# NTSB CEN12LA457: Bombardier CL-600-2C10, N502AE, Peoria, IL, July 19, 2012 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: July 18, 2012, 22:00 local (Jul 19, 2012, 03:00 UTC) - Place: Peoria, IL - Coordinates: 40.664165, -89.693336 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=40.6642&lon=-89.6933&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Defining event: [Approach: Sys/Comp malf/fail (non-power)](https://openairdocs.org/ntsb-events/330) - Highest injury: Serious injuries - Injuries: 1 serious, 56 uninjured - Status: Completed, report April 10, 2013 - Report: Approved by Office Director - NTSB office: Central Region - NTSB case key (mKey): 84369 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN12LA457 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/84369/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=84369 - Page: https://openairdocs.org/ntsb/CEN12LA457 ## Probable cause The emergency ground egress during which a passenger broke her ankle. Contributing to the accident was the failure of the environmental system, which allowed smoke from a nearby house fire to enter the airplane. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Air conditioning system: cooling sys (air/vapor cycle)](https://openairdocs.org/ntsb-findings/01022150): Aircraft › Aircraft systems · Failure (probable cause); cases with it: [Bombardier CL-600-2C10, 1 case](https://openairdocs.org/ntsb-findings/01022150/cases.md?model=1390015), [All aircraft, 1 case](https://openairdocs.org/ntsb-findings/01022150/cases.md) - [Physical workspace: air quality/dust/smoke](https://openairdocs.org/ntsb-findings/03041025): Environmental issues › Task environment · Decision related to condition (probable cause); cases with it: [Bombardier CL-600-2C10, 1 case](https://openairdocs.org/ntsb-findings/03041025/cases.md?model=1390015), [All aircraft, 9 cases](https://openairdocs.org/ntsb-findings/03041025/cases.md) - [Action: incorrect action performance](https://openairdocs.org/ntsb-findings/02041015): Personnel issues › Action/decision · Passenger (probable cause); cases with it: [Bombardier CL-600-2C10, 2 cases](https://openairdocs.org/ntsb-findings/02041015/cases.md?model=1390015), [All aircraft, 1,386 cases](https://openairdocs.org/ntsb-findings/02041015/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Approach: Sys/Comp malf/fail (non-power)](https://openairdocs.org/ntsb-events/330) (defining event); cases with it: [Bombardier CL-600-2C10, 2 cases](https://openairdocs.org/ntsb-events/330/sequence.md?model=1390015), [All aircraft, 994 cases](https://openairdocs.org/ntsb-events/330/sequence.md) - [Landing: Fire/smoke (non-impact)](https://openairdocs.org/ntsb-events/150); cases with it: [Bombardier CL-600-2C10, 2 cases](https://openairdocs.org/ntsb-events/150/sequence.md?model=1390015), [All aircraft, 504 cases](https://openairdocs.org/ntsb-events/150/sequence.md) - [Other: Evacuation](https://openairdocs.org/ntsb-events/460); cases with it: [Bombardier CL-600-2C10, 1 case](https://openairdocs.org/ntsb-events/460/sequence.md?model=1390015), [All aircraft, 103 cases](https://openairdocs.org/ntsb-events/460/sequence.md) ## Analysis While on approach to the airport, the flight crew smelled smoke in the airplane. The airplane landed without incident and the crew directed an emergency ground egress. During the ground egress, one passenger broke her ankle. A postflight review of the airplane found that the airplane was operating on a single environmental pack that failed during the final approach, resulting in ambient air entering the airplane via the ram air inlet. An assessment of the airplane did not find any on-board sources of smoke. However, smoke from a large house fire was present along the airplane's approach path and likely was the source of smoke detected by the crew. ## Factual narrative On July 18, 2012, about 2200 central daylight time, a Bombardier CL-600-2C10 airplane, N502AE, operating as American Eagle Flight 3773, diverted to the General Downing-Peoria International Airport (KPIA), Peoria, Illinois, due to weather. During the approach the crew detected smoke and after landing, an emergency evacuation was performed. The two pilots, two cabin crew, and 52 passengers were uninjured. One passenger sustained a serious injury during the egress. The airplane was owned and operated by American Airlines, Inc. under the provisions of the Code of Federal Regulations Part 121 as a scheduled passenger flight. Night visual meteorological conditions prevailed for the flight that was operated on an instrument flight rules flight plan. The flight departed Denver International Airport (KDEN) about 1855 mountain daylight time, and was originally destined for the Chicago O'Hare International Airport (KORD), Chicago, Illinois. The flight had diverted from KORD to KPIA due to weather. While on a three mile final to land, the crew detected smoke in the airplane. After landing, the crew directed an emergency ground egress. The two over wing exit and the main entrance door was utilized for the evacuation. During the egress, one passenger sustained a broken ankle. No obvious source of the smoke was determined during a post-landing examination. No damage to the airplane was observed. An examination of the airplane revealed that the airplane was operating on a single environmental pack, allowed per the airplane's minimum equipment list. The remaining environmental pack failed while the airplane was on final approach, reverting the system to allow ambient air to enter the airplane. There were no sources of fire located within the airplane. However, along the airplane's approach path to the airport, it overflew a large house fire. ## Aircraft - Registration: [N502AE](https://openairdocs.org/aircraft/N502AE), registered now, S/N 10018, built 2001 (OpenAirDocs) - Reported make and model: BOMBARDIER INC CL-600-2C10 - Registry model: [Bombardier CL-600-2C10](https://openairdocs.org/model/bombardier-cl-600-2c10) (registry code 1390015) (OpenAirDocs) - Registry engine: [GE CF34 series](https://openairdocs.org/engine/ge-cf34-series) (registry code 30015, turbo-fan) (OpenAirDocs) - Category: Airplane - Serial number: 10018 - Engines: GE CF34 SERIES 9140 lbs thrust turbo fan; GE CF34 SERIES 9140 lbs thrust turbo fan - Damage: No damage - Flight: Part 121 - Operator: American Eagle Airlines Inc, doing business as American Eagle Airlines, Inc. - Registered owner: American Eagle Airlines Inc - Airworthiness certificate: Standard, Transport - Departed: DEN, Denver, CO - Destination: ORD, Chicago, IL - Flight plan: IFR - Airport: PIA, General Downing-Peoria ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 48; injuries: none; airline transport, flight instructor, commercial; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 1, with waivers/limitations; last flight review June 4, 2012; seat: left; flight hours: 16,462 total, 10,474 as pilot in command - Pilot; age 24; injuries: none; flight instructor, commercial; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1, without waivers/limitations; last flight review August 27, 2011; seat: right; flight hours: 1,377 total ## Weather - Conditions: Visual (VMC), Night - Wind: 190° at 4 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 84 °F, dew point 70 °F - Altimeter: 29.86 inHg - Observed at: KPIA ## Docket (1 files) The files NTSB released with the investigation on September 14, 2012, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=84369. 889 KB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 889 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40375925&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.