US Airways A320 at Philadelphia on Mar 13th 2014, rejected takeoff
Last Update: February 25, 2016 / 14:42:54 GMT/Zulu time
Incident Facts
Date of incident
Mar 13, 2014
Classification
Accident
Cause
Rejected takeoff
Airline
US Airways
Flight number
US-1702
Departure
Philadelphia, United States
Destination
Fort Lauderdale, United States
Aircraft Registration
N113UW
Aircraft Type
Airbus A320
ICAO Type Designator
A320
The airport reported there were no injuries, all passengers have been bussed to the terminal.
On Mar 14th 2014 NTSB spokesman Terry Williams told The Aviation Herald, investigators were on site, they could not confirm or rule out the takeoff was rejected before or after V1, no details about the final position were known and asked for further communication on Monday. So far no reply to the Aviation Herald's follow up has occurred.
The French BEA reported in their weekly bulletin released on Mar 18th 2014, that the aircraft was at about 20 feet AGL when the takeoff was rejected. During the rejected takeoff the nose gear collapsed and the aircraft slightly veered off the side of the runway. The passengers were evacuated. Initial examination showed foreign object ingestion into engine #1.
On Jul 9th 2014 The Aviation Herald learned that the pilot flying was the first officer. The aircraft suffered a tail strike on rotation for takeoff, the takeoff was subsequently discontinued. The aircraft received damage beyond (economic) repair.
On Feb 24th 2016 the NTSB released their factual report stating, the captain rejected takeoff after rotation on Philadelphia's runway 27L. Two passengers received minor injuries, the aircraft sustained substantial damage.
The NTSB summarized crew testimonies that the captain (61, ATPL, 23,800 hours total, 7,500 hours on type) was pilot flying, the first officer (62, ATPL, 13,000 hours total, 4,700 hours on type) was pilot monitoring. During cockpit preparation for departure the captain was talking to the flight dispatcher while the first officer loaded the ATC flight plan into the flight management computer (FMC). Both pilots verified the flight plan on the FMC, but neither pilot recognized that runway 27R had been entered as departure runway rather than runway 27L, that had been assigned to the flight. While taxiing out for departure the crew received the final weight and balance data, the resulting takeoff performance data were manually entered into the FMC.
When ATC advised the aircraft would be next to depart, the first officer began reading the remainder of the taxi checklist when a flight attendant advised a passenger was in the lavatory, subsequently advising the passenger was on the way back to the seat. The checklist was completed while the captain taxied the aircraft onto runway 27L. While lining up for departure the captain recognized the wrong runway 27R had been entered into the FMC and instructed the first officer to correct the entry. The aircraft came to a full stop on runway 27L while awaiting takeoff clearance. The FMC was reprogrammed to runway 27L a few seconds prior to receiving takeoff clearance.
11 seconds after receiving takeoff clearance the thrust levers were moved into the MAX CLIMB detent and nose down inputs were provided by the captain's side stick. The thrust lever was subsequently moved into the FLEX detent, a chime sounded together with an ECAM message that thrust had not been set, the thrust levers were moved to the CL detent for a second and again into the FLEX detent, 3 seconds later the captain announced "They are set."
According to the cockpit voice recorder neither pilot called out 80 knots. Both pilots recognized at about the same time, that no V-speeds were displayed on the primary flight displays. When the aircraft accelerated through 86 knots an aural alert "RETARD" sounded. The captain queried "what did you do, you didn't load. We lost everything", while accelerating through 143 KIAS the captain stated "we'll get that straight when we get airborne" and continued takeoff. Accelerating through 152 KIAS the captain initiated rotation, the first officer stated "wh*. I'm sorry", the aircraft reached 6.9 degrees nose up at 164 KIAS and the nose weight on wheel sensors indicated airborne.
Over the next 4 seconds, with the nose wheel indicating airborne and the main wheel sensors indicating ground, the captain's side stick was pushed forward (nose down) and back (nose up) two times reaching 16 degrees nose up and 16 degrees nose down maximum inputs, the aircraft's pitch and vertical acceleration followed the pitch inputs. In response to the next nose down input, as vertical acceleration reduced, the thrust levers were reduced and the side stick was again pulled (nose up input). The vertical acceleration decreased, the thrust levers were reduced to idle, 4 seconds after the nose gear indicated airborne the weight on wheel sensor changed to ground again, the pitch reduced to -0.4 degrees, and the vertical acceleration suddenly increased to +3.7G consistent with the gear impacting the runway surface, at the same time the captain's pitch input again reached the maximum of 16 degrees nose up. The side stick input cycled nose down and nose up inputs over 2 seconds again and reached 16 degrees nose up again, nose and main gear sensors indicated airborne and the radio altimeter reached 15 feet AGL, the side stick input went to a nose down input, and the aircraft descended, the stick input changed to nose up again and the aircraft pitched up hitting the runway surface with the tail first, then the main landing gear, the nose rotated down until the nose gear impacted the runway and collapsed.
38 seconds after the nose gear had first indicated airborne the aircraft stopped at the left side of the runway, the crew advised ATC they had rejected takeoff and were evacuating the aircraft.
The NTSB described the aircraft damage: "The airplane nose gear collapsed upon impact with the paved runway, resulting in fuselage and engine cowling damage. As a result of the tailstrike, additional damage occurred to the lower aft fuselage section of the airplane, including the aft pressure bulkhead, fuselage, struts, and cross beams. Damage to the left engine occurred after the nose gear collapse due to ingestion of debris. "
The NTSB stated that in previous similiar occurrences, when the crew had received "Thrust not set" indications and "RETARD" calls during takeoff acceleration, the assumed temperature had not been set for flex takeoff, however, crews did not advance the thrust levers into the TOGA detent.
The NTSB reported that US Airways released a bulletin stating:
On September 5, 2014, US Airways published Bulletin 21-14 as a policy change to its A319/320/321 Pilot Handbook. The bulletin stated the following:
"RETARD" Auto Callout During Takeoff
Background. Airbus has identified the possibility to erroneously receive the auto callout "RETARD" during takeoff. This callout is generated during takeoff due to the incorrect calculation of flight phase by the Flight Warning Computers. This occurs at and above 80 knots on takeoff when the thrust levers have been placed in the FLX/MCT detent and no FLEX TEMP was entered in the MCDU PERF TO page. However, if the thrust levers are placed in the TO/GA detent prior to reaching 80 knots, the "RETARD" callout does not occur.
Procedure. Per current Pilot Handbook procedure, if a FLEX temperature was not entered in the MCDU, and the thrust levers are positioned in the FLEX/MCT detent, an ECAM caution will be generated. In this case, move the thrust levers to TO/GA detent and execute a max thrust takeoff in accordance with ECAM direction. When the thrust levers are moved to the TO/GA detent, the warning will be cancelled. (See Pilot Handbook, 2d.1.2). If the thrust levers are not moved to the TO/GA detent prior to 80 knots, the "RETARD" auto callout will sound. Should this occur, perform a rejected takeoff.
The following change to Pilot Handbook 2d.6.4, Rejected Takeoff, Recommended Guidelines, will not be reflected in Revision Cycle 5, but will be included in a subsequent revision:
Between 80 Knots and V1. US Airways recommends a rejected takeoff for items such as engine failure, aircraft aural fire warning, predictive windshear warning or caution, the occurrence of the "RETARD" auto callout, or the perception the aircraft is unsafe or unable to fly.
On Feb 25th 2016 the NTSB released their final report concluding the probable causes of the accident were:
the captain's decision to reject the takeoff after the airplane had rotated. Contributing to the accident was the flight crew's failure to follow standard operating procedures by not verifying that the airplane's flight management computer was properly configured for takeoff and the captain's failure to perform the correct action in response to the electronic centralized aircraft monitoring alert.
The NTSB analysed:
According to the captain, once the airplane was cleared for takeoff on runway 27L, he set FLEX thrust with the thrust levers, and he felt that the performance and acceleration of the airplane on the takeoff roll was normal. About 2 seconds later, as the airplane reached about 56 knots indicated airspeed (KIAS), cockpit voice recorder (CVR) data indicate that the flight crew received a single level two caution chime and an electronic centralized aircraft monitoring (ECAM) message indicating that the thrust was not set correctly. The first officer called "engine thrust levers not set." According to the operator's pilot handbook, in response to an "engine thrust levers not set" ECAM message, the thrust levers should be moved to the takeoff/go-around (TO/GA) detent.
However, the captain responded by saying "they're set" and moving the thrust levers from the FLEX position to the CL (climb) detent then back to the FLEX position. As the airplane continued to accelerate, the first officer did not make a callout at 80 KIAS, as required by the operator's standard operating procedures (SOPs). As the airplane reached 86 KIAS, the automated RETARD aural alert sounded and continued until the end of the CVR recording. According to Airbus, the RETARD alert is designed to occur at 20 ft radio altitude on landing and advise the pilot to reduce the thrust levers to idle. The captain later reported that he had never heard an aural RETARD alert on takeoff, only knew of it on landing, and did not know what it was telling him. He further said that when the RETARD aural alert sounded, he did not plan to reject the takeoff because they were in a high-speed regime, they had no red warning lights, and there was nothing to suggest that the takeoff should be rejected.
The first officer later reported that there were no V-speeds depicted on the PFD and, thus, she could not call V1 or VR during the takeoff. She was not aware of any guidance or procedure that recommended rejecting or continuing a takeoff when there were no V-speeds displayed. She further said she "assumed [the captain] wouldn't continue to takeoff if he did not know the V-speeds." The captain stated that he had recalled the V-speeds as previously briefed from the Taxi checklist, which happened to be the same V-speeds for runway 27L. The captain continued the takeoff roll despite the lack of displayed V-speeds, no callouts from the first officer, and the continued and repeated RETARD aural alert.
FDR data show that the airplane rotated at 164 KIAS. However, in a postaccident interview, the captain stated that he "had the perception the aircraft was unsafe to fly" and that he decided "the safest action was not to continue," so he commenced a rejected takeoff. FDR data indicate that the captain reduced the engines to idle and made an airplane-nose-down input as the airplane reached 167 KIAS (well above the V1 speed of 157 KIAS) and achieved a 6.7 degree nose-high attitude. The airplane's pitch decreased until the nosegear contacted the runway. However, the airplane then bounced back into the air and achieved a radio altitude of about 15 ft. Video from airport security cameras show the airplane fully above the runway surface after the bounce. The tail of the airplane then struck the runway surface, followed by the main landing gear then the nose landing gear, resulting in its fracture. The airplane slid to its final resting position on the left side of runway 27L.
The operator's SOPs address the conditions under which a rejected takeoff should be performed within both low-speed (below 80 KIAS) and high-speed (between 80 KIAS and V1) regimes but provide no guidance for rejecting a takeoff after V1 and rotation. Simulator testing performed after the accident demonstrated that increasing the thrust levers to the TO/GA detent, as required by SOPs upon the activation of the "thrust not set" ECAM message, would have silenced the RETARD aural alert. At the time of the accident, neither the operator's training program nor manuals provided to flight crews specifically addressed what to do in the event the RETARD alert occurred during takeoff; although, 9 months before the accident, US Airways published a safety article regarding the conditions under which the alert would activate during takeoff. The operator's postaccident actions include a policy change (published via bulletin) to its pilot handbook specifying that moving the thrust levers to the TO/GA detent will cancel the RETARD aural alert.
Although simulator testing indicated that the airplane was capable of sustaining flight after liftoff, it is likely that the cascading alerts (the ECAM message and the RETARD alert) and the lack of V-speed callouts eventually led the captain to have a heightened concern for the airplane's state as rotation occurred. FDR data indicate that the captain made erratic pitch inputs after the initial rotation, leading to the nose impacting the runway and the airplane bouncing into the air after the throttle levers had been returned to idle. Airbus simulation of the accident airplane's acceleration, rotation, and pitch response to the cyclic longitudinal inputs demonstrated that the airplane was responding as expected to the control inputs.
Collectively, the events before rotation (the incorrect runway programmed in the FMC, the "thrust not set" ECAM message during the takeoff roll, the RETARD alert, and the lack of required V-speeds callouts) should have prompted the flight crew not to proceed with the takeoff roll. The flight crewmembers exhibited a self-induced pressure to continue the takeoff rather than taking the time to ensure the airplane was properly configured. Further, the captain initiated a rejected takeoff after the airplane's speed was beyond V1 and the nosewheel was off the runway when he should have been committed to the takeoff. The flight crewmembers' performance was indicative of poor crew resource management in that they failed to assess their situation when an error was discovered, to request a delayed takeoff, to communicate effectively, and to follow SOPs. Specifically, the captain's decision to abort the takeoff after rotation, the flight crew's failure to verify the correct departure runway before gate departure, and the captain's failure to move the thrust levers to the TO/GA detent in response to the ECAM message were all contrary to the operator's SOPs.
The NTSB annotated that there was a partly dissenting/concurring opinion supported by 4 members of the board reading:
Generally, I agree with the report and probable cause determination of Notation 8736. This investigation ultimately reveals a crew that made decisions which resulted in minor injuries to passengers and substantial damage to what was otherwise a perfectly sound aircraft. While I concur that probable cause of this rejected takeoff of US Airways Flight 1702 was the captain's decision "to reject the takeoff after the airplane had rotated" and the flight crew's "failure to follow standard operating procedures," I believe that a critical piece of the puzzle remains inadequately examined. During the moments leading up to the rejected takeoff, the crew repeatedly heard an aural RETARD alert. There is no dispute that the crew did not understand what the alert, in those circumstance, was intended to convey. Moreover, the insistent nature of the alert affected the crew and drew their attention during this critical decision-making period. The first officer, in interviews, stated that once the RETARD aural alert began she did not "call any V-speeds" during the takeoff because the crew was "distracted with the aural RETARD alert." Further, the co-pilot reported thinking that she had just wanted the aural RETARD alert "to shut up."
Based on crew interviews and NTSB simulations, there is every indication that the airplane would have been capable of continued flight. Therefore, had the pilot continued after take-off, he essentially would have been able to recover from the initial deviations from SOPs. It remains unclear why the pilot became convinced that an otherwise sound airplane was not safe to fly. The co -pilot recalled her perception that the RETARD alert was very loud and seemed to become more rapid as the plane accelerated. The RETARD alert was not only a distraction to the crew at this crucial moment, it encouraged the crew to take the incorrect action during takeoff.
The extent of the RETARD alert's impact on the crew's decision making is unclear, but it obviously was forefront in their minds. We have underemphasized the impact of the RETARD alert on the crew actions. It is my belief that the RETARD alert contributed to the pilot's decision to reject the take-off after the airplane had rotated and that the alert should be considered a contributing factor to the probable cause. This inclusion should not and does not diminish the fact that the primary probable cause remains the pilot's failure to follow his training and continue with the take-off, nor should it be interpreted to reduce the impact of the other contributing factor, the crew's failure to follow standard SOPs.
Metars:
KPHL 140054Z 30016G25KT 10SM CLR M01/M22 A3006 RMK AO2 PK WND 29026/0001 SLP177 T10061217=
KPHL 132354Z 29016G22KT 10SM CLR M01/M21 A3002 RMK AO2 PK WND 29027/2311 SLP164 T10061211 10006 21011 53045=
KPHL 132254Z 30012G19KT 10SM CLR 00/M21 A2997 RMK AO2 PK WND 29032/2205 SLP147 T00001206=
KPHL 132154Z 29018G28KT 10SM CLR 00/M21 A2992 RMK AO2 PK WND 30033/2113 SLP130 T00001206=
KPHL 132054Z 30021G34KT 10SM FEW075 00/M20 A2988 RMK AO2 PK WND 30034/2048 SLP118 T00001200 53024=
KPHL 131954Z 29018G27KT 10SM FEW070 01/M19 A2985 RMK AO2 PK WND 31037/1940 SLP108 T00061194=
KPHL 131854Z 28020G32KT 10SM FEW065 M01/M19 A2983 RMK AO2 PK WND 28035/1837 SLP099 T10061189=
Incident Facts
Date of incident
Mar 13, 2014
Classification
Accident
Cause
Rejected takeoff
Airline
US Airways
Flight number
US-1702
Departure
Philadelphia, United States
Destination
Fort Lauderdale, United States
Aircraft Registration
N113UW
Aircraft Type
Airbus A320
ICAO Type Designator
A320
This article is published under license from Avherald.com. © of text by Avherald.com.
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