CEN14LA430

NTSB accident investigation · Bombardier CL600 2D24 - 900 · San Antonio, TX · August 9, 2014

Accident · No injuriesLimited investigationFinal report
Date
August 9, 2014, 07:34 local (12:34 UTC)
Place
San Antonio, TX
Injuries
80 uninjured
Damage
Substantial damage
Phase of flight
Pushback/towing
Aircraft
N943LRBombardier CL600 2D24 - 900
Defining event
Pushback/towing: Ground collision
Weather
Visual (VMC) · Day
Status
Completed · report August 28, 2017
Report
Approved by Office Director
NTSB office
Central Region
Parties
Federal Aviation Administration, NTSB
FAA report
20140809018479A
Case key
89879

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

Failure of the tow bar shear pin, which resulted in the tug operator’s loss of control of the airplane during pushback operations. Contributing to the accident was the tug operator’s inability to communicate to the flight crew to apply the airplane’s brakes.

Findings · 2

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Use of equip/info: use of equip/systemPersonnel issues › Task performance · Ground crewBombardier CL-600-2D24: 1 caseAll aircraft: 1,391 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

During pushback from the gate, the tug positioned the airplane on the taxiway. Before disconnecting, the tug reversed and the airplane rolled forward while still attached to the tug. As the airplane rolled past the tug, the tug impacted the left side of the fuselage. The tow bar pin was found sheared, but it could not be determined if the pin failed before or during the tow operation. Further, the operator did not have an immediate means of communicating with the flight crew the need to apply the brakes while the tug was still attached. The tug operator's postaccident urine test was positive for marijuana, which indicated prior use. However, it could not be determined whether the tug operator was impaired by the effects of marijuana at the time of the event.

Factual narrative

On August 9, 2014, about 0735 central daylight time (CDT), a Bombardier CL600 airplane, N943LR, collided with a tug during pushback from the gate at San Antonio International Airport (SAT) San Antonio, Texas. The airplane sustained substantial damage to the fuselage structure and internal damage to nose landing gear. The airplane was registered to and operated by Mesa Airlines Inc. as US Airways flight 2763. The four flight crewmembers and passengers on-board were not injured. Visual meteorological conditions prevailed at the time of the accident and the flight operated on a instrument flight rules flight plan. The scheduled, domestic passenger flight was operated under the provisions of 14 Code of Federal Regulations Part 121. The flight was destined for Phoenix Sky Harbor International Airport (PHX), Phoenix, Arizona. The first officer reported the tug driver did not have an operable headset and the pushback was initiated using hand signals. The airplane was positioned on the ramp at a 90-degree angle to the gate. The tug driver stated after turning the airplane onto the taxiway he "reversed back," pulling the airplane forward. The tug stopped perpendicular to the left nose of the airplane, but the airplane continued to roll forward while still attached to the tow bar. The airplane rolled into the tug impacting the left side of the fuselage. Examination revealed the tow bar shear pin had failed, but the investigation could not determine if the shear pin failed prior to or during the pushback process. In accordance with company policies and procedures, a postaccident drug test of the tug driver was administered about 9 hours after the accident, which was positive for marijuana. According to 49 CFR Part 40 Section 40.87, the initial test cut off is 50 ng/ml, but a positive marijuana test can be reported if the confirmatory test identifies 15 ng/ml or more of marijuana metabolite (tetrahydrocannabinol carboxylic acid, or THC-COOH) in urine. According to the NTSB Medical Officer, about 30% of THC is eventually excreted in urine, primarily as THC-COOH. However, its presence in urine only indicates prior THC exposure. After smoking marijuana, it can take as long as four hours for THC-COOH to appear in the urine at concentrations above the initial reporting cut off of 50 ng/ml. Positive urine test results generally indicate use within hours to a few days; however, the detection window can be significantly longer following chronic, heavy use.

Aircraft

Registration
N943LR
Reported as
Bombardier CL600 2D24 - 900
Category
Airplane
Serial number
15068
Built
2006
Airframe hours
12,283
Engines
General Electric CF34-8C5, 14,500 lbs thrust, turbo fanGeneral Electric CF34-8C5, 14,500 lbs thrust, turbo fan
Damage
Substantial damage
Flight
Part 121
Operator
Mesa Airlines Inc, doing business as American Eagle
Registered owner
Mesa Airlines Inc
Airworthiness certificate
Standard, Transport
Last inspection
Continuous airworthiness · June 26, 2014
Departed
SAT · San Antonio, TX
Destination
PHX · Phoenix, AZ
Flight plan
IFR
Airport
SAT · San Antonio Intl
Equipment
Electronic flight bag or handheld device, Electronic multifunction display, Electronic primary flight display, Onboard weather, Stall warning system, Angle of attack indicator, Auto-pilot, Data recorder

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew · 4

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
46
Injuries
None
Certificates
Airline transport, Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, With waivers/limitations
Last flight review
February 9, 2014
Seat
Left
Flight hours
11,454 total · 10,871 in this make and model · 11,381 as pilot in command · 238 in the last 90 days · 72 in the last 30 days · 4 in the last 24 hours
Role
Co-pilot
Age
35
Injuries
None
Certificates
Airline transport, Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, Without waivers/limitations
Last flight review
October 9, 2013
Seat
Right
Flight hours
1,864 total · 1,864 in this make and model · 208 in the last 90 days · 64 in the last 30 days · 4 in the last 24 hours
Role
Other flight crew
Injuries
None
Seat
Rear
Restraint
5-point
Role
Other flight crew
Injuries
None
Seat
Front

Weather

Conditions
Visual (VMC) · Day
Wind
180° at 5 knots
Visibility
10 statute miles
Temperature
79 °F, dew point 72 °F
Altimeter
30.02 inHg
Observed at
KSAT, 1 nm away

Docket · 6

The files NTSB released with the investigation on June 15, 2017, on NTSB’s docket system: statements, records, photos and specialists’ reports. 933 KB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.