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Safety Recommendation Details

Safety Recommendation A-10-069
Details
Synopsis: On January 15, 2009, about 1527 eastern standard time,1 US Airways flight 1549, an Airbus Industrie A320-214, N106US, experienced an almost total loss of thrust in both engines after encountering a flock of birds and was subsequently ditched on the Hudson River about 8.5 miles from LaGuardia Airport (LGA), New York City, New York. The flight was en route to Charlotte Douglas International Airport (CLT), Charlotte, North Carolina, and had departed LGA about 2 minutes before the in-flight event occurred. The 150 passengers, including a lap-held child, and 5 crewmembers evacuated the airplane via the forward and overwing exits. One flight attendant and four passengers received serious injuries, and the airplane was substantially damaged. The scheduled, domestic passenger flight was operating under the provisions of 14 Code of Federal Regulations (CFR) 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 14 Code of Federal Regulations Part 121, Part 135, and Part 91 Subpart K operators to include a dual-engine failure scenario occurring at a low altitude in initial and recurrent ground and simulator training designed to improve pilots‘ critical-thinking, task-shedding, decision-making, and workload-management skills.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Unacceptable Action
Mode: Aviation
Location: Weehawken, NJ, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA09MA026
Accident Reports: Loss of Thrust in Both Engines, US Airways Flight 1549 Airbus Industrie A320-214, N106US
Report #: AAR-10-03
Accident Date: 1/15/2009
Issue Date: 5/21/2010
Date Closed: 7/23/2014
Addressee(s) and Addressee Status: FAA (Closed - Unacceptable Action)
Keyword(s): Decision Making, Engine Out, Flightcrew, Simulator, Training and Education

Safety Recommendation History
From: NTSB
To: FAA
Date: 7/23/2014
Response: The FAA’s response to these recommendations is dependent on the successful completion of Safety Recommendation A-10-66, and the resulting availability for existing airplanes of checklists and procedures for a dual engine failure at low altitude. Because you do not plan to mandate changes to existing manuals to address this issue, Safety Recommendations A 10 67 and 69 are classified CLOSED—UNACCEPTABLE ACTION. We invite you to submit any additional information that we did not consider concerning actions that you have taken or plan to complete soon that address or will address these recommendations. If we receive this information in a timely manner, we may reclassify them.

From: NTSB
To: FAA
Date: 1/11/2013
Response: To fully satisfy this recommendation, the FAA’s actions in response to Safety Recommendations A-10-66 and -67 must first be completed. Until the development of checklists and procedures for a low altitude, dual-engine failure scenario, the FAA plans to rely on current training initiatives to develop the skills associated with a pilot’s critical thinking, task shedding, and workload management skills. Pending completion of the recommended action, Safety Recommendation A-10-69 remains classified OPEN—ACCEPTABLE RESPONSE.

From: FAA
To: NTSB
Date: 10/29/2012
Response: -From Michael P. Huerta, Acting Administrator: The FAA agrees with the intent of this recommendation. The FAA believes that a properly structured scenario occurring at a low altitude that can be incorporated in initial and recurrent ground and simulator training may improve pilot's critical-thinking, task-shedding, decision-making and workload-management skills. However, pending the development of an OEM's recommend checklist and procedure, the FAA will rely on current training initiatives to develop the skills associated with a pilot's critical-thinking, task-shedding, and workload-management skills. We will keep the board informed of the FAA's progress on these safety recommendations and provide an updated response by November 2013.

From: NTSB
To: FAA
Date: 7/15/2011
Response: Notation 8106A: The National Transportation Safety Board (NTSB) has reviewed the Federal Aviation Administration's (FAA) supplemental notice of proposed rulemaking (SNPRM) titled "Qualification, Service, and Use of Crewmembers and Aircraft Dispatchers," published at 76 Federal Register 29336-29526 on May 20, 2011. The notice proposes to amend the regulations for flight and cabin crewmember and aircraft dispatcher training programs in domestic, flag, and supplemental operations. The proposed regulations are intended to contribute significantly to reducing aviation accidents by requiring the use of flight simulation training devices (FSTD) for flight crewmembers and including additional training and evaluation requirements for all crewmembers and aircraft dispatchers in areas that are critical to safety. The proposal also reorganizes and revises the qualification, training, and evaluation requirements. The SNPRM is based on the FAA's review of comments submitted in response to the January 12, 2009, notice of proposed rulemaking (NPRM) on these issues and its determination that the NPRM did not adequately address or clarify some topics; it is also based on provisions of the Airline Safety and Federal Aviation Administration Extension Act of 2010. The NTSB did not find any proposed provisions in the SNPRM to require training for dual-engine power loss at low altitudes or of the visual illusions that can occur when landing on water. The NTSB believes this rulemaking is appropriate to address these issues and urges the FAA to include the recommended training requirements.

From: NTSB
To: FAA
Date: 3/17/2011
Response: The FAA's plan to include this recommendation as part of the review it is conducting in response to Safety Recommendations A-1O-66 and -67 is responsive to this recommendation. The FAA also stated that, after it completes action in response to Safety Recommendations A-10-66 and -67, it will review training programs and consider including in initial and recurrent training a dual-engine failure scenario occurring at a low altitude. Accordingly, pending the FAA's taking the recommended action, Safety Recommendation A-10-69 is classified OPEN – ACCEPTABLE RESPONSE. Although the NTSB understands the FAA's plan to wait for completion of the low altitude dual engine power loss checklist, we emphasize that the recommended training constitutes more than just finding and using the checklist in this scenario. The training should include critical thinking, task shedding, decision-making, and workload management.

From: FAA
To: NTSB
Date: 9/23/2010
Response: CC# 201000368: - From J. Randolph Babbitt, Administrator: Critical-thinking, task-shedding, decision-making, and workload-management skills are currently taught and tested in today's training environment. These pilot skills could be improved by implementing training for the recommended scenario; however, the information required to develop the recommended scenario is not currently available from the OEM. As indicated in our response to recommendations A-10-66 and A-I 0-67, we will review the existing regulations and policy for a checklist procedure for a dual-engine failure and investigate the feasibility of requiring OEMs to develop a specific checklist for a dual-engine failure occurring at a low altitude. Should a dual-engine failure at low altitude checklist procedure be developed for turbine-powered aircraft, we will consider the policy guidance options available to implement a global checklist change to include it. In addition, we will review training programs for part 121,135, and 91 subpart K operators and consider including a dual-engine failure scenario occurring at a low altitude in initial and recurrent training.