Flugunfall 17 FEB 1991 einer McDonnell Douglas DC-9-15RC N565PC - Cleveland-Hopkins International Airport, OH (CLE)

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Accident

Last updated: 23 May 2013

Status:	Schlussbericht
Datum:	17 FEB 1991
Zeit:	00:19
Flugzeugtyp:	McDonnell Douglas DC-9-15RC
Fluggesellschaft:	Ryan International Airlines
Kennzeichen:	N565PC
Werknummer:	47240/346
Baujahr:	1968
Triebwerk:	2 Pratt & Whitney JT8D-7B
Besatzung:	Todesopfer: 2 / Insassen: 2
Fluggäste:	Todesopfer: 0 / Insassen: 0
Gesamt:	Todesopfer: 2 / Insassen: 2
Sachschaden:	Zerstört
Konsequenzen:	Written off (damaged beyond repair)
Unfallort:	Cleveland-Hopkins International Airport, OH (CLE) (USA)
Flugphase:	Start (TOF)
Betriebsart:	Frachtflug
Flug von:	Cleveland-Hopkins International Airport, OH (CLE/KCLE), USA
Flug nach:	Indianapolis International Airport, IN (IND/KIND), USA
Flugnummer:	590

Unfallbericht:
Ryan Flight 590 landed at Cleveland at 23:44 and taxied to the mail ramp. Snow (dry and blowing) fell throughout the 35 minutes that the DC-9 was on the ground. The deicing service was not requested during this period. Clearance to taxi to runway 23 was received at 00:09. Takeoff clearance was given at 00:18.
The aircraft stalled during take-off and rolled 90° at 50-100 feet. The airplane then suffered compressor stalls, the left wing contacted the runway and the aircraft cart wheeled. The DC-9 came to rest inverted 6500 feet from the threshold.

PROBABLE CAUSE: "The failure of the flight crew to detect and remove ice contamination on the airplane's wings, which was largely a result of a lack of appropriate response by the Federal Aviation Administration, Douglas Aircraft Company, and Ryan International Airlines to the known effect that a minute amount of contamination has on the stall characteristics of the DC-9 series 10 airplane. The ice contamination led to wing stall and loss of control during the attempted takeoff."

Informationsquelle:
» Airport Operations Vol.19, No.6 (Nov/Dec 1993) / Flight Safety Foundation
» ICAO Adrep 2/93 (#45)
» ICAO Adrep 4/94 (#99)
» NTSB/AAR-91/09

Official accident investigation report

investigating agency:	National Transport Safety Bureau (NTSB) - USA
report status:	Final
report number:	NTSB/AAR-91-09
report released:	16-NOV-1991
duration of investigation:	272 days (9.1 months)
download report:	Ryan intl Airlines DC-9-15, N565PC Loss of Control on Takeoff Cleveland-Hopkins intl Airport Cleveland, OH February 17, 1991. (NTSB/AAR-91-09)

Sicherheitsempfehlungen

NTSB issued 6 Safety Recommendations

Issued: 11-DEC-1991	To: FAA	A-91-123
REQUIRE THE INCLUSION IN THE DC-9 SERIES 10 APPROVED AIRPLANE FLIGHT MANUAL OF A CAUTION ABOUT THE SUSCEPTIBILITY OF THE AIRPLANE TO FLIGHT CONTROL PROBLEMS WITH MINUTE AND MARGINALLY DETECTABLE AMOUNTS OF ICE ON THE LEADING EDGE AND UPPER SURFACE OF THE WING. (Closed - Acceptable Action)
Issued: 11-DEC-1991	To: FAA	A-91-124
REQUIRE IN AIR CARRIER OPERATIONS MANUALS AND APPROPRIATE AIRPLANE FLIGHT MANUALS THAT FLIGHTCREWS OF DC-9 SERIES 10 AIRPLANES PERFORM A VISUAL AND TACTILE INSPECTION OF THE WING LEADING EDGE AND UPPER SURFACE USING NECESSARY EQUIPMENT PRIOR TO DEPARTURE WHENEVER TEMPERATURES BELOW 5 DEGREES C AND VISIBLE MOISTURE EXIST OR WHENEVER THE AIRPLANE RECENTLY ENCOUNTERED ICING CONDITIONS. (Closed - Acceptable Action)
Issued: 11-DEC-1991	To: FAA	A-91-125
REQUIRE PRINCIPAL OPERATIONS INSPECTORS TO REVIEW CERTIFICATE HOLDERS OPERATING DC-9 SERIES 10 AIRPLANES TO DETERMINE THE ADEQUACY OF FLIGHTCREW TRAINING PROGRAMS RELATED TO AIRFRAME ICING CONDITIONS. (Closed - Acceptable Alternate Action)
Issued: 11-DEC-1991	To: FAA	A-91-126
EVALUATE THE NEED FOR ACTIONS AS DESCRIBED IN SAFETY RECOMMENDATIONS A-91-123 THROUGH A-91-125 FOR OTHER TRANSPORT CATEGORY TURBOJET AIRPLANES THAT DO NOT HAVE LEADING EDGE DEVICES AND ARE PARTICULARLY SUSCEPTIBLE TO FLIGHT CONTROL PROBLEMS ARISING FROM SMALL AMOUNTS OF FROST, ICE OR SNOW ON THE WINGS. (Closed - Acceptable Action)
Issued: 11-DEC-1991	To: FAA	A-91-127
EVALUATE A PROCEDURE TO USE THE MAXIMUM ROTATION SPEED DURING TAKEOFF THAT WILL RETAIN THE PRESENTLY REQUIRED END OF RUNWAY AND CLIMB GRADIENT SAFETY MARGINS WHEN OPERATING ON RUNWAYS THAT EXCEED THE MINIMUM TAKEOFF RUNWAY LENGTH REQUIRED; REQUIRE OPERATORS TO PROVIDE MAXIMUM ROTATION SPEED INFORMATION TO DC-9 SERIES 10 FLIGHTCREWS FOR USE IN WINTER OPERATIONS. (Closed - Acceptable Action)
Issued: 11-DEC-1991	To: FAA	A-91-128
REQUIRE AIR CARRIER OPERATORS, WHEN ACQUIRING A NEW MODEL AIRRAFT, TO FORMALLY REQUEST FROM THE MANUFACTURER ALL PERTINENT INFORMATION PREVIOUSLY DISSEMINATED REGARDING THE OPERATION OF THE PARTICULAR AIRCRAFT TYPE. (Closed - Acceptable Alternate Action)

Show all AD's and Safety Recommendations

Fotos

photo of McDonnell Douglas DC-9-15RC N9351

Purolator Courier bought this DC-9 in June 1984. Purolator merged into Emery Worldwide in September 1987.

Map

This map shows the airport of departure and the intended destination of the flight. The line between the airports does not display the exact flight path.
Distance from Cleveland-Hopkins International Airport, OH to Indianapolis International Airport, IN as the crow flies is 417 km (261 miles).

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