American B752 at New York on Sep 6th 2018, abrupt maneuver
Last Update: May 5, 2022 / 18:55:49 GMT/Zulu time
Date of incident
Sep 6, 2018
Edinburgh, United Kingdom
New York JFK, United States
ICAO Type Designator
Airport ICAO Code
The occurrence aircraft remained on the ground in JFK for 31 hours before returning to service.
The Aviation Herald learned about this occurrence on Feb 9th 2019, neither FAA nor NTSB databases showed the occurrence. The source reported the aircraft was a few minutes from landing in clear weather and sunshine, when the aircraft pitched up and down violently possibly as result of wake turbulence. Flight attendants were still up to prepare the cabin for landing, the fasten seat belt signs were already illuminated and the passengers had already fastened their seat belts.
In the late evening of Feb 12th 2019 the NTSB indicated they were investigating the occurrence, in the evening of Feb 13th 2019 the occurrence was included in the NTSB database. The NTSB reported one serious injury and rated the occurrence an accident.
ON Feb 27th 2021 the NTSB opened their docket.
The FDR specialists factual report states:
The aircraft cruised at or near 36,000 feet until an initial descent to 24,000 feet into KJFK began at approximately 16:31:50. At 16:37:49 the aircraft reached 24,000 feet and held at that altitude for about a minute until 12,000 feet was dialed into the mode control panel (MCP) at 16:39:04 and another descent began.
During the descent to 12,000 feet the auto throttle system was engaged in IAS mode, the autopilot vertical guidance varied between VNAV and vertical speed (V/S) mode engaged, and the autopilot lateral guidance had LNAV engaged. The altimeter was set to 29.92 inHg.
As the aircraft neared 12,000 feet, at 16:45:39 Altitude Hold mode engaged. 16 seconds later, at 16:45:55, the recorded altimeter setting changed from 29.92 inHg to 30.13 inHg (Note: the altimeter setting is only recorded once every four seconds, so the input change may have occurred any time between 16:45:51 and 16:45:55).
At 16:45:55 the flight change (FLCH) button was activated on the MCP and the auto throttle system immediately transitioned to FLCH descent mode. Immediately after engagement of this mode the MCP speed window switched to display the current airspeed, slightly above the flight crew’s desired 250 knots. The MCP speed was then manually dialed down to 250 knots, the engine throttle lever angle began to decrease (indicating the throttles were moving aft) and the airplane decelerated. Once the throttles reached the aft stop, the auto throttle system entered Throttle Hold mode.
With the autopilot in FLCH mode with a target altitude of 12,000 feet and the auto throttles in Throttle Hold mode, aircraft pitch attitude began to increase to attempt to hold 12,000 feet and airspeed started to decay below 250 knots. At 16:47:31, airspeed had degraded to 186.5 knots and the pitch attitude was approximately 6 deg nose up. Three seconds later, at 16:47:34 and an airspeed of 185.5 knots, throttle lever angles increased rapidly, and the auto throttle system exited Throttle Hold mode. N1 on both engines began to increase.
At 16:47:42, the autopilot and auto throttle systems were disengaged. Throttle lever angles began to decrease. Airspeed was 195 knots and increasing. Two seconds later, at 16:47:44, aircraft pitch attitude was approximately 10 degrees nose up and the control column position moved quickly forward (to command nose down attitude). From 16:47:44 to 16:47:55 vertical acceleration varied between 1.476 g and -0.156 g and pitch attitude varied between 10 degrees nose up and 3 degrees nose down.
Following the event, the auto throttle system was briefly engaged again at 16:48:01 and disengaged at 16:48:08. The aircraft continued to gain airspeed. Pressure altitude was 11149 feet and decreasing. At 16:48:16 the autopilot was reengaged with a target altitude of 7,000 feet. The auto throttle system remained disengaged until 16:49:31. The aircraft then landed on runway 22L at KJFK at 17:00:35, approximately 13 minutes following the event.
The NTSB summarized the captain's testimony:
When asked to describe the event, he said he set 12,000 feet [mean sea level] and 250 knots to cross Calverton per their ATC instructions. As they came down through 18,000, he set 30.13 on the altimeter and then set it in the back-up altimeter. It took about 3 times to get the button to flip over. He called everyone to the cockpit about 20 minutes ahead of landing, and the weather was VFR. They leveled off at 12,000, and the airspeed was about 253-255 knots. He dialed it back to 250 knots after they leveed off, and saw that they were at about 12,100 feet. He then saw that the altimeter was back to standard again. He said he had referred to the primary altimeter for the 30.13 setting during his third attempt at the standby altimeter. He told the FO he was going to use FLCH to get them down to 12,000, and the FO said they were a little high, so they went back down to 12,000 feet. They then started their briefing.
ATC then gave them a clearance to descend to 7,000 feet, expedite through 9,000, after ROBER fly heading 280. He hit FLCH and they started the descent. He said their briefings on a VFR day typically took about 45 seconds to a minute to go over everything. He had previously told the FB to back them up, be directive, and not let them do anything bad. About the time they were briefing the missed approach altitudes ad directions, the FB said “Speed.” Then, again, he said “Speed.” He then said, “push it over, push over” and the FB said it really loudly. When the FB said that, he almost leaped out of his seat. He looked down and saw a speed of about 190 knots, looked for a box blinking around it to indicate if they were near a stall but there was no box, then pushed over on the airplane, being careful since there were passengers onboard. He pushed it over, and when he pushed up the power, and the nose really wanted to come up since they were light, so he really pushed on the nose to arrest it from coming up. They then recovered the airplane.
They flew the approach to landing. They received a call from the back prior to landing, and he gave the phone to the FB to take care of it. He was advised that there were people and flight attendants down and injured and in need of an ambulance, and the FB then called the ramp control.
They landed uneventfully, set down softly, and taxied at a reasonable rate.
The NTSB summarized the Flight attendant's #1 testimony:
Approximately 20 minutes before landing in JFK, I was standing in my galley with the #3 flight attendant. All of a sudden the plane moved erratically down and then sharply up and accelerated. All the galley inserts came flying out at our heads. We put our arms up to catch them, but most fell to the ground. I did not know what happened and there was no communication from the flight deck. At this point I tried to make my way back to main cabin to check on my crew. What I saw in the back of the aircraft startled me. The amount of debris that had been thrown into the aisle and galley was astonishing. All the flight attendants reported being thrown to the ceiling and then onto the ground. The number 4 flight attendant was still laying in galley with obvious injuries to her wrist and in a great deal of pain.
About 10 minutes after the incident, the Captain called not to ask if we were ok, but to ask if he could make arrival PA. At this point, I asked him what the hell had happened and that we had multiple injuries and we're going to need ambulances to meet the flight. He said "a plane slowed down, so we had to speed up and that movement was the auto pilot disengaging".
THIS WAS NOT A TURBULENCE EVENT. It is something the cockpit intentionally did. I call it an evasive maneuver.
Paramedics met the flight. All flight attendants except myself were transported to an area hospital. I chose to go home and see my own physician. The flight crew stayed in cockpit while we were taken off plane. They never came out to assess what had happened or the condition of my crew. I told the Captain I was going home to see medical attention. He wrote down my cellphone number and provided me with his and directed me to "contact him before filling out any reports so that we could get our stories straight and make sure we tell the company the same thing." I am duty bound to do nothing of the sort, I am only stating the facts of what happened on the airplane as I saw it.
I would like to have a critical incident stress debrief about this incident with all crew members including flight deck present. The flight attendants deserve to know what caused this and they need to be given the tools to deal with the obvious stress of the event.
On May 5th 2022 the NTSB released their final report concluding the probable cause of the accident was:
The flight crew’s failure to adequately monitor the airplane’s airspeed, which led to the captain’s aggressive control inputs to increase airspeed; these aggressive inputs resulted in injuries to three cabin crewmembers.
The NTSB analysed:
The airplane was descending toward the destination airport with the autopilot and autothrottle systems engaged. As the airplane was approaching 12,000 ft, and the autopilot was capturing the altitude, the captain adjusted the altimeter resulting in a displayed altitude of 12,100 ft. The captain (the pilot flying) selected flight level change mode on the autopilot to recapture the altitude and set the speed at 250 knots to slow from about 255 knots. As a result, the autothrottles went to Throttle Hold mode when the throttle levers reached the aft stop. As the captain was briefing the approach, the airplane slowed and pitched up as it tried to maintain altitude with a reduced throttle setting. An international relief officer who was in the cockpit at the time commented on the airplane’s decreasing speed three times when the airplane’s airspeed was about 186 knots before stating that the captain should push the nose over. The captain disengaged the autopilot and auto throttles, aggressively pitched down, and increased the throttles. These aggressive maneuvers caused the flight attendants in the aft galley to be thrown against the ceiling. One flight attendant sustained a compound arm fracture; two other flight attendants sustained minor injuries. The crew subsequently landed the airplane without further incident.
KJFK 061951Z 19017KT 10SM FEW035 FEW250 29/26 A3005 RMK AO2 SLP177 TCU DSNT W-DSNT N T02940261=
KJFK 061851Z 18016G20KT 10SM FEW035 FEW250 30/26 A3007 RMK AO2 SLP182 TCU DSNT W-DSNT N T03000261=
KJFK 061751Z 18011KT 10SM FEW035 31/26 A3010 RMK AO2 SLP191 TCU DSNT W T03110261 10317 20261 58020=
KJFK 061651Z 18010KT 9SM FEW030 31/26 A3012 RMK AO2 SLP199 T03060256=
KJFK 061551Z 20010KT 8SM FEW027 FEW250 31/26 A3013 RMK AO2 SLP204 T03060256=
KJFK 061451Z 21009KT 7SM SCT015 SCT250 29/26 A3015 RMK AO2 SLP211 T02940256 56005=
KJFK 061351Z 23010KT 7SM SCT014 28/25 A3016 RMK AO2 SLP211 T02780250=
KJFK 061344Z 24009KT 7SM SCT014 28/25 A3016 RMK AO2 T02780250=
KJFK 061251Z 21009KT 8SM BKN014 27/25 A3016 RMK AO2 SLP214 T02670250=
KJFK 061151Z 22008KT 7SM BKN014 26/25 A3017 RMK AO2 SLP215 T02560250 10256 20244 51002=
Date of incident
Sep 6, 2018
Edinburgh, United Kingdom
New York JFK, United States
ICAO Type Designator
Airport ICAO Code
This article is published under license from Avherald.com. © of text by Avherald.com.
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