Crash of a Learjet 35A in Lebanon: 2 killed

Date & Time: Dec 24, 1996 at 1005 LT
Type of aircraft:
Registration:
N388LS
Flight Type:
Survivors:
No
Site:
Schedule:
Bridgeport - Lebanon
MSN:
35-388
YOM:
1981
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
4250
Captain / Total hours on type:
1000.00
Aircraft flight hours:
6897
Circumstances:
The first officer was in the left seat, flying the airplane, and the captain was in the right seat, for the positioning flight. Approaching the destination, the crew briefed, then attempted an ILS RWY 18 approach. The captain reported not receiving the localizer, when, in fact, the airplane was actually about 5 nautical miles to the left of it. Winds at the airport, about that time, were from 190 degrees true, at 5 knots; however, area winds at 6,000 feet were from 220 degrees, in excess of 40 knots. The crew executed a missed approach, but did not follow the missed approach procedures. The captain later requested, and received clearance for, the VOR RWY 25 approach. The captain partially briefed the approach to the first officer as the airplane neared the VOR, then subsequently "talked through" remaining phases of the approach as they occurred. The outbound course for the VOR RWY 25 approach was 066 degrees, and the minimum altitude outbound was 4,300 feet. After passing the VOR, the captain directed the first officer to maintain 4,700 feet. The airplane's last radar contact occurred as the airplane was proceeding outbound, 7 nautical miles northeast of the VOR, at 4,800 feet. As the airplane approached the course reversal portion of the procedure turn, the captain initially directed the first officer to turn the airplane in the wrong direction. When the proper heading was finally given, the airplane had been outbound for about 2 minutes. During the outbound portion of the course reversal, the captain told the first officer to descend the airplane to 2,900 feet, although the procedure called for the airplane to maintain a minimum of 4,300 feet until joining the inbound course to the VOR. During the inbound portion of the course reversal, the captain amended the altitude to 3,000 feet. As the airplane neared the inbound course to the VOR, the captain called out the outer marker. The first officer agreed, and the captain stated that they could descend to 2,300 feet. The first officer then noted that the VOR indications were fluctuating. The captain pointed out the VOR's continued reception, and the first officer noted, "but it's all over the place." Shortly thereafter, the first officer stated that he was descending the airplane to 2,300 feet. Three seconds later, the airplane impacted trees, then terrain. The wreckage was located at the 2,300-foot level, on rising mountainous terrain, 061 degrees magnetic, 12.5 nautical miles from the VOR. It was also 10.3 nautical miles prior to where a descent to 2,300 feet was authorized. There was no evidence that the crew used available DME information. There was also no evidence of pre-impact mechanical malfunction.
Probable cause:
The captain's failure to maintain situational awareness, which resulted in the airplane being outside the confines of the instrument approach; and the crew's misinterpretation of a stepdown fix passage, which resulted in an early descent into rising terrain. Factors included the captain's misreading of the instrument approach procedure, the crew's rushed and incomplete instrument approach briefing, their failure to use additional, available navigational aids, and their failure to account for the winds at altitude.
Final Report:

Crash of a Fairchild-Hiller FH-227C in Lebanon: 32 killed

Date & Time: Oct 25, 1968 at 1717 LT
Type of aircraft:
Operator:
Registration:
N380NE
Survivors:
Yes
Site:
Schedule:
Boston – Lebanon – Montpelier
MSN:
517
YOM:
1966
Flight number:
NE946
Crew on board:
3
Crew fatalities:
Pax on board:
39
Pax fatalities:
Other fatalities:
Total fatalities:
32
Captain / Total flying hours:
14700
Captain / Total hours on type:
1181.00
Copilot / Total flying hours:
2499
Copilot / Total hours on type:
281
Aircraft flight hours:
3828
Circumstances:
Northeast Airlines Flight 946 departed Boston 17:42 for a flight to Lebanon, NH and Montpelier, VT. The Fairchild climbed to a cruising altitude of 8000 feet. At 18:08 the crew were cleared for an approach to the Lebanon Airport to cruise at 5,000 feet and report leaving 6,000 feet. At 18:10:45, the controller advised the crew that radar service had been terminated and the flight was cleared to contact the Lebanon Flight Service Station (FSS). One minute later the FSS told the crew that the weather was an estimated ceiling of 2,000 feet overcast; visibility was 10 miles; there were breaks in the overcast; the altimeter setting was 29:55; and the wind was calm. The flight did not perform the published instrument approach procedure but executed an abbreviated approach by making a right turn from their northwesterly heading and then a left turn back to intercept the inbound radial to the VOR station. The inbound radial was intercepted at approximately 8 to 10 miles northeast of the VOR station where it passed through an altitude of about 4500 feet. The crew began the descent but did not level off at 2,800 feet m.s.l., the minimum altitude inbound to the VOR. During the approach to runway 25 the airplane contacted trees on the cloud-shrouded side of a steep, rocky, heavily wooded mountain 57 feet below the summit at 2,237 feet m.s.l. The aircraft cut a swath trough the trees broke up and caught fire. Two crew members and 30 passengers were killed while 10 others were injured.
Probable cause:
The premature initiation of a descent towards the Minimum Descent Altitude, based on navigational instrument indications of an impending station passage in an area of course roughness. The crew was not able to determine accurately its position at this time because they had performed a non standard instrument approach and there were no supplement navigational aids available for their use.