Contribution of Unstabilised Approaches to Aircraft Accidents and Incidents

Contribution of Unstabilised Approaches to Aircraft Accidents and Incidents

Description

The Flight Safety Foundation (FSF) established that unstabilised approaches were a causal factor in 66 % of 76 approach and landing accidents and incidents worldwide between 1984 and 1997.

It was found that many low and slow (low energy) approaches have resulted in controlled flight into terrain (Controlled Flight Into Terrain (CFIT)) because of inadequate vertical position awareness. Low energy approaches may also result in "loss-of-control" or "land-short" events.

High energy approaches have resulted in runway excursions and also have contributed to inadequate situational awareness in some of CFIT accidents.

It was found that a crew’s inability to control the aircraft to the desired flight parameters (airspeed, altitude, rate of descent) was a major factor in 45 % of 76 approach-and-landing accidents and serious incidents.

Flight-handling difficulties have occurred in situations which included rushing approaches, attempts to comply with demanding ATC clearances, adverse weather conditions and improper use of automation.

Consequences

Unstabilised approaches can be followed by:

  1. Runway excursions
  2. Landing short
  3. Controlled flight into terrain
  4. Hard landings
  5. Tail Strike

Contributory factors

Weather conditions or approach types which can increase the chances of an unstabilised approach are:

  1. wake turbulence
  2. strong winds
  3. low visibility
  4. heavy precipitation
  5. an approach with no visual references (e.g. night or Instrument Meteorological Conditions (IMC))
  6. visual approach
  7. circling approach

Aircraft Accidents and Incidents Related to Unstabilised Approach Listed on SKYbrary

On 16 May 2013, a DHC6-300 on a domestic passenger flight made a tailwind touchdown at excessive speed in the opposite direction of the of 740 metre-long runway to the notified direction in use and, after departing the runway to one side during deceleration, re-entered the runway and attempted to take off. This failed and the aircraft breached the perimeter fence and fell into a river. The Investigation identified inappropriate actions of the aircraft commander in respect of both the initial landing and his response to the subsequent runway excursion and also cited the absence of effective CRM.

On 8 February 2019, a Piper PA46-350P overran the landing runway at Courchevel and collided with a mound of snow which caused significant damage to the aircraft but only one minor injury to a passenger. The Investigation noted the Captain's low level of experience but the investigation effort was primarily focused on the risk which had resulted from a commercial air transport flight being conducted without complying with the appropriate regulatory requirements for such flights and without either the passengers involved or the State Safety Regulator being aware of this.

On 2 May 2016, a Boeing 737-800 veered off the 2,500 metre-long landing runway near its end at speed following a night non-precision approach flown by the Captain. It then stopped on grass having sustained damage to both the left engine and landing gear. The Investigation noted that a significant but allowable tailwind component had been present at touchdown and found that the approach had been unstable, the approach and touchdown speeds excessive and that touchdown had occurred beyond the touchdown zone after applicable operating procedures had been comprehensively ignored in the presence of a steep authority and experience gradient.

On 7 August 2020, a Boeing 737-800 making its second attempt to land at Calicut off a night ILS approach with a significant tailwind component became unstabilised and touched down approximately half way down the 2,700 metre-long wet table top runway and departed the end of it at 85 knots before continuing through the RESA and a fence and then dropping sharply onto a road. This caused the fuselage to separate into three pieces with 97 of the 190 occupants including both pilots being fatally or seriously injured and 34 others sustaining minor injuries. Significant fuel spillage occurred but there was no fire.

On 28 January 2019, an Airbus A320 became unstabilised below 1000 feet when continuation of an ILS approach at Muscat with insufficient thrust resulted in increasing pitch which eventually triggered an automatic thrust intervention which facilitated completion of a normal landing. The Investigation found that having temporarily taken control from the First Officer due to failure to follow radar vectors to the ILS, the Captain had then handed control back with the First Officer unaware that the autothrust had been disconnected. The context for this was identified as a comprehensive failure to follow multiple operational procedures and practice meaningful CRM.

On 19 October 2015, an ATR 72-600 crew mishandled a landing at Ende, Indonesia, and a minor runway excursion occurred and pitch control authority was split due to simultaneous contrary inputs by both pilots. A go around and diversion direct to the next scheduled stop at Komodo was made without further event. The Investigation noted that the necessarily visual approach at Ende had been unstable with a nosewheel-first bounced touchdown followed by another bounced touchdown partially off-runway. The First Officer was found to have provided unannounced assistance to the Captain when a high rate of descent developed just prior to the flare. 

On 3 May 2019, a Boeing 737-800 significantly overran the wet landing runway at Jacksonville Naval Air Station at night when braking action was less than expected and ended up in shallow tidal water. The Investigation found that although the approach involved had been unstabilised and made with a significant tailwind and with only a single thrust reverser available, these factors had not been the cause of the overrun which was entirely attributable to attempting to complete a landing after touching down on a wet runway during heavy rain in conditions which then led to viscous aquaplaning.

On 14 October 2019, a Sikorsky S92A manoeuvring below low cloud in poor daylight visibility in an unsuccessful attempt to locate the intended private landing site flew north towards rising ground approximately ¾ mile east of it, coming within a recorded 28 feet above terrain near to occupied houses before making an emergency climb and over-torqing the engines followed by an unstable but successful second approach. The Investigation found relevant operator procedures absent or ineffective, an intention by the management pilot in command to reach the landing site despite conditions and uncertainty about the applicable regulatory context for the flight. 

On 26 July 2017, a Hawker Beechcraft 850 left wing sustained extensive damage when it contacted the runway at Mykonos during a 2.7g touchdown after an unstabilised approach in benign weather conditions had been continued. The Investigation found that the aircraft was airworthy prior to a temporary loss of control at touchdown which occurred after stick pusher activation due to the airspeed being more than 20 knots below the applicable reference speed and only three knots above the applicable stall speed. The monitoring of the First Officer’s approach by the Captain was minimal and late with few alert calls given.

On 16 July 2020, an Antonov AN26 on which a new Captain’s final line check was being performed made two consecutive non-precision approaches to Runway 33 at Birmingham both of which resulted in ATC instructing the aircraft to go around because of failure to follow the prescribed vertical profile. A third approach using the ILS procedure for runway 15 was successful. On the limited evidence available, the Investigation was unable to explain the inability to safely perform the attempted two non precision approaches to runway 33 or the continuation of them until instructed to go around by ATC.

 

Stabilised Approach Awareness Toolkit for ATC

Further Reading

CANSO

Part of the Stabilised Approach Awareness Toolkit for ATC

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