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-   -   Ual 4933 (https://www.airlinepilotforums.com/safety/132031-ual-4933-a.html)

Excargodog 08-18-2024 01:35 PM

https://www.flightradar24.com/blog/wp-content/uploads/2022/07/NTSB_FINAL_Presque_Isle.pdf


https://data.ntsb.gov/Docket?ProjectID=99050

https://data.ntsb.gov/Docket/Document/docBLOB?ID=13700231&FileExtension=pdf&FileName=DCA 19FA089%20Operational%20Factors%20%20Factual%20Rep ort-Rel.pdf


https://data.ntsb.gov/Docket/Document/docBLOB?ID=13692224&FileExtension=pdf&FileName=HP% 20PQI%20Factual%20Final_Post%20Tech%20Review-Rel.pdf

Pilot4000 08-18-2024 02:54 PM

The captain is now at Omni.

John Carr 08-18-2024 03:13 PM


Originally Posted by Pilot4000 (Post 3829979)
The captain is now at Omni.

I forget, was VX the other place they (pronouns) were at?

1wife2airlines 08-18-2024 05:25 PM


Originally Posted by Peoplemvr (Post 3829843)
Or was it "pull the head, push the tail"?

i think that was after you landed from the ADF and got to the hotel.

rickair7777 08-18-2024 06:35 PM


Originally Posted by John Carr (Post 3829985)
I forget, was VX the other place they (pronouns) were at?

I think VX sunsetted just before that nonsenser caught on.

John Carr 08-18-2024 09:44 PM


Originally Posted by rickair7777 (Post 3830020)
I think VX sunsetted just before that nonsenser caught on.

Yeah, Vilaska.

Elevation 08-19-2024 02:07 AM


Originally Posted by rickair7777 (Post 3829555)
Executive summary....

Snow accumlated around the LOC antenna, casusing the LOC beam to be off center by 200'

Several crew (including the accident FO on a previous flight) experienced this in the preceeding five days but did not report it.

The arrival prior to the accident reported it, but FAA policy was that action would only be taken (such as placing the LOC OOS) if two or more aircraft reported problems (in case the first aircraft had bad avionics). Policy did say to switch to standby equipment, but there was no local tower to do that.

Crew kept descending below minimums with runway environment not identified, until impact.

FAA did change policy to require snow clearance around LOC antennas (previously only required around GS antennas).

The report had some interesting details on the boldface part. This is a pretty interesting human factors read.

A lot of the errors are from reasonable assumptions:
Many of us know that snow piles affect ILS signals. A good number know this affects localizer as well as glideslope signals. So it's understandable (not acceptable) that this wasn't reported by other crews. Many years ago I was based in Presque Isle. The town was a shell of its former self, and it hasn't grown since then. So is a small town airport going to deviate from procedures that have been working for Colgan, Commutair, Wiggins, AirNow, etc. for years? A brand, spaking new FO expects a captain to have some judgement and experience. The captain directs the FO to stay inside on the second approach, and the FO does. This also is understandable, but not acceptable. That captain expects the localizer to work as expected, gets needles and identification. She never considers that the signal may be off. This is also understandable.

I'm always making noise about something. Conflicts of interest, training curricula, GPS spoofing, etc. I'm fully aware of the political costs of speaking out. Others use that awareness to navigate promotion pathways (I've done so in the past. No judgement.). So there's real-world pressure on these crews to shut up and keep up. There was real-world pressure for commutair to get this particular captain through. A probationary FO feels real world pressure not to upset whoever's in the left seat.

The swiss cheese aligned in some pretty relatable ways here. Many of our own operations can and have experienced similar things. Not being a Commutair guy I can't speak to what goes on or went on there. I would wonder what pressures crews felt not to report things.

rickair7777 08-19-2024 05:48 AM


Originally Posted by Elevation (Post 3830065)
I'm always making noise about something. Conflicts of interest, training curricula, GPS spoofing, etc. I'm fully aware of the political costs of speaking out. Others use that awareness to navigate promotion pathways (I've done so in the past. No judgement.). So there's real-world pressure on these crews to shut up and keep up. There was real-world pressure for commutair to get this particular captain through. A probationary FO feels real world pressure not to upset whoever's in the left seat.

I routinely send emails to fleet captain office, training manager etc. pointing out technical issues I observe online. They've gotten used to me and will fix things.

Emailing CP's is usually a waste of time, unless it's an actual CP issue like no coffee cups for the machine in the crew lounge when you show for a redeye. CP's are generally too busy with crew drama.

If you're "that guy" on the company forums, always complaining to CP and union, then they'll tend to tune you out eventually, even when you have something worth saying.

Elevation 08-20-2024 04:34 AM


Originally Posted by rickair7777 (Post 3830106)
I routinely send emails to fleet captain office, training manager etc. pointing out technical issues I observe online. They've gotten used to me and will fix things.

Emailing CP's is usually a waste of time, unless it's an actual CP issue like no coffee cups for the machine in the crew lounge when you show for a redeye. CP's are generally too busy with crew drama.

If you're "that guy" on the company forums, always complaining to CP and union, then they'll tend to tune you out eventually, even when you have something worth saying.

I actually get decent responses from our folks. When I talk about the cost of opening my mouth I'm talking about the political costs. There's a cost to speaking out, and you have to be willing to bear that cost whether you're forced to pay it or not. I was really driving at the idea of being comfortable getting in trouble for speaking out; not my personal situation.

In the context of this event you have to wonder if these pilots thought their voices wouldn't be heard, would get them smacked, etc. There's a lot that people knew and didn't talk about. Seems there was a lot where people didn't want to offend a captain, etc.

JohnBurke 08-20-2024 08:08 AM

https://www.airlinepilotforums.com/s...se-report.html

The event was not a career-ender. It involved multiple external factors, including multiple reports of localizer mis-alignment, as well as pilot fatigue, more than one approach, and a descent to the surface without the runway environment in sight (despite the captain call of "lights," when clearly not aligned with the runway).

Despite multiple conspiracy insinuations here (read the linked thread), it was nothing of the sort, and was pretty much what it appeared to be. Nothing new.


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