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Safety Recommendation Details

Safety Recommendation A-09-023
Details
Synopsis: On September 28, 2007, about 1313 central daylight time, American Airlines flight 1400, a McDonnell Douglas DC-9-82 (MD-82),2 N454AA, experienced an in-flight engine fire during departure climb from Lambert-St. Louis International Airport (STL), St. Louis, Missouri. During the return to STL, the nose landing gear failed to extend, and the flight crew executed a go-around, during which the crew extended the nose gear using the emergency procedure. The flight crew conducted an emergency landing, and the 2 flight crewmembers, 3 flight attendants, and 138 passengers deplaned on the runway. No occupant injuries were reported, but the airplane sustained substantial damage from the fire. The scheduled passenger flight was operating under the provisions of 14 Code of Federal Regulations Part 121 on an instrument flight rules flight plan. Visual meteorological conditions prevailed at the time of the accident.
Recommendation: TO THE FEDERAL AVIATION ADMINISTRATION: Require MD-80 series airplane operators to incorporate information about the relationship between the pneumatic crossfeed valve and the engine fire handle into their training programs and written guidance.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Alternate Action
Mode: Aviation
Location: St. Louis, MO, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA07MA310
Accident Reports: In-Flight Left Engine Fire, American Airlines Flight 1400, McDonnell Douglas DC-9-82
Report #: AAR-09-03
Accident Date: 9/28/2007
Issue Date: 5/19/2009
Date Closed: 6/7/2016
Addressee(s) and Addressee Status: FAA (Closed - Acceptable Alternate Action)
Keyword(s): Flightcrew, Training and Education

Safety Recommendation History
From: NTSB
To: FAA
Date: 6/7/2016
Response: On August 5, 2008, prior to the issuance of this recommendation, you issued Safety Alert for Operators (SAFO) 08018, “Fire Handle Characteristics, DC-9, MD-80, and MD 90 Airplanes,” which alerted operators of these aircraft of the need to ensure that their training curricula, aircraft systems manuals, and checklists properly address the characteristics of the fire handle. On January 11, 2011, you issued Notice 8900.145, “Review of All DC-9 Series, MD-80 Series, and MD-90 Series Training Programs for Incorporation of SAFO 08018,” which instructed your principal operations inspectors to survey DC-9, MD-80, and MD-90 operators to determine whether they had voluntarily complied with the SAFO. We note that you found that all 18 operators of these aircraft in the United States have incorporated the guidance contained in the SAFO into their training programs, manuals, and procedures. This compliance satisfies the intent of the recommendation without issuance of the recommended requirement. Consequently, Safety Recommendation A-09-23 is classified CLOSED—ACCEPTABLE ALTERNATE ACTION.

From: FAA
To: NTSB
Date: 4/29/2016
Response: -From Michael P. Huerta, Administrator: As previously mentioned the Federal Aviation Administration (FAA) issued Notice 8900. 145. Review of All DC-9 Series. MD-80 Series and MD-90 Series Training Programs for Incorporation of Safety Alert for Operators (AFO) 080 18. Notice 8900.145 directed principal operations inspectors to review and determine if their assigned operators incorporated the recommended actions of SAFO 08018 Fire Handle Characteristics DC-9, MD-80, and MD-90 Airplanes into their training programs and appropriate manuals. As of July 14, 2015, the FAA identified 18 U.S. operators of DC-9, MD-80, and MD-90 series aircraft affected by SAFO 08018. Those 18 operators operate under the following parts: • Part 121 (8 operators); • Part 121 and/or 135 (2 operators); • Part 125 (6 operators); • Part 13 7 ( 1 operator); and • Part 91 (I operator, not Subpart K). Although not all of these operators are required to submit their training programs for FAA approval such as parts 125, 137, and 91, all 18 U.S. operators reported incorporation of the SAFO into their training programs and appropriate manuals. I believe that the FAA has effectively addressed this recommendation and consider our actions complete.

From: NTSB
To: FAA
Date: 9/27/2012
Response: On August 5, 2008, prior to the issuance of this recommendation, the FAA issued Safety Alert for Operators (SAFO) 08018, “Fire Handle Characteristics, DC-9, MD-80, and MD 90 Airplanes,” which alerted operators of these aircraft of the need to ensure that their training curricula, aircraft systems manuals, and checklists properly address the characteristics of the fire handle. In the letter that transmitted this recommendation, we commended the FAA for issuing SAFO 08018; however, as we pointed out, the actions recommended in a SAFO are not mandatory. Because more permanent action was warranted to prevent the recurrence of a fire, we issued Safety Recommendation A-09-23. On January 11, 2011, the FAA issued Notice 8900.145, “Review of All DC-9 Series, MD-80 Series, and MD-90 Series Training Programs for Incorporation of SAFO 08018,” which instructed FAA principal operations inspectors to survey DC-9, MD-80, and MD-90 operators to determine whether they have voluntarily complied with the SAFO. That notice expired in January 2012. The FAA is currently collating and reviewing the results of the survey, and expects to complete this work by January 2013. We have previously stated that the FAA’s survey of operators to determine whether they have adopted the guidance in the SAFO would constitute an acceptable alternate response to this recommendation, provided that the FAA ensures inclusion of the guidance for any operator who had not adopted it when surveyed. We asked the FAA to supply a copy of the results of the survey when it is completed and a description of what further action it planned to take for any operators who had not adopted the information specified in the SAFO. Although we are encouraged that the FAA conducted the survey and is currently reviewing the results, we are concerned by the slow pace of the remaining work. Nevertheless, pending communication of the survey results to the NTSB, and appropriate action being taken for any operator who has not yet incorporated the guidance, Safety Recommendation A-09-23 remains classified OPEN—ACCEPTABLE ALTERNATE RESPONSE.

From: FAA
To: NTSB
Date: 8/2/2012
Response: -From Michael P. Huerta, Acting Administrator: On August 5, 2008, the Federal Aviation Administration (FAA) issued Safety Alert for Operators (SAFO) 08018, Fire Handle Characteristics, DC-9, MD-80, and MD-90 Airplanes (previously provided). On January 11,2011, the FAA issued Notice 8900.145, Review of All DC-9 Series, MD-80 Series, and MD-90 Series Training Programs for Incorporation of SAFO 08018 (http://fsims.faa.gov/wdocs/notices/n8900_145.htrn).This notice instructed the FAA's principal operations inspectors to survey DC-9, MD-80, and MD-90 operators to determine if they have voluntarily complied with the SAFO. The FAA expects its review and analysis of the survey results to be completed by January 1, 2013. I will keep the Board informed of the FAA's progress on this recommendation and provide an update by January 31, 2013.

From: NTSB
To: FAA
Date: 4/2/2010
Response: In August 2008, prior to the issuance of this recommendation, the FAA issued SAFO 08018, Fire Handle Characteristics, DC-9, MD-80, and MD-90 Airplanes, which alerts operators of these aircraft of the need to ensure that their training curricula, aircraft systems manuals, and checklists properly address the characteristics of the fire handle. In the letter that transmitted this recommendation to the FAA, the NTSB commended the FAA for issuing SAFO 08018; however, the actions recommended in a SAFO are not mandatory. Because more permanent action was warranted to prevent the recurrence of a potentially unnecessary risk of fire, the NTSB issued Safety Recommendation A-09-23. The FAA now plans to issue a notice to POIs to survey their operators to determine whether the operators have voluntarily complied with SAFO 08018. The action to survey operators to determine whether they have adopted the guidance in the SAFO constitutes an acceptable alternate response to Safety Recommendation A-09-23, provided that the FAA ensures the inclusion of the guidance for any operator who has not done so when surveyed. The NTSB asks the FAA to supply a copy of the results of the survey when it is completed and a description of what further action it plans to take for any operators who have not adopted the information in the SAFO. Pending completion of the survey, communication of the survey results to the NTSB, and appropriate action for any operator who has not incorporated the guidance, Safety Recommendation A-09-23 is classified OPEN -- ACCEPTABLE ALTERNATE RESPONSE.

From: FAA
To: NTSB
Date: 8/11/2009
Response: Letter Mail Controlled 8/31/2009 2:09:47 PM MC# 2090551: - From J. Randolph Babbitt, Administrator: The FAA agrees with the importance of systems training for flight crewmembers. In August 2008, we issued SAFO 08018, Fire Handle Characteristics, DC-9, MD-80, and MD-90 Airplanes (Enclosure 2). This was done to alert operators of these aircraft of the need to ensure their training curricula, aircraft systems manuals, and checklists properly address the characteristics of the fire handle. We will issue a notice to our principal operations inspectors to have them survey their operators to determine if the operators have voluntarily complied with SAFO 08018. We will advise the Board of the results of the survey by August 31, 2010.