Investigation Summary
The accident occurred during a non-precision localizer approach to Runway 18. The airport's primary runway (06/24), which featured a precision ILS approach, was closed for maintenance at the time of arrival. The crew attempted to use the 'Profile' mode of the Flight Management Computer (FMC) to manage their descent, but they failed to properly program the system, resulting in the vertical profile not being captured. As the aircraft remained above the desired path, the Captain switched to 'Vertical Speed' mode to increase the rate of descent. However, he failed to level off at the minimum descent altitude. The First Officer, suffering from acute sleep loss, failed to make required altitude callouts. The aircraft descended through a variable cloud layer into a 'black abyss' environment where the pilots lacked external visual references until moments before impact. The Ground Proximity Warning System (GPWS) issued 'sink rate' alerts only seconds before the aircraft clipped trees and impacted a hillside.
Final Conclusions
The NTSB determined the probable cause was the flight crew's continuation of an unstabilized approach and their failure to monitor the aircraft's altitude, leading to an inadvertent descent below the minimum approach altitude. Contributing factors included the crew's failure to properly configure the FMC for the profile approach, the captain's failure to communicate his change in descent modes, the crew's reliance on incomplete weather information which led them to expect a higher cloud ceiling, and significant pilot fatigue. The investigation noted that the First Officer had not managed her off-duty time effectively, while the Captain exhibited performance deficiencies consistent with previous training struggles.
Photographic Evidence (1)
Video Analysis
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Airframe & Maintenance
Crew Experience
Captain
Cerea Beal, Jr., age 58.
First Officer
Shanda Fanning, age 37.
Systems & Failure Modes
Flight Management Computer (FMC)
The crew failed to properly program the FMC for a 'Profile' approach, which would have provided automated vertical guidance.
Ground Proximity Warning System (GPWS)
The GPWS issued 'sink rate' alerts 8 seconds before impact, but the high rate of descent and low altitude left the crew insufficient time to recover.
Autopilot (Vertical Speed Mode)
The Captain manually selected a high vertical speed to catch the glide path, which bypassed the altitude protections of the programmed profile.
Interesting Facts
- 01The aircraft was an Airbus A300-600F, a wide-body cargo jet.
- 02The primary runway (06/24) was closed for maintenance between 04:00 and 05:00 local time.
- 03The crew was performing a non-precision localizer approach to Runway 18, which lacks vertical guidance.
- 04Cockpit voice recordings revealed the pilots discussing their fatigue and the lack of rest requirements for cargo pilots shortly before the crash.
- 05The aircraft struck the ground approximately 3,300 feet short of the runway threshold.
Safety Actions & Advisories
Cargo Pilot Rest Requirements
The Independent Pilots Association lobbied the FAA to remove the cargo exemption from flight crew rest requirements, though a 2016 court ruling upheld the exemption based on cost-benefit analysis.
Dispatch Procedures
Recommendations were made to UPS to improve dispatcher communication regarding runway closures and weather updates during flight.
Known Controversies & Unanswered Questions
Cargo Rest Requirement Exemption
Reference ↗The accident sparked a major legal and regulatory dispute regarding why cargo pilots were exempt from the stricter rest rules applied to passenger airline pilots in 2011.
GPWS Performance Litigation
Reference ↗In 2014, the husband of First Officer Shanda Fanning filed a lawsuit against Honeywell Aerospace, alleging the GPWS failed to provide a timely alert. The NTSB investigation, however, found the system functioned as designed, providing a 'sink rate' warning 8 seconds before impact.