# NTSB DCA16CA009: Boeing 757 223, N183AN, Dallas, TX, October 21, 2015 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Data collection · Final report - Date: October 21, 2015, 17:56 local (22:56 UTC) - Place: Dallas, TX - Coordinates: 32.89722, -97.03778 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=32.8972&lon=-97.0378&mi=10 - Phase of flight: [Standing](https://openairdocs.org/ntsb-phases/150) (OpenAirDocs' grouping) - Defining event: [Standing-engine(s) not oper: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) - Highest injury: Serious injuries - Injuries: 1 serious, 166 uninjured - Status: Completed, report April 8, 2016 - Report: Approved by Office Director - NTSB office: Major Investigations Division - NTSB case key (mKey): 92219 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=DCA16CA009 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/92219/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=92219 - Page: https://openairdocs.org/ntsb/DCA16CA009 ## Probable cause the disabled passenger not being properly secured during the transfer from the aisle chair causing him to slide to floor and receive a serious injury. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Action: incorrect action performance](https://openairdocs.org/ntsb-findings/02041015): Personnel issues › Action/decision · Other (probable cause); cases with it: [Boeing 757-223, 3 cases](https://openairdocs.org/ntsb-findings/02041015/cases.md?model=1384957), [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. - [Standing-engine(s) not oper: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) (defining event); cases with it: [Boeing 757-223, 1 case](https://openairdocs.org/ntsb-events/900/sequence.md?model=1384957), [All aircraft, 1,556 cases](https://openairdocs.org/ntsb-events/900/sequence.md) ## Analysis According to a company report, after boarding all other passengers, gate agents proceeded with boarding a quadriplegic passenger who required assistance and use of an aisle chair to be moved to his seat on the airplane. A seatbelt and additional belts across the passenger's chest were used to secure him in the aisle chair while moving him onboard. When the belts were removed in order to transfer the passenger from the aisle chair to the airplane seat the passenger slid to the floor. The passenger was then lifted into his seat by the gate agents. According to crew statements, after the gate agents left the airplane and the jetway had been retracted, a flight attendant (FA) observed that the passenger appeared to be injured and the crew requested emergency services. The passenger was transported to a hospital and diagnosed with a broken right tibia. ## Factual narrative According to a company report, after boarding all other passengers, gate agents proceeded with boarding a quadriplegic passenger who required assistance and use of an aisle chair to be moved to his seat on the airplane. A seatbelt and additional belts across the passenger's chest were used to secure him in the aisle chair while moving him onboard. When the belts were removed in order to transfer the passenger from the aisle chair to the airplane seat the passenger slid to the floor. The passenger was then lifted into his seat by the gate agents. According to crew statements, after the gate agents left the airplane and the jetway had been retracted, a flight attendant (FA) observed that the passenger appeared to be injured and the crew requested emergency services. The passenger was transported to a hospital and diagnosed with a broken right tibia. ## Aircraft - Registration: [N183AN](https://openairdocs.org/deregistered/N183AN-2022-02-28), registration cancelled 2022-02-28, S/N 29593, built 1999 (OpenAirDocs) - Reported make and model: BOEING 757 223 (223) - Registry model: [Boeing 757-223](https://openairdocs.org/model/boeing-757-223) (registry code 1384957) (OpenAirDocs) - Registry engine: [Rolls-Royce RB-211 series](https://openairdocs.org/engine/rolls-royce-rb-211-series) (registry code 54555, turbo-fan) (OpenAirDocs) - Category: Airplane - Serial number: 29593 - Year built: 1999 - Engines: ROLLS-ROYC RB.211 SERIES turbo fan; ROLLS-ROYC RB.211 SERIES turbo fan - Damage: No damage - Flight: Part 121 - Operator: American Airlines Inc - Registered owner: American Airlines Inc - Airworthiness certificate: Standard, Transport - Departed: DFW, Dallas, TX - Destination: MCO, Orlando, FL - Airport: DFW, Dallas / Ft Worth - Equipment: Unknown ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 62; injuries: none; airline transport; airplane ratings: multi-engine land; instrument ratings: airplane; medical: class 1, without waivers/limitations; seat: left; flight hours: 11,468 total, 807 in this make and model - Co-pilot; age 53; injuries: none; airline transport; airplane ratings: multi-engine land; instrument ratings: airplane; medical: class 1, without waivers/limitations; seat: right; flight hours: 2,876 total, 650 in this make and model ## Weather - Conditions: Day - Wind: 110° at 12 knots - Visibility: 10 statute miles - Lowest ceiling: 25,000 ft broken - Temperature: 82 °F, dew point 63 °F - Altimeter: 30.06 inHg - Observed at: KDFW ## Docket (2 files) The files NTSB released with the investigation on April 8, 2016, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=92219. 1.1 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 845 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40438701&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Employee Statements (item 2, .PDF, 302 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40438702&FileExtension=.PDF&FileName=Employee%20Statements-Master.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.