Southwest Airlines Flight 1455
Encyclopedia
Southwest Airlines Flight 1455 (N668SW) was a scheduled passenger flight from
McCarran International Airport
(LAS), Las Vegas
, Nevada
to Burbank-Glendale-Pasadena Airport
(BUR), Burbank
, California
that overran the runway during landing on March 5, 2000. The aircraft came to rest on a city street adjacent to a gas station. The National Transportation Safety Board
found that the incident was due to the pilots attempting to land with excessive speed. They also blamed the air traffic controller
for placing them in a position when their only option was a go around. There were no fatalities either on the plane or on the ground. Two of the passengers were seriously injured, and there were many minor injuries. As a result of the incident, the airport installed an Engineered Materials Arrestor System
(EMAS) at the east end of the incident runway.
(LAS), Las Vegas
, Nevada
at 1650, more than 2 hours behind schedule due to inclement weather in the area. At 1804:02, when the aircraft was 19 nmi (35.2 km) north of the BUR
outer marker
, the SoCal approach
controller instructed the aircraft to maintain 230 knots (450.8 km/h) or greater until further notice. The controller later indicated this was to place the aircraft into the approach pattern between two other flights. The captain acknowledged the instructions.
At 1804:42 the first officer informed the captain that the target airspeed for landing would be 138 knots (270.5 km/h). This value was based on standard procedures in the Southwest Airlines Flight Operations Manual (FOM). At 1805:13 the captain told the first officer that the air traffic controller had instructed them to remain at 230 knots (450.8 km/h) or greater "for a while."
At 1805:54 the controller cleared Flight 1455 to descend to 5000 feet (1,524 m), and at 1807 cleared the flight to descend to 3000 feet (914.4 m). At 1808 the controller cleared flight 1455 for a visual approach to runway 8 with a restriction to remain at or above 3,000 ft (above mean sea level) until passing the Van Nuys VOR
beacon. This navigational aid is approximately 6 miles (10 km) from the runway. Radar data suggest that the flight began its descent from 3000 ft (914.4 m) about 4 mi (6 km) from the runway.
According to the Aeronautical Information Manual
Section 4-4-12f, this approach clearance automatically canceled any previous speed assignments. According to the final accident report, traffic conditions no longer warranted the speed assignment after the controller cleared the flight to descend to 3000 ft (914.4 m), but the controller did not verbally cancel the speed assignment.
Southwest Airlines procedures instruct the pilot not flying to make altitude call-outs at 1000, 500, 400, 300, 200, 100, 50, 30, and 10 feet (3 m). Additionally, call-outs are required if certain parameters are not met, in this case flight speed and sink rate. At 1809:32, one minute and thirteen seconds after approach clearance was given, and at 3000 feet (914.4 m) of altitude, the captain began to slow the aircraft by deploying the flaps
.
At 1810:24 the ground proximity warning system
(GPWS) began to sound a "sink rate" warning in the cockpit. The aircraft was descending at an angle of 7 degrees, when the angle of descent for most aircraft landing on that runway was 3 or 4 degrees. Both pilots ignored the warnings. At 1810:44 the warning system in the cockpit began to sound. The captain responded to these warnings with "that's all right."
The captain stated after the accident that he knew as the aircraft passed 500 feet (152.4 m) that he was not "in the slot," meaning the conditions had not been met for a safe landing, in this case because of an excessive airspeed. The captain further stated that he understood that if he was not "in the slot," procedures demanded a go-around
maneuver to abort the landing. He could not explain why he did not perform a go-around maneuver. The first officer likewise indicated after the accident that he was aware that they were not "in the slot," but said he believed the captain was taking corrective action.
The aircraft touched down on the wet runway at 44 knots (86.2 km/h) over the target airspeed. Furthermore, it touched down 2150 feet (655.3 m) from the runway threshold, 650 feet (198.1 m) beyond the 1000–1500 ft range established by the Southwest Airlines FOM. The captain deployed the thrust reversers and then he and the first officer applied manual brakes, but according to the NTSB findings, under those conditions even maximum braking would not have prevented the aircraft from overrunning the end of the runway.
The NTSB released a transcript of the cockpit voice recorder
, in which the flight's captain was quoted as saying, "Well, there goes my career," moments after the accident.
The NTSB concluded that the probable cause for the accident was excessive flight speed and the steep angle of the glidepath (7 degrees, as opposed to the 3 degrees normally used for both visual and instrument approaches), and the flight crew's failure to abort the approach when conditions were not met for a stable approach and landing. The action of the flight controller
was listed as a contributing factor in the accident: "Contributing to the accident was the controller's positioning of the airplane in such a manner as to leave no safe options for the flight crew other than a go-around maneuver."
Months later, the pilots were fired as a result of this incident. Southwest Airlines admitted the pilots' actions were negligent.
At the time, a Southwest spokesperson termed it "the worst accident" in the airline's history. Air safety experts and pilots suggested the accident was an example of a situation where "fast, steep, unstabilized approaches" are dangerous, and of how inadequate the safety margins around the Burbank runways are (as well as similar U.S. airports).
The gas station missed by the aircraft was later closed and demolished due to safety concerns. The lot is now a dedicated green space.
The inflated escape slide blocked both forward doors from being used to evacuate the aircraft, and prevented two flight attendants seated on the forward jumpseat from assisting the evacuation. There was no fire, but had there been a fire, this malfunctioning slide would have dramatically affected the survivability of the occupants. As a result of this occurrence, the NTSB issued a safety recommendation to replace the slide cover latch brackets on forward slide compartments of all older Boeing 737 models with the latch brackets installed on later models.
As with runway 4R/22L at the Little Rock National Airport
, site of the American Airlines Flight 1420
overrun accident, runway 8/26 in Burbank was exempt from the 1000 feet (304.8 m) runway safety area standard. The NTSB cited this accident in a recommendation for installing the Engineered Materials Arrestor System
(EMAS) at airports where it is not feasible to establish the 1000 feet (304.8 m) runway safety area
(RSA). A US$4,000,000 EMAS subsequently installed as a result of this accident at this airport, now the Bob Hope Airport
, stopped a private jet on Friday, October 13, 2006 with no injuries or aircraft damage.
McCarran International Airport
McCarran International Airport
McCarran International Airport is the principal commercial airport serving Las Vegas and Clark County, Nevada, United States. The airport is located five miles south of the central business district of Las Vegas, in the unincorporated area of Paradise in Clark County. It covers an area of and...
(LAS), Las Vegas
Las Vegas, Nevada
Las Vegas is the most populous city in the U.S. state of Nevada and is also the county seat of Clark County, Nevada. Las Vegas is an internationally renowned major resort city for gambling, shopping, and fine dining. The city bills itself as The Entertainment Capital of the World, and is famous...
, Nevada
Nevada
Nevada is a state in the western, mountain west, and southwestern regions of the United States. With an area of and a population of about 2.7 million, it is the 7th-largest and 35th-most populous state. Over two-thirds of Nevada's people live in the Las Vegas metropolitan area, which contains its...
to Burbank-Glendale-Pasadena Airport
Bob Hope Airport
Bob Hope Airport is a public airport located 3 miles northwest of the central business district of Burbank, a city in Los Angeles County, California, United States...
(BUR), Burbank
Burbank, California
Burbank is a city in Los Angeles County in Southern California, United States, north of downtown Los Angeles. The estimated population in 2010 was 103,340....
, California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
that overran the runway during landing on March 5, 2000. The aircraft came to rest on a city street adjacent to a gas station. The National Transportation Safety Board
National Transportation Safety Board
The National Transportation Safety Board is an independent U.S. government investigative agency responsible for civil transportation accident investigation. In this role, the NTSB investigates and reports on aviation accidents and incidents, certain types of highway crashes, ship and marine...
found that the incident was due to the pilots attempting to land with excessive speed. They also blamed the air traffic controller
Air traffic controller
Air traffic controllers are the people who expedite and maintain a safe and orderly flow of air traffic in the global air traffic control system. The position of the air traffic controller is one that requires highly specialized skills...
for placing them in a position when their only option was a go around. There were no fatalities either on the plane or on the ground. Two of the passengers were seriously injured, and there were many minor injuries. As a result of the incident, the airport installed an Engineered Materials Arrestor System
Engineered Materials Arrestor System
An engineered materials arrestor system or engineered materials arresting system is a bed of engineered materials built at the end of a runway. Engineered materials are defined in FAA Advisory Circular No 150/5220-22A as "high energy absorbing materials of selected strength, which will reliably...
(EMAS) at the east end of the incident runway.
Flight details
Flight 1455 departed McCarran International AirportMcCarran International Airport
McCarran International Airport is the principal commercial airport serving Las Vegas and Clark County, Nevada, United States. The airport is located five miles south of the central business district of Las Vegas, in the unincorporated area of Paradise in Clark County. It covers an area of and...
(LAS), Las Vegas
Las Vegas, Nevada
Las Vegas is the most populous city in the U.S. state of Nevada and is also the county seat of Clark County, Nevada. Las Vegas is an internationally renowned major resort city for gambling, shopping, and fine dining. The city bills itself as The Entertainment Capital of the World, and is famous...
, Nevada
Nevada
Nevada is a state in the western, mountain west, and southwestern regions of the United States. With an area of and a population of about 2.7 million, it is the 7th-largest and 35th-most populous state. Over two-thirds of Nevada's people live in the Las Vegas metropolitan area, which contains its...
at 1650, more than 2 hours behind schedule due to inclement weather in the area. At 1804:02, when the aircraft was 19 nmi (35.2 km) north of the BUR
Bob Hope Airport
Bob Hope Airport is a public airport located 3 miles northwest of the central business district of Burbank, a city in Los Angeles County, California, United States...
outer marker
Marker beacon
A marker beacon is a particular type of VHF radio beacon used in aviation, usually in conjunction with an instrument landing system , to give pilots a means to determine position along an established route to a destination such as a runway...
, the SoCal approach
Terminal Control Center
A terminal radar approach control is an air traffic control facility usually located within the vicinity of a large airport. Typically, the TRACON controls aircraft within a 20-50 nautical mile radius of the major airport and a number of "satellite airports" between surface and up to between and...
controller instructed the aircraft to maintain 230 knots (450.8 km/h) or greater until further notice. The controller later indicated this was to place the aircraft into the approach pattern between two other flights. The captain acknowledged the instructions.
At 1804:42 the first officer informed the captain that the target airspeed for landing would be 138 knots (270.5 km/h). This value was based on standard procedures in the Southwest Airlines Flight Operations Manual (FOM). At 1805:13 the captain told the first officer that the air traffic controller had instructed them to remain at 230 knots (450.8 km/h) or greater "for a while."
At 1805:54 the controller cleared Flight 1455 to descend to 5000 feet (1,524 m), and at 1807 cleared the flight to descend to 3000 feet (914.4 m). At 1808 the controller cleared flight 1455 for a visual approach to runway 8 with a restriction to remain at or above 3,000 ft (above mean sea level) until passing the Van Nuys VOR
VHF omnidirectional range
VOR, short for VHF omnidirectional radio range, is a type of radio navigation system for aircraft. A VOR ground station broadcasts a VHF radio composite signal including the station's identifier, voice , and navigation signal. The identifier is typically a two- or three-letter string in Morse code...
beacon. This navigational aid is approximately 6 miles (10 km) from the runway. Radar data suggest that the flight began its descent from 3000 ft (914.4 m) about 4 mi (6 km) from the runway.
According to the Aeronautical Information Manual
Aeronautical Information Manual
In United States aviation, the Aeronautical Information Manual is the Federal Aviation Administration's official guide to basic flight information and ATC procedures....
Section 4-4-12f, this approach clearance automatically canceled any previous speed assignments. According to the final accident report, traffic conditions no longer warranted the speed assignment after the controller cleared the flight to descend to 3000 ft (914.4 m), but the controller did not verbally cancel the speed assignment.
Southwest Airlines procedures instruct the pilot not flying to make altitude call-outs at 1000, 500, 400, 300, 200, 100, 50, 30, and 10 feet (3 m). Additionally, call-outs are required if certain parameters are not met, in this case flight speed and sink rate. At 1809:32, one minute and thirteen seconds after approach clearance was given, and at 3000 feet (914.4 m) of altitude, the captain began to slow the aircraft by deploying the flaps
Flap (aircraft)
Flaps are normally hinged surfaces mounted on the trailing edges of the wings of a fixed-wing aircraft to reduce the speed an aircraft can be safely flown at and to increase the angle of descent for landing without increasing air speed. They shorten takeoff and landing distances as well as...
.
At 1810:24 the ground proximity warning system
Ground Proximity Warning System
A ground proximity warning system is a system designed to alert pilots if their aircraft is in immediate danger of flying into the ground or an obstacle. The United States Federal Aviation Administration defines GPWS as a type of terrain awareness warning system...
(GPWS) began to sound a "sink rate" warning in the cockpit. The aircraft was descending at an angle of 7 degrees, when the angle of descent for most aircraft landing on that runway was 3 or 4 degrees. Both pilots ignored the warnings. At 1810:44 the warning system in the cockpit began to sound. The captain responded to these warnings with "that's all right."
The captain stated after the accident that he knew as the aircraft passed 500 feet (152.4 m) that he was not "in the slot," meaning the conditions had not been met for a safe landing, in this case because of an excessive airspeed. The captain further stated that he understood that if he was not "in the slot," procedures demanded a go-around
Go-around
A go-around is an aborted landing of an aircraft that is on final approach.- Origin of the term :The term arises from the traditional use of traffic patterns at airfields. A landing aircraft will first join the circuit pattern and prepare for landing in an orderly fashion...
maneuver to abort the landing. He could not explain why he did not perform a go-around maneuver. The first officer likewise indicated after the accident that he was aware that they were not "in the slot," but said he believed the captain was taking corrective action.
The aircraft touched down on the wet runway at 44 knots (86.2 km/h) over the target airspeed. Furthermore, it touched down 2150 feet (655.3 m) from the runway threshold, 650 feet (198.1 m) beyond the 1000–1500 ft range established by the Southwest Airlines FOM. The captain deployed the thrust reversers and then he and the first officer applied manual brakes, but according to the NTSB findings, under those conditions even maximum braking would not have prevented the aircraft from overrunning the end of the runway.
The NTSB released a transcript of the cockpit voice recorder
Cockpit voice recorder
A cockpit voice recorder , often referred to as a "black box", is a flight recorder used to record the audio environment in the flight deck of an aircraft for the purpose of investigation of accidents and incidents...
, in which the flight's captain was quoted as saying, "Well, there goes my career," moments after the accident.
NTSB accident summary
The SWA Boeing 737-3T5, overran the end of Runway 8 while landing at Burbank-Glendale-Pasadena Airport. "The airplane touched down at approximately 182 knots, and about 20 seconds later, at approximately 32 knots, collided with a metal blast fence and an airport perimeter wall." It finally came to rest on Hollywood Way, a four-lane city street, near a Chevron gas station.The NTSB concluded that the probable cause for the accident was excessive flight speed and the steep angle of the glidepath (7 degrees, as opposed to the 3 degrees normally used for both visual and instrument approaches), and the flight crew's failure to abort the approach when conditions were not met for a stable approach and landing. The action of the flight controller
Air traffic controller
Air traffic controllers are the people who expedite and maintain a safe and orderly flow of air traffic in the global air traffic control system. The position of the air traffic controller is one that requires highly specialized skills...
was listed as a contributing factor in the accident: "Contributing to the accident was the controller's positioning of the airplane in such a manner as to leave no safe options for the flight crew other than a go-around maneuver."
Months later, the pilots were fired as a result of this incident. Southwest Airlines admitted the pilots' actions were negligent.
At the time, a Southwest spokesperson termed it "the worst accident" in the airline's history. Air safety experts and pilots suggested the accident was an example of a situation where "fast, steep, unstabilized approaches" are dangerous, and of how inadequate the safety margins around the Burbank runways are (as well as similar U.S. airports).
The gas station missed by the aircraft was later closed and demolished due to safety concerns. The lot is now a dedicated green space.
Injuries
Of the 142 persons on board, 2 passengers sustained serious injuries; 41 passengers and the captain sustained minor injuries; and 94 passengers, 3 flight attendants, and the first officer sustained no injuries. The airplane sustained extensive exterior damage and some internal damage to the passenger cabin. During the accident sequence, the forward service door (1R) escape slide inflated inside the airplane; the nose gear collapsed; and the forward dual flight attendant jumpseat, which was occupied by two flight attendants, partially collapsed.The inflated escape slide blocked both forward doors from being used to evacuate the aircraft, and prevented two flight attendants seated on the forward jumpseat from assisting the evacuation. There was no fire, but had there been a fire, this malfunctioning slide would have dramatically affected the survivability of the occupants. As a result of this occurrence, the NTSB issued a safety recommendation to replace the slide cover latch brackets on forward slide compartments of all older Boeing 737 models with the latch brackets installed on later models.
As with runway 4R/22L at the Little Rock National Airport
Little Rock National Airport
Little Rock National Airport , officially Little Rock National Airport/Adams Field, is located 2 miles east of the central business district of Little Rock, a city in Pulaski County, Arkansas, United States. It is Arkansas' largest commercial service airport, serving more than 2.1 million...
, site of the American Airlines Flight 1420
American Airlines Flight 1420
American Airlines Flight 1420 was a flight from Dallas-Fort Worth International Airport to Little Rock National Airport in USA. On June 1, 1999, a McDonnell Douglas MD-82 overran the runway upon landing in Little Rock and crashed...
overrun accident, runway 8/26 in Burbank was exempt from the 1000 feet (304.8 m) runway safety area standard. The NTSB cited this accident in a recommendation for installing the Engineered Materials Arrestor System
Engineered Materials Arrestor System
An engineered materials arrestor system or engineered materials arresting system is a bed of engineered materials built at the end of a runway. Engineered materials are defined in FAA Advisory Circular No 150/5220-22A as "high energy absorbing materials of selected strength, which will reliably...
(EMAS) at airports where it is not feasible to establish the 1000 feet (304.8 m) runway safety area
Runway safety area
A runway safety area or runway end safety area is defined as "the surface surrounding the runway prepared or suitable for reducing the risk of damage to airplanes in the event of an undershoot, overshoot, or excursion from the runway."Past standards called for the RSA to extend only 60m from the...
(RSA). A US$4,000,000 EMAS subsequently installed as a result of this accident at this airport, now the Bob Hope Airport
Bob Hope Airport
Bob Hope Airport is a public airport located 3 miles northwest of the central business district of Burbank, a city in Los Angeles County, California, United States...
, stopped a private jet on Friday, October 13, 2006 with no injuries or aircraft damage.
Dispute with city of Burbank
Burbank city officials demanded that Southwest Airlines pay their $40,000 bill for services, including overtime for police officers and firefighters, related to the March 5 accident. Southwest refused to pay stating that the airline is entitled to emergency services since the airline pays taxes to the city.See also
- Southwest Airlines Flight 1248Southwest Airlines Flight 1248Southwest Airlines Flight 1248 was a scheduled passenger flight from Baltimore-Washington International Airport, in Baltimore, Maryland, to Chicago Midway International Airport, in Chicago, Illinois, to Salt Lake City International Airport in Salt Lake City, Utah, and then to McCarran...
— Chicago Midway International Airport overrun accident on December 8, 2005. - Runway safety areaRunway safety areaA runway safety area or runway end safety area is defined as "the surface surrounding the runway prepared or suitable for reducing the risk of damage to airplanes in the event of an undershoot, overshoot, or excursion from the runway."Past standards called for the RSA to extend only 60m from the...
- Engineered materials arrestor systemEngineered Materials Arrestor SystemAn engineered materials arrestor system or engineered materials arresting system is a bed of engineered materials built at the end of a runway. Engineered materials are defined in FAA Advisory Circular No 150/5220-22A as "high energy absorbing materials of selected strength, which will reliably...
- Ground effect in aircraft
External links
- Eyewitness Report: Southwest Airlines 1455 with photos