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post #1 of 40 (permalink) Old 08-30-2006, 07:23 PM Thread Starter
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Comair flight had lots of odd things

This tragedy continues to get stranger. Now there is also evidence that the crew earlier that day had mistakenly gotten on the wrong plane. (Article below.)

I think the NTSB has a point that a second person in the tower probably wouldn't have mattered, given that ATC tower folks don't have to monitor a plane after they clear it for takeoff. Yeah, the guy perhaps shouldn't have been doing paperwork, but even if he'd been monitoring the radar or communicating with aircraft, it seems reasonble that he still wouldn't have noticed that the jet was on the wrong runway.

I tend to agree with all the issues re: the confusing layout of the airport, the hump in the long runway that makes it appear shorter, the new painting, etc. I'm sure all of that contributed.

What I still can't comprehend is why two experienced pilots would have proceeded to attempt a takeoff in predawn hours when the runway lights were out. That just seems like a huge red flag to me (particularly since the lights on the correct runway presumably were lit). It will be interesting when the copilot recovers enough to be questioned. Assuming, of course, that he did not suffer head injuries sufficient to have cleared his recent memory.




NTSB: Wrong runway wasn't Comair crew's only preflight error

LEXINGTON, Kentucky (CNN) -- As Comair Flight 5191 began rolling down the wrong runway, the lone air traffic controller on duty at Lexington's Blue Grass Airport was busy with paperwork. And the 47 passengers onboard were unaware that the flight crew had started that Sunday morning by mistakenly getting onto another plane.

Seconds later, the commuter jet crashed, killing everyone onboard except the co-pilot, who remains in critical condition at a Lexington hospital.

The Federal Aviation Administration on Tuesday acknowledged that only one controller was in the tower, in violation of the agency's policy, when the Comair jet crashed.

The revelation came after CNN obtained a November 2005 FAA memorandum spelling out staffing levels at the airport. The memo says two controllers are needed -- one to monitor air traffic on radar and another to perform other tower functions, such as communicating with taxiing aircraft.

When two controllers are not available, the memo says, the radar monitoring function should be handed off to the FAA center in Indianapolis, Indiana.

The FAA told CNN that the lone controller at Blue Grass was performing both functions Sunday in violation of the policy.

The controller's last look at the Comair CRJ-100 occurred when it was on the taxiway, according to National Transportation Safety Board investigators.

"He had cleared the aircraft for takeoff, and he turned his back and performed administrative duties in the tower," said Debbie Hersman, the NTSB member in charge of the investigation.

She said the controller cleared Flight 5191 to take off on Runway 22, the 7,000-foot lighted runway used by commercial jets.

Instead, the crew tried to take off on the unlit Runway 26, which was about half as long.

The controller told the NTSB he had an unobstructed view of both runways, Hersman said, but because he was not looking in that direction, he was unaware of a problem until he heard the crash.

Air traffic controllers are not responsible for making sure pilots are on the right runway, John Nance, a pilot and aviation analyst, told The Associated Press. "You clear him for takeoff and that's the end of it," Nance said, according to the AP.

The Lexington Herald-Leader reported Tuesday that in 1993 a plane mistakenly lined up on Runway 26 instead of Runway 22, but the tower noticed the error in time.

Turning onto the wrong runway was not the only mistake the crew made Sunday, according to the NTSB. When they arrived at the airport at 5:15 a.m., the captain and first officer boarded the wrong plane and turned on the power before a ramp worker pointed out their mistake.

Hersman said it was the flight's captain, Jeffrey Clay, who taxied the aircraft into position at the start of the wrong runway. Clay then turned over the controls to the co-pilot, James Polehinke, who was flying the plane when it crashed. Hersman said that was standard procedure since only the captain can reach the tiller used to steer the plane while it's on the ground.

Hersman said both crew members were familiar with the Lexington airport but that neither had been to the airport since a repaving project a week earlier altered the taxiway route.

She said investigators will continue to gather information on how the pilot and co-pilot spent the 72 hours before the flight. She said toxicology testing for alcohol and drugs is routine.

Staffing boosted after crash
Andrew Cantwell, regional vice president of the controller's union, said he could not say with certainty whether additional staffing would have prevented the crash, but a second person would have allowed the controller to focus on operations.

In a statement Tuesday, the FAA suggested that a second controller would not have prevented the accident.

"Had there been a second controller present on Sunday, that controller would have been responsible for separating airborne traffic with radar, not aircraft on the airport's runways," the statement said.

The FAA this week increased overnight staffing at Lexington as well as at airports in Duluth, Minnesota, and Savannah, Georgia, Cantwell said.

Doug Church, spokesman for the National Air Traffic Controllers Association, said there has been a net loss of 1,081 controllers in the last three years, due largely to a wave of retirements, the AP reported.

Tire marks indicate the plane's wheels went into grass beyond the end of the runway. It became airborne after hitting an earthen berm, clipped a perimeter fence and struck a stand of trees before hitting the ground, said Hersman.

A longtime pilot familiar with Blue Grass Airport told the Lexington newspaper that the airport is confusing and getting onto the wrong runway is easier than it sounds.

Russ Whitney told the paper that Runway 22, the one Flight 5191 should have been on, has a hump in the middle, so pilots cannot see the whole thing as they begin takeoff. Runway 22 and the much shorter Runway 26 can appear to be the same length, he said, according to the newspaper.

On Wednesday, victims' families were scheduled to tour the crash site before a memorial service, the AP reported.
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post #2 of 40 (permalink) Old 08-30-2006, 11:20 PM
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A couple of things about the layout of the airport. I fly a 182 out of Bluegrass on a regular basis and was paged out on the crash due to DES work at 8am Sunday morning.

First, the tower, the TO end of 26 and the TO end of 22 are in a direct line. From the tower, at that hour an ATC could not tell which TOP the plane was on.

Second, 22, the 7K runway had just been repaved, along with the X where 26 crosses it and was pitch black new blacktop. On a dark, overcast, low vis morning it would be very hard to see terrain.

Third, the taxiway had been changed three days prior and had some confusion to experienced pilots at the field, even in daylight. Markings were not all that clear.

Fourth, from the TO point on 26 the co pilot saw some lighting [taxi and some 22 lights but not the entire runway as the 22 crown would have blocked view]

Fifth, once he calculated his roll rate for 7k feet runway, he left and would not have realized error until his landing lights lit up the fence 50 yds past the runway. At that point he tried to autorotate but did not have airspeed.

Unknown why he did not see the 22 runway lights to his left when he pasted 22 75 yds after he started his roll. Also, when he keyed back ATC's clearance for "go for 22" he only responded "roger", not "roger 22" which would be proper procedure as he looks at compass on comfirmation.

Both pilots were fresh with no flights within 48 hours prior to this flight and Raddison manager advised that no drinking had occured [private confirmation to manager of restaurant I hang out at] but also told same to NTSB. Got on wrong plane but that was not a biggie as there were three identical planes setting on tarmac at that hour waiting on crews.

NTSB looking real close at Airport to see if all work done previous week during repaving was done to spec and if all inspections were done correctly and if all signage was up. Airport was Closed entire previous weekend for that project since there is only one primary runway. 26 was suppose to be closed. It sucks to take off or land on since is has not been repaved in 20 years.

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post #3 of 40 (permalink) Old 08-30-2006, 11:24 PM
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Originally Posted by 67_250SE
For sure they will be doing tox panels on what is left of the pilot and on the co-pilot.
They can tox the co-pilot [who was piloting the plane] but no one else on the plane has any tissue left to tox. All ID is through dental records ONLY It was a VERY hot fire. We used 12-18 inch evidence baggies for retrieval.

Fortunately none of us had to do that for over an hour or two. That is very hard work.

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post #4 of 40 (permalink) Old 08-31-2006, 05:28 AM
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Originally Posted by mcbear
A couple of things about the layout of the airport. I fly a 182 out of Bluegrass on a regular basis and was paged out on the crash due to DES work at 8am Sunday morning.

First, the tower, the TO end of 26 and the TO end of 22 are in a direct line. From the tower, at that hour an ATC could not tell which TOP the plane was on.

Second, 22, the 7K runway had just been repaved, along with the X where 26 crosses it and was pitch black new blacktop. On a dark, overcast, low vis morning it would be very hard to see terrain.

Third, the taxiway had been changed three days prior and had some confusion to experienced pilots at the field, even in daylight. Markings were not all that clear.

Fourth, from the TO point on 26 the co pilot saw some lighting [taxi and some 22 lights but not the entire runway as the 22 crown would have blocked view]

Fifth, once he calculated his roll rate for 7k feet runway, he left and would not have realized error until his landing lights lit up the fence 50 yds past the runway. At that point he tried to autorotate but did not have airspeed.

Unknown why he did not see the 22 runway lights to his left when he pasted 22 75 yds after he started his roll. Also, when he keyed back ATC's clearance for "go for 22" he only responded "roger", not "roger 22" which would be proper procedure as he looks at compass on comfirmation.

Both pilots were fresh with no flights within 48 hours prior to this flight and Raddison manager advised that no drinking had occured [private confirmation to manager of restaurant I hang out at] but also told same to NTSB. Got on wrong plane but that was not a biggie as there were three identical planes setting on tarmac at that hour waiting on crews.

NTSB looking real close at Airport to see if all work done previous week during repaving was done to spec and if all inspections were done correctly and if all signage was up. Airport was Closed entire previous weekend for that project since there is only one primary runway. 26 was suppose to be closed. It sucks to take off or land on since is has not been repaved in 20 years.
As a fellow pilot I can understand you comment and your apparent support of the pilots, however, don't you check your DG (directional gyro) prior to take off, I sure as heck do.
As to the tower crew, with all the changes that the airport has been going through, there is NO excuse for him NOT to follow that A/C to the departure end of the runway to insure that this didn't happen.....
It's a shame, but there is PLENTY of blame to go around for everbody to get a good sized dose

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post #5 of 40 (permalink) Old 08-31-2006, 07:10 AM
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Originally Posted by mcbear
They can tox the co-pilot [who was piloting the plane] but no one else on the plane has any tissue left to tox. All ID is through dental records ONLY It was a VERY hot fire. We used 12-18 inch evidence baggies for retrieval.

Fortunately none of us had to do that for over an hour or two. That is very hard work.
McBear, are you saying you are working with the recovery crew?
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post #6 of 40 (permalink) Old 08-31-2006, 07:11 AM
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Originally Posted by Bruce R.
As a fellow pilot I can understand you comment and your apparent support of the pilots, however, don't you check your DG (directional gyro) prior to take off, I sure as heck do.
As to the tower crew, with all the changes that the airport has been going through, there is NO excuse for him NOT to follow that A/C to the departure end of the runway to insure that this didn't happen.....
It's a shame, but there is PLENTY of blame to go around for everbody to get a good sized dose
Hey Bruce where do you fly out off? I use Laurel and Easton a lot. Which crafts do you like to play with?
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post #7 of 40 (permalink) Old 08-31-2006, 07:33 AM
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Originally Posted by mcbear
They can tox the co-pilot [who was piloting the plane] but no one else on the plane has any tissue left to tox. All ID is through dental records ONLY It was a VERY hot fire. We used 12-18 inch evidence baggies for retrieval.

Fortunately none of us had to do that for over an hour or two. That is very hard work.
I did not realize that the fire had consumed all tissue.

My only experience with previous plane crashes has involved instances where there was sufficient tissue remaining to conduct tox tests.

It must be extremely traumatic to be part of a rescue/recovery effort.
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post #8 of 40 (permalink) Old 08-31-2006, 11:04 AM
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As a fellow pilot I can understand you comment and your apparent support of the pilots, however, don't you check your DG (directional gyro) prior to take off, I sure as heck do.
As to the tower crew, with all the changes that the airport has been going through, there is NO excuse for him NOT to follow that A/C to the departure end of the runway to insure that this didn't happen.....
It's a shame, but there is PLENTY of blame to go around for everbody to get a good sized dose
I was not intending to support the pilots, just stating some of the known facts surrounding the airport. Infact, when he failed to "roger 22" that was when he should have been looking straight at the DG.

Just came out today that the sole ATC was running on TWO hours sleep after a 10 hour break from a previous shift. This incident was at hour SIX of his shift.

Also, from ATC's position in that tower, in the dark, it would be hard to tell whether 5191 was, or was not, at the correct departure point. Their line of site is a near perfect line.

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post #9 of 40 (permalink) Old 08-31-2006, 11:13 AM
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Hey Bruce where do you fly out off? I use Laurel and Easton a lot. Which crafts do you like to play with?
I used to teach in Cessna 150's and 172's as well as Piper 150's, 180's and Arrows. I am a CFI and multi engine rated. I sold my Bonanza a few years back, and the fool ferry pilot crashed it before it could be delivered to the new owner in California. I used to fly out of Spring Valley, NY, Greenwood Lake, NJ, and Montgomery County, MD...... Waaay more then you asked for huh....

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post #10 of 40 (permalink) Old 08-31-2006, 11:14 AM
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McBear, are you saying you are working with the recovery crew?
I worked Sunday from 8am until 8pm with a couple of breaks. As a retired AF officer guy I am one of the DES management people and got paged out early. The crash site is right at three miles from my house.

I also worked a bit on Monday but had other obligations that took me to other meetings.

We also had another crash on Monday about 70 miles east of Lexington where 7 were killed in a small plane in the mountains. I took some of the NTSB guys up there to set up a staging area for their investigation.

Yesterday and today have been memorial services for the families. There are 5 large busses full of family. Yesterday they went to the crash site which was rough on all of them.

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