Accident Details
Probable Cause and Findings
the captain's failure to maintain airspeed which resulted in an inadvertent stall/mush, and hard landing. Factors were the failure of both pilots to follow company CRM and flight manual procedures, and the captains improper approach briefing.
Aircraft Information
Registered Owner (Historical)
Analysis
HISTORY OF FLIGHT
On October 16, 2001, at 2214 eastern daylight time, an Embraer 145LR, N825MJ, operated by Mesa Airlines as US Airways Express flight 5733, was substantially damaged while landing at Roanoke Regional/Woodrum Field Airport (ROA), Roanoke, Virginia. The 2 certificated pilots, 1 flight attendant, and 30 passengers were not injured. Night visual meteorological conditions prevailed for the scheduled passenger flight. The flight was conducted on an instrument flight rules (IFR) flight plan under 14 CFR 121.
According to the pilots, the flight originated at Pittsburgh International Airport (PIT), Pittsburgh, Pennsylvania. No problems were reported with the en route or approach phases, and the flight was radar vectored for a visual approach to runway 33.
According to the captain:
"While on short final approach to landing at Roanoke "(...[reported winds] of 280 at 25 [knots] gust to 40 [knots]), there was an abrupt drop in indicated airspeed. Upon simultaneous notification of the stick shaker, I applied power accordingly and landed without apparent incident.
As the landing was more firm than usual, the first officer and I mutually agreed to visually inspect the aircraft upon arrival at the gate. The visual post flight inspection noted nothing unusual, nor any damage to the aircraft.
As the occurrence noted no damage to aircraft, passengers, or crew, no further action was taken."
According to the first officer:
"We arrived into the Roanoke area approximately 9:45 PM, and began a visual approach to runway 33. The captain briefed that a go-around was not an option due to hills on the other side of the runway. Takeoffs were not authorized on 33 during night and IFR operations. Although we had a quartering crosswind at 15 mph gusting to 21 mph, I do not think there was any wind shear. The approach was normal until approximately 300 feet AGL, when I called that we were one dot high on the PAPI and Ref +5. The captain appeared to pull the thrust levers to idle and placed both hands back on the yoke. At 200-300 feet I called Ref -5, Ref -10, then the stick shaker activated for one second and we began to sink rapidly. I saw the airspeed reach 110 KIAS, the captain pushed the thrust levers up, but the engines did not spool up in time, and the stall stick shaker went off [again]. At this point, approximately 100 feet AGL, the aircraft seemed to stall and within seconds hit the end of the runway. The main gear hit the runway very hard, then the nose gear followed quickly. I do not recall the pitch attitude. The events happened very quickly, and by the time I thought about going around it was too late.
Immediately upon deplaning, I inspected the entire aircraft with a flashlight, paying particular attention to the landing gear. I did not notice any damage to the aircraft, and if I had, I would have reported it immediately. The captain verified that there was no damage and said that it was not necessary to have maintenance inspect the aircraft. I felt uneasy but complied."
The flight attendant stated:
"I strapped in, heard all the necessary commands from the computer in the cockpit: '300', '200', '100'...then right after I heard the computer say the 100...I heard this alarming shaking noise and rapid beeping alarm...The aircraft immediately slammed to the ground."
According to a check captain for Mesa Airlines:
"At approximately midnight on October 16, 2001, I received a phone call from Captain... telling me she thought I was taking her plane the next morning...she told me about her arrival into ROA in strong gusty winds. She described it as a rough ride with a possible stick shaker and a hard landing at the end. I asked her if there was any damage to the aircraft. She said the FO and her had inspected the landing gear and tires during post flight and found no damage. I told her that if she was in doubt, she needed to report it as a hard landing...Upon arrival at the airport the next morning; I discovered that the Charlotte crew had the [accident] airplane and not myself. Wanting to pass on the information to...[that captain], I summarized the story from the night before...."
The check captain further reported that after relaying the information to the flight crew, he departed the airplane. He did not observe the flight crew deplane and conduct a visual check of the airplane.
The accident airplane was subsequently flown to Charlotte, North Carolina, where a crew swap took place. The departing flight crew did not report any damage on the airplane, and the damage was finally discovered by the accepting flight crew at Charlotte during a pre-flight inspection.
PERSONNEL INFORMATION
The accident occurred on the last flight, of the third day on the flight sequence, following 2 days off for both pilots. The flight sequence was scheduled to continue the following day.
Captain
The captain held an airline transport pilot certificate with a rating for multi-engine land airplanes, and a type rating for the Embraer 145. She also held a commercial pilot certificate with a rating for single engine land airplanes. In addition, she held a flight instructor certificate for single and multi-engine airplanes and instrument airplane. She was last issued a first class Federal Aviation Administration (FAA), airman medical certificate with no limitations on October 2, 2001.
She listed her total flight experience as 2,548 hours, with 1,410 hours in multi-engine airplanes and 213 hours in the EMB-145. Her total pilot-in-command experience was 1,499 hours, which included 174 hours as pilot in command in the EMB-145.
She reported that after college, she had accumulated her flight hours by working as a flight instructor. She was hired by Air Mid-west, a subsidiary of Mesa Airlines on January 24, 2000. Her initial assignment was as a first officer on the Beech 1900. She reported that she had accumulated about 600 hours in the Beech 1900 as a first officer prior to bidding and being accepted for a captain upgrade in the EMB-145 with Mesa Airlines.
First Officer
The first officer held a commercial pilot certificate with ratings for single and multi-engine land airplanes, and instrument airplanes. She was last issued a first class FAA airman medical certificate with no limitations on July 20, 2001.
She listed her total flight experience as 1,919 hours, with 1,531 hours in multi-engine airplanes and 758 hours in the EMB-145. Her total pilot-in-command experience was 356 hours.
The first officer reported that after college, she was employed by Boeing as an analyst, and then was hired by Mesa Airlines. When hired by Mesa Airlines, her total flight experience was about 400 hours. She was initially employed as a Beech 1900 first officer. At the time of the accident, she had been flying the EMB-145 for about 1 year.
During interviews, both pilots reported that they had not received a jet indoctrination course or any specialized training on swept wing aerodynamics.
AIRCRAFT INFORMATION
There were no entries in the airplane's log sheets regarding a hard landing at either Roanoke or Charlotte. However, the accepting flight crew at Charlotte, which discovered the damage on the airplane, entered a maintenance discrepancy of a tail strike due to overrotation.
AIRPORT INFORMATION
Runway 33 was 5,800 feet long, 150 feet wide, and had a grooved, asphalt surface. The landing threshold was not displaced, and the runway was painted with precision instrument approach markings.
A 4-light PAPI (precision approach path indicator) was located on the left side of the runway, and the glide slope was set for 3 degrees. A medium approach lighting system was available, and was 1,400 feet long. The useable landing runway beyond the ILS glideslope touchdown point on the runway was 4,849 feet. The touchdown elevation of the approach end of the runway was 1,143 feet. The elevation at the departure end of the runway was 1,166 feet.
The terrain beyond the departure end of runway 33 increased, to 1,500 feet at 1.4 nautical miles (NM); 2,000 feet at 2.6 nm; and 3,100 feet at 4.6 nm.
In addition, Roanoke was designated a special use airport by the FAA. The reason for the designation was mountainous terrain. According to the approach chart issued to Mesa Airlines pilots, for runway 33, "...Takeoffs from Runway 33 are not authorized at night or in IFR weather conditions due to high terrain...Rejected landing, missed approach, and engine inoperative procedures may require special attention due to high climb gradients required for obstacle clearance. Check to see if your company provides special procedures for this runway...."
The approach chart also contained a picture aligned with the runway, and the mountains were visible in the background.
The following comments was contained on the flight release signed by the captain, "...I also certify that I am familiar and current in accordance with FAR 121.445 [Special Use Airports]...."
In interviews, both the captain and first officer were asked the following question: Assume a flight operating under 14 CFR Part 121. The planned runway for landing was not authorized for takeoffs at night or in IMC conditions. Under these conditions, could a pilot execute a go-around at any time prior to touchdown, or a rejected landing once the airplane had touched down on the runway?
The captain responded that the go-around could not be performed once the airplane had passed below minimums for the approach, and once the airplane had touched down, a rejected landing could not be performed.
The first officer responded that there were no restrictions in performing a go-around or rejected landing.
A check with Mesa Airlines revealed no restrictions on the execution of a go-around or rejected landing on runway 33 at Roanoke.
METEOROLOGICAL INFORMATION
The 2054 and 2154 weather observations at Roanoke reported winds from 300 degrees at 17 knots with gust...
Data Source
Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# NYC02LA013