Crash of a Fokker F28 Fellowship 4000 in Quito

Date & Time: Sep 22, 2008 at 1115 LT
Type of aircraft:
Operator:
Registration:
HC-CDT
Flight Phase:
Survivors:
Yes
Schedule:
Quito – Coca
MSN:
11222
YOM:
1985
Flight number:
ICD504
Country:
Crew on board:
4
Crew fatalities:
Pax on board:
62
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
9292
Captain / Total hours on type:
109.00
Copilot / Total flying hours:
3889
Copilot / Total hours on type:
380
Aircraft flight hours:
42422
Aircraft flight cycles:
47727
Circumstances:
During the takeoff roll from runway 25 at Quito-Mariscal Sucre Airport, the crew noted a fire alarm connected to the forward cargo compartment. The captain decided to abandon the takeoff procedure and initiated an emergency braking manoeuvre. Unable to stop within the remaining distance, the aircraft overran, collided with the ILS antenna, went down an embankment then impacted a brick wall and came to rest 300 metres past the runway end. All 66 occupants were rescued, among them eight passengers were injured. The aircraft was damaged beyond repair.
Probable cause:
Failure of the crew to follow the published procedures following a fire alarm, as stated in the Operations Manual and the late application of the procedures once the decision to abort the takeoff was taken.
Contributing factors:
- Complacency on part of the crew who failed to proceed with a pre-takeoff briefing,
- A fact that influenced the lack of appropriate action from the crew to successfully tackle any emergency,
- Lack of crew resources management,
- The braking coefficient was low because the runway surface was wet.
Final Report:

Crash of a Boeing 737-291 near Toacaso: 3 killed

Date & Time: Aug 30, 2008 at 2103 LT
Type of aircraft:
Operator:
Registration:
YV102T
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Caracas – Latacunga
MSN:
21545/525
YOM:
1978
Country:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
9018
Captain / Total hours on type:
5915.00
Copilot / Total flying hours:
3000
Copilot / Total hours on type:
989
Aircraft flight hours:
60117
Aircraft flight cycles:
52091
Circumstances:
The aircraft was parked at Caracas Airport for a while and had just been sold to an Ecuadorian operator. A crew of three departed Caracas-Maiquetía-Simón Bolívar Airport in the evening on a delivery flight to Latacunga, Ecuador. After being cleared to descend to FL180, FL150 then FL130, the crew was flying over a mountainous area when the GPWS alarm sounded. The crew apparently elected to gain height but the alarm sounded for 22 seconds when the aircraft collided with the Iliniza Volcano. The aircraft disintegrated on impact and all three occupants were killed. The wreckage was found the following day at an altitude of 3,992 metres.
Probable cause:
Non-compliance by the crew of the technical procedures, configuration, speed and bank angle of the aircraft required for the completion of the initial turn of the Instrument Approach Procedure n°4 published in the AIP Ecuador, to Latacunga Airport, a failure that placed the aircraft outside of the protected area (published pattern), leading to high elevation mountainous terrain.
Contributing factors:
- Ignorance of the crew of the area which was under the approach path.
- Lack of documentation and procedures of the airline that govern the conduct of flights to non-scheduled and special airports.

Crash of an Airbus A340-642 in Quito

Date & Time: Nov 9, 2007 at 1706 LT
Type of aircraft:
Operator:
Registration:
EC-JOH
Survivors:
Yes
Schedule:
Madrid - Quito
MSN:
731
YOM:
2006
Flight number:
IB6463
Country:
Crew on board:
14
Crew fatalities:
Pax on board:
345
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
14024
Captain / Total hours on type:
2375.00
Copilot / Total flying hours:
10095
Copilot / Total hours on type:
1742
Aircraft flight hours:
8704
Aircraft flight cycles:
965
Circumstances:
Following an uneventful flight from Madrid, the crew contacted Quito Approach at 1650LT and received descent instructions in preparation for an instrument approach no. 4 (VOR QIT DME/ILS) for runway 35. During the descent the crew were notified that preceding flights had reported braking action medium to poor. The flight crew selected auto braking to 'High'. At 17:05, the crew reported the runway in sight, after which the controller stated that the wind was 170° at 4 knots, the runway was wet and reported braking action was poor. The flight was cleared to land. The pilot in command, following the procedures established by Iberia, decided to leave the ILS glide path and captured the path of the PAPI lights. The aircraft touched down 200 metres past the threshold at a 3.09g side load. The spoilers deployed automatically and main gear tyres 3 and 8 blew. The flap lever was moved involuntarily by the copilot, from the full position to position 2. The crew applied full manual braking and select reverse thrust. The Auto Brake function failed, after which the crew disconnected the antiskid braking system and continued to apply manual braking. The aircraft passed the end of runway 35, with a ground speed of 90 knots, hit the ILS localizer and stopped 232 meters further. Passengers and crew were evacuated using the slide at door 2R, thirty minutes after the aircraft stopped. All occupants escaped uninjured while the aircraft was considered as damaged beyond repair.
Probable cause:
Wrong approach configuration on part of the crew who decided to continue the approach to Quito Airport, knowing the poor runway conditions, poor weather conditions and the aircraft weight, and his failure to initiate a go-around procedure while forcing the aircraft to intercept the PAPI, causing the aircraft to be unstabilized.
Contributing factors:
- On the date of the incident, the crew did not have specific regulations and operating procedures (the briefing of the operator for the airport in Quito was inappropriate to the existent conditions).
- The fact that the crew still being experienced similar airports in Quito and had not experienced similar weather situations, circumstances that would have allowed a strategy of approximation consistent with the terms of this operation, in particular as regards:
- Calculations in flight for landing runway length,
- Minimum altitude to start the maneuver of changing the path of ILS to PAPI,
- Carrying out a very detailed briefing that allowed unwanted deviations on approach,
- The weather conditions existing at the time of landing (visibility, tail wind and moderate rain).

Crash of a Cessna 208B Grand Caravan in Cuenca: 5 killed

Date & Time: Mar 24, 2006 at 1102 LT
Type of aircraft:
Operator:
Registration:
HC-BXD
Flight Phase:
Survivors:
Yes
Site:
Schedule:
Cuenca – Macas
MSN:
208B-0591
YOM:
1997
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
12
Pax fatalities:
Other fatalities:
Total fatalities:
5
Captain / Total flying hours:
11250
Copilot / Total flying hours:
8007
Aircraft flight hours:
5736
Aircraft flight cycles:
10332
Circumstances:
Shortly after takeoff from runway 05 at Cuenca-Mariscal La Mar Airport, while climbing to a height of 300 feet, the engine failed. The airplane lost height, causing the nose wheel to struck the roof of a building. Out of control, the aircraft crashed onto a building occupied by a rubber company. Five passengers were killed while nine other occupants were seriously injured. There were no injuries on the ground. The aircraft was destroyed.
Probable cause:
Investigations revealed that one or more blades located on the turbine compressor failed as a result of deformation due to excessive high temperatures. It was also reported that the company's maintenance failed to follow the engine maintenance program that had not been inspected in accordance with the procedures published by the engine manufacturer. The Hot Section Inspection (HSI) should be performed at 3,600 flight hours but the airplane accumulated 200 additional hours since without the required checks.
Final Report:

Crash of a Fokker F28 Fellowship 4000 in Coca

Date & Time: Apr 7, 2005 at 0955 LT
Type of aircraft:
Operator:
Registration:
HC-CDA
Survivors:
Yes
Schedule:
Quito – Coca
MSN:
11230
YOM:
1986
Flight number:
ICD504
Location:
Country:
Crew on board:
5
Crew fatalities:
Pax on board:
60
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
36087
Aircraft flight cycles:
46662
Circumstances:
Following an uneventful flight from Quito, the crew started the approach to Coca Airport runway 15. Too low on final, the aircraft landed 4,5 metres short of runway. Upon impact, the left main gear was torn off. The aircraft rolled for 112 metres then veered off runway to the left, rolled another 263 metres then came to rest against a concrete wall. All 65 occupants were rescued, among them seven passengers were injured. The aircraft was damaged beyond repair.
Probable cause:
It was determined that the crew thought the Coca runway was short. To be able to stop the plane on the runway without excessive use of the brakes, the crew decided to land as early as possible. Doing so, the aircraft landed 4,5 metres short of runway. The published procedure request a minimum altitude of 50 feet over the threshold and the AFM showed a landing distance of 930 metres needed at maximum landing weight considering 42° of flaps, speed brakes out, lift dumpers armed, antiskid operative. Wrong approach procedure on part of the crew.

Crash of a Partenavia P.68 off Puerto Villamil: 2 killed

Date & Time: Dec 21, 2004 at 1219 LT
Type of aircraft:
Operator:
Survivors:
No
Schedule:
Baltra Island - Puerto Villamil
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
2
Circumstances:
The twin engine aircraft departed Galapagos International Airport (Baltra Island) at 1200LT on a flight to Puerto Villamil Airport, Isabela Island, carrying one passenger and one pilot. At 1219LT, the pilot was cleared to descend to Puerto Villamil Airport when he lost control of the airplane that crashed in the sea. The wreckage was found few hundred metres offshore at 1655LT. Both occupants were killed. The accident occurred three minutes prior to landing.

Crash of a Dornier DO.28D-2 Skyservant near Guayaquil

Date & Time: Mar 5, 2004 at 1755 LT
Type of aircraft:
Registration:
HC-CBK
Flight Phase:
Survivors:
Yes
Schedule:
Machala – Guayaquil
MSN:
4080
YOM:
1971
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
12
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
2977
Circumstances:
En route from Machala to Guayaquil, while cruising at an altitude of 6,000 feet in rain showers, the left engine lost power. The crew shut down the engine and feathered the propeller then decided to continue at an altitude of 600 feet and a speed of 80 knots. Several attempts to restart the left engine were unsuccessful when the right engine lost power as well. Unable to maintain a safe altitude, the crew attempted an emergency landing when the aircraft crashed in a river, some 23 km south of Guayaquil. All 14 occupants escaped with minor injuries and the aircraft was damaged beyond repair.
Probable cause:
A possible failure of the hydraulic pump on the left engine due to poor maintenance.

Crash of a Fokker F28 Fellowship 4000 in Quito

Date & Time: Jan 17, 2003 at 0940 LT
Type of aircraft:
Operator:
Registration:
HC-BMD
Flight Phase:
Survivors:
Yes
Schedule:
Quito – Tulcán – Cali
MSN:
11220
YOM:
1984
Flight number:
EQ120
Country:
Crew on board:
5
Crew fatalities:
Pax on board:
72
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
7085
Captain / Total hours on type:
4103.00
Copilot / Total flying hours:
1666
Copilot / Total hours on type:
124
Aircraft flight hours:
21547
Aircraft flight cycles:
40084
Circumstances:
During the takeoff roll on runway 35, at a speed of 125 knots, after a course of 2,110 metres, both tyres on the left main gear burst. The crew rejected the takeoff procedure but the aircraft was unable to stop within the remaining distance (runway 35 is 3,120 metres long). It overran, causing the nose gear to collapse, and came to rest 81 metres further. All 77 occupants escaped uninjured while the aircraft was damaged beyond repair.
Probable cause:
Lack of a positive actions and reaction on part of the crew following the bursting of both tires on the left main gear, causing the aircraft to overrun the runway.
Final Report:

Crash of a Dornier DO.28D-2 Skyservant in San Pablo: 1 killed

Date & Time: Sep 9, 2000 at 1751 LT
Type of aircraft:
Operator:
Registration:
HC-BNT
Flight Type:
Survivors:
Yes
Schedule:
Manta - San Pablo
MSN:
4342
YOM:
1979
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
1
Aircraft flight hours:
6234
Circumstances:
The airplane departed Manta-Eloy Alfaro Airport at 1711LT on a cargo flight to San Pablo, carrying one passenger, two pilots (among them an instructor) and a Load consisting of 70 boxes of shrimp larvae. En route, while cruising at an altitude of 5,000 feet, the right engine suffered power fluctuations. The instructor pilot switched on the auxiliary fuel pump and changed the fuel mixture but the engine problems persisted. On final approach to San Pablo, the right engine failed and the crew continued the approach on one engine. Following a high approach, the aircraft landed too far down the runway, about 292 metres from the runway end. It bounced and landed firmly six metres further. Realizing that the runway distance available was insufficient, the instructor pilot decided to initiate a go-around procedure. The aircraft climbed to a height of about 20 metres then impacted ground 140 metres to the right of the runway centreline and 26 metres past the runway end. The copilot was killed and both other occupants were seriously injured.
Probable cause:
The instructor pilot's decision to initiate a go-around procedure after landing in the last third portion of the runway with the right engine inoperative, an insufficient runway length and an aircraft's weight that required to stay on the ground. The following contributing factors were identified:
- The decision of the crew to continue the flight after the failure of the right engine that required an immediate landing,
- The crew failed to follow the checklist,
- Failure of the instructor pilot to proceed to an adequate approach briefing,
- Wrong approach configuration,
- Lack of awareness about the runway's characteristics on part of the pilot-in-command,
- The total weight of the aircraft was above the permissible limit,
- Lack of crew coordination,
- The crew mistakenly feathered the left propeller.

Crash of a Tupolev TU-154M in Quito: 80 killed

Date & Time: Aug 29, 1998 at 1303 LT
Type of aircraft:
Operator:
Registration:
CU-T1264
Flight Phase:
Survivors:
Yes
Schedule:
Quito - Guayaquil - Havana
MSN:
85A720
YOM:
1985
Flight number:
CU389
Country:
Crew on board:
14
Crew fatalities:
Pax on board:
77
Pax fatalities:
Other fatalities:
Total fatalities:
80
Aircraft flight hours:
9256
Circumstances:
While parked on the apron at Quito-Mariscal Sucre Airport, the crew started the engine when a pneumatic valve blocked. The problem was resolved and two engines were started with ground power unit while the third engine was started during taxi. During the takeoff roll on runway 17, at Vr speed, the pilot-in-command started the rotation but the aircraft failed to respond. For unknown reasons, the crew took 10 seconds to decide to abort the takeoff. The captain initiated an emergency braking procedure but the remaining distance of 800 metres was insufficient. Unable to stop, the aircraft overran, struck a concrete wall, an auto spare parts building and crashed near a soccer field, bursting into flames. Seventy people in the aircraft was well as 10 people on the ground were killed while 21 people in the airplane and 15 on the ground were injured, some seriously. At the time of the accident, the total weight of the aircraft was 73,309 kilos, within limits.
Probable cause:
It is believed that the crew failed to follow the taxi and pre-takeoff checklist and forgot to select the switches for the hydraulic valves of the control system. No technical anomalies were found on the aircraft and engines.