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Attributes | |
ACN | 85455 |
Time | |
Date | 198804 |
Day | Thu |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | airport : las |
State Reference | NV |
Altitude | msl bound lower : 0 msl bound upper : 0 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | Medium Large Transport, Low Wing, 2 Turbojet Eng |
Navigation In Use | Other |
Flight Phase | ground : preflight |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Experience | flight time last 90 days : 200 flight time total : 5750 flight time type : 2500 |
ASRS Report | 85455 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : instrument pilot : atp pilot : commercial |
Experience | flight time last 90 days : 250 flight time total : 10000 flight time type : 7000 |
ASRS Report | 85355 |
Events | |
Anomaly | aircraft equipment problem : critical |
Independent Detector | other other : unspecified |
Resolutory Action | none taken : unable other |
Consequence | other |
Supplementary | |
Primary Problem | Aircraft |
Air Traffic Incident | other |
Narrative:
Aircraft at the gate was facing 070 degrees with ATIS winds 220/17g30 (tailwind). Temperature 88 degrees F. APU inoperative, thus forcing engine start at the gate via start bottle assist. #1 engine start normal, but slightly slow to spool. #2 engine start was aborted when it appeared of a possibility of a hot start. Engine motored, but egt continued to climb slowly, eventually overtemping the engine. Ground crew observed an engine fire and reported it to cockpit crew. Cockpit crew (me) had no indication of a fire, but went ahead and pulled the fire warning switch and rotated it to discharge extinguishing agent into the engine. At this time, captain initiated ground evacuate/evacuation and I initiated evacuate/evacuation flows and checklist, calling las ground control for fire truck assistance. All 110 passenger evacuated in less than 2 mins as the fire was put out (egt decreasing). Four minor injuries were reported to the las station. All passenger evacuated left side of aircraft (away from the fire). Airlines's procedures were followed and executed. The captain and I were aware of the tailwind conditions and the pressure of the start bottle. We were prepared for a possible engine problem at start. Despite this care, a near disastrous situation developed. With the onset of new advanced technology jet (fan) engines, aircrews need to be fully informed of specific characteristics and have adequate procedures to ensure a safe operation, i.e., in this case, the potential critical nature of starting a jet fan engine with a tailwind condition, and that it may be possible to have an engine fire condition, but not have an indication in the cockpit of an overheat or fire. Supplemental information from acn 85355: I had no fire indication in the cockpit, but I pulled #2 fire handle and fired the bottle anyway. 10-15 seconds later we still had fire in #2 engine, so I called for an evacuate/evacuation of the aircraft on the left side. The crew was possibly in error in their engine start abort procedures as we feel we may have cut off the air supply to the engine and hence no motoring for cool down. Callback conversation with reporter revealed the following: captain had requested the ground crew if the air bottle pressure went below 200 psi. Flight operations manual has no restriction reference to tailwind during air bottle start. Company is in the process of changing the procedure for this type start and expects to see a restriction to start 1 engine only. During the investigation it was determined the particular engine had a history of start problems, hung and hot start. Only minor injuries to passenger.
Original NASA ASRS Text
Title: HOT START WITH TAILPIPE FIRE WHEN USING GND AIR BOTTLE TO START SECOND ENGINE. ACFT EVACUATED.
Narrative: ACFT AT THE GATE WAS FACING 070 DEGS WITH ATIS WINDS 220/17G30 (TAILWIND). TEMP 88 DEGS F. APU INOP, THUS FORCING ENG START AT THE GATE VIA START BOTTLE ASSIST. #1 ENG START NORMAL, BUT SLIGHTLY SLOW TO SPOOL. #2 ENG START WAS ABORTED WHEN IT APPEARED OF A POSSIBILITY OF A HOT START. ENG MOTORED, BUT EGT CONTINUED TO CLB SLOWLY, EVENTUALLY OVERTEMPING THE ENG. GND CREW OBSERVED AN ENG FIRE AND RPTED IT TO COCKPIT CREW. COCKPIT CREW (ME) HAD NO INDICATION OF A FIRE, BUT WENT AHEAD AND PULLED THE FIRE WARNING SWITCH AND ROTATED IT TO DISCHARGE EXTINGUISHING AGENT INTO THE ENG. AT THIS TIME, CAPT INITIATED GND EVAC AND I INITIATED EVAC FLOWS AND CHKLIST, CALLING LAS GND CTL FOR FIRE TRUCK ASSISTANCE. ALL 110 PAX EVACUATED IN LESS THAN 2 MINS AS THE FIRE WAS PUT OUT (EGT DECREASING). FOUR MINOR INJURIES WERE RPTED TO THE LAS STATION. ALL PAX EVACUATED LEFT SIDE OF ACFT (AWAY FROM THE FIRE). AIRLINES'S PROCS WERE FOLLOWED AND EXECUTED. THE CAPT AND I WERE AWARE OF THE TAILWIND CONDITIONS AND THE PRESSURE OF THE START BOTTLE. WE WERE PREPARED FOR A POSSIBLE ENG PROB AT START. DESPITE THIS CARE, A NEAR DISASTROUS SITUATION DEVELOPED. WITH THE ONSET OF NEW ADVANCED TECHNOLOGY JET (FAN) ENGS, AIRCREWS NEED TO BE FULLY INFORMED OF SPECIFIC CHARACTERISTICS AND HAVE ADEQUATE PROCS TO ENSURE A SAFE OPERATION, I.E., IN THIS CASE, THE POTENTIAL CRITICAL NATURE OF STARTING A JET FAN ENG WITH A TAILWIND CONDITION, AND THAT IT MAY BE POSSIBLE TO HAVE AN ENG FIRE CONDITION, BUT NOT HAVE AN INDICATION IN THE COCKPIT OF AN OVERHEAT OR FIRE. SUPPLEMENTAL INFO FROM ACN 85355: I HAD NO FIRE INDICATION IN THE COCKPIT, BUT I PULLED #2 FIRE HANDLE AND FIRED THE BOTTLE ANYWAY. 10-15 SECS LATER WE STILL HAD FIRE IN #2 ENG, SO I CALLED FOR AN EVAC OF THE ACFT ON THE LEFT SIDE. THE CREW WAS POSSIBLY IN ERROR IN THEIR ENG START ABORT PROCS AS WE FEEL WE MAY HAVE CUT OFF THE AIR SUPPLY TO THE ENG AND HENCE NO MOTORING FOR COOL DOWN. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING: CAPT HAD REQUESTED THE GND CREW IF THE AIR BOTTLE PRESSURE WENT BELOW 200 PSI. FLT OPERATIONS MANUAL HAS NO RESTRICTION REF TO TAILWIND DURING AIR BOTTLE START. COMPANY IS IN THE PROCESS OF CHANGING THE PROC FOR THIS TYPE START AND EXPECTS TO SEE A RESTRICTION TO START 1 ENG ONLY. DURING THE INVESTIGATION IT WAS DETERMINED THE PARTICULAR ENG HAD A HISTORY OF START PROBS, HUNG AND HOT START. ONLY MINOR INJURIES TO PAX.
Data retrieved from NASA's ASRS site as of August 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.