ASRS recently has received
several reports describing unusual ramp operation hazards that require
flight and ground crew awareness. We lead off with an incident that
presents a new slant on fatigue, as reported by an air carrier Captain.
- At FL200
I was notified by my Flight Attendant that there was a loud knocking
noise from the forward baggage bin. After checking with our departure
station, we discovered a baggage handler was missing. We returned
to the station to find a scared but otherwise O.K. baggage handler.
Cause: Sleeping in the baggage bin before loading. Corrective action:
Don't do it.
In addition to our reporter's
firm admonition, we add another: ground crews should conduct a visual
inspection of cargo bin interiors before closing and securing doors.
COD
Caterer Object Damage
The Captain of a Boeing 727-200
describes a harrowing incident that has led his company to revise its
ramp procedures. The incident underscores the importance of ensuring
that contract, as well as company ground personnel, undergo training
in ramp safety procedures. In particular, all ground personnel need
to understand that flashing aircraft beacons mean extreme caution
engines are running, or engine start is imminent.
- Arriving
at gate, could not get aircraft to accept external power (Auxiliary
Power Unit inoperative). Left #1 engine running while off-loading
passengers, while still trying to get aircraft to accept external
power (beacon on). Lead Flight Attendant came running up aisle saying
to shut down the engine, that somebody had been sucked inside. Shut
down engine. Went to back of aircraft and talked to caterer after
he had been removed from intake. He said he did not know the engine
was running. #1 engine received FOD [Foreign Object Damage].
The Captain provided additional
details about this incident to ASRS analysts during a callback. The
B-727's #1 engine had been left on idle power while maintenance attempted
to get ground power on the aircraft. The aircraft's upper and lower
beacons were on, and flashing, to alert all ramp personnel that one
or more engines were operating. The station procedures required that
the aft galley be serviced through the left aft exit. The catering truck
parked next to this exit. As the catering supervisor approached the
aircraft door from the walkway of the elevated catering truck, he was
immediately sucked into the turning engine. After he was removed and
checked for injuries, he was asked whether he had heard the engine running.
He replied "no."
The caterer suffered a number
of broken ribs, but amazingly avoided more serious injury thanks to
quick intervention by the cabin and flight crew. A preventative for
this type of event is procedures that prohibit service vehicles from
approaching parked aircraft until all aircraft beacons have been turned
off.
It's
in the Bag
A lost-communications incident
that affected this air carrier flight crew may inspire other pilots
to take a second look at where they place book bags containing flight
charts and manuals.
- About 30
nm out of airport at 10,000 feet, I reviewed the approach and runway
diagram and set my approach book back on top of my book bag. After
about 4-5 minutes of silence on the radio and about 10 miles from
the airport I asked the First Officer to query Approach Control about
his intentions. The First Officer was unable to contact Approach.
I attempted to no avail, but the First Officer now told me he was
getting feedback even when I was not transmitting. I looked down and
realized that my approach book had shifted up to my comm panel and
had toggled the transmission switch to 'on.' I removed the book, contacted
and apologized to Approach and continued to landing. Approach was
very understanding even though I knew we had unintentionally disrupted
his operation.
The comm panel on the [aircraft] on the Captain's side has been moved
down and aft to make room for the steering wheel. This puts it right
at the same level as the approach books, and the transmit switch is
the first to be touched should the book shift.
"Go,
and Listen as Thou Goest"
Dante's Inferno
What's in a word? Sometimes
a world of difference, especially when ATC clearances are involved.
Several recent ASRS reports illustrate, beginning with a First Officer's
account:
- It was a
nice day and we were heavy for the flight
This was my leg and
we were departing Runway 22L with the SID. I briefed the departurean
immediate left [turn] to 190o with a right [turn] at 2.3 DME to 220
degrees, climb to 2,500 feet (ATC restriction).
Flying the departure, ATC issued a left [turn] to 230 degrees as we
crossed the 2.3 DME fix, climb to 6,000 feet and a frequency change.
The next controller, who was very busy, issued a "tight turn
to 040o," which I mistakenly assumed to be a left turn. Starting
the turn, ATC commented, "need a nice tight turn
"
which the Captain responded to affirmatively. Then ATC came back,
"just wanted to confirm a right turn." We complied immediately.
Looking back, I should have requested clarification on direction of
turn. ATC never issues a "tight turn," always a direction
of turn"right turn" is what he must have said.
In this situation, I knew there was a parallel departure off Runway
22R, and at the time the 040 degree turn heading was issued, left
was the closest direction. Also, I was too eager to comply instantly
in a very busy environment with rapidly issued clearances. Next time
I will...verify any ATC clearance that seems vague or non-standard,
especially one as critical as direction of turn that close to the
airport.
Taxi
Where?
A "mea culpa" from
a General Aviation pilot who misheard an initial taxi instruction, and
didn't question the logic of the clearance:
- Inadvertent
runway incursion due to misheard Tower clearance. "Taxi to"
heard as "taxi onto." No other traffic in vicinity at time.
No other aircraft involved. Error identified by Tower radio call.
Apology offered!
Unusual
Attitudes and Outcomes
Several highly experienced
General Aviation pilots share new lessons learned about pre-flight as
the result of aerobatic maneuvers. We hear first from a pilot who went
out to practice aerobatics right after an annual inspection:
- Lost about
two quarts of engine oil during negative "G" maneuver. Oil
covered the canopy, limiting visibility. Declared an emergency with
Tower, but landed at Army airfield , as it was closer. Discovered
oil dipstick loose, but not out of filler tube.
I had just completed annual. When I buttoned up the cowl, I saw the
dipstick in place, and it appeared fully seated, however I did not
check to verify its security.
Another experienced pilot
indulged in uncoordinated spirals in a light plane that was not approved
or stressed for such maneuvers. Result: an off-airport emergency landing.
- After dropping
skydivers at 1,500 feet AGL a steep uncoordinated spiral was entered
to rapidly lose altitude. At approximately 1,000 feet AGL, the spiral
was discontinued and a forward slip applied as a 45 degree entry to
a left downwind
About 1/3 mile from the runway at approximately
400 feet AGL the engine quit making power, [and] an immediate turn
to the runway was made and a glide established. It became obvious
that some trees off the end of the runway would not be cleared and
an alternate landing site was selected. The alternate site required
a right 120o turn. After making the right turn, just before touchdown,
the engine began making power. A precautionary landing was made off-airport.
Fuel quantity was checked and approximately 8 gallons remained in
the right tank. The left tank was less than 1 gallon. The unusable
fuel for this aircraft is listed as 5 gallons. Fuel was added and
the aircraft flown to the airport.
I suspect fuel was unported by prolonged uncoordinated flight and
low fuel levels. I recommend no prolonged uncoordinated flight below
1,500 feet AGL
The low fuel state that contributed
to this incident could have been avoided by a manual or visual fuel
check prior to taking up each group of skydivers. The reporter also
placed himself in jeopardy by performing aerobatic maneuvers that were
not approved for this aircraft at any altitude.
A
Plea for PIREPs
ASRS has received an important
reminder from an air traffic controller to pilots everywhere: Pilot
Reports (PIREPs) are sometimes the only way that ATC can know about
adverse flight-related events that can affect all aircraft:
- On taxi-out,
[commuter aircraft] indicated he was involved in a bird strike
ATC was not notified of the bird strike in a timely fashion. It is
understood that the flight crew [was] busy at the time of the occurrence.
However, due to the time of day (night, after sunset) and distance
from field (4 miles) it [was] impossible for ATC to know of the occurrence
without a PIREP. With the PIREP we could have warned subsequent inbounds
of birds in the area, allowing us to provide better service to the
aircraft landing here. Please, help us to help you make your job easier.