|Title:||Runway overrun, McDonnell Douglas MD-88, Cleveland, November 11, 1996|
|Micro summary:||This McDonnell Douglas MD-88 overran a slippery runway on landing.|
|Event Time:||1996-11-11 at 2130 EST|
|Publishing Agency:||National Transportation Safety Board (NTSB)|
|Site of event:||Cleveland, OH|
|Departure:||Hartsfield-Jackson Atlanta International Airport, Atlanta, Georgia, USA|
|Destination:||Cleveland Hopkins International Airport, Cleveland, Ohio, USA|
|Airplane Type(s):||McDonnell Douglas DC-9-88 (MD-88)|
|Operator(s):||Delta Air Lines|
|Type of flight:||Revenue|
NTSB short summary:
The pilot's failure to follow checklist procedures and extend the spoilers.
Before landing, the flight crew was advised and acknowledged that the braking action on the runway was reported as 'fair.' After landing, the first officer selected reverse thrust to slow the airplane. The crew then noticed that the airplane was not slowing normally. The captain assumed control of the airplane, applied maximum braking and reverse thrust; however, the airplane continued off the departure end of the runway. Measurements taken immediately after the incident indicated braking action for the runway was 38 (fair), 23 (poor), and 27 (poor). Review of the flight data recorder revealed that the spoilers remained retracted at touchdown and during rollout to zero airspeed. According to the MD-80 Flight Crew Operating Manual, 'When armed, the automatic brake system (ABS) will automatically apply brakes during landing and takeoff modes of flight. ABS landing mode is activated when spoilers are deployed either automatically or manually.' The Abnormal Flight Profiles section of the Pilots Reference Manual stated, 'Ground spoilers significantly increase brake effectiveness. In order to achieve a maximum performance stop, ensure that ground spoilers have extended.' Review of the Delta Airlines MD-80/90 Normal Checklist revealed that it was the duty of the 'pilot not flying' to ensure that spoilers were in the 'ARM' position.
NTSB factual narrative text:
On November 11, 1996, about 2130 Eastern Standard Time, a McDonnell Douglas MD-88, N918DL, operated by Delta Airlines as flight 256, sustained minor damage when it ran off the departure end of a runway at Cleveland-Hopkins International Airport (CLE), Cleveland, Ohio. The certificated airline transport crew, three flight attendants, and 118 passengers were not injured. Instrument meteorological conditions prevailed and an instrument flight rules flight plan was filed. The flight was conducted under 14 CFR Part 121, and originated from Atlanta, Georgia.
According to the captain, an ACARS message was received in the cockpit indicating that the field conditions at CLE were good with only patchy snow and ice on the runway. The initial ATIS obtained by the crew was for clear skies with 10 miles of visibility, landing on Runway 23L. The crew briefed the approach to 23L. A subsequent ATIS was received by the crew, which indicated a change to Runway 05R as the runway in use, and the winds from 240 degrees at 5 knots. An ILS Runway 05R approach was briefed and flown by the first officer. A 40-degree flap landing was planned and medium auto-brakes were selected. During the approach the crew noticed snow falling, but the visibility was good. On initial contact, the tower stated that a previous aircraft reported that the braking action was fair. On short final, the captain observed that the runway was fully covered with snow instead of the reported patchy snow. Touchdown was normal and in the landing zone. When the first officer selected reverse thrust, the crew noticed that the airplane was not slowing normally. The captain assumed control of the airplane, and applied maximum braking and reverse thrust. However, the airplane continued off the departure end of the runway. It came to rest on its landing gear, about 530 feet past the Runway 23L threshold lights, and 345 feet northeast beyond the edge of the Runway 23L hard surface.
Before the airplane touched down, air traffic control (ATC) advised the flight crew that the braking action on Runway 05R was reported as "fair" by a Boeing 737 crew, and was acknowledged. Measurements taken immediately after the incident by a Federal Aviation Administration (FAA)-approved decelerometer, indicated braking action for Runway 05R was 38 (fair), 23 (poor), and 27 (poor). Rudimentary braking action testing in both directions of Runway 05R/23L was conducted about one hour after the incident. According to an observer who was seated in the vehicle that performed the testing, the runway surface was covered with what appeared to be a patchy layer of snow. The observer estimated the braking action was "intermittently fair in the center portion of the runway with predominantly poor at both ends." At no time did the observer "believe the braking action of the vehicle to be any less effective than fair to poor."
A Supervisory Air Traffic Control Specialist (SATCS) located in the Cleveland Air Traffic Control Tower observed the airplane pass taxiway Romeo at a high rate of speed and asked another controller if the airplane was a departure.
Delta Airlines personnel retrieved the airplane flight data recorder and the downloaded information was forwarded to the FAA. Review of the data by a FAA Aerospace Engineer revealed that the spoilers remained retracted at touchdown and during rollout to zero airspeed. A review of the airplanes previous flight and landing recorded data revealed normal deployment and retraction of the left and right spoilers.
According to the MD-80 Flight Crew Operating Manual, "When armed, the automatic brake system (ABS) will automatically apply brakes during landing and takeoff modes of flight... ABS landing mode is activated when spoilers are deployed either automatically or manually with throttles retarded and brake pedals released."
A review of the airplane's maintenance log entries for the previous 16 flights did not reveal any abnormalities related to the spoiler or brake systems.
According to the Delta Airlines Pilot's Reference Manual (PRM), during normal landing, "If the spoilers fail to deploy automatically after main wheel spin-up and ground shift, deploy them manually." Landing on wet/icy runways the PRM stated, "When landing wet/icy runways, use 40[degrees] Flaps and manually extend spoilers if they do not deploy on touchdown." In the Abnormal Flight Profiles, the PRM stated, "Ground spoilers significantly increase brake effectiveness. In order to achieve a maximum performance stop, ensure that ground spoilers have extended."
Review of the Delta Airlines MD-80/90 Normal Checklist revealed that it was the duty of the "pilot not flying" to ensure that spoilers were in the "ARM' position.
The weather reported by CLE, at 2033 was, winds from 250 degrees at 13 knots, 3/4 mile visibility, light snow and mist, few clouds at 200 feet, and an overcast cloud layer at 1,100 feet. The temperature and dew point were at 28 degrees Fahrenheit, and there was an altimeter setting of 30.36 inches of mercury.
|Learning Keywords:||Operations - Braking Issues (General)|
|Operations - Runway Overrun|
|Systems - Flight Controls - Spoilers - Slats - Flaps|
|Systems - Landing Gear|
|Close match:||Runway overrun, MD-11 World Airways (N272WA) at Shannon Airport, September 18, 1999|
|Runway overrun, Piedmont Airlines, Boeing 737, N751N, Greensboro, North Carolina, October 28, 1973|
Accident Reports on DVD, Copyright © 2006 by Flight Simulation Systems, LLC. All Rights Reserved. All referenced trademarks are the property of their respective owners.www.fss.aero