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|
Attributes | |
ACN | 719867 |
Time | |
Date | 200612 |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | navaid : ujm.vor |
State Reference | AR |
Altitude | msl single value : 10000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : mem.tracon |
Operator | common carrier : air carrier |
Make Model Name | MD-11 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other Other |
Flight Phase | descent : approach |
Route In Use | arrival star : marvell 3 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 146 flight time total : 13342 flight time type : 3355 |
ASRS Report | 719867 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Events | |
Anomaly | altitude deviation : undershoot non adherence : far non adherence : published procedure |
Independent Detector | other flight crewa other flight crewb |
Resolutory Action | none taken : detected after the fact |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Narrative:
How many times has a professional flight crew with 60+ yrs of experience reset the altimeter descending through FL180? At least a zillion times or more. Well; we forgot it the other day and with the local altimeter setting of 30.74 we were almost 1000 ft high on the memphis marvel arrival. The clearance was to cross the tammy fix at 10000 ft. We were looking good with a setting of 29.92; on speed and on altitude approaching tammy. Oh; oh! Fortunately for us approach control turned us for a radar vector about 3 NM short of tammy and descended us to a lower altitude. It appears that we dodged a bullet this time because we never busted any altitude or clrncs; did not receive any TCAS alerts or queries from ATC. A thorough post-flight debrief did little to pinpoint the lapse of consciousness passing through FL180. We were unable to determine why we missed that checklist item or what might have distraction us at that critical period of time. Maybe the boredom of routine has affected my ability to concentrate...maybe not. Whatever the case; from now on I will change my old habit pattern for this particular checklist. My new pattern; once the landing card is completed I will place it on my yoke clip as a reminder of resetting altimeters at FL180. It seems like a good time to shake up my thoughts about the old boring routines.
Original NASA ASRS Text
Title: MD11 FLT CREW HAS AN ALTDEV DURING STAR.
Narrative: HOW MANY TIMES HAS A PROFESSIONAL FLT CREW WITH 60+ YRS OF EXPERIENCE RESET THE ALTIMETER DSNDING THROUGH FL180? AT LEAST A ZILLION TIMES OR MORE. WELL; WE FORGOT IT THE OTHER DAY AND WITH THE LCL ALTIMETER SETTING OF 30.74 WE WERE ALMOST 1000 FT HIGH ON THE MEMPHIS MARVEL ARR. THE CLRNC WAS TO CROSS THE TAMMY FIX AT 10000 FT. WE WERE LOOKING GOOD WITH A SETTING OF 29.92; ON SPD AND ON ALT APCHING TAMMY. OH; OH! FORTUNATELY FOR US APCH CTL TURNED US FOR A RADAR VECTOR ABOUT 3 NM SHORT OF TAMMY AND DSNDED US TO A LOWER ALT. IT APPEARS THAT WE DODGED A BULLET THIS TIME BECAUSE WE NEVER BUSTED ANY ALT OR CLRNCS; DID NOT RECEIVE ANY TCAS ALERTS OR QUERIES FROM ATC. A THOROUGH POST-FLT DEBRIEF DID LITTLE TO PINPOINT THE LAPSE OF CONSCIOUSNESS PASSING THROUGH FL180. WE WERE UNABLE TO DETERMINE WHY WE MISSED THAT CHKLIST ITEM OR WHAT MIGHT HAVE DISTR US AT THAT CRITICAL PERIOD OF TIME. MAYBE THE BOREDOM OF ROUTINE HAS AFFECTED MY ABILITY TO CONCENTRATE...MAYBE NOT. WHATEVER THE CASE; FROM NOW ON I WILL CHANGE MY OLD HABIT PATTERN FOR THIS PARTICULAR CHKLIST. MY NEW PATTERN; ONCE THE LNDG CARD IS COMPLETED I WILL PLACE IT ON MY YOKE CLIP AS A REMINDER OF RESETTING ALTIMETERS AT FL180. IT SEEMS LIKE A GOOD TIME TO SHAKE UP MY THOUGHTS ABOUT THE OLD BORING ROUTINES.
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.