Dynamic B762 at Fort Lauderdale on Oct 29th 2015, fuel leak results in engine fire

Last Update: June 10, 2020 / 15:58:01 GMT/Zulu time

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Incident Facts

Date of incident
Oct 29, 2015

Classification
Accident

Flight number
2D-405

Aircraft Registration
N251MY

Aircraft Type
Boeing 767-200

ICAO Type Designator
B762

A Dynamic Airways Boeing 767-200, registration N251MY performing flight 2D-405 from Fort Lauderdale,FL (USA) to Caracas (Venezuela) with 79 passengers and 11 crew, was taxiing for departure holding short of Fort Lauderdale's runway 28R after contacting tower, when the crew of another aircraft advised there was a massive fuel leak from the left hand engine (JT9D), the 767 crew acknowledged and requested to return to the ramp, when the other crew alerted the engine was now on fire. The 767 was evacuated via slides, emergency services responded and put the fire out using foam reporting the fire was out 7 minutes after the other crew had alerted of the engine fire. One occupant received serious, 21 minor injuries as result of the evacuation, the 767 received substantial damage.

Airport Operations reported a large, very smelly puddle of fuel at taxiway T4 about 700 meters/2300 feet prior to the holding point runway 28R.

Runway 28R was closed for about 75 minutes, all operations of the airport were switched to runway 28L.

Broward Sheriff Fire Rescue Office reported one person received serious but non-life threatening burns during the evacuation, 14 others minor injuries like bruises, bumps or feeling the stres of the situation and were taken to a hospital.

On Oct 30th 2015 the FAA reported there were 15 injuries and substantial damage to the aircraft when the left hand engine caught fire during taxi. The occurrence was rated an accident.

The NTSB dispatched four investigators on site.

On Nov 3rd 2015 the NTSB reported that a coupling of the main fuel supply line had disconnected in the wing to engine strut above and aft of the engine. The coupling has been retained for further investigation. No evidence of an uncontained engine failure or other failure was found. The left engine cowling, the lower inboard portion of wing and the center fuselage received thermal damage, the fuselage was not penetrated by the fire. The aircraft had been in storage for 29 months until September 2015 when Dynamic Airways leased the aircraft. Under that lease the aircraft had been operated for 240 flight hours until the accident. Review of the logbooks revealed no maintenance action around the fuel coupling prior to departure from Fort Lauderdale. There was one serious and 21 minor injuries as result of the emergency evacuation out of the 90 passengers and 11 crew on board.

On Jun 10th 2020 the NTSB released their final report concluding the probable cause of the accident was:

the separation of the flexible fuel line coupling and subsequent fuel leak due to the failure of maintenance personnel to install the required safety lockwire. Contributing to the severity of the accident was the initiation of the evacuation before the right engine was shut down which led to the passenger's injury.

The NTSB described the sequence of events:

About 20 minutes prior to pushback, during pre-flight preparation, the crew noted an anomaly with a fuel quantity indication and fuel tank configuration set by mechanics. The airplane pushed back from Gate E9 at 12:28 pm for taxi to Runway 28 right. At 12:32, the crew of another airplane taxiing behind the accident airplane advised ATC that they saw a large amount of fluid leaking from the left engine of the accident airplane. The flight crew heard the transmissions and advised they would need to return to the ramp. ATC instructed the crew to stop on taxiway B just east of taxiway T1. At 12:33, the other flight crew advised that the engine was on fire, and the accident flight crew shut down the left engine using the fire handle and requested fire equipment. At the same time, the CVR recorded sounds consistent with doors opening and a flight attendant on the public address system (PA) calling for evacuation.

According to the flight attendants, passengers witnessed the fire on the left engine, and many moved from the left side to the right side of the cabin while the airplane was still taxiing. Passengers were requesting the crew to open the doors and evacuate. Flight attendants opened the forward left (1L), forward right (1R), and aft right (2R) cabin doors. The slide rafts deployed, although the flight attendant at 2R noted that the slide did not appear to inflate quickly or symmetrically. Flight attendants did not open the aft left door (2L) due to the fire, and because all passengers had moved away from that area. A passenger opened the right side overwing exit, but the ramp/slide did not deploy. Flight attendants directed passengers away from the overwing exit, and out the door exits.

After the evacuation had already begun, the flight crew advised over the PA to evacuate out the right side of the airplane. The number 2 (right) engine was still running as the passengers evacuated out the 2R door. About 11 seconds after the airplane came to a stop, one of the passengers who evacuated through 2R passed behind the engine, where the exhaust caused him to fall to the pavement resulting in serious injuries. About 35 seconds later, the number 2 engine was shut down.

About 54 seconds after the airplane stopped, an airport authority official arrived, and repositioned the 2R slide. About one minute later, airport firefighting vehicles arrived and began extinguishing the fire.

The NTSB reported:

During a visual examination of the left engine and strut, a fuel coupling assembly was found separated with the coupling body pushed aft on a main fuel supply line. There were indications of fuel leakage at the flange interface of the fuel supply lines where the coupling had separated including discoloration from fluid pooling in the strut compartments and streaking down the left engine cowling. There was no safety lockwire present on either the body or nut side of the fuel coupling as required in the Boeing aircraft maintenance manual (AMM), and no broken lockwire was recovered in the surrounding strut compartments. A material examination of the fuel supply lines and coupling components verified that the parts met dimensional drawing specifications and were free of defects or damage that would have affected normal operation.

A Boeing Service Letter recommending replacement of fuel line flexible coupling (Wiggins coupling) retainer components was issued on March 14, 2000. Maintenance records of the accident airplane indicate the last time this service was performed was by Kalitta Air LLC on October 12, 2012 just prior to going into storage in Arizona.

Additionally, the strut fuel feed line components, while not specifically called out, could be looked at during a Zonal Inspection (General Visual) of the area during a 1C interval. The last Zonal Inspection was accomplished May 5, 2015, by Kalitta Air LLC.

The airplane accumulated about 240 flight hours between the fuel line coupling service and the accident.

After the accident, Dynamic International Airways issued a Fleet Campaign Directive to inspect the remainder of their aircraft to ensure proper installation of the fuel line coupling assemblies. No other instances of improper installation were found.

The NTSB stated following additional findings:

COMMUNICATIONS

The "A" flight attendant activated the emergency signaling system located on a panel above the jumpseat to notify the flight deck and other crewmembers of an emergency. The chime was audible in the CVR recording, but the flight crew did not respond via interphone. There was no indication on the CVR of an evacuation checklist or communication between the cabin and flight deck.

FIRE

The flight data recorder (FDR) included an engine exhaust gas temperature (EGT) parameter. The highest recorded value during taxi was 452°C (845.6°F). The heat transfer from the exhaust gas through the exhaust nozzle exterior surface would have resulted in temperatures high enough for a hot surface ignition source to be available to ignite the fuel originating from the engine strut leak.

TESTS AND RESEARCH

The right over-wing exit was opened by a passenger, but the slide did not deploy. Testing at the manufacturer revealed a misalignment in the pull-force increase mechanism created a binding in the firing cable.
Incident Facts

Date of incident
Oct 29, 2015

Classification
Accident

Flight number
2D-405

Aircraft Registration
N251MY

Aircraft Type
Boeing 767-200

ICAO Type Designator
B762

This article is published under license from Avherald.com. © of text by Avherald.com.
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