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|
Attributes | |
ACN | 652242 |
Time | |
Date | 200503 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | navaid : teh.ndb |
Altitude | msl single value : 13000 |
Environment | |
Flight Conditions | IMC |
Weather Elements | Thunderstorm |
Light | Dusk |
Aircraft 1 | |
Controlling Facilities | tracon : skbo.tracon |
Operator | common carrier : air carrier |
Make Model Name | B727-200 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | climbout : initial climbout : intermediate altitude |
Route In Use | departure sid : bosa 4 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : multi engine pilot : instrument pilot : flight engineer pilot : atp pilot : cfi pilot : commercial |
Experience | flight time last 90 days : 130 flight time total : 6000 flight time type : 1270 |
ASRS Report | 652242 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Experience | flight time last 90 days : 50 flight time total : 8500 flight time type : 400 |
ASRS Report | 651682 |
Events | |
Anomaly | aircraft equipment problem : less severe inflight encounter : turbulence inflight encounter : weather non adherence : published procedure other anomaly other spatial deviation |
Independent Detector | aircraft equipment other aircraft equipment : stall warning other flight crewa other flight crewb |
Resolutory Action | flight crew : regained aircraft control |
Supplementary | |
Problem Areas | Flight Crew Human Performance Weather |
Primary Problem | Flight Crew Human Performance |
Narrative:
On departure we had a pressurization problem and a mistuned ADF which distraction the crew. When the ADF was tuned correctly; a turn was made to return to our proper course. In the turn; the aircraft penetrated a cloud bank. The PNF and so were heads down. The aircraft was in flaps up confign. In the turn; the stick shaker activated and the appropriate recovery was flown. Some altitude could have been lost during maneuver. Supplemental information from acn 651682: maximum performance takeoff at maximum gross weight; flaps 5 degrees; packs off. Bosa 4 departure at bogota; columbia. Due to power loss; the GPS unit required to be reprogrammed. The first turn point on the departure was not manually input into the system. After passing the first ADF on the departure; the third ADF was not correctly tuned; and finally; the packs were not turned back on after takeoff; which resulted in the cabin altitude warning horn sounding. The crew was distraction; I was fighting to maintain situational awareness; because of the programming error in the GPS; I mistuned ADF. The first officer was retuning and identing the correct ADF; and the so was regaining control of the cabin altitude. I called for flaps up and the after takeoff checklist. The min maneuvering speed from flap 2 degrees to flap 0 degrees was 10 KTS and the aircraft appeared to be accelerating toward flap 0 degrees min maneuvering speed by the time the flaps were up. Simultaneously with the flaps up call; I begin a 15 degree bank turn to re establish back on course. At the same time; we entered a dry but convective cloud with turbulence. I noticed that the bank was greater than 15 degrees and the airspeed was declining and the stick shaker sounded. Went to firewall power and flew out of the stick shaker. No engine red lines were exceeded. Decided to continue to destination; since bogota had thunderstorm in the vicinity and we only had 17 mins of extra fuel. Contributing factors: end of duty day (13 hours) fatigue. Multiple mistakes that distraction crew. Turbulence that caused a loss of protection at 0 degrees min maneuvering speed and 15 degrees of bank. Flying at min maneuvering speeds at high altitude leaves no room for error. Allowing the nose to track up during recovery resulted in a stick shaker.
Original NASA ASRS Text
Title: AT 13000 FT DURING A DEP FROM BOGOTA; A B727 CREW DEALING WITH SEVERAL DISTRS SUCCESSFULLY RECOVER FROM A STICK SHAKER THAT ACTIVATED AS FLAPS WERE REDUCED TO ZERO.
Narrative: ON DEP WE HAD A PRESSURIZATION PROB AND A MISTUNED ADF WHICH DISTR THE CREW. WHEN THE ADF WAS TUNED CORRECTLY; A TURN WAS MADE TO RETURN TO OUR PROPER COURSE. IN THE TURN; THE ACFT PENETRATED A CLOUD BANK. THE PNF AND SO WERE HEADS DOWN. THE ACFT WAS IN FLAPS UP CONFIGN. IN THE TURN; THE STICK SHAKER ACTIVATED AND THE APPROPRIATE RECOVERY WAS FLOWN. SOME ALT COULD HAVE BEEN LOST DURING MANEUVER. SUPPLEMENTAL INFO FROM ACN 651682: MAX PERFORMANCE TKOF AT MAX GROSS WT; FLAPS 5 DEGS; PACKS OFF. BOSA 4 DEP AT BOGOTA; COLUMBIA. DUE TO PWR LOSS; THE GPS UNIT REQUIRED TO BE REPROGRAMMED. THE FIRST TURN POINT ON THE DEP WAS NOT MANUALLY INPUT INTO THE SYSTEM. AFTER PASSING THE FIRST ADF ON THE DEP; THE THIRD ADF WAS NOT CORRECTLY TUNED; AND FINALLY; THE PACKS WERE NOT TURNED BACK ON AFTER TKOF; WHICH RESULTED IN THE CABIN ALT WARNING HORN SOUNDING. THE CREW WAS DISTR; I WAS FIGHTING TO MAINTAIN SITUATIONAL AWARENESS; BECAUSE OF THE PROGRAMMING ERROR IN THE GPS; I MISTUNED ADF. THE FO WAS RETUNING AND IDENTING THE CORRECT ADF; AND THE SO WAS REGAINING CONTROL OF THE CABIN ALT. I CALLED FOR FLAPS UP AND THE AFTER TKOF CHKLIST. THE MIN MANEUVERING SPD FROM FLAP 2 DEGS TO FLAP 0 DEGS WAS 10 KTS AND THE ACFT APPEARED TO BE ACCELERATING TOWARD FLAP 0 DEGS MIN MANEUVERING SPD BY THE TIME THE FLAPS WERE UP. SIMULTANEOUSLY WITH THE FLAPS UP CALL; I BEGIN A 15 DEG BANK TURN TO RE ESTABLISH BACK ON COURSE. AT THE SAME TIME; WE ENTERED A DRY BUT CONVECTIVE CLOUD WITH TURB. I NOTICED THAT THE BANK WAS GREATER THAN 15 DEGS AND THE AIRSPEED WAS DECLINING AND THE STICK SHAKER SOUNDED. WENT TO FIREWALL POWER AND FLEW OUT OF THE STICK SHAKER. NO ENG RED LINES WERE EXCEEDED. DECIDED TO CONTINUE TO DEST; SINCE BOGOTA HAD TSTM IN THE VICINITY AND WE ONLY HAD 17 MINS OF EXTRA FUEL. CONTRIBUTING FACTORS: END OF DUTY DAY (13 HRS) FATIGUE. MULTIPLE MISTAKES THAT DISTR CREW. TURB THAT CAUSED A LOSS OF PROTECTION AT 0 DEGS MIN MANEUVERING SPD AND 15 DEGS OF BANK. FLYING AT MIN MANEUVERING SPDS AT HIGH ALT LEAVES NO ROOM FOR ERROR. ALLOWING THE NOSE TO TRACK UP DURING RECOVERY RESULTED IN A STICK SHAKER.
Data retrieved from NASA's ASRS site as of January 2009 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.