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General Aviation Safety
ON JANUARY 23, 1982, WORLD AIRWAYS, INC., FLIGHT 30H, A MCDONNELL DOUGLAS DC-10-30, WAS A REGULARLY SCHEDULED PASSENGER FLIGHT FROM OAKLAND, CALIFORNIA, TO BOSTON, MASSACHUSETTS, WITH AN EN ROUTE STOP AT NEWARK, NEW JERSEY. FOLLOWING A NONPRECISION INSTRUMENT APPROACH TO RUNWAY 15R AT BOSTON-LOGAN INTERNATIONAL AIRPORT, THE AIRPLANE TOUCHED DOWN ABOUT 2,500 FEET BEYOND THE DISPLACED THRESHOLD OF THE RUNWAY, LEAVING 6,691 FEET REMAINING ON WHICH TO STOP. ABOUT 1936:40, THE AIRPLANE VEERED TO AVOID THE APPROACH LIGHT PIER AT THE DEPARTURE END OF THE RUNWAY AND SLID INTO THE SHALLOW WATER OF BOSTON HARBOR. THE NOSE SECTION SEPARATED FROM THE FORWARD FUSELAGE AFTER THE AIRPLANE DROPPED ONTO THE SHORE EMBANKMENT. OF THE 212 PERSONS ON BOARD, 2 ARE MISSING AND PRESUMED DEAD. THE OTHERS EVACUATED THE AIRPLANE SAFELY, BUT WITH SOME INJURIES. THE REPORTED WEATHER WAS A MEASURED 800-FOOT OVERCAST, 2 1/2 MILE VISIBILITY, LIGHT RAIN AND FOG, TEMPERATURE 35 DEGREES, AND WIND 165 DEGREES AT 3 KNS. THE WET RUNWAY WAS COVERED WITH HARD-PACKED SNOW AND A COATING OF RAIN AND/OR GLAZED ICE.
THE NTSB RECOMMENDS THAT THE FEDERAL AVIATION ADMINISTRATION: STRESS IN INITIAL AND RECURRENT AIR TRAFFIC CONTROLLER TRAINING PROGRAMS, THE IMPORTANCE OF TRANSMITTING ALL KNOWN CONTAMINATED RUNWAY CONDITION INFORMATION TO DEPARTING AND ARRIVING FLIGHTS, THAT A "FAIR" OR "POOR" BRAKING REPORT FROM A PILOT MAY INDICATE CONDITIONS WHICH ARE HAZARDOUS FOR A HEAVIER AIRPLANE, AND THAT DEPARTING AND ARRIVING PILOTS SHOULD BE INFORMED WHEN NO RECENT LANDING BY A COMPARABLE AIRPLANE HAS BEEN MADE. (Supersedes Safety Recommendations A-74-119 through -121 and A-76-136 and -137)
Original recommendation transmittal letter:
Closed - Acceptable Action
BOSTON, MA, United States
World Airways, Inc., Flight 30H, McDonnell Douglas DC-10-30CF, N113WA
Addressee(s) and Addressee Status:
FAA (Closed - Acceptable Action)
Air Traffic Control,Runway Safety,Training and Education
Safety Recommendation History
The Safety Board is pleased to learn that the FAA has incorporated the recent changes to controller handbooks related to the issues of A-82-158 into initial traffic controller training at the FAA Academy. We understand also that the handbook changes are being transmitted to all air traffic field facilities with briefing papers to explain and emphasize required actions when conditions are conducive to deteriorating runway conditions. The Safety Board accepts these actions as providing adequately for initial and recurrent training of air traffic controllers as recommended and has classified Safety Recommendation A-82-158 as "Closed--Acceptable Action." Your continued efforts to improve transportation safety are appreciated.
FAA LETTER: THE CHANGES TO FAA HANDBOOKS AS RECOMMENDED BY THE BOARD IN SAFETY RECOMMENDATIONS A-82-156, -157, -159, AND -160, WHICH ARE CLASSIFIED AS "CLOSED," HAVE BEEN INCORPORATED INTO THE INITIAL TRAINING PROGRAM AT THE FAA ACADEMY. IN ADDITION, HANDBOOK CHANGES ARE TRANSMITTED TO ALL AIR TRAFFIC FIELD FACILITIES WITH BRIEFING PAPERS TO EXPLAIN AND EMPHASIZE REQUIRED ACTIONS WHEN CONDITIONS ARE CONDUCIVE TO DETERIORATING RUNWAY CONDITION.
We acknowledge the FAA's actions to review the air traffic controller training Data Source: NTSB Recommendations to FAA and FAA Responses materials used at the FAA Academy as an appropriate step in satisfying the intent of Safety Recommendation A-82-158. However, you have not indicated that FAA intends to pursue this review beyond the action described in your November 7 letter, and we do not consider that the Air Traffic Control Handbook amendments constitute acceptable pecific actions to increase emphasis on this issue during controller training. Therefore, we have classified the recommendation as "Open--Unacceptable Action." We believe more specific action is necessary to emphasize this subject in the controller training syllabus.
FAA LETTER: ENCLOSED FOR THE BOARD'S INFORMATION AND FILE ARE THE FOLLOWING AMENDMENTS TO THE FAA'S HANDBOOK 7110.65C, AIR TRAFFIC CONTROL: PARAGRAPH 49, PILOT REPORT (PIREP) INFORMATION, REQUIRES THE SOLICITATION OF CLOUD BASES/TOPS AND BRAKING ACTION PIREPS UNDER CERTAIN CONDITIONS; CHAPTER 5, SECTION 3, AIRPORT CONDITIONS, PARAGRAPH 942, BRAKING ACTION, ALLOWS CONTROLLERS TO FURNISH RUNWAY FRICTION MEASUREMENT READINGS/VALUES OBTAINED FROM SEVERAL TYPES OF FRICTION MEASURING DEVICES, AND INCORPORATES THE PROVISIONS OF THE OLD PARAGRAPH 943, RUNWAY SURFACE CONDITION/RUNWAY CONDITION READING; PARAGRAPH 980, DEPARTURE INFORMATION, AND PARAGRAPH 1010, LANDING INFORMATION, ADDS THE REQUIREMENT THAT CURRENT BRAKING ACTION BE ISSUED WHENEVER BRAKING ACTION ADVISORIES ARE IN EFFECT. IN ADDITION, THE FOLLOWING TWO AMENDMENTS HAVE BEEN MADE TO THE AIRMAN'S INFORMATION MANUAL: SECTION 3, AIRPORT OPERATIONS, PARAGRAPH 229, BRAKING ACTION ADVISORIES, AND THE PILOT/CONTROLLER GLOSSARY, BRAKING ACTION ADVISORIES.
FAA LETTER: THE AIR TRAFFIC SERVICE HAS REQUESTED, THROUGH THE OFFICE OF PERSONNEL AND TRAINING, THAT TRAINING MATERIALS DEVELOPED BY THE FAA ACADEMY CONCERNING BRAKING ACTION BE REVIEWED. THIS REVIEW WOULD BE TO ASSURE APPROPRIATE EMPHASIS IS BEING PLACED ON THE CURRENT PROCEDURES CONTAINED IN FAA HANDBOOK 7110.65C, CHAPTER 5, SECTION 3, AIRPORT CONDITIONS. PARTICULAR ATTENTION SHOULD BE PAID TO PARAGRAPH 942, BRAKING ACTION. IN ADDITION, FAA HANDBOOKS ARE CURRENTLY UNDERGOING A THOROUGH REVIEW TO DETERMINE WHICH PROCEDURES MAY BE AMENDED TO ENHANCE THE EFFECTIVE GATHERING AND TIMELY DISTRIBUTION OF RUNWAY BRAKING ACTION REPORTS. ANY CHANGES TO THESE PROCEDURES WILL BE INCORPORATED INTO THE TRAINING PROGRAM.
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