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Safety Recommendation Details

Safety Recommendation A-10-074
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 Airbus operators to expand the angle-of-attack-protection envelope limitations ground-school training to inform pilots about alpha-protection mode features while in normal law that can affect the pitch response of the airplane.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable 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: 12/27/2013
Addressee(s) and Addressee Status: FAA (Closed - Acceptable Action)
Keyword(s): Flightcrew, Training and Education

Safety Recommendation History
From: NTSB
To: FAA
Date: 12/27/2013
Response: The FAA issued Change 285 to Order 8900.1, “Flight Standards Information Management System,” effective August 28, 2013. This change added Paragraph 3-276 to Volume 3, Chapter 10, Section 1, “Operational Emphasis Items”; the new paragraph includes information regarding reviewing and approving pilot training programs. It also clarifies that FAA inspectors must ensure that both ground and flight training must address the effects of envelope protection during normal, abnormal, and emergency operations. Accordingly, Safety Recommendation A-10-74 is classified CLOSED—ACCEPTABLE ACTION.

From: NTSB
To: FAA
Date: 5/13/2013
Response: We are encouraged (1) that the FAA is preparing a revision to FAA Order 8900.1, “Flight Standards Information Management System,” to direct FAA principal operations inspectors to ensure that their operators’ training programs adequately discuss the effects of angle-of-attack protection and (2) that this revision will be issued shortly. Pending issuance of the revision, Safety Recommendation A-10-74 remains classified OPEN—ACCEPTABLE RESPONSE.

From: FAA
To: NTSB
Date: 3/14/2013
Response: -From Michael P. Huerta, Administrator: After further review of the information provided to pilots regarding alpha-protection features while operating in normal law, the Federal Aviation Administration agrees that a revision to FAA Order 8900.1, Flight Standards Information Management System is appropriate. Therefore, we plan to revise this Order to direct principal operations inspectors (POIs) of flight-envelope protected aircraft operators to ensure their operators' training programs adequately discuss the effects of angle-of-attack protection. We plan to issue the revised Order in March 2013. The revision would also cover additional forms of envelope protection, such as stick-shaker and stick-pusher training. The change to the Order would inform POIs of the available manufacturer information on envelope protection and the need to evaluate their operators' training programs. This evaluation must ensure that operators' training programs adequately discuss the effects of envelope-protection during abnormal or emergency operations and incorporate these effects into flight training. In our previous letter to the Board on this recommendation, we stated we would consider policy and regulatory options such as revising guidance material to POIs, issuing Information for Operators (InFO), and Safety Alert for Operators (SAFO), or any combination of these and other programs. At this time, we believe a change to FAA Order 8900.1 is the best way to address this recommendation. We currently do not plan to issue a SAFO or InfO. I will keep the Board informed of the FAA's progress on this safety recommendation and provide an update to the Board by January 2014.

From: NTSB
To: FAA
Date: 3/17/2011
Response: This recommendation was issued because the NTSB found during the US Air flight 1549 accident investigation that the airplane's airspeed in the last 150 feet of the descent was low enough to activate the alpha-protection mode of the airplane's fly-by-wire envelope protection features. The captain progressively pulled aft on the sidestick as the airplane descended below 100 feet, and he pulled the sidestick to its aft stop in the last 50 feet, indicating that he was attempting to raise the airplane's nose to flare and soften the touchdown on the water. The A320 alpha-protection mode incorporates features that can attenuate pilot sidestick pitch inputs. Because of these features, the airplane could not reach the maximum AOA attainable in pitch for the airplane weight and configuration. The investigation found that during the descent, the airplane had been in alpha-protection mode from 150 feet to touchdown, and that the captain's aft sidestick inputs in the last 50 feet of the flight had been attenuated, limiting the airplane nose-up response even though about 3.5 degrees of margin existed between the airplane's AOA at touchdown and the maximum AOA for this airplane weight and configuration. The investigation also found that Airbus' training curricula did not contain information on the effects of alpha-protection-mode features that might affect the airplane's response to pilot sidestick pitch inputs. The NTSB concluded that instructing pilots that sidestick inputs may be attenuated when the airplane is in the alpha-protection mode would provide them with a better understanding of how entering the alpha-protection mode might affect the pitch response of the airplane; accordingly, we issued this recommendation. The FAA replied that information regarding alpha-protection features while operating in normal law is currently available and is normally addressed in ground school for pilots who operate Airbus airplanes. The FAA plans to evaluate options for disseminating the recommended information to Airbus operators, including such policy and regulatory options as revising guidance material to POIs or issuing an Information for Operators (InFO) or a Safety Alert for Operators (SAFO) bulletin. The NTSB reiterates the finding from the US Air flight 1549 accident investigation that the information and training provided to Airbus pilots does not adequately inform them about the airplane's response in the type of situation faced by the pilot of US Air flight 1549. The FAA's plan to review the information provided to pilots is the first step of an acceptable response, provided that it results in sufficiently detailed information for a POI to use when reviewing and approving a carrier's pilot training programs. We do not believe that either an InFO or a SAFO can provide the level of detail needed for an adequate response. Other guidance options available to the FAA, such as revisions to Order 8900.1 or the provision of appropriate guidance in an AC may be the basis for a fully acceptable response. In the interim, pending completion of the recommended action, Safety Recommendation A-10-74 is classified OPEN – ACCEPTABLE RESPONSE.

From: FAA
To: NTSB
Date: 9/23/2010
Response: CC# 201000368: - From J. Randolph Babbitt, Administrator: The information regarding alpha-protection features while operating in normal law is currently available and normally addressed during ground school. We will evaluate all available options for disseminating the recommended information to Airbus operators. We will consider policy and regulatory options such as revising guidance material to principal operations inspectors, issuing Information for Operators and Safety Alert for Operators, or any combination of these and other programs.