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|
Attributes | |
ACN | 597972 |
Time | |
Date | 200310 |
Day | Sat |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : orf.airport |
State Reference | VA |
Altitude | agl single value : 0 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | MD-88 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : taxi |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : commercial pilot : instrument pilot : multi engine |
Experience | flight time last 90 days : 120 flight time total : 6000 flight time type : 800 |
ASRS Report | 597972 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : multi engine pilot : private pilot : atp pilot : commercial pilot : instrument |
Experience | flight time last 90 days : 185 flight time total : 5000 flight time type : 2000 |
ASRS Report | 597589 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : non compliance with mel maintenance problem : improper documentation non adherence : company policies non adherence : published procedure |
Independent Detector | other other : coord 3 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Supplementary | |
Problem Areas | Company Environmental Factor Flight Crew Human Performance Aircraft Chart Or Publication |
Primary Problem | Flight Crew Human Performance |
Situations | |
Publication | MEL |
Narrative:
While approaching the runway for takeoff, the captain's EFIS went blank. We complied with the pom procedure for this failure, but could not find it in the MEL. As the pom stated that we could still fly CAT I approachs with the EFIS switch in the 'both on 2' position, and we felt comfortable completing the placards in the air, we continued the flight. Midway through the next flight of the day, flight control informed us that as this item is not listed in the MEL, we were not legal to take off. I feel several factors contributed to this mistake: primarily, our desire to maintain an on-time operation, my own complacency or 'copilot' syndrome,' the MEL does not contain a list of 'no-go' items that are not included in its scope. It is a large and complicated document and this made it difficult to conclude definitely that something is not listed (as opposed to 'I just can't find the item'), also, in both initial and recurrent training, it is a fairly highly stressed item to recall (from memory) 'what switch do you use to fix a symbol generator and what approach may you still fly?' this engenders a somewhat cavalier attitude and belittles the importance of a rarely used switch. Supplemental information from acn 597589: during taxi out captain's EFIS (pfd, navigation display) goes blank. Checked for popped circuit breakers and found none. After thoroughly checking the MEL, neither I or the first officer could find anything about EFIS malfunctions! My reasoning was it's VFR here, it's VFR at our destination, my company has no maintenance here except for contract maintenance, we are keeping the operation safe, let's go. Wrong! I should have contacted my dispatcher and I'm sure he would have pointed out that I need maintenance to mco the captain's EFIS. I know the MEL applies right up to the takeoff event, but it sure would have helped if the MEL index had anything about EFIS malfunctions. We found nothing. Maybe something should be written in order to take the doubt out of any captain's mind! Lesson learned!
Original NASA ASRS Text
Title: AN MD80 LOSES THE CAPT'S EFIS DISPLAY ON TAXI OUT. AFTER COMPLYING WITH THE PROC IN THE POM AND UNABLE TO FIND ANY REF TO THE INOP #1 EFIS IN THE MEL, THE CREW TAKES OFF FROM ORF, VA.
Narrative: WHILE APCHING THE RWY FOR TKOF, THE CAPT'S EFIS WENT BLANK. WE COMPLIED WITH THE POM PROC FOR THIS FAILURE, BUT COULD NOT FIND IT IN THE MEL. AS THE POM STATED THAT WE COULD STILL FLY CAT I APCHS WITH THE EFIS SWITCH IN THE 'BOTH ON 2' POS, AND WE FELT COMFORTABLE COMPLETING THE PLACARDS IN THE AIR, WE CONTINUED THE FLT. MIDWAY THROUGH THE NEXT FLT OF THE DAY, FLT CTL INFORMED US THAT AS THIS ITEM IS NOT LISTED IN THE MEL, WE WERE NOT LEGAL TO TAKE OFF. I FEEL SEVERAL FACTORS CONTRIBUTED TO THIS MISTAKE: PRIMARILY, OUR DESIRE TO MAINTAIN AN ON-TIME OP, MY OWN COMPLACENCY OR 'COPLT' SYNDROME,' THE MEL DOES NOT CONTAIN A LIST OF 'NO-GO' ITEMS THAT ARE NOT INCLUDED IN ITS SCOPE. IT IS A LARGE AND COMPLICATED DOCUMENT AND THIS MADE IT DIFFICULT TO CONCLUDE DEFINITELY THAT SOMETHING IS NOT LISTED (AS OPPOSED TO 'I JUST CAN'T FIND THE ITEM'), ALSO, IN BOTH INITIAL AND RECURRENT TRAINING, IT IS A FAIRLY HIGHLY STRESSED ITEM TO RECALL (FROM MEMORY) 'WHAT SWITCH DO YOU USE TO FIX A SYMBOL GENERATOR AND WHAT APCH MAY YOU STILL FLY?' THIS ENGENDERS A SOMEWHAT CAVALIER ATTITUDE AND BELITTLES THE IMPORTANCE OF A RARELY USED SWITCH. SUPPLEMENTAL INFO FROM ACN 597589: DURING TAXI OUT CAPT'S EFIS (PFD, NAV DISPLAY) GOES BLANK. CHKED FOR POPPED CIRCUIT BREAKERS AND FOUND NONE. AFTER THOROUGHLY CHKING THE MEL, NEITHER I OR THE FO COULD FIND ANYTHING ABOUT EFIS MALFUNCTIONS! MY REASONING WAS IT'S VFR HERE, IT'S VFR AT OUR DEST, MY COMPANY HAS NO MAINT HERE EXCEPT FOR CONTRACT MAINT, WE ARE KEEPING THE OP SAFE, LET'S GO. WRONG! I SHOULD HAVE CONTACTED MY DISPATCHER AND I'M SURE HE WOULD HAVE POINTED OUT THAT I NEED MAINT TO MCO THE CAPT'S EFIS. I KNOW THE MEL APPLIES RIGHT UP TO THE TKOF EVENT, BUT IT SURE WOULD HAVE HELPED IF THE MEL INDEX HAD ANYTHING ABOUT EFIS MALFUNCTIONS. WE FOUND NOTHING. MAYBE SOMETHING SHOULD BE WRITTEN IN ORDER TO TAKE THE DOUBT OUT OF ANY CAPT'S MIND! LESSON LEARNED!
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.