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|
Attributes | |
ACN | 559801 |
Time | |
Date | 200209 |
Day | Thu |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | msl bound lower : 3000 msl bound upper : 4000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tower : lch.tower |
Operator | common carrier : air carrier |
Make Model Name | A300 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | landing : go around |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 100 flight time total : 15000 flight time type : 1200 |
ASRS Report | 559801 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Events | |
Anomaly | aircraft equipment problem : critical other anomaly |
Independent Detector | other flight crewa other flight crewb |
Resolutory Action | flight crew : overrode automation flight crew : overcame equipment problem flight crew : declared emergency flight crew : landed as precaution flight crew : regained aircraft control |
Consequence | other other |
Supplementary | |
Problem Areas | Flight Crew Human Performance Aircraft |
Primary Problem | Flight Crew Human Performance |
Narrative:
Conducting a functional test of the automatic go around feature of autoplt #2 during a post 'C' check acceptance flight. Initial pitch and airspeed normal at 15 degrees anu and V3 (150 KTS). At 1000 ft control column nose down inputs initiated, however aircraft pitch increased. At 3000 ft pitch exceeded 20 degrees anu and speed decreased below 120 KTS. Maximum thrust was applied. Trim was not moving at 4.5 degrees anu and elevator effectiveness was diminishing. Pitch increased to 29 degrees (from digital flight data recorder) at 4000 ft. Manual trim wheel was moved nose down, disconnecting pitch trim and autoplt. Recovery was made. Thrust was reduced after 10-15 seconds of overtemp on CF6-50-C2 engines. Declared an emergency and returned without further event to ZZZ. Infrequency of training in automatic go around caused breakdown in SOP. Complacent approach to poor aircraft performance due to on-going multiple mechanical faults/failures in test flight. Failure to disconnect autoplt. PF did not quickly and definitely announce pitch control problem allowing entire crew to focus on resolution. Callback conversation with reporter revealed the following information: reporter stated that the flight crew was not prepared for the autotrim and autoplt to malfunction during the go around. This malfunction is a rare occurrence and the high angle of attack of the aircraft was very unusual. He stated that his lack of communicating to the other crew members (CRM) when the malfunction was realized caused for a slow reaction to the situation. The fact that the autoplt was not disconnected immediately was a factor. As the aircraft achieved a dangerously high angle of attack the situation deteriorated and the flight crew became fixated and did not perform the sops as per the operating manual.
Original NASA ASRS Text
Title: A300 AIRBUS FLC, DURING A GAR, HAS A MALFUNCTION OF THE AUTOPLT AND THE ACFT PITCHES INTO AN UNSAFE NOSE HIGH ATTITUDE.
Narrative: CONDUCTING A FUNCTIONAL TEST OF THE AUTO GAR FEATURE OF AUTOPLT #2 DURING A POST 'C' CHK ACCEPTANCE FLT. INITIAL PITCH AND AIRSPD NORMAL AT 15 DEGS ANU AND V3 (150 KTS). AT 1000 FT CTL COLUMN NOSE DOWN INPUTS INITIATED, HOWEVER ACFT PITCH INCREASED. AT 3000 FT PITCH EXCEEDED 20 DEGS ANU AND SPD DECREASED BELOW 120 KTS. MAX THRUST WAS APPLIED. TRIM WAS NOT MOVING AT 4.5 DEGS ANU AND ELEVATOR EFFECTIVENESS WAS DIMINISHING. PITCH INCREASED TO 29 DEGS (FROM DIGITAL FLT DATA RECORDER) AT 4000 FT. MANUAL TRIM WHEEL WAS MOVED NOSE DOWN, DISCONNECTING PITCH TRIM AND AUTOPLT. RECOVERY WAS MADE. THRUST WAS REDUCED AFTER 10-15 SECONDS OF OVERTEMP ON CF6-50-C2 ENGS. DECLARED AN EMER AND RETURNED WITHOUT FURTHER EVENT TO ZZZ. INFREQUENCY OF TRAINING IN AUTO GAR CAUSED BREAKDOWN IN SOP. COMPLACENT APCH TO POOR ACFT PERFORMANCE DUE TO ON-GOING MULTIPLE MECHANICAL FAULTS/FAILURES IN TEST FLT. FAILURE TO DISCONNECT AUTOPLT. PF DID NOT QUICKLY AND DEFINITELY ANNOUNCE PITCH CTL PROB ALLOWING ENTIRE CREW TO FOCUS ON RESOLUTION. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: RPTR STATED THAT THE FLC WAS NOT PREPARED FOR THE AUTOTRIM AND AUTOPLT TO MALFUNCTION DURING THE GAR. THIS MALFUNCTION IS A RARE OCCURRENCE AND THE HIGH ANGLE OF ATTACK OF THE ACFT WAS VERY UNUSUAL. HE STATED THAT HIS LACK OF COMMUNICATING TO THE OTHER CREW MEMBERS (CRM) WHEN THE MALFUNCTION WAS REALIZED CAUSED FOR A SLOW REACTION TO THE SIT. THE FACT THAT THE AUTOPLT WAS NOT DISCONNECTED IMMEDIATELY WAS A FACTOR. AS THE ACFT ACHIEVED A DANGEROUSLY HIGH ANGLE OF ATTACK THE SIT DETERIORATED AND THE FLC BECAME FIXATED AND DID NOT PERFORM THE SOPS AS PER THE OPERATING MANUAL.
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.