a flight crew of an MD11 has an engine flameout due to improper fuel management.
| Attributes | |
| ACN | 377165 |
| Time | |
| Date | 199708 |
| Day | Tue |
| Local Time Of Day | 1201 To 1800 |
| Place | |
| Locale Reference | atc facility : hnl |
| State Reference | HI |
| Altitude | msl bound lower : 33000 msl bound upper : 33000 |
| Environment | |
| Flight Conditions | VMC |
| Light | Daylight |
| Aircraft 1 | |
| Controlling Facilities | artcc : zoa |
| Operator | common carrier : air carrier |
| Make Model Name | MD-11 |
| Operating Under FAR Part | Part 121 |
| Navigation In Use | Other Other |
| Flight Phase | cruise other |
| Route In Use | enroute : other oceanic enroute : pacific |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | flight crew : captain oversight : pic |
| Qualification | pilot : atp |
| Experience | flight time last 90 days : 120 flight time total : 9500 flight time type : 2000 |
| ASRS Report | 377165 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | flight crew : first officer |
| Qualification | pilot : atp |
| Experience | flight time last 90 days : 150 flight time total : 8000 flight time type : 790 |
| ASRS Report | 377455 |
| Events | |
| Anomaly | aircraft equipment problem : critical non adherence : published procedure other anomaly other |
| Independent Detector | aircraft equipment other aircraft equipment : unspecified other flight crewa |
| Resolutory Action | flight crew : overcame equipment problem |
| Consequence | Other |
| Supplementary | |
| Primary Problem | Flight Crew Human Performance |
| Air Traffic Incident | Pilot Deviation |
Narrative:
Hopefully this report makes sense but I wouldn't guarantee it. The official duty day ended up being 21 hours 55 mins and 14 hours 42 mins flight time. That is the background on the flight. Somewhere between 3 and 4 hours out of guam en route to hnl I, captain, was in the bunk taking a break for the first time since leaving mnl -- an evening departure out of mnl. At no time did I know or feel anything out of the ordinary. Normally I feel/hear every climb and descent even in the bunk. When I came back up on the flight deck the 2 first officer's (both type rated) told me that they had accidentally shut down #2 engine. We had elected to run the fuel system in manual to keep fuel in the tail tank for center of gravity control. One of the auxiliary xfer pumps was inoperative. With that pump inoperative in automatic the fuel system controller will not give you tail fuel management -- it just pumps it forward into the tank with the inoperative pump. Thus the reason for choosing manual. The 2 first officer's on duty were balancing fuel between tanks. One held his finger up to the xfer pump switch and got confirmation from the other first officer before moving it. The same process was repeated to turn it off. Then for some unknown reason the first officer reached up to press the switch again. Just as the other first officer said no, he pushed it -- it was the #2 tank fuel pumps. #2 is the only engine that won't gravity feed. It was dead instantly. They went through the checklists, restarted the engine with no problem, and we continued the flight without further incident. I think the biggest factor in this incident was the fatigue level at this point in the flight. Supplemental information from acn 377455: due to an inoperative fuel pump in the #2 tank, the fuel system was being operated in manual. A slight fuel imbalance required xfer from tank #2 to tank #3. Instead of turning the xfer pump on, I inadvertently turned the #2 pump switch off. The #2 engine then flamed out. We accomplished the engine restart in-flight procedure and continued to our destination.
Original NASA ASRS Text
Title: HALFWAY BTWN GUM AND HNL, A FLC OF AN MD11 HAS AN ENG FLAMEOUT DUE TO IMPROPER FUEL MGMNT.
Narrative: HOPEFULLY THIS RPT MAKES SENSE BUT I WOULDN'T GUARANTEE IT. THE OFFICIAL DUTY DAY ENDED UP BEING 21 HRS 55 MINS AND 14 HRS 42 MINS FLT TIME. THAT IS THE BACKGROUND ON THE FLT. SOMEWHERE BTWN 3 AND 4 HRS OUT OF GUAM ENRTE TO HNL I, CAPT, WAS IN THE BUNK TAKING A BREAK FOR THE FIRST TIME SINCE LEAVING MNL -- AN EVENING DEP OUT OF MNL. AT NO TIME DID I KNOW OR FEEL ANYTHING OUT OF THE ORDINARY. NORMALLY I FEEL/HEAR EVERY CLB AND DSCNT EVEN IN THE BUNK. WHEN I CAME BACK UP ON THE FLT DECK THE 2 FO'S (BOTH TYPE RATED) TOLD ME THAT THEY HAD ACCIDENTALLY SHUT DOWN #2 ENG. WE HAD ELECTED TO RUN THE FUEL SYS IN MANUAL TO KEEP FUEL IN THE TAIL TANK FOR CTR OF GRAVITY CTL. ONE OF THE AUX XFER PUMPS WAS INOP. WITH THAT PUMP INOP IN AUTO THE FUEL SYS CTLR WILL NOT GIVE YOU TAIL FUEL MGMNT -- IT JUST PUMPS IT FORWARD INTO THE TANK WITH THE INOP PUMP. THUS THE REASON FOR CHOOSING MANUAL. THE 2 FO'S ON DUTY WERE BALANCING FUEL BTWN TANKS. ONE HELD HIS FINGER UP TO THE XFER PUMP SWITCH AND GOT CONFIRMATION FROM THE OTHER FO BEFORE MOVING IT. THE SAME PROCESS WAS REPEATED TO TURN IT OFF. THEN FOR SOME UNKNOWN REASON THE FO REACHED UP TO PRESS THE SWITCH AGAIN. JUST AS THE OTHER FO SAID NO, HE PUSHED IT -- IT WAS THE #2 TANK FUEL PUMPS. #2 IS THE ONLY ENG THAT WON'T GRAVITY FEED. IT WAS DEAD INSTANTLY. THEY WENT THROUGH THE CHKLISTS, RESTARTED THE ENG WITH NO PROB, AND WE CONTINUED THE FLT WITHOUT FURTHER INCIDENT. I THINK THE BIGGEST FACTOR IN THIS INCIDENT WAS THE FATIGUE LEVEL AT THIS POINT IN THE FLT. SUPPLEMENTAL INFO FROM ACN 377455: DUE TO AN INOP FUEL PUMP IN THE #2 TANK, THE FUEL SYS WAS BEING OPERATED IN MANUAL. A SLIGHT FUEL IMBALANCE REQUIRED XFER FROM TANK #2 TO TANK #3. INSTEAD OF TURNING THE XFER PUMP ON, I INADVERTENTLY TURNED THE #2 PUMP SWITCH OFF. THE #2 ENG THEN FLAMED OUT. WE ACCOMPLISHED THE ENG RESTART INFLT PROC AND CONTINUED TO OUR DEST.
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.