# NTSB GAA19CA288: Luscombe 8, N45729, Carbondale, IL, May 26, 2019 - Type: NTSB accident investigation - Classification: Accident · No injuries · Data collection · Final report - Date: May 26, 2019, 13:35 local (18:35 UTC) - Place: Carbondale, IL - Coordinates: 37.778057, -89.251945 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=37.7781&lon=-89.2519&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing-flare/touchdown: Loss of control on ground](https://openairdocs.org/ntsb-events/230) - Highest injury: No injuries - Injuries: 2 uninjured - Status: Completed, report April 13, 2020 - Report: Approved by Office Director - NTSB office: General Aviation Accidents - NTSB case key (mKey): 99506 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=GAA19CA288 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/99506/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=99506 - Page: https://openairdocs.org/ntsb/GAA19CA288 ## Probable cause The pilot's inadvertent left heel brake application during the landing roll, which resulted in a noseover. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Luscombe 8A, 39 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=8190104), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Luscombe 8A, 8 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=8190104), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) - [Landing gear system: brake](https://openairdocs.org/ntsb-findings/01023242): Aircraft › Aircraft systems · Unintentional use/operation (probable cause); cases with it: [Luscombe 8A, 4 cases](https://openairdocs.org/ntsb-findings/01023242/cases.md?model=8190104), [All aircraft, 297 cases](https://openairdocs.org/ntsb-findings/01023242/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing-flare/touchdown: Loss of control on ground](https://openairdocs.org/ntsb-events/230) (defining event); cases with it: [Luscombe 8A, 32 cases](https://openairdocs.org/ntsb-events/230/sequence.md?model=8190104), [All aircraft, 4,585 cases](https://openairdocs.org/ntsb-events/230/sequence.md) - [Landing-flare/touchdown: Runway excursion](https://openairdocs.org/ntsb-events/300); cases with it: [Luscombe 8A, 18 cases](https://openairdocs.org/ntsb-events/300/sequence.md?model=8190104), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) - [Landing-flare/touchdown: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Luscombe 8A, 33 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=8190104), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The pilot reported that, during the landing roll, the airplane encountered a wind gust. He applied right rudder to counter the gust; however, his foot slipped off the right rudder pedal. To prevent a runway excursion to the left, the pilot attempted to use only the right heel brake to realign the airplane's heading; however, he inadvertently depressed both the left and right heel brakes, and the airplane nosed over. The airplane sustained substantial damage to the vertical stabilizer and the rudder. The pilot reported that there were no preaccident mechanical malfunctions or failures with the airplane that would have precluded normal operation. ## Factual narrative The pilot in the tailwheel-equipped airplane reported that during the landing roll, the airplane encountered a wind gust. He applied right rudder to counter the gust, however, his foot slipped "completely off" the right rudder pedal. A runway excursion to the left was imminent, and the pilot attempted to use only the right heel brake to realign the airplane's heading. However, he inadvertently depressed both the left and right heel brakes, and the airplane nosed over. The airplane sustained substantial damage to the vertical stabilizer and the rudder. The pilot reported that there were no mechanical malfunctions or failures with the airplane that would have precluded normal operation. ## Aircraft - Registration: [N45729](https://openairdocs.org/aircraft/N45729), registered now, S/N 2256, built 1946 (OpenAirDocs) - Reported make and model: Luscombe 8 (A) - Registry model: [Luscombe 8A](https://openairdocs.org/model/luscombe-8a) (registry code 8190104) (OpenAirDocs) - Registry engine: [Continental A&C65 series](https://openairdocs.org/engine/continental-a-c65-series) (registry code 17003, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 2256 - Year built: 1946 - Airframe hours: 2044.9 - Engines: Continental A65-8 65 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, February 19, 2019 - Departed: HRO, Harrison, AR - Destination: MDH, Carbondale, IL - Airport: MDH, Southern Illinois, runway 36R, 6,506 × 100 ft, asphalt - Equipment: Electronic flight bag or handheld device, Handheld GPS ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 61; injuries: serious; flight instructor, commercial, flight engineer, airline transport; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1, with waivers/limitations; last flight review August 18, 2018; seat: left; restraint: 3-point; flight hours: 20,300 total, 32 in this make and model, 16,870 as pilot in command, 134 in the last 90 days, 21 in the last 30 days, 7 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 330° at 8 knots - Visibility: 10 statute miles - Temperature: 82 °F, dew point 73 °F - Altimeter: 30.04 inHg - Observed at: KMDH ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20190526005189A](https://openairdocs.org/incident/20190526005189A), May 26, 2019: Luscombe 8A, Carbondale, IL, Substantial damage. On 26MAY19 at Southern Illinois Airport (mdh) at 1335 local, N45729, s/n 2256, a 1946 Luscombe model 8A was taxing on runway 36R after touchdown, when a wind… ## Docket (2 files) The files NTSB released with the investigation on September 4, 2019, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=99506. 3.9 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 3.8 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40475482&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Photo (item 2, .PDF, 1 photo, 94 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40475483&FileExtension=.PDF&FileName=Photo-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.