37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 701486 |
Time | |
Date | 200606 |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | msl single value : 24000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zzz.artcc tower : fll.tower |
Operator | general aviation : personal |
Make Model Name | Super King Air 200 HDC |
Operating Under FAR Part | Part 91 |
Flight Phase | descent : intermediate altitude |
Flight Plan | IFR |
Person 1 | |
Affiliation | other |
Function | flight crew : captain oversight : pic |
Qualification | pilot : flight engineer pilot : atp |
Experience | flight time last 90 days : 95 flight time total : 4800 flight time type : 450 |
ASRS Report | 701486 |
Person 2 | |
Affiliation | other |
Function | flight crew : first officer |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance |
Independent Detector | aircraft equipment other aircraft equipment : cabin alt indicator other flight crewa |
Resolutory Action | flight crew : declared emergency flight crew : overcame equipment problem |
Consequence | other |
Supplementary | |
Problem Areas | Flight Crew Human Performance Maintenance Human Performance Aircraft Company |
Primary Problem | Maintenance Human Performance |
Narrative:
After we had started our initial descent and I increased the rate of descent slightly; I heard a 'thump' or 'snap' followed by an extreme sensation of cabin climb (my ears). It took me a second or two to assess what was happening while the cabin masks were deploying and I was trying to interpretation the 'cabin rate' needle; which was pegged to the right (strange looking because I had flown other planes with a normal indication to the right; so it took me a second; even though physically I knew what was happening. It was about this time that I started to feel 'funny' and 'warm.' it then all came to me about what exactly was going on and what I had to do (I guess it was at this time that my training took over). I then immediately tried to don my mask; and it wouldn't fit over my headset. I just held to my face with my right hand and flew the airplane with my left and continued breathing while notifying ATC I needed lower (I was already in a fast descent); and that we had a pressurization failure. I think initially he cleared me to FL190. I insisted lower and he asked if I was declaring an emergency. I replied 'affirmative' and he cleared me to (I think) 6000 ft. We descended; returned to ZZZ safely. Upon notifying maintenance and some inspecting they discovered that the air-to-ground squat switch linkage had been removed from its mount (disconnected) to perform system testing on the ground and had failed to reconnect it. I failed to catch it on my preflight. Apparently it was positioned in such a way as to allow the aircraft to pressurize on takeoff; but must have moved to the 'on-the-ground position' when I began my descent; and dumped the cabin because it thought we were on the ground.
Original NASA ASRS Text
Title: KINGAIR BE200 PLT HAS PRESSURIZATION LOSS; DECLARES AN EMER AND LANDS.
Narrative: AFTER WE HAD STARTED OUR INITIAL DSCNT AND I INCREASED THE RATE OF DSCNT SLIGHTLY; I HEARD A 'THUMP' OR 'SNAP' FOLLOWED BY AN EXTREME SENSATION OF CABIN CLB (MY EARS). IT TOOK ME A SECOND OR TWO TO ASSESS WHAT WAS HAPPENING WHILE THE CABIN MASKS WERE DEPLOYING AND I WAS TRYING TO INTERP THE 'CABIN RATE' NEEDLE; WHICH WAS PEGGED TO THE R (STRANGE LOOKING BECAUSE I HAD FLOWN OTHER PLANES WITH A NORMAL INDICATION TO THE R; SO IT TOOK ME A SECOND; EVEN THOUGH PHYSICALLY I KNEW WHAT WAS HAPPENING. IT WAS ABOUT THIS TIME THAT I STARTED TO FEEL 'FUNNY' AND 'WARM.' IT THEN ALL CAME TO ME ABOUT WHAT EXACTLY WAS GOING ON AND WHAT I HAD TO DO (I GUESS IT WAS AT THIS TIME THAT MY TRAINING TOOK OVER). I THEN IMMEDIATELY TRIED TO DON MY MASK; AND IT WOULDN'T FIT OVER MY HEADSET. I JUST HELD TO MY FACE WITH MY R HAND AND FLEW THE AIRPLANE WITH MY L AND CONTINUED BREATHING WHILE NOTIFYING ATC I NEEDED LOWER (I WAS ALREADY IN A FAST DSCNT); AND THAT WE HAD A PRESSURIZATION FAILURE. I THINK INITIALLY HE CLRED ME TO FL190. I INSISTED LOWER AND HE ASKED IF I WAS DECLARING AN EMER. I REPLIED 'AFFIRMATIVE' AND HE CLRED ME TO (I THINK) 6000 FT. WE DSNDED; RETURNED TO ZZZ SAFELY. UPON NOTIFYING MAINT AND SOME INSPECTING THEY DISCOVERED THAT THE AIR-TO-GND SQUAT SWITCH LINKAGE HAD BEEN REMOVED FROM ITS MOUNT (DISCONNECTED) TO PERFORM SYS TESTING ON THE GND AND HAD FAILED TO RECONNECT IT. I FAILED TO CATCH IT ON MY PREFLT. APPARENTLY IT WAS POSITIONED IN SUCH A WAY AS TO ALLOW THE ACFT TO PRESSURIZE ON TKOF; BUT MUST HAVE MOVED TO THE 'ON-THE-GND POS' WHEN I BEGAN MY DSCNT; AND DUMPED THE CABIN BECAUSE IT THOUGHT WE WERE ON THE GND.
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.