reducing "Crew-caused"
approach and landing
accidents 

Pilot-in-charge Monitored Approach

2011 E190 overrun Quito Ecuador

Brief account : 

The ERJ-190 crew encountered a flap extension problem prior to landing in rain at night. The aircraft landed but could not stop on the runway. The aircraft went over soft ground, through the localizer antenna and came to a stop at the airport perimeter wall about 275 meters/900 feet past the runway end. 4 people received minor injuries, the aircraft received substantial damage.

Crew-related factors : 

The full report has not yet been traced but a limited version is available via Aviation Herald.  It appears that the crew were reasonably experienced. 

The approach was made in the early evening with broken cloud and rain.  The slats did not extend and the flaps only partially but after several re-selection attempts the crew continued the approach without carrying out the QRH actions including recomputing speeds and runway required. The runway length was in fact adequate but the approach was carried out at 15 kts faster than required.    

The aircraft crossed the threshold low and fast and made a long touchdown.  

The investigation analysis showed that the while Captain was concerned about fuel and a delayed departure, in fact there was more than enough fuel for a diversion with full reserves. 

The report noted that "The JIA thus analysed that the crew did not work the relevant checklists after encountering the slat failure, did not abort the approach although the stabilized approach criteria were never met, and applied brakes late and irregular thus preventing the aircraft to stop within the shortest landing distance possible.

The crew was under significant discomfort and stress, especially the captain following the argument with dispatch and the delay in Loja, their performance was therefore impaired. The JIA stated: "the human factor, including a good deal of time spent during flight in conversation about these issues unrelated to the conduct of the flight, was a dominant factor into the accident sequence leading to loss of situational awareness and inappropriate decision making".

While there is not enough information for a detailed analysis, it seem likely that if the crew had used a PicMA procedure

1) the Captain would have been under lower workload while considering the options available when the flap/slat problem arose;

2) he might have given more consideration to the actual landing criteria if he had been responsible for the checklist as PNF 

3) the approach might have been flown at a speed closer to the correct Vref and not 15 kts fast

 

Type: 
Embraer ERJ 190
Where: 
Quito Ecuador
Expected weather: 
Instrument
Pilot in charge: 
Capt
Early transition: 
Unknown
Go-around : 
No
Damage: 
Serious
PicMA potential: 
Major
Year: 
2011
Time: 
Night
Deterioration: 
Unknown
Vert Guidance: 
G/S
Both Head Up: 
No
LoC: 
No
Operator: 
TAME
Fully prepared: 
No
Actual Weather: 
Rain
Autopilot : 
Unknown
CCAG: 
Normal