Safety Board blames poor pilot skills for crash of FedEx MD-10

 - October 10, 2006, 6:41 AM

The NTSB blamed the first officer’s poor techniques for the Dec. 18, 2003, crash of a FedEx Boeing MD-10-10F in Memphis, Tenn. The Safety Board attributed the crash to “the first officer’s failure to properly apply crosswind landing techniques to align the airplane with the runway centerline and to properly arrest the airplane’s descent rate before touchdown. As a result, the airplane touched down extremely hard while still in a crab.” The Safety Board also blamed the captain for failing “to adequately monitor the first officer’s performance and command or initiate corrective action during the final approach and landing.”

Approaching Memphis International Airport (MEM), FedEx cargo Flight 647 was flown by the first officer, who “had demonstrated unsatisfactory performance during proficiency checkrides at a previous employer and at FedEx,” the Safety Board found. She had two unsatisfactory proficiency checkrides at FedEx, which, the Board said, “demonstrated deficiencies in multiple areas,” but the Board could not “directly link her previous deficiencies to her actions on the day of the accident.” On the flight, the captain was check airman and pilot-in-command, expected “to continually monitor the first officer’s performance,” the Board determined, and “be responsible for the overall safe conduct of the flight.”

“This accident highlights the need for proper training,” said NTSB acting chairman Mark Rosenker when the Safety Board released the final report on the accident on May 17.

As a result of the accident, the Board recommended that the FAA require all Part 21 air carrier operators to establish programs for flight crewmembers who have demonstrated performance deficiencies or experienced training failures and to add oversight and training to correct deficiencies. FedEx Flight Operations has since developed an enhanced oversight program to identify pilots who exhibit deficiencies during training or checkrides.

The Board also recommended improvements in emergency exit procedures. As a result of the accident, the door slide separated from the airplane during inflation, forcing the occupants to leave through the cockpit window. (During the evacuation, occupants threw at least 13 pieces of baggage from the airplane; FedEx now requires pilots to evacuate an accident airplane “in the most expeditious manner possible,” ignoring baggage.)

Wind Shear and Wake Turbulence Warnings

The captain was conducting a line check for the first officer on a four-day trip, which left MEM on December 15, for Indianapolis, then headed to Oakland, Calif., on the 16th. After a day’s layover in Oakland, the crew took off on December 18 to return to MEM.

Approaching MEM at around noon, the first officer, the pilot flying, briefed the captain, the pilot not flying, on arrival and approach procedures for Runways 27 and 36L. The captain said, “I need to see a stable approach at 1,000 feet. If for some reason we’re not stable, go around…all right?” The first officer responded, “Yep, no problem there.”

The captain relayed the current MEM ATIS: wind was “320…16 gusts to 22, so…it’s more favorable to the three sixes.” The first officer replied, “I just think we should start putting out slats [at] about 20 miles…because I’m…still fairly unfamiliar with Memphis, so I wanna get configured a bit earlier for that.”

The captain responded, “Do what you want,” and discussed normal arrival operations, addressing typical stepdown and traffic pattern procedures, altitudes, airspeeds and the probability of an early turn into MEM. The first officer acknowledged the information and requested the in-range checklist. The captain stated, “You’re driving and you stay focused on that and make me do whatever you need done.” The first officer replied, “OK.”

Contacting MEM Approach, the pilots were advised to expect 36L and cleared to 8,000 feet. The captain advised the first officer that the wind was still 320 at 16 with gusts to 22. “It’s still saying wind shear.”

“Goodness,” she replied. Approach instructed the pilots to reduce airspeed to 210 knots, then descend to 6,000 feet. The first officer asked the captain to extend the slats.

When the airplane was level at 6,000 feet, the first officer requested 15 degrees of flaps. Approach advised the crew to expect to land on 36R instead of 36L, as previously instructed.

The captain pointed out that 36R was in the FMS. The captain acknowledged a reduction in airspeed to 190 knots. The first officer called for the approach checklist, and the captain responded, “Approach check. Briefing’s complete to three six right. The altimeter is three zero one zero.” Approach told the pilots to turn left to intercept the localizer. The captain acknowledged and continued the approach checklist.

The captain noted the localizer was “alive,” 18 miles from touchdown. The controller told the pilots to slow to 170 knots and cautioned about possible wake turbulence from an Airbus 6.5 miles ahead. The captain acknowledged. The first officer said, “Flaps 22 please.” Cleared to 2,000 feet, the captain advised the first officer that they had intercepted the localizer, adding, “We’re not yet cleared for the approach.” The first officer responded, “That’s noted.”

With the airport in sight, the controller cleared the flight to land on 36R and to contact the tower. The local controller said they were “number two following a heavy Airbus two-mile final caution wake turbulence runway three six right. Gain and loss of 10 [knots] short final runway three six right, cleared to land.”

A Hard Landing

The captain said to the first officer, “How ’bout four extra knots. I don’t like to add extra speed, but you know, three or four knots can make a lot of difference…if you’re bumpin’ around back and forth.” The first officer responded, “Good enough… let’s go with ah landing gear down. Before landing checklist, please…glideslope’s alive.”

The captain responded, “Spoilers are armed. The gear’s down… and three green. Flaps are 22. Flaps to go.” The first officer requested 35 degrees of flaps, and the captain complied. The CVR recorded a tailwind-shear alert. The captain said, “OK, it’s all right,” and the first officer replied, “Goodness.”

At 1,000 feet, the captain said, “Visual. Stable. We got a 9,000-foot runway…and we land at 146. A pretty good headwind oughta work out OK.” The first officer said, “Autopilot’s coming off.” The captain said, “Checklist is complete. You’re cleared to land.” After touchdown, the first officer stated, “Wow,” and the CVR recorded the sound of increasing background noise, similar to increased engine rpm, and the sound of rumbling that was increasing in volume.

About 14 seconds after touchdown, the flight data recorder showed a lateral load factor of about 1g as the right wing suddenly moved about six degrees lower. At about the same time, the landing gear alert began to sound. The captain said, “Here we go.”

As the airplane veered to the right and came to a stop in the grass, fire broke out on the right side of the airplane, destroying the right wing and part of the fuselage. The first officer and one nonrevenue FedEx pilot on board received minor injuries during the evacuation; the captain and four other nonrevenue passengers were not injured.

A spokesman for FedEx told AIN that the first officer was on nonflying status, awaiting disciplinary action. The captain has since retired.