Introduction
Reeve Aleutian Airways, Inc., Flight 69, took off from Anchorage Alaska on a scheduled cargo and passenger flight and headed towards Cold Bay on February 16, 1982. The plane was scheduled for intermediate which was a Nihon Y-11A was carrying a total of 33 passengers and 3 crew members. The plane departed from Anchorage at around 0751 Alaskan time and roughly two hours later, the plane made an emergency gear landing at the frozen waters of River Naknek which is just adjacent to the King Salmon Airport in King Salmon (NTSB, 1982). The plane had lost power in both its engines and upon impact, it underwent substantial damage. Luckily there was no casualty in this accident. In fact, injuries only accrued to two passengers, two fire fighters, and one crew member during the subsequent rescue, evacuation and firefighting activities after the emergency landing of the plane (NTSB, 1982). This was one of the many accidents that happened to planes operated by the now defunct Reeve Aleutian Airline. Luckily, the plane crash was a little low profile as it did not result in any loss of life.
Brief Description of the accident scenario
At around 0900:30, the plane was descending through an altitude of 2600 feet and contact was made with the King Salmon Tower where information was relayed that the plane was due for a touchdown and it was subsequently cleared. The first officer started performing the before landing checks that included moving the plane’s HP (high pressure) cock levers to the HSWL (high stop withdrawal) position, turning off the plane’s fuel heaters and then scanning the engine instruments (NTSB, 1982). After the fuel heaters were turned off, a check of the engines revealed that the no. 2 flight engine’s torque pressure was 40 psi and the fuel flow indication was significantly below 500 pounds per hour. This was clearly abnormal because at normal throttle position, torque pressure would have been around 100 psi while fluid flow would have been 850 pounds per hour (NTSB, 1982). However, according to the first officer, neither the low fuel pressure nor the fuel differential pressure warning lights were illuminated. At this time, the captain felt the plane yank to the right and the first officer then informed him that the plane had lost one engine (NTSB, 1982). The pilot made some crucial decisions regarding the plane including the fact that it could be landed using the remaining engine. The captain instructed the first officer to select the gear down and the captain started descending the plane. It was then a problem with second engine was noted. After the gear had been lowered and the plane descent was moving towards the final from the base leg, several popping sounds were heard and the crew smelt smoke. This was followed by large fluctuations in the fuel flow of the left engine and the plane yawed to the left. The left engine started losing powered rapidly (NTSB, 1982). Attempts to restart the right engine were unsuccessful and were stopped as the plane was about to land on ice. The rate of decent increased and the captain realized that the plane could not make it to the airport and the decision was made to land on the nearby frozen Naknek River. The plane touched down before the full retraction of the gear and the slid for roughly one and a half miles. The plane’s fire warning lights started after the plane on ice and everybody was evacuated from the plane before fire extinguishers arrived soon to extinguish the fire that had stated on the left engine turbine section (NTSB, 1982).
Major Sources of Investigator’s Information
Many plane accidents occur due to multiple and random failures of the plane’s working system. It is very are for an accident to be caused by one factor (Cobb & Primo, 2003). In many situations, multiple inter-related causal factors are what lead to plane accidents. Investigators are therefore required to be very keen when it comes investigations in order to identify each of these interrelated causal factors. The investigators are also supposed to remain unbiased and neutral in plane crash investigations so that accurate descriptions of the causes of the accident can be given (Cobb & Primo, 2003).
The main sources of the investigator’s information were the plane’s material itself which were comprehensively scrutinized. The NTSB was at the center of this particular investigation. Materials including the plane’s engines were extracted and taken for investigation and testing (NTSB, 1982). Other aspects and functioning systems of the plane were analyzed to feed the investigators with information. These included tests on the propeller, the plane’s electrical systems, fuel amongst other aspects. Research was also conducted on the plane’s history. In addition, the testimonies of the crew members were used to furnish the investigators with details about the crash. The cockpit recorder also revealed a great detail about the events preceding the accident.
Selected Major Findings
Plane accidents are sometimes unavoidable and even in the face of extreme caution; a plane accident can still go ahead and happen. For instance, in this particular case, the plane was not only well maintained but was also well equipped. The investigation also found that the crew was also properly certificated and qualified but in spite of all these, the accident went ahead and happened.
The findings also showed how pilots are often made to make split second decisions when it comes to planes and how some mechanical failures can take place simultaneously and not be identified on time (Love, 1995). For instance, it was found that the right engine’s loss of power occurred the first officer was still performing the before landing check. In addition, turbine over temperature in the left engine caused loss of power (NTSB, 1982). Another primary finding was that the water dissolved in the fuel came out of solution because of low fuel temperature and this water subsequently froze in right fuel engine filter the turning off the fuel heat as the before landing measures (NTSB, 1982). This shows how some unconscious actions may trigger some other unprecedented events that contribute to the overall accident.
Causes of the Accident
The NTSB did not come up with solutions to some of the questions regarding the accident. For example, the investigators could not pinpoint what caused the left engine over temperature (NTSB, 1982). Ina addition, the airplane’s manual of operations was not detailed sufficiently enough to permit adequate determination of when it is safe to discontinue fuel heat when the operation temperatures are very low. However, the NTSB was able to forward a probable cause of the accident. According to the NTSB, the most probable cause of this accident was power loss in the right engine as a result of water freezing in the fuel filter after the turning off of the fuel heaters in accordance with a plane’s before-landing criteria (NTSB, 1982). In addition, the accident was attributable to power loss due to left engine turbine’s destruction from over temperature due excessive flow which happened for reasons that could not be determined (NTSB, 1982).
Recommendations
In regard to this accident several recommendations were given. The first was that a review of the operations manual of the Nihon YS-1, the training manual of Reeve Aleutian Airlines, and the YS-11 before landing checklist. The latter had to be particularly specific on when fuel deicing should be safely done as the current one is not clear on this issue (NTSB, 1982). The other recommendation was that an Operations Bulletin be issued requiring all the Principal Operations Inspectors to inform commercial operators and carriers of YS-11 planes that there is a need to mark or indicate the catches on emergency exits so that they can be located and distinguished from exit handles amongst other components (NTSB, 1982).
General Thoughts and Reflections
The Reeve Aleutian plane accident is an example of the risky nature of air transport. The upside in this case is that there were no major casualties. However, the accidents show that although some accidents may not be attributable to human error, there is need to furnish the plane crew with all the knowledge and skills as well as clear guidelines on how to operate a plane. There should not be an ambiguity on any aspect since a little ambiguity such as the one in this case can have massive ramifications. Therefore, it is of crucial importance that all airlines and transport boards review existing manuals on flight transport to ensure that any element of ambiguity that affect decision making in the course of flying is eliminated.
References
Cobb, R. W., & Primo, D. M. (2003). The plane truth airline crashes, the media, and transportation policy. Washington, D.C.: Brookings Institution Press.
Love, Michael C. (1995). Better Takeoffs and Landings. United States:
McGraw- Hill.
NTSB. February 16,1982 Accident Report. Reeve Aleutian Airways Nihon YS-l1A, N169RV King Salmon, Alaska
