Final Report: Fatigue a factor in landing accident

By Mary F. Silitch

June 1, 2008
Accidents

Embraer E170, Cleveland, Ohio, Feb. 18, 2007–The NTSB determined that the probable cause of the Delta Connection/Shuttle America runway overrun at Cleveland-Hopkins International Airport was “the flight crew’s failure to execute a missed approach when visual cues for the runway were not distinct and identifiable.” Contributing to the accident were the crew’s descent to the ILS decision height instead of the localizer (glideslope-out) minimum descent altitude (MDA); the long landing on a short, snow-contaminated runway and the failure to use reverse thrust and braking effectively; the captain’s fatigue, which affected his planning and monitoring ability; and Shuttle America’s failure to administer an attendance policy that permitted flight crewmembers to call in as fatigued without fear of reprisals. At the time of the accident, the captain had been awake for 31 of the preceding 32 hours.

Weather conditions had deteriorated rapidly from marginal VFR, and moderate to heavy snow was falling during the approach and landing. The crew was told that the glideslope was unusable. The jet touched down 2,900 feet down the 6,017-foot Runway 28 and ran off the runway, collapsing the nose gear. Three of the 71 passengers sustained minor injuries.

As a result of the accident, the NTSB made several recommendations to the FAA, including that the agency develop a policy that would allow flight crewmembers to decline assignments or remove themselves from duty if they were impaired by lack of sleep.

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