Vliegtuigongeval op 01 FEB 1991 met Boeing 737-3B7 N388US - Los Angeles International Airport, CA (LAX)
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Status:Accident investigation report completed and information captured
Datum:vrijdag 1 februari 1991
Tijd:18:07
Type:Silhouette image of generic B733 model; specific model in this crash may look slightly different
Boeing 737-3B7
Luchtvaartmaatschappij:USAir
Registratie: N388US
Constructienummer: 23310/1145
Bouwjaar: 1985-08-23 (5 years 5 months)
Motoren: 2 CFMI CFM56-3B1
Bemanning:slachtoffers: 2 / inzittenden: 6
Passagiers:slachtoffers: 20 / inzittenden: 83
Totaal:slachtoffers: 22 / inzittenden: 89
Botsingsslachtoffers:slachtoffers: 12
Schade: Vernield
Gevolgen: Written off (damaged beyond repair)
Plaats:Los Angeles International Airport, CA (LAX) (   Verenigde Staten)
Fase: Landing (LDG)
Soort vlucht:Binnenlandse lijnvlucht
Vliegveld van vertrek:Columbus-Port Columbus International Airport, OH (CMH/KCMH), Verenigde Staten
Vliegveld van aankomst:Los Angeles International Airport, CA (LAX/KLAX), Verenigde Staten
Vluchtnummer:1493
Beschrijving:
USAir Flight 1493 left Columbus at 13:17 for a flight to Los Angeles. The Boeing 737 aircraft entered LAX airspace around 17:57 and was cleared for a CIVET Two Profile Descent and ILS runway 24R approach. At 17:59 this was changed to a runway 24L approach clearance.
At about the same time a SkyWest Metro II aircraft (Flight 5569 to Palmdale) taxied out from Terminal 6, Gate 32 to runway 24L. At 18:03 the crew were advised to "taxi up to and hold short of 24L" because of other traffic. At 18:04:49 the flight was cleared to taxi into position and hold. Immediately thereafter the controller became preoccupied with instructing WingsWest Flight 5006 who had unintentionally departed the tower frequency. The WingsWest 5072 reporting ready for takeoff caused some confusion because the controller didn't have a flight progress strip in front of her. The strip appeared to have been misfiled at the clearance delivery position. Meanwhile, Flight 5569 was still on the runway at the intersection with taxiway 45, awaiting takeoff clearance.
At 18:07 Flight 1493 touched down. Simultaneous to the nosegear touchdown, the Boeing 737 collided with the SkyWest Metro. Both aircraft caught fire and slid to the left into an unoccupied fire station.

Probable Cause:

PROBABLE CAUSE: "The failure of the Los Angeles Air Traffic Facility Management to implement procedures that provided redundancy comparable to the requirements contained in the National Operational Position Standards and the failure of the FAA ATS to provide adequate policy direction and oversight to its ATC facility managers. These failures created an environment in the Los Angeles ATC tower that ultimately led to the failure of the Local Controller 2 (LC2) to maintain awareness of the traffic situation, culminating in the inappropriate clearances and the subsequent collision of the USAir and SkyWest aircraft. Contributing to the cause pf the accident was the failure of the FAA to provide effective quality assurance pf the ATC system."

Accident investigation:

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Investigating agency: NTSB
Status: Investigation completed
Duration: 263 days (9 months)
Accident number: NTSB/AAR-91-08
Download report: Final report

Bronnen:
» NTSB/AAR-91/08


Veiligheidsmaatregelen

NTSB issued 18 Safety Recommendations

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Foto's

photo of Boeing-737-3B7-N388US
accident date: 01-02-1991
type: Boeing 737-3B7
registration: N388US
photo of Boeing-737-3B7-N388US
Wreckage diagram
photo of Boeing-737-3B7-N388US
Airport map
photo of Boeing-737-3B7-N388US
Seat map Boeing 737-3B7 N388US
photo of Boeing-737-3B7-N388US
accident date: 01-02-1991
type: Boeing 737-3B7
registration: N388US
 

Kaart
Deze kaart geeft het vliegveld van vetrek weer en de geplande bestemming van de vlucht. De lijn tussen de vliegvelden geeft niet de exacte vliegroute weer.
De afstand tussen Columbus-Port Columbus International Airport, OH en Los Angeles International Airport, CA bedraagt 3182 km (1989 miles).
Accident location: Exact; deduced from official accident report.

This information is not presented as the Flight Safety Foundation or the Aviation Safety Network’s opinion as to the cause of the accident. It is preliminary and is based on the facts as they are known at this time.
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