NTSB Accident Records

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LJS1993

Line Up and Wait
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LJ Savala
Last night for whatever reason I decided to peruse the accident reports to see just what type of mistakes pilots were making out there. I was shocked to see how many accidents occurred because of pilots taking off in a plane that had known issues before the accident. One guy even took off with one bad engine after a mechanic warned him NOT to take the plane the previous day. What in heck is going on guys? If an auto mechanic tells us our brakes are bad and we could kill someone if we drive the car do we still hop in the car and drive? No we get it fixed right? Why would you do something so absurd in a plane?
 
Look in the docket as well... that is less massaged by the NTSB and sometimes you can see the raw statements from the FAA which can be more enlightening.
 
That's the real secret of GA - most crashes are caused by people bound and determined to kill themselves.
 
My two cents:

This is a term called "on a mission". Sometimes I refer to it as the worse drug on this planet!
Its takes a lot of courage to say "no"!

However, once you've been up there, barely hanging to your dear life, wishing you were on the ground, staying on the ground next time around is much easier!
 
I did a search on my own accident databases, looking for " known" in the "Probable Cause" column and manually eliminating cases which referred to non-mechanical issues (e.g., " known instrument conditions," " known obstacle," etc.).

I've got separate data for Homebuilts, Cessna 172s, and a combination of PA-28 models. These are the percentage of total accidents where the NTSB referenced flying with known mechanical difficulties:

Homebuilts: 1.0%
PA-28: 0.7%
Cessna 172: 0.3%

Homebuilts have a higher rate of mechanical issues, so the higher percentage of operation with known deficiencies probably follows.

Surprisingly, it's doesn't seem related to the number of aircraft hours... For the 22 cases where the NTSB report included the aircraft total time, only 3 were within the test period. The involved aircraft averaged about seven years old.

Ron Wanttaja
 
There's also a question as to what the mechanical difficulty is and what your backups are. I think in a lot of piston singles there is nothing for a backup. In the Aztec, I had a vacuum pump fail somewhere over Arizona. Continued flying home on the one (good) vacuum pump in VMC and no icing. No big deal. In a piston single, would've been harder.
 
bbchien said:
It cuts across all spectra....the Yitzak Jacoby accident at Newark comes to mind.

http://dms.ntsb.gov/aviation/AccidentReports/0pxeov55qmd0jlmetr2qhuqn1/K09012013120000.pdf

He had headache issues, too, but this is just contributory. If you read as an aviator, he had to have departed with a known deficiency. He was the Bonanza Society's Partial Panel guru.
Click to expand...

So he had headaches that had the capacity to render him functionally incapacitated and jumped in an airplane in bad weather?


Derp.
 
I had the option a couple days ago to take off with a mechanical issue, but I didn't. Instead, I called Jesse to come pick me up in my Mooney. Then the Mooney broke - we drove back.

Departing with a known issue is no bueno.
 
We had just landed at our home airport after pounding through 200 miles of "stuff" on the gauges - and some of that stuff had hairy chested thunder bumpers embedded.
While we unloaded the plane a couple landed to refuel and in the casual conversation I found that HE intended to go VFR out across Lake Michigan to the Wisconsin side. I mentioned that we had just come through some of that along the shoreline in hard IMC and going VFR seemed a bit 'iffy'.
I could see that the had "get home itis" (typical bull headed doctor)
So I said to my wife, you get her in the bathroom and you tell her that if she leaves the ground this afternoon it will be her last day on earth.
She came steaming out of that bathroom and informed him in no uncertain terms she was not getting back into that plane until the weather improved, and that was that. So they took the courtesy car to a motel.
The next morning was CAVU (typical of a front passing through). She called my wife at the office later that day and said he was only an hour late getting to the office and thanked her for being so blunt.
 
DavidWhite said:
I had the option a couple days ago to take off with a mechanical issue, but I didn't. Instead, I called Jesse to come pick me up in my Mooney. Then the Mooney broke - we drove back.

Departing with a known issue is no bueno.
Click to expand...

See David you guys made what should be a basic decision to stay on the ground. I ask you this? Did you almost go up or was it a no go from the onset of an issue? Were you even the least bit close to maybe being an NTSB report?
 
LJS1993 said:
See David you guys made what should be a basic decision to stay on the ground. I ask you this? Did you almost go up or was it a no go from the onset of an issue? Were you even the least bit close to maybe being an NTSB report?
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I thought it was perhaps vapor lock at first, so I ran the fuel pump for awhile and if it cleared I would have taken off and written it off as vapor lock. It didn't though - when I tried to run it up (to troubleshoot, not a preflight runup) the throttle lagged and the best way I could describe it was the engine was surging. I turned around and parked on the ramp.

The Mooney was an easy choice - no mag = no go.

I've been closer to being in an NTSB report.
 
bbchien said:
It cuts across all spectra....the Yitzak Jacoby accident at Newark comes to mind.

http://dms.ntsb.gov/aviation/AccidentReports/0pxeov55qmd0jlmetr2qhuqn1/K09012013120000.pdf

He had headache issues, too, but this is just contributory. If you read as an aviator, he had to have departed with a known deficiency. He was the Bonanza Society's Partial Panel guru.
Click to expand...
"Partial panel guru"...?
I wonder if this status made him overconfident, to the point where he'd actually depart IFR (in pretty challenging wx) with a known problem... and a history of debilitating migraines. Gurus are supposed to be wise, not just skilled. :rolleyes2:
Thinking of this accident always gives me the willies, because he basically flew over my building on the way to the crash site, and I live on the top floor. :nonod:
 
Probably means no amount of regulation will really change it much, doesn't it?
 
About twenty years ago ...

Departed K017 late in the afternoon on Father's Day with 3 pax in a 172 that was down to about quarter tanks, so we were OK on CG & gross.

On departure at the far end of the runway, about 300' AGL, the engine power came back to 1600 or so and running rougher than a cob. Thankfully, airport is a "carrier" strip on a hill over town about 800' above average terrain, so I had some time to think.

Switch from both to left to right and wait a few seconds. No help. Switch both to right, both to left mags and wait a few seconds. No help.
Pull full carb heat, wait a few seconds. No help.

Squawk 7700 but I'm so far back up in the hills they have to pipe in sunshine. Called Unicom and told them to have an ambulance waiting on the little mountain "freeway" we are on.

Lined up on the freeway, came to WAY above best glide about 100 AGL to go over the cars to indicate that we were in trouble. Most of them stopped. One didn't.

Clapped out Datsun with three kids in the back seat, I could see their eyes getting bigger and bigger. Amazing what you can see under these circumstances.

Pulled out of the center lane into the passing lane to miss the Datsun -- kids didn't pay for the ride, I did. Took the wing off on the bridge overpass, airplane turned over, and four of us scrambled out. Two casualties. One video camera from the guy in the back seat (still have the video, all the way to impact) and my watchband, busted all to hell.

Kindly old FAA guy came out the next day when we had the carcass dragged onto the airport. We were trying to figure out what happened when he said words I'll never forget -- "If you guys figure it out, let me know."

Figured it out a few hours later ... single mag failure followed by multiple spark plug failures (long story, lead fuel involved).

The NTSB, in its infinite wisdom (LAX89LA221) came to the conclusion that it was improper maintenance. NOTWITHSTANDING the fact that I sent them the aircraft logbooks AND my personal notes showing when and where not only were the required inspections/maintenance performed but the manufacturer's own documents with annotations as to when the (not required) service bulletins were complied with.

If I am ever diagnosed with a terminal illness, I'll go back and raise holy hanna about this conclusion. Right now, if I did so, I'd probably stand a hell of a chance losing not only my IA, but my A&P as well while they "sorted it out" with glacial speed.

Miserable bastards, they are.

Jim
 
denverpilot said:
Probably means no amount of regulation will really change it much, doesn't it?
Click to expand...

Not necessarily, one of the reasons experimentals accident rates are slightly higher was due in part to regulations. CFI's could not instruct in experimental a due to the "not for hire" regs attached to them. That (I believe) was changed recently. I expect the accident rate to continue to decline now that builders and pilots can get transitional training. ;)
 
weirdjim said:
About twenty years ago ...

Departed K017 late in the afternoon on Father's Day with 3 pax in a 172 that was down to about quarter tanks, so we were OK on CG & gross.

On departure at the far end of the runway, about 300' AGL, the engine power came back to 1600 or so and running rougher than a cob. Thankfully, airport is a "carrier" strip on a hill over town about 800' above average terrain, so I had some time to think.

Switch from both to left to right and wait a few seconds. No help. Switch both to right, both to left mags and wait a few seconds. No help.
Pull full carb heat, wait a few seconds. No help.

Squawk 7700 but I'm so far back up in the hills they have to pipe in sunshine. Called Unicom and told them to have an ambulance waiting on the little mountain "freeway" we are on.

Lined up on the freeway, came to WAY above best glide about 100 AGL to go over the cars to indicate that we were in trouble. Most of them stopped. One didn't.

Clapped out Datsun with three kids in the back seat, I could see their eyes getting bigger and bigger. Amazing what you can see under these circumstances.

Pulled out of the center lane into the passing lane to miss the Datsun -- kids didn't pay for the ride, I did. Took the wing off on the bridge overpass, airplane turned over, and four of us scrambled out. Two casualties. One video camera from the guy in the back seat (still have the video, all the way to impact) and my watchband, busted all to hell.

Kindly old FAA guy came out the next day when we had the carcass dragged onto the airport. We were trying to figure out what happened when he said words I'll never forget -- "If you guys figure it out, let me know."

Figured it out a few hours later ... single mag failure followed by multiple spark plug failures (long story, lead fuel involved).

The NTSB, in its infinite wisdom (LAX89LA221) came to the conclusion that it was improper maintenance. NOTWITHSTANDING the fact that I sent them the aircraft logbooks AND my personal notes showing when and where not only were the required inspections/maintenance performed but the manufacturer's own documents with annotations as to when the (not required) service bulletins were complied with.

If I am ever diagnosed with a terminal illness, I'll go back and raise holy hanna about this conclusion. Right now, if I did so, I'd probably stand a hell of a chance losing not only my IA, but my A&P as well while they "sorted it out" with glacial speed.

Miserable bastards, they are.

Jim
Click to expand...

The FAA's motto is "We're not happy, until you're unhappy."

That is a hell of a story BTW. Glad I burn mogas! But more glad you walked away. ;)
 
Geico266 said:
The FAA's motto is "We're not happy, until you're unhappy."

That is a hell of a story BTW. Glad I burn mogas! But more glad you walked away. ;)
Click to expand...

More gladder that my three pax walked away without a (literally) scratch on them.

Of course, two of them that were going through a divorce at the time tagged my insurance company for almost a hundred grand claiming that the trauma caused them to be sexually incapable. The other one got religion and went to Africa as a missionary.

Me, I got back on the horse the next day and only shiver and quiver a few times a year thinking about it :yes:

Thanks for the sentiments ...

Jim
 
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What kind of gripes are we talking about here? Because in my world, if you refused a jet with an open gripe, you would never fly. Obviously there are things that make you change your mind, but I am interested to hear what the folks around here would say no to. I'll leave it at that for now......
 
In much of the part 91 world, takeoffs are optional.

35 AoA said:
What kind of gripes are we talking about here? Because in my world, if you refused a jet with an open gripe, you would never fly. Obviously there are things that make you change your mind, but I am interested to hear what the folks around here would say no to. I'll leave it at that for now......
Click to expand...
 
35 AoA said:
What kind of gripes are we talking about here? Because in my world, if you refused a jet with an open gripe, you would never fly. Obviously there are things that make you change your mind, but I am interested to hear what the folks around here would say no to. I'll leave it at that for now......
Click to expand...

What is a "gripe"? If you are talking about a written up squawk in the aircraft log then that means something. If the squawk is something like "the forward light in the aft biffy is out" that is one thing. Anything more (and honestly we tried to fix these ****ant little things on turnaround) and it was "this airplane ain't going nowhere."

THis was for a major but regional airline not so many years ago.

Jim
 
weirdjim said:
More gladder that my three pax walked away without a (literally) scratch on them.

Of course, two of them that were going through a divorce at the time tagged my insurance company for almost a hundred grand claiming that the trauma caused them to be sexually incapable. The other one got religion and went to Africa as a missionary.

Me, I got back on the horse the next day and only shiver and quiver a few times a year thinking about it :yes:

Thanks for the sentiments ...

Jim
Click to expand...

That's a heck of a adventure!

Not to side track, but I noticed you're a CPL Gilder and CFIG, I've been looking to do the addons myself, any recommendations near CA?
 
weirdjim said:
The NTSB, in its infinite wisdom (LAX89LA221) came to the conclusion that it was improper maintenance. NOTWITHSTANDING the fact that I sent them the aircraft logbooks AND my personal notes showing when and where not only were the required inspections/maintenance performed but the manufacturer's own documents with annotations as to when the (not required) service bulletins were complied with.

If I am ever diagnosed with a terminal illness, I'll go back and raise holy hanna about this conclusion. Right now, if I did so, I'd probably stand a hell of a chance losing not only my IA, but my A&P as well while they "sorted it out" with glacial speed.

Miserable bastards, they are.

Jim
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You can say that again.

In my accident, no injuries, engine failure at take-off, off field landing at night in a Walmart parking lot, the NTSB revised the factual 4 times due to repeated errors I pointed out. I even had to get my congressman involved to get them to accept my GPS/engine log data and ultimately filed a criminal complaint with the FBI (at my congressman's suggestion) against the NTSB investigator for fraud. All of sudden the factual was finally revised to at least resemble something factual even though the probable was a work of fiction.

So kick them in the ass as hard as you can if they won't do their job... which is supposed to enhance aviation safety and learn from our accidents... and they only can do that with accurate reports. The NTSB has no direct say on your AP/IA certificate anyways.
 
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When my partner and his wife were killed in the crash of our 340, I flew to the crash site to see the scene and bring their remains home. When I approached the wreck the NTSB dude in the blue jumpsuit asked why I was there so I told him. He said he was there to represent me so I should leave.

I had been up all night, had flown from KC to Colorado and promptly offered to whip his ass on the spot at which point he allowed as how it would probably be OK if I stayed.
 
weirdjim said:
What is a "gripe"? If you are talking about a written up squawk in the aircraft log then that means something. If the squawk is something like "the forward light in the aft biffy is out" that is one thing. Anything more (and honestly we tried to fix these ****ant little things on turnaround) and it was "this airplane ain't going nowhere."

THis was for a major but regional airline not so many years ago.

Jim
Click to expand...

Any airplane with a single engine demands maybe a little more respect, so wrt the OP, I don't mean to get out of my lane, but I am purely curious what the folks around here consider to be downing discrepancies. By "gripe", yes I mean a maintenance "squawk" in civilian parlance. There are definitely hard and fast things that I will not take flying, don't get me wrong, but given the example of a burned out light, it seems like folks are mistaking an airplane that isn't brand new and without any sort of discrepancy for an airplane that isn't airworthy.
 
The "inconvenient truth" (to quote a famous American) is that a high percentage of GA pilots know little about the planes they are flying. They don't "work on stuff or know how stuff works" and are therefore totally dependent on others to provide that piece of the puzzle.

The old saw that "we teach from the cockpit out, not from the toolbox in" is usually applicable, so troubleshooting and no-go decision-making are given short shrift and pilots are often on their own with decisions they can't adequately evaluate. I don't see any foreseeable change until/unless the training requirements change.

35 AoA said:
Any airplane with a single engine demands maybe a little more respect, so wrt the OP, I don't mean to get out of my lane, but I am purely curious what the folks around here consider to be downing discrepancies. By "gripe", yes I mean a maintenance "squawk" in civilian parlance. There are definitely hard and fast things that I will not take flying, don't get me wrong, but given the example of a burned out light, it seems like folks are mistaking an airplane that isn't brand new and without any sort of discrepancy for an airplane that isn't airworthy.
Click to expand...
 
weirdjim said:
The NTSB, in its infinite wisdom (LAX89LA221) came to the conclusion that it was improper maintenance. NOTWITHSTANDING the fact that I sent them the aircraft logbooks AND my personal notes showing when and where not only were the required inspections/maintenance performed but the manufacturer's own documents with annotations as to when the (not required) service bulletins were complied with.

If I am ever diagnosed with a terminal illness, I'll go back and raise holy hanna about this conclusion. Right now, if I did so, I'd probably stand a hell of a chance losing not only my IA, but my A&P as well while they "sorted it out" with glacial speed.

Miserable bastards, they are.

Jim
Click to expand...

NTSB sez


THE PILOT REPORTED THE AIRCRAFT CLIMBED 50 TO 150 FEET ABOVE THE RUNWAY WHEN THE ENGINE BEGAN RUNNING ROUGH AND LOOSING POWER. HE WAS UNABLE TO MAINTAIN ALTITUDE AND ELECTED TO LAND ON A ROAD. THE AIRCRAFT'S WING STRUCK A BRIDGE DURING THE LANDING ROLL AND THE AIRCRAFT OVERTURNED. THE ENGINE LOG REFLECTED THAT THE RIGHT MAGNETO POINTS AND DISTRIBUTOR BLOCK WERE REPLACED AND BOTH MAGNETOS WERE RETIMED ON JULY 14, 1981 AT 4329 TOTAL AIRFRAME HOURS. THERE WAS NO EVIDENCE THAT INSPECTIONS WERE PERFORMED DURING THE EIGHT YEARS AND 1,233 OPERATIONAL HOURS PRECEDING THE ACCIDENT. DURING THE POST ACCIDENT ENGINE TEST THE RIGHT MAGNETO FAILED AFTER OPERATING FOR 10 MINUTES. AN EXAMINATION OF THE RIGHT MAGNETO COIL DISCLOSED EVIDENCE OF ARCING. The National Transportation Safety Board determines the probable cause(s) of this accident to be:
FAILURE TO PERFORM MAINTENANCE INSPECTIONS PRESCRIBED BY THE MAGNETO, ENGINE AND AIRCRAFT MANUFACTURERS. THE HIGH DENSITY ALTITUDE AND TERRAIN CONDITIONS WERE CONTRIBUTING FACTORS.
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Never dealt with the NTSB, but it's good to know that they are as incompetent as the state police accident investigators I have dealt with. :rolleyes:
 
NineThreeKilo said:
That's a heck of a adventure!

Not to side track, but I noticed you're a CPL Gilder and CFIG, I've been looking to do the addons myself, any recommendations near CA?
Click to expand...

I got my private Glider at Otay Mesa (near Brown Field San Diego), commercial glider at Lake Elsinore (near March AFB in Riverside County), and my CFIG at Vacaville gliderport, none of which I believe exist any more.

I've heard good words about Truckee gliderport at Truckee airport and Williams gliderport over northwest of Sacramento. No experience flying out of either one.

Jim
 
Okay so after reading the responses in regards to the inadequacy of the NTSB I have concluded the following from you guys. Many of these accidents were possibly not truly the fault of the pilot and the NTSB sucks and is to blame?
 
LJS1993 said:
Okay so after reading the responses in regards to the inadequacy of the NTSB I have concluded the following from you guys. Many of these accidents were possibly not truly the fault of the pilot and the NTSB sucks and is to blame?
Click to expand...

You didn't conclude that from my posting...although the suck part you won't get an argument about. What I will say is the NTSB is not doing the mission the taxpayer is paying them for, at least with regards to General aviation. The majority of non-fatal accidents they won't even send anyone out... instead doing what is called a "desk investigation". Yet every accident should get the same amount of attention if the mission is truly to develop safety recommendations to prevent future accidents.

And in the case of Jim's accident we also see they aren't beyond manufacturing facts to suite the narrative they want to produce. As I first stated to you when I entered the thread... you need to also review the dockets... still somewhat suspect but at least the data there is less massaged by the NTSB storyteller.
 
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35 AoA said:
What kind of gripes are we talking about here? Because in my world, if you refused a jet with an open gripe, you would never fly. Obviously there are things that make you change your mind, but I am interested to hear what the folks around here would say no to. I'll leave it at that for now......
Click to expand...

This is, of course, a valid point. The more you get into the professional world, the more it becomes a "Why check the weather, you're going anyway" sort of arrangement. Of course, those people also usually understand what they're operating without and how to deal with it (MELs or the like).

The reports you read that just make you shake your head are the ones like the 320 that crashed a few months ago in Texas. Owner had no instrument rating, plane had just gone through paint, owner and plane hadn't flown in 8 months. Shop ran up the plane and said the one engine wouldn't make power, owner said "That's normal, it clears up after flying a while." Radios didn't work well, and he departed before dawn into 0/0 because he wanted to leave before the tower opened (no instrument rating, no radios).

Didn't make it far, to nobody's surprise.
 
35 AoA said:
Any airplane with a single engine demands maybe a little more respect, so wrt the OP, I don't mean to get out of my lane, but I am purely curious what the folks around here consider to be downing discrepancies. By "gripe", yes I mean a maintenance "squawk" in civilian parlance. There are definitely hard and fast things that I will not take flying, don't get me wrong, but given the example of a burned out light, it seems like folks are mistaking an airplane that isn't brand new and without any sort of discrepancy for an airplane that isn't airworthy.
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I always had the luxury of saying, "chief, you're flying with us today.....'cause I want you to see/hear/feel this......"

But when you are dispatched, you are going. There was only ONE exception and I learned a lot about how large organizations work, from that one time.
 
During my days at Aviation Safety, I would routinely request the full dockets for certain accidents. Some of the investigations were thorough and insightful. Many were just exercises in form filling. It got to the point where I could almost look at the docket and know which NTSB guy had done the investigation. Some are very good. Many are not. And there appears to be no impetus within the NTSB to change that.
 
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