FTW99FA201

NTSB accident investigation · Aerospatiale ATR-42-500 · Little Rock, AR · July 28, 1999

Accident · FatalField investigationFinal report
Date
July 28, 1999, 11:27 local (16:27 UTC)
Place
Little Rock, AR
Injuries
1 fatal, 36 uninjured; on the ground: 1 fatal
Damage
Minor damage
Phase of flight
Standing
Aircraft
N14451Aerospatiale ATR-42-500
Weather
Visual (VMC) · Day
Status
Completed · report October 10, 2000
Report
Approved by Office Director
FAA report
19990728010019A
Case key
46926

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

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Probable cause

The station manager's inadvertent encounter with the rotating propeller due to his diverted attention.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Propeller/rotor contact to personStanding - engine(s) operating
Propeller/jet blast encounter - inadvertentGround personnelCause
Diverted attentionGround personnelCause

Analysis

The turbo-propeller airplane was standing with both engines running when the station manager inadvertently walked into a rotating propeller. Witnesses to the accident stated that the airplane came to a stop on the ramp, and the station manager walked from behind the left wing toward the nose of the airplane. According to the witnesses, the station manager appeared to be listening to, or talking on, a shoulder mounted radio and then looked up at the people in the terminal. He looked back down and contacted the left propeller.

Factual narrative

History of flight

On July 28, 1999, at 1127 central daylight time, an Aerospatiale ATR 42-500 turbo-propeller airplane, N14451, was terminating its flight at gate 7 at Adams Field, Little Rock, Arkansas, when a ground crewmember received fatal injuries from contact with a rotating propeller. The two pilots, one flight attendant, and 33 passengers on board were not injured. The airplane, which received minor damage, was registered to Continental Express, Inc., and operated as Jet Link flight 3402. Visual meteorological conditions prevailed and an instrument flight rules flight plan was filed for the 14 Code of Federal Regulations Part 121 scheduled domestic passenger flight, which originated from Houston, Texas, at 0830.

According to ground personnel, who were working the aircraft at the time of the accident, the airplane was marshaled to a stop on the parking ramp. Shortly after the airplane stopped, the ground crew heard a noise and saw that the station manager, who was acting as the left wing walker, was laying on the ground outboard of the left propeller.

During interviews conducted by the NTSB investigator-in-charge, witnesses, watching the arrival of the airplane from inside the terminal building, stated that the station manager walked from behind the left wing toward the nose of the airplane. According to the witnesses, the station manager appeared to be listening to, or talking on, a shoulder mounted radio and then looked up at the people in the terminal. The station manager then looked back down and contacted the left propeller.

Personnel information

According to personnel with Continental Express, the station manager had been working as a ground operator for approximately 31 years. At the time of the accident, he was employed by Continental Express as the Little Rock facilities station manager. On January 10, 1998, the station manager received recurrent training and a certificate of completion from Continental Express in the following areas:

Ramp Safety Emergency Procedures Ground Support Equipment BE1900 Aircraft Familiarization Embraer 120 Familiarization ATR-72 Aircraft Familiarization ATR 42-300/500 Familiarization

The station manager's co-workers stated that he was in a "good mood" the morning of the accident. He reported to work prior to the first airplane arrival of the morning, which was around 0500. The co-workers added that the station manager appeared to be in "good health." When asked if the station manager was wearing any hearing protection at the time of the accident, they replied in the negative.

Meteorological information

At 1153, the Adams Field weather observation facility reported the wind from 290 degrees at 9 knots, scattered clouds at 4,000 feet agl, visibility 7 statute miles, temperature 97 degrees Fahrenheit, dewpoint 72 degrees Fahrenheit, and altimeter setting 30.02 inches of mercury.

Medical and pathological information

A medical examination was performed on the station manager at the Pulaski County Coroner's office. Tests for drugs were negative. Tests for alcohol revealed "0.035g%" present in the blood, which was "ethanol production from post-mortem decomposition."

Additional information

Two of the ground personnel, who were working the accident airplane when the accident occurred, stated that the airplane taxied to the ramp with both engines running. They added that airplanes would "sometimes taxi into the ramp area with the left engine shut down to expedite the removal of baggage and passengers." The ground personnel stated that it "was not unusual for the airplane to taxi onto the ramp with both engines running to assist in sharp turns to the right." They added that it was up to them to ensure that they did not approach the airplane until both propellers were stopped.

The aircraft's flight log indicated that on July 27, 1999, there was a "#1 DC Gen [Generator] Fault," and the airplane was released in accordance with Minimum Equipment List (MEL)24-30-01A. Part of that MEL instruction requires that "single engine taxi is not conducted." According to personnel at Aerospatiale ATR support, the reason single-engine taxi is prohibited with one generator inoperative, is to prevent the pilots from inadvertently shutting off the remaining operative generator, which would lead to a Basic Electrical Power situation, and would result in the loss of normal aircraft braking.

Continental Express issued an Alert Bulletin 92-3 on November 23, 1992, which pictorially defined a propeller danger area for the ATR-42. The propeller danger area extended from just aft of the cockpit back to the trailing edge of the wing, and from the fuselage outboard to the wing tips. The Alert Bulletin stated that the "Propeller Danger Area should NEVER be entered when the propeller or propellers are spinning." See the enclosed excerpts from the Continental Express Ground Operations Manual (Volume 5) for more details.

The airplane was released to the operator on July 28, 1999.

Aircraft

Registration
N14451
Reported as
Aerospatiale ATR-42-500 (ATR 42-500)
Category
Airplane
Serial number
512
Airframe hours
7,949
Engine
P&W PW-127-E, 2,750 horsepower, turbo prop
Damage
Minor damage
Flight
Part 121
Registered owner
Continental Express, Inc.
Airworthiness certificate
Standard, Transport
Last inspection
Continuous airworthiness · July 8, 1999 · 195 hours before
Departed
IAH · Houston, TX
Destination
LIT
Flight plan
IFR
Airport
LIT · Adams Field

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

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
25
Certificate
Airline transport
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Left
Flight hours
2,748 total

Weather

Conditions
Visual (VMC) · Day
Wind
290° at 9 knots
Visibility
7 statute miles
Lowest ceiling
None
Temperature
97 °F, dew point 72 °F
Altimeter
30.00 inHg
Observed at
LIT

FAA reports on this event · 1

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