Luxair Flight 9642
LX-LGB, the aircraft involved in the accident, in 1992 | |
Accident summary | |
---|---|
Date | 6 November 2002 |
Summary | Pilot error aggravated by inclement weather |
Site |
Luxembourg City 49°39′21″N 6°16′26″E / 49.65583°N 6.27389°ECoordinates: 49°39′21″N 6°16′26″E / 49.65583°N 6.27389°E |
Passengers | 19 |
Crew | 3 |
Fatalities | 20 |
Survivors | 2 |
Aircraft type | Fokker 50 |
Operator | Luxair |
Registration | LX-LGB |
Flight origin | Berlin Tempelhof Airport |
Destination | Luxembourg Findel Airport |
Luxair Flight 9642 was a scheduled international passenger flight, flying from Berlin Tempelhof Airport, Berlin, Germany, to Luxembourg Findel Airport, Niederanven, Luxembourg, near Luxembourg City. The flight was operated by Luxair, the flag carrier(national airline) of Luxembourg, with its headquarters in Luxembourg Findel Airport. On 6 November 2002, LX-LGB, the Fokker 50 aircraft on the route crashed and burned while on final approach to Luxembourg Findel Airport about 6 nautical miles (11 km) short of the runway while trying to land in fog. Twenty of the twenty-two passengers and crew perished.
Lufthansa had a codeshare on the flight as LH2420.[1] The accident was the first fatal accident in Luxair's history and the only fatal accident in the company. It held as the deadliest plane crash in Luxembourg's aviation history.[2]
Accident
The crews were approaching Findel Airport in foggy condition.
- 09:02:57 ATC : « Luxair 9642 good morning, continue approach. The wind is calm RVR beginning 250 meters, mid section 250 meters, stop end 225 meters ».
- 09:03:08 Flight 9642 : « That’s copied Luxair 9642… but we need 300 meters for the approach ».
- 09:03:18 ATC : « 9642 copied… uh so continue approach and I’ll keep you advised we didn’t have 300 uh… uh during the last time ».
- 09:03:28 Flight 9642 : « Euh Roger 9642, we keep you advised we’re proceeding to ELU now and … uh standing by 9642».
The flight crews decided to go-around, but then they later aborted the go-around and continued their approach.
- 09:04:46 Flight 9642 : «Yes, well we do a go-around, missed approach».
- 09:04:57 ATC : «Luxair 9642 RVR 300 meters 275 meters stop end 275 meters».
- 09:05:05 Flight 9642 : «9642 Roger so we continue».
- 09:05:08 ATC : «9642 you are cleared to land, wind 180°….knots».
The co-pilot later acknowledged this message. It was the last communication with the ATC. As the landing gear retracted, the pitch angle of the two propellers simultaneously reached a value that is lower than the minimum values for flight. This setting caused the aircraft's speed and altitude decreasing rapidly. Few seconds later, the left engine and the right engine stopped, and the flight data recorders ceased functioning. The first impact marks are found on the south edge of the road RN1. They represent the two main landing gears and the fuselage tail cone. The left wing tip scratched across the road before hitting an embankment at the north side of the road RN1. Both wheels and blades came off from the aircraft. The aircraft bounced. At this point, the empennage and part of the right wing broke away, the aft portion of the fuselage turned around to the right and the aircraft came to rest 25 meters further away. At 09:05:42 (local tine),the aircraft disappeared from the radar screen. It was immediately found that the aircraft had crashed in a field seven hundred meters to the north of runway centreline.[3]
However, the thickness of the fog was so thick in fact nearby residents were unaware of the crash. Most of them claimed they didn't see or even heard anything when the crash occurred, and only realized that something had happened nearby when ambulances and emergency services arriving at the crash site.[4]
Rescue services found passengers had been ejected from the cabin. Some passengers were still attached to their seat and others were not. The cabin crew member was found in the corridor next to the fuselage front entrance. The cockpit did not catch fire. As the Captain survived the impact and trapped in the cockpit, rescuers cut a hole to retrieve him.[3]
Passengers
Most of the passengers were businesspeople from Germany.[5] 17 people died at the crash site. Initially five people survived, but three died in the hospital. By nightfall, 18 bodies out of 20 were found, while the other two remained missing. Both of them were thought to be buried under the smouldering fuselage. Rescue workers were using a crane to disentangle the charred remains.[5] Amongst the passengers killed on the flight was artist Michel Majerus.[6]
The Captain is a 26-year-old male, with a total flying experience of 4242 flight hours and 2864 hours on type. The First Officer is a 32-year-old male with a total flight hours of 1156 and 443 hours on type.
Nationalities of passengers and crew
Nationality[7][8] | Passengers | Crew | Total | |||
---|---|---|---|---|---|---|
Total | Killed | Total | Killed | Total | Killed | |
France | 2 | 1 | 0 | 0 | 2 | 1 |
Germany | 15 | 15 | 0 | 0 | 15 | 15 |
Luxembourg | 2 | 2 | 3 | 2 | 5 | 4 |
Total | 19 | 18 | 3 | 2 | 22 | 20 |
Investigation
In the evening before the day of the accident, the aircraft had been inspected with maintenance crew. The result was satisfying. However, on the Hold Item List (HIL), it was found out that the aircraft's antiskid system on the right hand landing gear was inoperative. This was detected on 27 September 2002 and had been replaced. However, on 24 October 2002, the same antiskid system went inoperative again. Despite changing the outboard wheel speed sensor, the system remained inoperative. On 5 November 2002, one day before the accident, the problem was solved by replacing the inboard wheel speed sensor.
Investigators noted that the weather around the airport at the time of the accident was foggy. Nearby residents of Niederanven stated that fog was present at the time of the accident. The thickness of the fog was very thick, and nearby residents couldn't see or even hear the moment of impact, even though Niederanven was in close proximity to the crash site.
CVR analysis
According to CVR analysis by investigators, they are cleared for the approach as they are descending through 6000 ft at a distance of thirteen NM from the airport. They express some surprise about the fact that they pass before all the aircraft in the hold and they begin to prepare the aircraft for the approach. But, as they are caught off their guard by the priority given to them, they did not have much time to do so. At 09:02:12, the captain told the First Officer: “Tell him ….that if we don’t have 300 meters atEcho, we are going to perform a go-around”. This message which was never delivered to ATC because they were transferred to the tower frequency at this time.
The Captain decides to perform the go-around. However, The copilot does not react and continues with the checklist, placing the ground idle stop in the OFF position, this being the last action of this checklist. This misunderstanding most probably results from the lack of preparation and of accuracy resulting from the previous flight phase. Moreover, as the crew never got prepared for a go-around and as the aircraft was not in descent, this go around decision did not imply any significant action.
The crew then realized that they had deviated from the Standard Operating Procedures (SOP). Shortly afterwards, a confusion occurred in the cockpit. Although the Captain continued the approach, he didn't call for flaps and gear. He waits for several seconds before putting the aircraft into descend.
The captain, faced now with a sudden time pressure and all mechanical locks being removed,and with the hand pressure on the power levers, may have unintentionally moved the power levers further backwards, passing through the ground idle position, towards full reverse. The increase in reverse power triggered a propeller overspeed that was heard and noticed by the crew. Feeling a tremendous increase in drag and the consequent deceleration, one of the crew members retracted the flaps. The power levers were moved into the flight range but the propellers could not exit the beta range. Few seconds later, the aircraft impacted terrain.
Cause
The investigation found that a series of non-standard actions resulted in severe loss of airspeed due to the accidental selection of the propellers into reverse pitch (reverse pitch is normally only used to slow an aircraft on the ground).[9][10] The aircraft subsequently impacted 6NM (11 km) short of the runway. Contributing to the accident were errors concerning the implementation of a safety recommendation which had been made by the manufacturer to Fokker 50 operators. Also this warning was not adequately communicated to the flight crews of Luxair.
See also
- Airlines PNG Flight 1600, a similar crash in Papua New Guinea involving a Dash 8 in which the pilots accidentally changed the aircraft's propeller switch into reverse pitch while still in mid-air
- Kish Air Flight 7170, a similar crash in United Arab Emirates in which the pilots accidentally changed the aircraft's propeller switch into reverse pitch while still in mid-air
- Merpati Nusantara Airlines Flight 6517, a similar crash in Indonesia involving a Xian MA60 in which the pilots accidentally changed the aircraft's propeller switch into reverse pitch while still in mid-air
- List of accidents and incidents involving commercial aircraft
References
- ↑ "Info: Hotline". Berliner Morgenpost. 2 June 2008. Retrieved on 1 November 2009.
- ↑ "RZ Luxair_rapp_intro_UK". Luxair 15/56. 2 May 2003. Archived from the original (PDF) on 7 November 2007. Retrieved 2 November 2009.
- 1 2 http://www.mt.public.lu/ministere/services/coordination_generale/AET/aviation/pdf_EN_fokker.pdf
- ↑ Andrew Osborn. "Mystery as 20 die in Luxembourg plane crash". The Guardian. Retrieved 15 March 2016.
- 1 2 "Luxembourg plane crashes in fog" (Archive). BBC. Wednesday 6 November 2002. Retrieved on 26 August 2014.
- ↑ Morrison, Donald. "A Coming-Out Party." TIME. 28 February 2007. Retrieved on 1 November 2009.
- ↑ "Press Release 06.11.2002 08.15 pm". Luxair. 6 November 2002. Archived from the original on 13 February 2003. Retrieved 1 November 2009. (Webcitation archive)
- ↑ "Namelist of persons that died in aircraft accident 06.11.02". Luxair. 7 November 2002. Archived from the original on 13 February 2003. Retrieved 1 November 2009. (Webcitation Archive)
- ↑ "Investigation Commission On The Accident Which Occurred 6 November 2002 (Preliminary Report, January 2003)" (PDF). Government of Luxembourg
- ↑ "FINAL REPORT (REVISED ISSUE)" (PDF). Ministry of Transport, Administration for technical investigations. July 2009. Retrieved 23 July 2012.
Further reading
- (French) "Jugement dans l'affaire dite Luxair" (Archive). Government of Luxembourg. 27 March 2012.
External links
Wikimedia Commons has media related to Luxair Flight 9642. |
- Administration for Technical Investigations
- Final Report (Archive) – Translation of French report
- (French) Final Report." (Archive) – Original report
- Preliminary Report (Archive, Alternate) – Translation of French Report
- (French) Preliminary Report (Archive, Alternate) – Original report
- "AIRCRAFT ACCIDENT LG9642/LH2420". Luxair.
- Government of Luxembourg
- (French) Accident aérien au Luxembourg (6 novembre 2002)
- (French) Communiqué Déroulement de l'accident d'un avion Luxair." (Archive) – 6 Nov 2002
- (French) Communiqué du parquet du Luxembourg (2003) (Archive)
- Accident description at the Aviation Safety Network
- Cockpit Voice Recorder transcript and accident summary