Aircraft Accident/Incident Report

Nashville, Tennessee 37217
Tuesady, May 3, 1994 6:03 CDT

NTSB Narrative Summary Released at Completion of Accident

THE ACFT WAS PARKED ON THE RAMP OVER NIGHT, UNCOVERED, IN CONTINOUS RAIN. TAKEOFF WAS MADE IN HARD RAIN. AFTER REACHING CRUISE FLIGHT (FL250), ENGINE POWER INTERRUPTIONS OCCURRED IN BOTH ENGINES. FLIGHT CONDITIONS WERE IMC, -20 DEG. OAT, AND LIGHT RIME ICING. ALSO, ALL AIRSPEED INDICATIONS DECREASED TO ZERO. A DESCENT WAS BEGUN, AND THE FLIGHT CREW DECLARED AN EMERGENCY. THE AIRPLANE WAS LANDED SAFELY AT ITS DESTINATION. THE INVESTIGATION DISCOVERED THAT ENGINE POWER INTERRUPTIONS HAVE OCCURRED IN LIGHT ICING CONDITIONS SINCE THE INTRODUCTION INTO REVENUE SERVICE OF THE ACFT. AD'S WERE ISSUED TO PROHIBIT REVENUE FLTS, THEN FLTS IN ICING CONDITIONS WITHOUT AN AUTO IGNITION. THE MANUFACTURER HAD DETERMINED THAT ICE/SLUSH COULD BUILD UP ON THE INLET PARTICLE SEPARATOR, BREAK OFF, AND ENTER THE ENGINE, RESULTING IN FLAMEOUT. THE ICE/SLUSH COULD NOT BE SEEN BY THE PILOTS, AND WAS NOT REDUCED BY ENGINE ANTI-ICE. AN AUTO IGNITION WAS ADDED THAT RESTARTED THE ENGINE WITHIN 2 SECONDS. ACFT CERTIFICATION RULES REQIRE THAT NO ACCUMULATION OF ENGINE INLET ICE OCCUR THAT WILL ADVERSELY AFFECT THE ENGINE OPERATION.

NTSB Probable Cause Narrative

ENGINE ICE/SLUSH INGESTION THAT RESULTED IN POWER INTERRUPTIONS AND FAILURE OF THE AIR DATA COMPUTER COUPLED WITH MOISTURE INGESTION OF THE STATIC SYSTEM. FACTORS WERE THE FAILURE OF THE MANUFACTURER TO CORRECT A PREVIOUSLY IDENTIFIED DESIGN DEFICIENCY THAT PERMITTED THE ACCUMULATION OF ENGINE INLET ICE/SLUSH, WHICH COULD NOT BE OBSERVED BY THE FLIGHT CREW, NOR PREVENTED BY ON-BOARD ENGINE ANTI-ICE EQUIPMENT, THE LACK OF A PROACTIVE STANCE BY THE FAA WHEN INVOLVED WITH AIRCRAFT CERTIFICATION UNDER BI-LATERAL AGREEMENTS, AND THE INADEQUACY OF THE FEDERAL AVIATION REGULATIONS REGARDING ENGINE INLET ICE PROTECTION.

Event Information

Type of Event Incident
Event Date 5/3/1994
Event Day of the Week Tuesday
Time of Event 603
Event Time Zone Central Daylight Time
Event City NASHVILLE
Event State TENNESSEE
Event Country --
Zipcode of the event site 37217
Event Date Year 1994
Event Date Month 5
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude
Event Location Longitude
Event Location Airport
Event Location Nearest Airport ID
Indicates whether the acc/inc occurred off or on an airport Off Airport/Airstrip
Distance from airport in statute miles --
Degrees magnetic from airport --
Airport Elevation --
Weather Briefing Completeness Full
Investigator's weather source Weather Observation Facility
Time of the weather observation 644 Central Daylight Time
Direction of event from weather observation facility (degrees) 210
Weather Observation Facility ID BNA
Elevation of weather observation facility 598
Distance of event from weather observation facility (units?) 87
Time Zone of the weather observation CDT
Lighting Conditions Day
Lowest Ceiling Height 3200
Lowest Non-Ceiling Height 0
Sky/Lowest/Cloud Conditions Unknown
Sky Condition for Lowest Ceiling Overcast
Visibility Runway Visual Range (Feet) 0
Visibility Runway Visual Value (Statute Miles) 0
Visibility (Statute Miles) 2.5
Air Temperature at event time (in degrees celsius) 10
Dew Point at event time (in degress fahrenheit) 9
Wind Direction (degrees magnetic) 40
Variable Wind Indicator Unknown
Wind Speed (knots) 4
Wind Velocity Indicator Unknown
Wind Gust Indicator Not Gusting
Wind Gust (knots) 0
Altimeter Setting at event time (in. Hg) 30
Density Altitude (feet) --
Intensity of Precipitation Light
METAR weather report --
Event Highest Injury None
On Ground, Fatal Injuries 0
On Ground, Minor Injuries 0
On Ground, Serious Injuries 0
Injury Total Fatal --
Injury Total Minor --
Injury Total None 16
Injury Total Serious --
Injury Total All --
Investigating Agency NTSB
NTSB Docket Number (internal use) 5030
NTSB Notification Source --
NTSB Notification Date May 3 1994 12:00AM
NTSB Notification Time 1215
Fiche Number and/or location -used to find docket information IMAGE
Date of most recent change to record Dec 6 2000 11:10AM
User who most recently changed record dbo
Basic weather conditions Instrument Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N245AE
NTSB Number ATL94IA092
Missing Aircraft Indicator N
Federal Aviation Reg. Part Part 135: Air Taxi & Commuter
Type of Flight Plan filed IFR
Flight plan Was Activated? --
Damage None
Aircraft Fire None
Aircraft Explosion None
Aircraft Manufacturer's Full Name Saab-Scania AB (Saab)
Aircraft Model S340B
Aircraft Series Identifier S340B
Aircraft Serial Number 340B-245
Certified Max Gross Weight 29000
Aircraft Category Airplane
Aircraft Registration Class U.S. Registered/U.S. Soil
Aircraft is a homebuilt? No
Flight Crew Seats --
Cabin Crew Seats --
Passenger Seats --
Total number of seats on the aircraft 36
Number of Engines 2
Fixed gear or retractable gear Retractable
Aircraft, Type of Last Inspection Continuous Airworthiness
Date of Last Inspection Apr 26 1994 12:00AM
Airframe hours since last inspection 46
Airframe Hours 6003
ELT Installed Yes
ELT Activated No
ELT Aided Location of Event Site Unknown
ELT Type --
Aircraft Owner Name FLAGSHIP AIRLINES
Aircraft Owner Street Address P.O.BOX 619616 MD 4280
Aircraft Owner City DFW AIRPORT
Aircraft Owner State TX
Aircraft Owner Country
Aircraft Owner Zipcode 75261
Operator is an individual? --
Operator Name WINGS WEST AIRLINES, INC.
Operator Same as Owner? No
Operator Is Doing Business As --
Operator Address Same as Owner? No
Operator Street Address 835 AIRPORT DRIVE
Operator City SAN LUIS OBISBO
Operator State CA
Operator Country
Operator Zip code 93403
Operator Code WWMA
Owner has at least one certificate Yes - certificate holder
Other Operator of large aircraft? No
Certified for Part 133 or 137 Operation Unknown
Operator Certificate Number --
Indicates whether an air carrier operation was scheduled or not Scheduled
Indicates Domestic or International Flight Domestic
Operator carrying Pax/Cargo/Mail Passenger Only
Type of Flying (Per_Bus / Primary) Unknown
Second Pilot on Board Yes
Departure Point Same as Event No
Departure Airport Code BTR
Departure City BATON ROUGE
Departure State LA
Departure Country
Departure Time 512
Departure Time Zone CDT
Destination Same as Local Flt crash at destination city
Destination Airport Code BNA
Destination City
Destination State TN
Destination Country
Specific Phase of Flight Cruise
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record Jan 2 2001 10:30AM
User who most recently changed record dbo
Since inspection or accident --
Event Location Runway Number and Location 0
Runway Length --
Runway Width --
Sight Seeing flight No
Air Medical Flight No
Medical Flight --