Embraer EMB-120COMAIR INC
West Palm Beach, FL, USA · 2001-03-19·N266CA
What happened
NTSB summary, verbatimOn March 19, 2001, about 1825 eastern standard time, an Empresa Brasileira de Aeronautica, S/A (Embraer) EMB-120, N266CA, operated by Comair Airlines, Inc., as flight 5054, encountered icing conditions while in cruise flight at 17,000 feet mean sea level (msl) and departed controlled flight, descending to an altitude of about 10,000 feet. The pilots recovered control of the airplane and diverted to West Palm Beach, Florida, where they landed without further incident. The 2 flight crewmembers, 1 flight attendant, and 25 passengers were uninjured, and the airplane sustained substantial damage to the elevators and the horizontal stabilizer. Flight 5054 was operating under 14 Code of Federal Regulations Part 121 as a scheduled international passenger flight from Nassau International Airport, Bahamas, to Orlando International Airport, Florida. The flight departed in visual meteorological conditions (VMC). In postaccident interviews, the captain stated that while in VMC, the airplane flew normally. Flight data recorder (FDR) data indicate that about 7 minutes before the upset occurred, the airplane was at about 17,000 feet msl, with the autopilot engaged and airspeed stabilized near 200 knots indicated airspeed (KIAS). These data indicate that beginning about 1818, the airspeed slowed to 185 KIAS over a 1?minute period as the autopilot began trimming airplane nose-up (ANU) to maintain altitude. The airspeed then decreased to about 137 KIAS over the next 3 minutes. The airplane continued to maintain a constant altitude as the autopilot trimmed the airplane from about 0 to about 7 degrees ANU. The first officer stated that immediately before the upset occurred, he switched the leading-edge deicing system inflation cycles switch from "light" to "heavy" and the propeller deicing system cycles switch from "norm" to "cold" because he saw "more ice accumulation than he had ever seen" on the wing and spinner. FDR data indicate that when torque indications for both engines were about 55 percent and the airspeed was about 141 KIAS, the autopilot was disengaged. The airplane then pitched down and rolled about 80 degrees to the left, then rolled back to near level. During the next 20 seconds, engine torque increased to about 98 percent on both engines, the airplane rolled about 110 degrees to the left, returned to level flight, rolled about 130 degrees to the right, returned to level flight, then rolled 360 degrees to the right before returning to near wings level, with torque on both engines stabilized at about 22 percent. The airplane's behavior during the upset is consistent with an ice-induced stall event. The first officer stated in postaccident interviews that the stick shaker and aural stall warning, which is part of the airplane's stall warning/protection system, activated but did not indicate whether it was before, during, or after the upset. The Safety Board's investigation could not precisely determine whether or when the stick shaker and aural stall warning activated. Meteorological data at the time of the accident indicate that Comair flight 5054 may have encountered an area of icing conducive to the formation of super-cooled large droplets (SLD). The EMB-120 is not certified for flight in SLD conditions. FDR data indicate that airspeed had decreased to only about 137 KIAS before control of the airplane became difficult and altitude was no longer maintained. However, according to the Embraer EMB-120 Airplane Flight Manual (AFM) performance section, the airplane stalling speed is about 115 knots calibrated airspeed for an airplane at the accident airplane's approximate gross weight at the time of the event (23,800 pounds).
Probable cause
the Board's determinationthe failure of the flight crew to maintain airspeed during an encounter with severe icing conditions, which resulted in an inadvertent stall, loss of control, and structural damage to the airplane.
Safety recommendations
2 issuedwhat changed because of this accidentThe National Transportation Safety Board recommends that the Federal Aviation Administration: Instruct Rockwell Collins to modify its production test and final alignment requirements for the AHC-85 to demonstrate that each AHC-85 is capable of operation throughout its specified operating range of 128º per second of roll, and ensure that the modified test procedures are incorporated in production and postproduction maintenance requirements.
The National Transportation Safety Board recommends that the Federal Aviation Administration: Require that all AHC-85 model units be tested in accordance with the modified test requirements recommended in A-03-02 to ensure that each unit is capable of operation throughout its specified operating range.
Sequence of events
13 timed eventsfrom the FDR factual report · claude-fable-5-1 (in-session)- about 17:40 ESTclimb/cruisep.3Takeoff; climbed and levelled at about 18,100 ft pressure altitude on a heading of about 312 deg
- about 18:11 ESTcruisep.3At 210 kts and SAT -4 to -5 C, increased activity in the acceleration parameters (icing/turbulence)
- 18:12:40 ESTcruisep.3Engine torque (both) reduced from 75% in three steps to 52% over 3 min 20 s while SAT fell to -6 C
- 18:16-18:19 ESTcruisep.3Pressure altitude decreased to about 17,100 ft, SAT rose from -5 to -3 C; airspeed decayed from 200 to 185 kts as pitch trim moved slightly nose up; airspeed fluctuated around 185 kts for 3 minutes
- 18:22:04 ESTcruisep.3Master caution on for 5 seconds; engine torque 57%; over the next 2 min 50 s airspeed decreased and pitch trim moved nose up with altitude and torque constant, SAT -3 to -5 C
- 18:24:54 ESTupsetp.3At 141 kts with pitch trim at 7 units nose up, the aircraft rolled left, torque began increasing and pitch decreased from 7 deg nose up; autopilot disengaged the next second (stall/upset onset)
- 18:25:00 ESTupsetp.3Roll -81 deg left, minimum airspeed 137 kts, pitch -1 deg; rolling back through wings level pitch about -12 deg
- 18:25:07 ESTupsetp.3Roll -108 deg left with pitch almost -30 deg nose down for nearly 6 s; rolled back through 0 deg at -21 deg pitch
- 18:25:17-18:25:18 ESTupsetp.4Right roll 132 deg with pitch -44 deg; pitch reached -54 deg one second later; then -35 deg left roll at -33 deg pitch
- 18:25:23-18:25:24 ESTupsetp.4134 deg right roll followed by -145 deg left roll; maximum airspeed 239 kts, maximum nose-down pitch -60 deg, maximum roll rate 163 deg/s
- 18:25:25 ESTrecoveryp.4Maximum vertical acceleration 3.7 g
- 18:25:28-18:25:36 ESTrecoveryp.4Passed through 0 deg roll at -4 deg pitch; 34 deg right at -13 deg pitch, then -44 deg left at -14 deg; near wings level around 18:25:36 at about 9,600 ft; pitch trim reduced from 7 to 3 units
- 18:37:15 ESTlandingp.4Landed at West Palm Beach about 12 minutes after the upset
NTSB analysis
from the final reportOn March 19, 2001, about 1825 eastern standard time, an Empresa Brasileira de Aeronautica, S/A (Embraer) EMB-120, N266CA, operated by Comair Airlines, Inc., as flight 5054, encountered icing conditions while in cruise flight at 17,000 feet mean sea level (msl) and departed controlled flight, descending to an altitude of about 10,000 feet. The pilots recovered control of the airplane and diverted to West Palm Beach, Florida, where they landed without further incident. The 2 flight crewmembers, 1 flight attendant, and 25 passengers were uninjured, and the airplane sustained substantial damage to the elevators and the horizontal stabilizer. Flight 5054 was operating under 14 Code of Federal Regulations Part 121 as a scheduled international passenger flight from Nassau International Airport, Bahamas, to Orlando International Airport, Florida. The flight departed in visual meteorological conditions (VMC). In postaccident interviews, the captain stated that while in VMC, the airplane flew normally. Flight data recorder (FDR) data indicate that about 7 minutes before the upset occurred, the airplane was at about 17,000 feet msl, with the autopilot engaged and airspeed stabilized near 200 knots indicated airspeed (KIAS). These data indicate that beginning about 1818, the airspeed slowed to 185 KIAS over a 1?minute period as the autopilot began trimming airplane nose-up (ANU) to maintain altitude. The airspeed then decreased to about 137 KIAS over the next 3 minutes. The airplane continued to maintain a constant altitude as the autopilot trimmed the airplane from about 0 to about 7 degrees ANU. The first officer stated that immediately before the upset occurred, he switched the leading-edge deicing system inflation cycles switch from "light" to "heavy" and the propeller deicing system cycles switch from "norm" to "cold" because he saw "more ice accumulation than he had ever seen" on the wing and spinner. FDR data indicate that when torque indications for both engines were about 55 percent and the airspeed was about 141 KIAS, the autopilot was disengaged. The airplane then pitched down and rolled about 80 degrees to the left, then rolled back to near level. During the next 20 seconds, engine torque increased to about 98 percent on both engines, the airplane rolled about 110 degrees to the left, returned to level flight, rolled about 130 degrees to the right, returned to level flight, then rolled 360 degrees to the right before returning to near wings level, with torque on both engines stabilized at about 22 percent. The airplane's behavior during the upset is consistent with an ice-induced stall event. The first officer stated in postaccident interviews that the stick shaker and aural stall warning, which is part of the airplane's stall warning/protection system, activated but did not indicate whether it was before, during, or after the upset. The Safety Board's investigation could not precisely determine whether or when the stick shaker and aural stall warning activated. Meteorological data at the time of the accident indicate that Comair flight 5054 may have encountered an area of icing conducive to the formation of super-cooled large droplets (SLD). The EMB-120 is not certified for flight in SLD conditions. FDR data indicate that airspeed had decreased to only about 137 KIAS before control of the airplane became difficult and altitude was no longer maintained. However, according to the Embraer EMB-120 Airplane Flight Manual (AFM) performance section, the airplane stalling speed is about 115 knots calibrated airspeed for an airplane at the accident airplane's approximate gross weight at the time of the event (23,800 pounds).