Pinnacle Airlines Flight 3701

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Pinnacle Airlines Flight 3701
N8396A Canadair CRJ.200LR Northwest (9141190057).jpg
The wreckage of N8396A, stored in Rantoul, Kansas, April 2013
Accident
DateOctober 14, 2004 (2004-10-14)
Summary Pilot error leading to dual engine flameout [1]
SiteNear Jefferson City Memorial Airport, Jefferson City, Missouri, U.S.
38°32′57″N92°8′36″W / 38.54917°N 92.14333°W / 38.54917; -92.14333 Coordinates: 38°32′57″N92°8′36″W / 38.54917°N 92.14333°W / 38.54917; -92.14333
Aircraft
Aircraft type Bombardier CRJ200
Operator Pinnacle Airlines
(d/b/a Northwest Airlink)
IATA flight No.9E3701
ICAO flight No.FLG3701
Call signFlagship 3701
Registration N8396A
Flight origin Little Rock National Airport, Little Rock, Arkansas, U.S.
Destination Minneapolis–Saint Paul International Airport, Minneapolis and St. Paul, Minnesota, U.S.
Occupants2
Passengers0
Crew2
Fatalities2
Survivors0

On October 14, 2004, Pinnacle Airlines Flight 3701 ( ICAO : FLG3701, IATA: 9E3701, or Flagship 3701) crashed while flying from Little Rock National Airport in Little Rock, Arkansas, United States, to Minneapolis–Saint Paul International Airport in Minnesota, United States. No passengers were aboard; both pilots were killed. Federal investigators determined the crash was due to the pilots' unprofessional behavior and disregard for training and procedures. [1] [2]

Contents

Aircraft and crew

A Northwest Airlink CRJ-200 similar to the one involved. CRJ-200.jpg
A Northwest Airlink CRJ-200 similar to the one involved.

Pinnacle Airlines Flight 3701, operating under the Northwest Airlink banner, was a repositioning flight [lower-alpha 1] of an empty 50-seat Bombardier CRJ200 (aircraft registration N8396A [3] ). The aircraft was built in 2000 and had accumulated 10,168 hours of flight time and completed 9,613 flight cycles [lower-alpha 2] at the time of the crash.

On October 14, 2004, a different Pinnacle Airlines flight crew was scheduled to fly the incident aircraft from Little Rock National Airport to Minneapolis–Saint Paul International Airport. However, this crew received an error message and aborted their takeoff. Pinnacle Airlines dispatched maintenance crews to Little Rock to resolve the problem. The problem was identified and fixed. Because the aircraft was needed in Minneapolis the next morning, Flight 3701 was scheduled overnight as a repositioning flight, to move the plane from Little Rock to Minneapolis. [1] :11 [4]

The only persons on board Flight 3701 were the two pilots, Captain Jesse Rhodes (31) and First Officer Peter Cesarz (23). [2] Cesarz trained at Gulfstream Academy, and Rhodes trained at Embry–Riddle Aeronautical University, both in Florida. Both pilots flew for Gulfstream International Airlines before being hired for Pinnacle Airlines. Rhodes had logged a total of 6,900 flight hours, including 973 hours on the CRJ-200, and Cesarz had 761 hours, with 222 of them on the CRJ-200. [1] :7–10

Accident

Flight 3701 departed Little Rock at 21:21 Central Daylight Time (CDT). [lower-alpha 3] The flight plan from Little Rock to Minneapolis indicated a planned cruising altitude of Flight Level (FL) 330, or approximately 33,000 ft (10,000 m). [1] :1 After departing Little Rock, the plane pitched up sharply several times during its ascent, briefly reaching 10,000 feet per minute (3,000 m/min). [1] :2

At 21:35, Flight 3701 requested clearance to climb to 41,000 feet (12,497 m), the maximum operating altitude of the Bombardier CRJ series. Clearance was granted by air traffic control (ATC) at 21:36, and the plane climbed to its new cruising altitude shortly thereafter. [1] :2 At 21:54, the pilots began to struggle with control of their plane. Both engines lost power and the plane's stick shaker warned the pilots of an impending stall. The pilots declared an emergency and descended, temporarily regaining control of their aircraft at 34,000 feet (10,400 m). [1] :4

The pilots attempted to restart the engines, but could not do so. At 22:09, Flight 3701 asked ATC to direct them to the nearest airport for an emergency landing, and the controller on duty directed them to Jefferson City Memorial Airport in Jefferson City, Missouri. At 22:14, the pilots realized they were not going to reach the airport and began looking for a road or highway on which to land. [1] :5–6

At approximately 22:15, the plane crashed into the ground outside Jefferson City. Both crew members were killed. There were no casualties on the ground. [1] :6 [5]

Investigation

The investigation into the accident focused mainly on information contained on the flight data recorder and the cockpit voice recorder. This is the official version of events as determined by that investigation.

Investigators determined that the two pilots were exploring the performance limits of the empty CRJ-200 on the flight. The pilots decided to test the limits of the CRJ and join the "410 club", referring to pilots who pushed CRJs to their maximal approved altitude of flight level 410 (FL410) or 41,000 feet (12,497 m) above sea level (MSL).

The accident sequence started when the pilots performed several non-standard maneuvers at 15,000 feet (4,600 m), including a pitch-up at 2.3 g (23 m/s²) that induced a stall warning. They set the autopilot to climb at 500 ft/min (150 m/min) to FL410. This exceeded the manufacturer's recommended climb rate at altitudes above FL380. In the attempt to reach FL410, the plane was pulled up at over 1.2 g, and the angle of attack became excessive to maintain climb rate in the thinner upper atmosphere. After reaching FL410, the plane was cruising at 150 knots (170 mph; 280 km/h) indicated airspeed (IAS), barely above stall speed, and had over-stressed the engines.

The plane's anti-stall devices activated while they were at altitude, but the pilots repeatedly overrode the automatic nose-down that would increase speed to prevent stall. After four overrides, both engines experienced flameout and shut down. The plane then stalled, and the pilots recovered from the stall at FL380 or 38,000 ft (11,582 m) while still having no engine thrust. At that altitude, there were six diversion airports within reach for a forced landing. This led the pilots to pitch nose down in an attempt to restart the engines, which requires a dive sharp enough to attain the required 300 knots (350 mph; 560 km/h) IAS for a windmill restart to make the blades in the turbines windmill at 10% N2 (turbine rotational speed). The captain did not take the necessary steps to ensure that the first officer achieved the 300 knots (350 mph; 560 km/h) IAS or greater airspeed required for the windmill engine restart procedure and then did not demonstrate command authority by taking control of the airplane and accelerating it to at least that speed.

The turbine blades expanded, however, contacting the honeycomb labyrinth seals and allowing the metal to scrape together when the engine overheated, with zero core rotation. When the engine is shut down at altitude, the core begins to cool, and the stator, including the static interstage static seal (ISS), contracts at a faster rate than the adjacent rotating parts in both the radial and axial direction because of its smaller thermal time constant. The relative rate of cooling of the stator and rotor results in an alignment of the rotating-seal knife edges aft of the normal operating groove in the static seal. If the clearances are tight enough and the relative cooling rates are right, contact can occur between the static and rotating seal elements. The resulting stiction can temporarily prevent the rotor from turning when only the force of ram air is applied to the core. Air turbine starter (ATS) torque has been shown adequate to overcome this restriction. [6] Thus, when the engine cooled, the assembly did not match anymore, and the blades could not rotate freely. The crew ended the descent when they had reached 230 knots (260 mph; 430 km/h) indicated airspeed but neither engine core (N2) ever indicated any rotation during the entire descent. Since they were too high for an APU start, the ram air turbine (known as an "air-driven generator" on Bombardier products) was deployed to provide electric power for the aircraft, and the crew donned oxygen masks, as the cabin slowly depressurized due to loss of pressurization air from the engines.

The crew glided for several minutes and then tried to restart engines using the APU at 13,000 feet (4,000 m). This was again unsuccessful. They then declared to ATC that they had a single-engine flameout. At this point they had four diversion airports available to them. They lost considerable altitude while continuing unsuccessfully to attempt to restart both the left engine (two times) and the right engine (two times) for over fourteen minutes, using the emergency restart procedure. Despite their four auxiliary power-unit-assisted engine restart attempts, the pilots were unable to restart the engines because their cores had locked. Without core rotation, recovery from the double engine failure was not possible. At that point, the pilots finally declared to ATC that they had in fact lost both engines.

The NTSB also determined from flight data recorder information that the turbofan jet engine (General Electric CF34-3B1) engine 2 turbine was operating at 300 °C (540 °F) above the maximal redline temperature of 900 °C (1,650 °F) at 41,000 feet (12,497 m). Engine 1 HPT stayed 100 °C (180 °F) below the redline.

On January 9, 2007, the National Transportation Safety Board (NTSB) issued its final report on Flight 3701. In its report, the NTSB concluded that the probable causes of the accident were:

  1. the pilots' unprofessional behavior, deviation from standard operating procedures, and poor airmanship;
  2. the pilots' failure to prepare for an emergency landing in a timely manner, including communicating with air traffic controllers immediately after the emergency about the loss of both engines and the availability of landing sites; and
  3. the pilots' improper management of the double engine failure checklist. [1]

Aftermath

Thomas Palmer, former manager of Pinnacle Airlines' training program, said about the crash: "It's beyond belief that a professional air crew would act in that manner." [2] After the accident, the airline restricted CRJ-200 flights to a maximum altitude of FL370. It also changed its training program to include ground school and simulator training in high-altitude operations. [4] In the year following the accident, each Pinnacle pilot was given simulator training up to FL410 and shown what occurred on Flight 3701.

Pinnacle Airlines was renamed Endeavor Air in 2013 following Chapter 11 bankruptcy restructuring.

Media

This accident is featured in Book 4 of the Darwin Awards. [7]

See also

Notes

  1. A repositioning flight is a flight operated to move an aircraft from one location to another without passengers on board. [1] :1
  2. The NTSB defines a flight cycle as "one complete takeoff and landing sequence." [1] :10
  3. The NTSB describes all times in its final report using Central Daylight Time. [1] :1

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References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Aircraft Accident Report, Crash of Pinnacle Airlines Flight 3701, Bombardier CL-600-2B19, N8396A, Jefferson City, Missouri, October 14, 2004 (PDF). National Transportation Safety Board. January 9, 2007. NTSB/AAR-07-01. Archived (PDF) from the original on April 30, 2017. Retrieved December 28, 2017.
  2. 1 2 3 Wald, Matthew L. (June 14, 2005). "Just Before Dying, a Thrill at 41,000 Feet". The New York Times . ISSN   0362-4331. Archived from the original on January 3, 2015. Retrieved December 28, 2017.
  3. "FAA Registry (N8396A)". Federal Aviation Administration.
  4. 1 2 "What Went Wrong: The Crash Of Flight 3701". Popular Mechanics . January 5, 2006. Archived from the original on May 22, 2011. Retrieved January 18, 2011.
  5. Ranter, Harro. "ASN Aircraft accident Canadair CL-600-2B19 Regional Jet CRJ-200LR N8396A Jefferson City, MO". aviation-safety.net. Aviation Safety Network. Archived from the original on April 25, 2019. Retrieved September 6, 2019.
  6. NTSB Accident Information Brief Update for October 29, 2004 Archived March 28, 2021, at the Wayback Machine .
  7. "2004 Darwin Award: 4-1-0 Club". darwinawards.com. Archived from the original on April 25, 2019. Retrieved April 25, 2019.

PD-icon.svg This article incorporates  public domain material from websites or documents ofthe National Transportation Safety Board .