Runway excursion Accident Airbus A300B4-203 (F) PR-STN,
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Date:Friday 21 October 2016
Time:06:30
Type:Silhouette image of generic A30B model; specific model in this crash may look slightly different    
Airbus A300B4-203 (F)
Owner/operator:Sterna Linhas Aéreas
Registration: PR-STN
MSN: 236
Year of manufacture:1985
Engine model:General Electric CF6-50C2
Fatalities:Fatalities: 0 / Occupants: 4
Aircraft damage: Substantial, written off
Category:Accident
Location:Recife-Guararapes International Airport, PE (REC) -   Brazil
Phase: Landing
Nature:Cargo
Departure airport:São Paulo-Guarulhos International Airport, SP (GRU/SBGR)
Destination airport:Recife-Guararapes International Airport, PE (REC/SBRF)
Investigating agency: CENIPA
Confidence Rating: Accident investigation report completed and information captured
Narrative:
Sterna Linhas Aéreas flight 9302, an Airbus A300B4-203F, suffered a runway excursion after landing at Recife-Guararapes International Airport, Brazil, causing the nose landing gear to collapse.
The flight was cleared to land on runway 18 and at 500 feet Radio Altitude, the aircraft was in stabilized approach, with slats, flaps and landing gear properly configured for landing. During the flare for landing, the captain did not reduce the power levers of both engines to IDLE, as stipulated in the AOM.
After the touch down, the thrust lever for the no.1 (left) engine was pushed to maximum takeoff power and the thrust lever for engine no. 2 (right) was simultaneously adjusted to idle and then to reverse.
This asymmetric thrust conditions caused the aircraft to drift to the right of the runway. Control could not be regain by the crew and the aircraft ran off the right side off the runway. The nose landing gear collapsed and retracted after the plane entered the grassy area, due to overload fractures.

Contributing factors.
- Control skills - undetermined.
Inadequate use of aircraft controls, particularly as regards the mode of operation of the Autothrottle in use and the non-reduction of the IDLE power levers at touch down, may have led to a conflict between pilots when performing the landing and the automation logic active during approach.
In addition, the use of only one reverse (on the right engine) and placing the left throttle lever at maximum takeoff power resulted in an asymmetric thrust that contributed to the loss of control on the ground.
- Attitude - undetermined.
The adoption of practices different from the aircraft manual denoted an attitude of noncompliance with the procedures provided, which contributed to put the equipment in an unexpected condition: non-automatic opening of ground spoilers and asymmetric thrust of the engines.
These factors required additional pilot intervention (hand control), which may have made it difficult to manage the circumstances that followed the touch and led to the runway excursion.
- Crew Resource Management - a contributor.
The involvement of the PM in commanding the aircraft during the events leading up to the runway excursion to the detriment of its primary responsibility, which would be to monitor systems and assist the PF in conducting the flight, characterized an inefficiency in harnessing the human resources available for the airplane operation.
Thus, the improper management of the tasks assigned to each crewmember and the non-observance of the CRM principles delayed the identification of the root cause of the aircraft abnormal behavior.
- Organizational culture - a contributor.
The reliance on the crew's technical capacity, based on their previous aviation experience, has fostered an informal organizational environment. This informality contributed to the adoption of practices that differed from the anticipated procedures regarding the management and operation of the aircraft.
This not compliance with the procedures highlights a lack of safety culture, as lessons learnt from previous similar accidents (such as those in Irkutsk and Congonhas involving landing using only one reverse and pushing the thrust levers forward), have apparently not been taken into account at the airline level.
- Piloting judgment - undetermined.
The habit of not reducing the throttle lever to the IDLE position when passing at 20ft diverged from the procedures contained in the aircraft-operating manual and prevented the automatic opening of ground spoilers.
It is possible that the consequences of this adaptation of the procedure related to the operation of the airplane were not adequately evaluated, which made it difficult to understand and manage the condition experienced.
- Perception - a contributor.
Failure to perceive the position of the left lever denoted a lowering of the crew's situational awareness, as it apparently only realized the real cause of the aircraft yaw when the runway excursion was already underway.
- Decision-making process - a contributor.
An inaccurate assessment of the causes that would justify the behavior of the aircraft during the landing resulted in a delay in the application of the necessary power reduction procedure, that is, repositioning the left engine power lever.

METAR:

09:00 UTC / 06:00 local time:
METAR SBRF 210900Z 07007KT 9999 BKN020 SCT050 26/23 Q1012=

10:00 UTC / 07:00 local time:
METAR SBRF 211000Z 08008KT 9999 SCT020 BKN060 28/23 Q1013=

Accident investigation:
cover
  
Investigating agency: CENIPA
Report number: A-137/CENIPA/2016
Status: Investigation completed
Duration: 4 years and 5 months
Download report: Final report

Sources:

Globo

Revision history:

Date/timeContributorUpdates
15-Mar-2024 19:49 ASN Updated [Destination airport, Accident report]

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