37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 380317 |
Time | |
Date | 199709 |
Day | Mon |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | airport : sna |
State Reference | CA |
Altitude | msl bound lower : 10000 msl bound upper : 10500 |
Environment | |
Flight Conditions | VMC |
Light | Dusk |
Aircraft 1 | |
Controlling Facilities | artcc : zla tracon : lax |
Operator | common carrier : air carrier |
Make Model Name | B757 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Navigation In Use | Other Other |
Flight Phase | climbout : intermediate altitude |
Route In Use | departure : noise abatement departure other enroute other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : flight engineer pilot : atp |
Experience | flight time last 90 days : 100 flight time total : 7000 flight time type : 900 |
ASRS Report | 380317 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : flight engineer pilot : cfi pilot : atp |
Experience | flight time last 90 days : 150 flight time total : 16000 flight time type : 400 |
ASRS Report | 380202 |
Events | |
Anomaly | aircraft equipment problem : less severe altitude deviation : overshoot inflight encounter other non adherence : clearance non adherence : published procedure other anomaly other |
Independent Detector | other flight crewa |
Resolutory Action | controller : issued new clearance flight crew : became reoriented flight crew : returned to intended course or assigned course |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation other |
Situations | |
ATC Facility | procedure or policy : unspecified |
Airport | procedure or policy : unspecified |
Narrative:
The noise abatement takeoff from sna is demanding when everything goes right. When something minor goes wrong, things get busy real quick. After takeoff with the FMC and autothrottles programmed correctly, the power did not reduce when VNAV was selected at 800 ft. The captain flew the profile while I attempted to get the power reduced. We were handed off to socal departure. They gave us a westerly heading and a climb to 10000 ft. I was still working with the thrust management computer and the MCP as we approached 10000 ft. When I looked up, we were at 10300 ft and climbing. The captain immediately descended to 10000 ft as I checked on another frequency. No mention was made by ATC and we were cleared to 16000 ft. Our maximum altitude deviation was 500 ft. Sna is by far the most difficult departure in our system. Not because the procedure is that difficult, but because it is completely different from anything else in our system. It is a major departure from normal sops that causes distrs not only in the departure area but well beyond. The NTSB and FAA should re-evaluate the safety of this procedure dictated to many airlines by one city in the country. Supplemental information from acn 380202: the aircraft was very light climbing at 5000 FPM and to a cleared altitude of 10000 ft. Passing about 9000 ft we were switched to ZLA. At the same time we encountered unexpected moderate clear air turbulence. First officer was in the process of switching frequencys and did not notice captain's failure to level at 10000 ft. When ZLA answered our check-in they immediately cleared us to a higher altitude. The crew allowed themselves to become overly occupied with the anticipated problem of noise exceedance and failed to adequately focus on the continuing climb out. The high rate of climb, autothrottle problem, frequency change, moderate turbulence, all within the first 2 mins of flight, resulted in a very high workload situation. The workload could have been moderated if the autoplt had been engaged, but it was not. The sna noise situation is an example of how priorities can be misplaced when there is any glitch in the planned departure, such as our autothrottle problem.
Original NASA ASRS Text
Title: B757 FLC TALE OF AN ALT OVERSHOOT THAT WAS PROMOTED BY A FAILURE OF THEIR AUTOTHROTTLE SYS AND OTHER DISTRS. NEITHER PLT LIKES THE NOISE ABATEMENT PROC AT SNA.
Narrative: THE NOISE ABATEMENT TKOF FROM SNA IS DEMANDING WHEN EVERYTHING GOES RIGHT. WHEN SOMETHING MINOR GOES WRONG, THINGS GET BUSY REAL QUICK. AFTER TKOF WITH THE FMC AND AUTOTHROTTLES PROGRAMMED CORRECTLY, THE PWR DID NOT REDUCE WHEN VNAV WAS SELECTED AT 800 FT. THE CAPT FLEW THE PROFILE WHILE I ATTEMPTED TO GET THE PWR REDUCED. WE WERE HANDED OFF TO SOCAL DEP. THEY GAVE US A WESTERLY HDG AND A CLB TO 10000 FT. I WAS STILL WORKING WITH THE THRUST MGMNT COMPUTER AND THE MCP AS WE APCHED 10000 FT. WHEN I LOOKED UP, WE WERE AT 10300 FT AND CLBING. THE CAPT IMMEDIATELY DSNDED TO 10000 FT AS I CHKED ON ANOTHER FREQ. NO MENTION WAS MADE BY ATC AND WE WERE CLRED TO 16000 FT. OUR MAX ALTDEV WAS 500 FT. SNA IS BY FAR THE MOST DIFFICULT DEP IN OUR SYS. NOT BECAUSE THE PROC IS THAT DIFFICULT, BUT BECAUSE IT IS COMPLETELY DIFFERENT FROM ANYTHING ELSE IN OUR SYS. IT IS A MAJOR DEP FROM NORMAL SOPS THAT CAUSES DISTRS NOT ONLY IN THE DEP AREA BUT WELL BEYOND. THE NTSB AND FAA SHOULD RE-EVALUATE THE SAFETY OF THIS PROC DICTATED TO MANY AIRLINES BY ONE CITY IN THE COUNTRY. SUPPLEMENTAL INFO FROM ACN 380202: THE ACFT WAS VERY LIGHT CLBING AT 5000 FPM AND TO A CLRED ALT OF 10000 FT. PASSING ABOUT 9000 FT WE WERE SWITCHED TO ZLA. AT THE SAME TIME WE ENCOUNTERED UNEXPECTED MODERATE CLR AIR TURB. FO WAS IN THE PROCESS OF SWITCHING FREQS AND DID NOT NOTICE CAPT'S FAILURE TO LEVEL AT 10000 FT. WHEN ZLA ANSWERED OUR CHK-IN THEY IMMEDIATELY CLRED US TO A HIGHER ALT. THE CREW ALLOWED THEMSELVES TO BECOME OVERLY OCCUPIED WITH THE ANTICIPATED PROB OF NOISE EXCEEDANCE AND FAILED TO ADEQUATELY FOCUS ON THE CONTINUING CLBOUT. THE HIGH RATE OF CLB, AUTOTHROTTLE PROB, FREQ CHANGE, MODERATE TURB, ALL WITHIN THE FIRST 2 MINS OF FLT, RESULTED IN A VERY HIGH WORKLOAD SIT. THE WORKLOAD COULD HAVE BEEN MODERATED IF THE AUTOPLT HAD BEEN ENGAGED, BUT IT WAS NOT. THE SNA NOISE SIT IS AN EXAMPLE OF HOW PRIORITIES CAN BE MISPLACED WHEN THERE IS ANY GLITCH IN THE PLANNED DEP, SUCH AS OUR AUTOTHROTTLE PROB.
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.