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Safety Recommendation Details

Safety Recommendation A-18-005
Details
Synopsis: On October 28, 2016, about 1432 central daylight time, American Airlines flight 383, a Boeing 767-323, N345AN, had started its takeoff ground roll at Chicago O’Hare International Airport, Chicago, Illinois, when an uncontained engine failure and subsequent fire occurred. The flight crew aborted the takeoff and stopped the airplane on the runway, and the flight attendants initiated an emergency evacuation. Of the 2 flight crewmembers, 7 flight attendants, and 161 passengers on board, 1 passenger received a serious injury, and 1 flight attendant and 19 passengers received minor injuries during the evacuation. The airplane was substantially damaged from the fire. The airplane was operating under the provisions of 14 Code of Federal Regulations Part 121. Visual meteorological conditions prevailed at the time of the accident.
Recommendation: TO THE FEDERAL AVIATION ADMINISTRATION: Revise Advisory Circular (AC) 20-128A, “Design Considerations for Minimizing Hazards Caused by Uncontained Turbine Engine and Auxiliary Power Unit Rotor Failure,” based on an analysis of uncontained engine failure data since the time that the AC was issued, to minimize hazards to an airplane and its occupants if an uncontained engine failure were to occur. The revised AC should include modifications to the accepted design precautions for fuel tanks given the fires that have occurred after uncontained engine failures.
Original recommendation transmittal letter: PDF
Overall Status: Open - Acceptable Response
Mode: Aviation
Location: Chicago, IL, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA17FA021
Accident Reports: ​Uncontained Engine Failure and Subsequent Fire American Airlines Flight 383 Boeing 767-323, N345AN
Report #: AAR-18-01
Accident Date: 10/28/2016
Issue Date: 2/6/2018
Date Closed:
Addressee(s) and Addressee Status: FAA (Open - Acceptable Response)
Keyword(s):

Safety Recommendation History
From: NTSB
To: FAA
Date: 6/6/2018
Response: We note that, as discussed in our report about the American Airlines flight 383 accident, you are actively working on a revision of AC 20-128A, including incorporating a new debris model. Our report pointed out that in the 20 years since AC 20-128A was issued, we have investigated, participated in the investigation of, or become aware of at least 40 uncontained rotor burst events, and that the AIA has a database of rotor burst events involving high-bypass turbofan engines that includes events between 1997 (the time that the AC was last updated) and 2006. We believe all of these events provide valuable information about the revisions needed to the AC. Pending completion and issuance of the revised AC, Safety Recommendation A-18-5 is classified OPEN—ACCEPTABLE RESPONSE.

From: FAA
To: NTSB
Date: 4/26/2018
Response: -From Daniel K. Elwell, Acting Administrator: The FAA agrees with the Board' s concerns regarding the revision of AC 20-l 28A. As noted by the Board in its Aircraft Accident Report (NTSB/ AAR-18/01), the FAA is working on a revision to this AC. We are evaluating a new debris model for inclusion into the AC as an acceptable means of compliance. We are also updating the uncontained engine debris model defined in DOT/FAN AR-99/11 , '·Large Engine Uncontained Debris Analysis," based on information from past incidents. If appropriate, we will incorporate further changes into the AC to address this recommendation.

From: NTSB
To: FAA
Date: 2/6/2018
Response: On January 30, 2018, the NTSB adopted its report Uncontained Engine Failure and Subsequent Fire, American Airlines Flight 383, Boeing 767-323, N345AN, Chicago, Illinois, October 28, 2016, AAR1801. The details of this accident investigation and the resulting safety recommendations may be found in the attached report, which can also be accessed at http://www.ntsb.gov. Among the Safety Recommendations seven are issued to Federal Aviation Administration, which can be found on page 77 of the report. The NTSB is vitally interested in these recommendations because they are designed to prevent accidents and save lives. We would appreciate a response within 90 days, detailing the actions you have taken or intend to take to implement these recommendations. When replying, please refer to the safety recommendations by number.