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DH8D, Chania Greece, 2010

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Summary
On 23 February 2010, a Bombardier DHC8-400 being operated by Flybe for Olympic Air on a scheduled passenger flight from Athens to Chania unintentionally made an approach at destination in day VMC towards a landing on a part of the runway which was closed and only corrected the profile shortly before touchdown to achieve an ultimately uneventful landing on the available part of the runway. None of the 55 occupants were injured.
Event Details
When February 2010
Actual or Potential
Event Type
Controlled Flight Into Terrain (CFIT), Human Factors
Day/Night Day
Flight Conditions VMC
Flight Details
Aircraft BOMBARDIER Dash 8 Q400
Operator Flybe
Domicile United Kingdom
Type of Flight Public Transport (Passenger)
Origin Athens/Eleftherios Venizelos International Airport
Intended Destination Chania
Take off Commenced Yes
Flight Airborne Yes
Flight Completed Yes
Flight Phase Descent
ENR / APR
Location - Airport
Airport Chania
General
Tag(s) Extra flight crew (no training)
CFIT
Tag(s) Undershoot on Landing
HF
Tag(s) Data use error,
Distraction,
Ineffective Monitoring,
Manual Handling
Outcome
Damage or injury No
Causal Factor Group(s)
Group(s) Aircraft Operation
Safety Recommendation(s)
Group(s) None Made
Investigation Type
Type Independent

Description

On 23 February 2010, a Bombardier DHC8-400 being operated by Flybe for Olympic Air on a scheduled passenger flight from Athens to Chania unintentionally made an approach at destination in day Visual Meteorological Conditions (VMC) towards a landing on a part of the runway which was closed and only corrected the profile shortly before touchdown to achieve an ultimately uneventful landing on the available part of the runway. None of the 55 occupants were injured.

Investigation

An investigation was carried out by the UK AAIB. It was established that the incident flight had been intended as a Line Check for the Aircraft Commander who was operating as PF and that the Check Captain had planned to conduct this from the supernumerary crew seat. However the Check Captain was unable to get his COM box to work and as he was therefore unable to monitor the RT or intercom, he cancelled the line check, but decided to travel as an observer anyway.

During the crew pre-flight briefing, a Notice To Airmen for Chania Airport which stated that the first 800 metres of Runway 11 was unserviceable and indicated by closed runway markings had been discussed by the crew. The NOTAM was found to have explained that resurfacing work in progress and given the temporarily reduced length of Runway 11/29 as 2,331 metres. It also stated that the new Runway 11 threshold was equipped with threshold, side and end lights, with PAPIs installed at the displaced threshold of Runway 11.

After advising Runway 11 in use, the Automatic Terminal Information Service (ATIS) had included the caution ‘new threshold located 1017 metres inwards’ and the receipt of this ATIS was confirmed to ATC by the crew. At 30nm55,560 m
55.56 km
182,283.465 ft
from destination, the PF declared a visual approach and positioned towards a 10nm18,520 m
18.52 km
60,761.155 ft
final for landing on Runway 11. Range and altitude cross checks were called by the co pilot based on the VOR/DME approach plate data.

The runway remained clearly visible throughout the approach but it was confirmed during the investigation that both the aircraft commander and the co pilot had forgotten about the displaced threshold and therefore the aircraft was flown towards the normal Runway 11 touchdown point. The investigation noted that the Check Captain in the supernumerary seat “began to be concerned that this may be the case and late in the approach he intervened”. It was reported that the aircraft commander had then increased power to adjust the flight path for the displaced threshold and achieved a touchdown at the correct location.

The Investigation was advised that “Following a discussion about the incident, the crew did not recall any information regarding the displaced runway on the ATIS and ATC had not reminded them in any of their transmissions. The closed runway markings had not stood out in the bright sunlight and none of the crew could remember the PAPIs being illuminated.”

The airport authority stated that in addition to the caution on the ATIS broadcast which the crew had acknowledged receiving, the runway markings for the revised runway availability were correct and that the PAPIs had been working normally.

The aircraft commander had subsequently come to the view that a go around followed by a second approach may have been a better option than continuing to a landing.

The Investigation considered that “when a third crew member is present they should assist the operating crew at the earliest opportunity if they observe potentially incorrect practices or procedures.”

The Final Report was published on 8 July 2010 and it may be seen at SKYbrary bookshelf: AAIB Bulletin: 7/2010 EW/G2010/02/14

Further Reading