Unicom

August 2001 Issue




A Hero to Whom?

Accident pilot passed up many chances to save himself

As the Airport Director of the DeKalb Peachtree Airport, I must take great umbrage with “The Clock Runs Out” [Accident Probe, June]. It is apparent and unfortunate that Mr. Ibold either did not read the final NTSB report, or, at the very least, took great literary license in his interpretation of the report.

To intimate the fire response crew did anything wrong is totally without merit.

Because PDK is the second-busiest airport in Georgia, our ARFF crew gets to “practice” responding to many alerts throughout the year in all types of weather conditions. Responding to this specific alert was almost second nature to them in communicating with the tower and in responding to a staging location. The only reason the ARFF crew did not respond to the pre-arranged staging location is because the on-scene vehicle/incident commander made quick, professional decisions in a very dynamic environment in which the incident pilot continued to fly virtually around the entire east side of the airport, missing the opportunity to land on three different runways.

The pilot did not return to the airport to land directly on runway 20L or attempt to land on runway 27 the first time he passed it on downwind to runway 02R or attempt to land on runway 34 the first time he passed it on downwind to runway 02R. Why in the world would you give him “credit” for doing a 270-degree turn after doing a go-around on runway 02R when he was, by now, burning up in the cockpit?

After he made the decision to go-around off of runway 02R, there is nothing to indicate he was either making competent decisions or even in physical control of the aircraft.

You ask rhetorically “Why were the fire trucks on runway 27 rather than on a taxiway?” Again, your comment implies some sort of misjudgment by the fire crew. This is dependent on the assumption you made that the pilot was consciously trying to use runway 27 at all.

Knowing the pilot was in extremis by listening to the radio exchanges between the tower and the aircraft, the ARFF crew took thoroughly prudent action in attempting to position the equipment as near the crash scene as possible without getting in the way. If the pilot had made any of several different decisions during the accident chain, the positioning of the equipment on runway 27 would never have been an issue whatsoever.

Second, even though this airport does not have commercial service and is not a FAR Part 139 certificated airport, we literally operate to 139 standards because we are the primary reliever field for the Atlanta metro area, and the aircraft using the field can carry the same number of passengers and the same fuel loads that most regional jets and certainly all turbo-props can carry.

You say, “The controllers as a group agreed that emergency training in the form of actual drills was never done.” This is blatantly not a true statement. We have documented proof of when drills were conducted and who was part of the exercise. Clearly, we don’t do these without the involvement of the FAA ATCT.

I was at the airport within 30 minutes of the accident. I saw the wreckage; I saw where the body was located in the right seat of the aircraft – not strapped in – where the pilot was most assuredly trying to get away from a very intense fire under the left seat. I’ve been “doing aviation” for many years in airport management, in the military, and as a pilot, and I do not like to speak badly of my fellow aviators. However, to state this pilot in some way deserves some type of credit for “avoiding harm to others” is, again, not substantiated in any way, shape, or form.

In my opinion, this never was a consideration on his part. The pilot was totally absorbed from the very beginning in trying to understand and handle an emergency that was clearly above his ability to unravel and solve. Can you imagine if this pilot had gone directly into the clouds with this problem? The accident would have been over in seconds instead of minutes, because this pilot was not able to deal with what was important first.

Regardless of what the tower told him to do, the incident pilot had many opportunities to break the accident chain and get safely down and away from the aircraft, not to mention his not understanding aircraft systems and emergency fire-in-flight procedures. I’ve listened to the radio transmissions again and again. For literally minutes, you keep expecting the pilot to make the correct choice – land as soon as possible on any runway; he chose not to do this and died as a result.

I wish he could be declared a hero, but, in this case, we’re just lucky he didn’t wipe out an entire ARFF crew or a part of a neighborhood with his decisions.

-Lee Remmel
PDK Airport Director
Atlanta, Ga.


Mr. Ibold replies: I assure you the article was based on a thorough analysis of the complete docket of materials included in the NTSB file, as well as direct input from pilots waiting in the runup area who watched the event unfold before their eyes, but whose statements were not gathered by NTSB investigators.

In my opinion, the article clearly lays the blame on the shoulders of the unfortunate pilot for failing to put the airplane on the ground immediately upon detecting smoke and fire aboard, and I agree with you that he had several opportunities to do so safely. I think it’s a truly fortunate thing that no one else got hurt, and I had the experience of talking with someone waiting in the runup area who thought the airplane was aiming right at where her airplane waited on the ramp.

The pilot does deserve credit for avoiding the fire trucks (during the second go-around) and the waiting airplanes. That statement is not an attempt to justify his actions, merely to reflect on the fortunes of everyone involved. You can easily see how this accident may well have resulted in more than one fatality.

You raise some good points, and I suspect that in many ways we’re looking at the accident from the same point of view. The crux of our differences of opinion lies, I believe, in my attempt to try to get inside the pilot’s head during the critical go-arounds.

With the window open, the smoke problem (early on) was secondary. Certainly that was a big mistake. When the gear started to collapse and the tower called a go-around, he should have plunked it on anyway. But the “need” to defer to ATC authority is well-ingrained during training.

After the first go-around, when the smoke was pouring out, I agree that logic went out the window and he probably just started aiming for concrete. But I submit that enough remained that when he saw the trucks on runway 27 he aborted the landing.

Obviously, if he was anywhere short of panic, he would have seen them moving, but that’s armchair quarterbacking to an even greater extreme.

I don’t pretend to have all the answers in this case. My analysis was aimed at trying to raise enough questions to get readers to think about how they might handle a similar situation. That is, after all, more important than a morbid dissection of events just out of curiosity.

For the record, I believe the fire crew did what it should have done in responding to such an unpredictable event.

I believe (with slightly less conviction) that ATC should not have asked for a go-around, although I think I understand their motivation for doing so. I believe the pilot failed on several fronts – knowing emergency procedures for that airplane, passing up chances to land to try to “solve” the gear problem, and communicating his intentions, if possible.

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Pilot’s Besmirched Memory
The article “The Clock Runs Out” makes a number of statements which impugn the reputation of the pilot who was killed in the accident.

On page 14: “The pilot apparently was flying a non standard pattern.” On page 15: “When they (the fire fighters) looked inside they confronted the gruesome reality. The pilot had not been wearing a seat belt and, in the words of one, was ‘obviously deceased.’ ” On page 16: “The pilot either ignored or did not know about the cardinal rule of electrical fire in flight: turn off the master switch.”

Let me make it clear that I do not know who this pilot was and that all I know about this accident is what I read in Aviation Safety. I would like to draw attention to the following statement from page 16: “The heat required to cause the extensive pre-crash fire damage makes it somewhat surprising that the pilot could maintain control as well as he did and for as long as he did. In fact, the fire even compromised the integrity of the pilot’s seat track, which may have been the final straw in the eventual loss of control.”

I suggest that the reason the pilot was not wearing a seat belt may have been that his seat got too hot to sit on. This may also explain why he was flying a nonstandard pattern.

The article does NOT state that the master switch was in fact left on. Also it is possible that he turned it off, but that the fire caused a short circuit across the master switch or the solenoid controlled by the master switch, in which case turning off the master switch would have no effect.

I feel that a deceased pilot should at least be given the “benefit of the doubt” regarding his last actions..

-John Lawton
Seville, Ohio


Mr. Ibold replies: Perhaps my statements do soil his reputation, but there is evidence to back them up.

The nonstandard traffic pattern is indicated by both the radar track and the controller wondering if he was trying to land on runway 34. That’s in the NTSB report, but not in the article.

His lack of a seat belt may, indeed have been from trying to get away from the fire. In any event, it certainly limited his chances of surviving the impact.

The master switch was found in the on position and, in fact, the pilot apparently transmitted “get out of the way” only seconds before crashing.

I agree with you in one respect, it is not our job (nor intent) to throw stones at the reputation of someone who’s not around to defend himself. That’s why in virtually all of the Accident Probe articles the pilots in question are not identified. However, illustrating the mistakes people make in the heat of battle helps us be better prepared if the same fate should befall us.

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Malibu Misfortune
I would like to obtain the name of the author/owner/pilot of the PA-46 with the nose gear problem [Squawk Box, June]. Ours recently collapsed upon landing (not a hard landing) due to the upper actuator attachment coming unwelded on the motor mount assembly.

The actuator had been replaced on December 3 followed with intermittent “gear warning” lights on the annunciator panel. I squawked the lights during two oil changes but was told that it was probably “a small short or something.” All systems were normal prior to the landing.

-Bob Cairncross
Via e-mail


The incident you refer to was derived from the FAA’s Service Difficulty Reporting System, and in fact there are several references in the database to similar failures of the actuator itself or its attachment to the engine mounts. As of this point there is no AD in effect for inspection or replacement of the affected parts.

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Trainer Comparison Biased
I’m sure you’ll be receiving lots of mail on “Trainers Compared,” [Risk Management, June], but wanted to write anyway. The numbers you quote for the Cessna 172 are different in the Rankings by Model graph from those presented in the Rates at a Glance for the 172. Question is, which set is correct?

Furthermore, I would have to see more detail on the alleged high rate of engine failures, since the planes use the same engine, the Lycoming O-320. In previous articles you have stated unequivocally that this is the most reliable of all aircraft engines.

So why would the same engine have a higher rate of valve problems when installed in a Piper versus a Cessna? Since this data is admittedly vague in many respects, it seems that the conclusions are so positively pointed to the Cessna 172 that the final verdict might well be biased by the author’s experience or other factors not presented here.

I, for one, really like your publication and read it cover to cover. All of them are saved on my bookshelves and used for reference. This is the first one I’ve read that seems to be blatantly biased, based on the facts presented.

You might want to print a more detailed followup presenting the data used in more detail to justify the conclusions reached by the authors.

-John R. Stalick
Via e-mail


Your catch on the discrepancies in the charts is on the money. The Rates at a Glance chart published for the 172 was apparently a graphic “placeholder” put there early in the magazine’s design stage and not replaced. The correct numbers are: Overall rate: 3.3, Fatal rate: .54, Group average: 4.2 and Fatal average: .55.

Engine failure rates can vary for several reasons. First, the airframe and propeller with which the engine is mated subject the assembly to different cooling flows, vibration signatures and oil flows.

In addition, different variations of the same basic engine have slightly different designs for some of the components. Sometimes this is a tweak meant to solve an earlier problem, other times it may be an attempt to better match the engine to the specific application.

So while you may consider, say, a Lycoming O-320 to be a bulletproof engine, there are differences among O-320s that may lead to different service histories.

As for the charge of bias, we have to plead not guilty. This research was based solely on accident records. Although we applied some judgment in assigning the “cause” of individual accidents into a particular category in the accident summaries, it had no bearing on the overall or fatal rate for the specific airplane. Furthermore, the categories are broad enough that it was seldom difficult to assign a particular accident into a category.

The accident record is available to the public for free. You’re welcome to review the data and draw your own conclusions. We think you’ll come up with substantially the same results we did.

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Is This Rant Constructive?
I have always felt the quality of the articles in Aviation Safety to be above average and very useful to raise my awareness on safety matters. That is why I felt compelled to write after reading the article “Runway Safety and Sanity” [Commentary, June].

I feel that this article is below the standards normally upheld by your magazine. The article is full of sarcasm and ridicule, even crude at times, regarding the FAA’s report and recommendations on reducing runway incursions.

What I would suppose to be one of the author’s main points (that the apparent increase in incursions coincided with a renewed emphasis on reporting) is buried in the caption of the graph, rather than in the text of the article.

The entire piece comes across as little more than a rant against the FAA and their methods. The author does not mention other efforts that are already underway to reduce runway incursions, including renewed emphasis in check rides and flight reviews, and the AOPA refresher training available over the Internet. The only useful recommendations for pilots in the article appear in two short paragraphs at the end.

Since the article is published under the heading of “Commentary”, this implies that it is an opinion piece and the author is speaking only for himself.

However, the author’s continuous use of the plural pronouns “we” and “our” suggest that he may be speaking for the magazine. If this is not true, there should have been a disclaimer.

I am not defending bureaucracies in general or the FAA in particular, but I would like the article to have something constructive to say. I enjoy the magazine and almost always find something of use to me in my flying or something that makes me think.

-Jeff Callen
Pittsburgh, PA.


Given the emphasis the FAA has put on defeating the enemy of runway incursions (with your tax dollars), we felt a skeptical look at the program and its goals and its goals was in order. You are free to disagree with Mr. Geier, as long as you think about it first.

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Runway Piece Right On
Runway and taxiway incursions and the National Blueprint for Runway Safety are of primary interest to me, and I was most impressed with Breeze Geier’s intuitive understanding and explanation of this subject [Commentary, June]. I have been passionately interested in general sport and recreational aviation since I was very young, and believe me, that was some time ago.

I have been studying the matter of runway and taxiway incursions since learning of their terrible consequences after the Canary Islands Boeing 747 incident in the late 1970s.

An associate and I have recently collaborated on the idea of identifying and directing airport traffic with the use of unique technology applied to airport lighting.

We have just been granted provisional patent rights to our Target Logic Controller and Location Identification Transmit elements, as these devices pertain to airport traffic control. Our system specifically addresses and exceeds the requirements for total system identification, communications under all weather conditions and control of zero-zero airport movements.

You can get more details on our project at www.adpacs.com. There are many companies already deep in debt over the wrong solutions to this problem. We would like the general aviation and commercial aviation communities to evaluate our proposal and help us make our system contribute to aviation safety now.

-Steve Killelea
Centreville, Va.

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Harder Than it Needs to Be
In his article on autopilots [Proficiency, June], Ron Levy analyzes a Baron accident where the pilot crashed because he was looking for the runway and trying to fly an approach at the same time. Levy says you should either have another person looking or have the autopilot fly while the pilot monitors it and looks for the runway.

What about simply flying the airplane down to minimums, focusing only on the instruments, and then at DH look up for the runway environment. If it’s there, land. If not, go around. This is how I was taught and how I’ve been hand-flying single pilot approaches to minimums for more than 20 years.

This business of looking and flying is risky. Let’s say you’re looking and flying and at 500 feet you don’t see the runway. What are you going to do if the DH is 200? Keep flying on down to minimums. Why not just go ahead and do it in the first place and look up then?

Second, in the article on the Cessna 210 fire/gear related crash at PDK [Accident Probe, June], I wish you’d taken your analysis farther.

Was there anything in the pilot’s background and/or training that would have accounted for his not getting the airplane on the ground more quickly or turning off the master switch? I may be wrong, but I don’t think the average pilot would have stayed in the air as long as this pilot did.

-Bob Thomason
Via e-mail


Historically one of the most dangerous parts of an instrument approach comes at the transition from instrument flight to visual flight in low weather when the ceiling is indefinite. If the approach involved busting out of a defined cloud deck, the transition is fairly simple.

Not so easy is when the lights of a city or highway or airport begin to show sporadically as you approach decision height. To look up at that point and make an instant call is where many pilots get into trouble, either by descending into something unfriendly or by putting their heads on a swivel and getting disoriented.

As for the 210 crash at PDK, we agree that this is a prime example of how fire in flight requires the pilot to get the airplane on the ground immediately.