1
00:00:01,726 --> 00:00:05,752
While landing at Dutch Harbor, Alaska,
2
00:00:05,836 --> 00:00:07,457
Hang on, I'm sliding.
3
00:00:07,540 --> 00:00:12,021
the pilots of PenAir flight 3296
run out of runway.
4
00:00:12,105 --> 00:00:13,807
All I could see is water.
5
00:00:13,891 --> 00:00:15,528
Everyone brace!
6
00:00:17,819 --> 00:00:19,512
We're gonna go in.
7
00:00:24,796 --> 00:00:26,903
Not everyone makes it out alive.
8
00:00:26,986 --> 00:00:29,714
You never want to lose
a passenger, for any reason.
9
00:00:30,453 --> 00:00:31,816
These are pretty beat up.
10
00:00:31,900 --> 00:00:35,550
NTSB investigators must
piece together the evidence.
11
00:00:35,634 --> 00:00:39,229
We've got a dark 170 foot long skid mark.
12
00:00:39,312 --> 00:00:40,691
So the tire blew.
13
00:00:40,774 --> 00:00:42,863
We needed to do a deeper dive.
14
00:00:42,947 --> 00:00:46,144
They soon discover a critical oversight.
15
00:00:46,227 --> 00:00:48,061
There's no numbering on these wires.
16
00:00:48,145 --> 00:00:49,845
That was really the "aha" moment.
17
00:00:55,924 --> 00:00:57,271
Mayday. Mayday.
18
00:01:00,218 --> 00:01:01,051
PULL UP!
19
00:01:02,998 --> 00:01:07,316
[indistinct radio chatter]
20
00:01:20,320 --> 00:01:25,980
{\an8}PenAir flight 3296 cruises
over Alaska's Aleutian Islands.
21
00:01:28,600 --> 00:01:31,444
We should be getting
directions here to descend soon.
22
00:01:31,527 --> 00:01:33,647
I'm gonna see if I can't get the weather.
23
00:01:33,730 --> 00:01:39,930
Yeah, it's changed. Weather's
been updated. It's 310 at 11 knots.
24
00:01:40,575 --> 00:01:44,960
56 year old Captain Paul
Wells is a new hire to PenAir,
25
00:01:45,044 --> 00:01:48,550
but has 25 years of
experience with other airlines.
26
00:01:49,593 --> 00:01:51,014
Mm 'kay.
27
00:01:51,097 --> 00:01:55,563
Paul is, an amazing guy.
I flew with him several times.
28
00:01:55,646 --> 00:01:59,456
He was, a true decision maker as a captain.
29
00:01:59,539 --> 00:02:03,162
Peninsula 3296,
descend pilot's discretion.
30
00:02:03,246 --> 00:02:06,270
Maintain flight level 290.
31
00:02:06,359 --> 00:02:10,636
Pilot's discretion 290, Peninsula 3296.
32
00:02:11,757 --> 00:02:16,931
39 year old First Officer Justin Lunn
has been with PenAir for five months.
33
00:02:17,870 --> 00:02:20,054
I couldn't have been
with a better copilot.
34
00:02:20,137 --> 00:02:24,400
He's a very thorough
individual, um, ex-military.
35
00:02:24,483 --> 00:02:27,314
There are 39 passengers on today's flight,
36
00:02:27,397 --> 00:02:31,330
including a high school swim
team and their chaperones.
37
00:02:31,413 --> 00:02:35,562
Commercial pilot Steve Ranney
is escorting his son, Jacob.
38
00:02:36,742 --> 00:02:39,995
We were on the flight,
um, to go to a swim meet.
39
00:02:40,078 --> 00:02:43,828
We'd worked really hard raising the
money for the trip. It was a big deal.
40
00:02:45,335 --> 00:02:51,738
It's a two hour flight from Anchorage to
Unalaska Airport, also known as Dutch Harbor.
41
00:02:53,146 --> 00:02:57,966
The journey crosses some of the most
rugged and isolated terrain in the world.
42
00:02:59,076 --> 00:03:01,997
The flight is over a
spectacular part of Alaska.
43
00:03:02,080 --> 00:03:05,240
The entire, um, Alaska Peninsula is in view.
44
00:03:06,010 --> 00:03:09,423
It's a great view. You can go
grab a window seat further back.
45
00:03:12,019 --> 00:03:17,553
My son did move to a couple of rows
back so that he could get that view, too.
46
00:03:19,967 --> 00:03:23,571
The pilots are flying a
Swedish made Saab 2000.
47
00:03:24,800 --> 00:03:31,636
Saab 2000 is a twin-engine turbojet
aircraft. It seats approximately 50 people.
48
00:03:32,887 --> 00:03:37,227
It's a good aircraft for reaching
remote communities in Alaska.
49
00:03:38,016 --> 00:03:40,186
Dutch Ops 3296.
50
00:03:40,269 --> 00:03:43,857
Thirty minutes before landing,
the first officer contacts the weather
51
00:03:43,941 --> 00:03:47,153
observer at Unalaska Airport
for the latest conditions.
52
00:03:48,016 --> 00:03:51,918
Hello, 3296. Right now, winds,
53
00:03:52,002 --> 00:03:55,960
210 at 6 knots, gusting to 14.
54
00:03:56,043 --> 00:03:57,986
Temperature 8, dew point 1.
55
00:03:58,070 --> 00:04:00,432
Altimeter 29.50.
56
00:04:00,759 --> 00:04:02,339
All right, copy the weather.
57
00:04:05,042 --> 00:04:07,950
The airport at Dutch
Harbor has a short runway,
58
00:04:08,033 --> 00:04:11,417
vulnerable to severe and
unpredictable weather.
59
00:04:11,500 --> 00:04:14,060
Pilots need special training to land here.
60
00:04:15,170 --> 00:04:19,012
The terrain around the area in
Dutch Harbor is mountainous.
61
00:04:19,096 --> 00:04:22,325
The wind conditions can change in seconds.
62
00:04:22,409 --> 00:04:28,191
Turbulence can be bad. Icing can be bad.
So we have dedicated weather observers.
63
00:04:28,275 --> 00:04:30,786
That is, invaluable.
64
00:04:31,348 --> 00:04:33,652
What did she say the wind was?
65
00:04:33,735 --> 00:04:35,275
Wind was 210.
66
00:04:35,981 --> 00:04:38,154
-Pretty much a direct crosswind.
-Hm.
67
00:04:39,171 --> 00:04:41,702
I guess we can go ahead
and start heading down.
68
00:04:41,786 --> 00:04:43,127
All right.
69
00:04:53,540 --> 00:04:58,569
Peninsula 3296, are you
planning on RNAV runway 31?
70
00:04:58,652 --> 00:05:02,106
Twenty minutes before landing,
Anchorage Air Traffic Control
71
00:05:02,190 --> 00:05:04,942
asks the pilots about
their runway preference.
72
00:05:05,026 --> 00:05:07,083
Affirmative. Uh, uh, negative.
73
00:05:07,166 --> 00:05:10,792
We want the RNAV 13, Peninsula 3296.
74
00:05:12,947 --> 00:05:18,911
Unalaska Airport is on an island,
tucked behind a 1,600 foot mountain.
75
00:05:18,994 --> 00:05:21,328
Planes can land in either direction,
76
00:05:21,411 --> 00:05:26,161
runway 13 from the west,
or runway 31 from the east.
77
00:05:26,244 --> 00:05:31,741
Most pilots would prefer to use runway 13,
basically because they have more room to
78
00:05:31,824 --> 00:05:36,833
maneuver, more room to escape if you've got
to punch out, or you've got to go around.
79
00:05:36,916 --> 00:05:41,087
And just like the other day, if there's
any major changes in the wind,
80
00:05:41,170 --> 00:05:42,996
-we'll just.
-We'll switch.
81
00:05:44,813 --> 00:05:47,583
We always prepare for the
worst and hope for the best.
82
00:05:47,666 --> 00:05:50,146
Minimize risk. That's what we do.
83
00:05:53,407 --> 00:05:55,347
Ladies and gentlemen, in order to…
84
00:05:55,431 --> 00:05:58,763
Twelve miles from the airport,
passengers prepare for landing.
85
00:05:58,846 --> 00:06:01,898
…items are stowed completely beneath the
seat in front of you.
86
00:06:05,086 --> 00:06:09,319
All right. Flaps 20.
Flight attendant is secure.
87
00:06:10,046 --> 00:06:13,439
Flaps set 20. Indicating 20.
88
00:06:14,540 --> 00:06:15,732
Gear down.
89
00:06:17,059 --> 00:06:20,806
Four minutes from the airport,
the crew begins the landing procedure.
90
00:06:22,026 --> 00:06:23,533
Down three green.
91
00:06:27,155 --> 00:06:29,056
At less than 1,000 feet,
92
00:06:31,029 --> 00:06:33,596
the plane is rocked by turbulence.
93
00:06:35,130 --> 00:06:36,792
Ah, bump.
94
00:06:37,470 --> 00:06:39,732
There's a bit of a bump there too.
95
00:06:39,816 --> 00:06:42,609
-Yeah.
-Yeah, there you go.
96
00:06:42,693 --> 00:06:45,372
It's gonna be ugly in here, isn't it?
97
00:06:45,456 --> 00:06:46,933
Hmm.
98
00:06:47,017 --> 00:06:50,828
Paul was fighting the winds
as we were coming in.
99
00:06:53,183 --> 00:06:58,408
Seconds from touchdown, Captain Wells
notices he's too high for a safe landing.
100
00:06:59,586 --> 00:07:03,826
An updraft may cause you to balloon,
so that causes you to go high.
101
00:07:03,910 --> 00:07:07,048
-What do you think?
-Go around.
102
00:07:07,131 --> 00:07:12,257
At Dutch Harbor, I don't take chances.
If we're high, we're going around.
103
00:07:13,463 --> 00:07:14,755
Max power.
104
00:07:25,274 --> 00:07:27,517
I would not have been able to safely,
105
00:07:27,600 --> 00:07:32,240
get back down, without,
putting people at, horrible risk.
106
00:07:34,220 --> 00:07:36,243
The pilot pulled up and went around.
107
00:07:36,326 --> 00:07:41,711
I was assuming it was
because of, uh, visibility issues.
108
00:07:41,794 --> 00:07:44,963
Dutch Harbor traffic,
Peninsula 3296, going around.
109
00:07:45,046 --> 00:07:47,271
We're gonna come back around for a visual.
110
00:07:48,544 --> 00:07:50,361
We were contending with the terrain,
111
00:07:50,445 --> 00:07:55,429
a lower layer of clouds, and
maintaining a safe airspeed.
112
00:07:55,513 --> 00:07:58,951
You're very busy scanning
inside and outside of the airplane.
113
00:08:01,476 --> 00:08:06,170
It only takes three minutes before
the pilots of PenAir flight 3296
114
00:08:06,253 --> 00:08:08,676
are ready to attempt another landing.
115
00:08:08,759 --> 00:08:12,790
If we couldn't land on this attempt,
then we would go to our alternate airport.
116
00:08:12,873 --> 00:08:14,250
200.
117
00:08:14,333 --> 00:08:16,216
-Plus 10, you got it?
-Got it.
118
00:08:16,832 --> 00:08:19,684
The pilots are seconds from touching down.
119
00:08:26,227 --> 00:08:28,440
-Sink rate.
-Yeah, I know.
120
00:08:30,851 --> 00:08:36,523
Seemed like we floated down the runway
quite a bit, which didn't alarm me too much.
121
00:08:43,370 --> 00:08:45,437
-Down.
-Okay, you got the yoke.
122
00:08:45,520 --> 00:08:48,250
I got it yeah, we're down there, 80 knots.
123
00:08:48,339 --> 00:08:50,924
As the captain begins slowing the plane,
124
00:08:52,391 --> 00:08:53,899
something isn't right.
125
00:08:55,164 --> 00:08:57,150
I was pushing on the brakes harder,
126
00:08:57,234 --> 00:09:01,487
and noticing that I'm not getting
any more effect from the brakes.
127
00:09:02,829 --> 00:09:06,309
When I saw the wind suck,
the wind was definitely strong.
128
00:09:06,393 --> 00:09:11,570
And at that point,
all alarm bells went off in me.
129
00:09:11,653 --> 00:09:15,986
-Brakes.
-I got 'em all the way down.
130
00:09:16,956 --> 00:09:20,293
The pilots cannot
reduce their plane's speed.
131
00:09:20,376 --> 00:09:24,786
I had to make a decision on whether
to continue the landing or abort.
132
00:09:24,869 --> 00:09:26,711
In an instant, I realized that,
133
00:09:26,794 --> 00:09:30,533
no, there's not enough room
to get the aircraft airborne again.
134
00:09:30,616 --> 00:09:33,704
In the cabin, Steve Ranney notices, too.
135
00:09:33,787 --> 00:09:34,620
Brace!
136
00:09:35,319 --> 00:09:36,717
Everyone brace!
137
00:09:37,953 --> 00:09:44,011
I actually went in the brace position and
I told the passengers around me to brace.
138
00:09:45,167 --> 00:09:46,527
Hang on, I'm sliding.
139
00:09:49,053 --> 00:09:52,254
The plane is swerving back and forth.
140
00:09:52,337 --> 00:09:56,114
I thought I was going to be able
to turn off into the taxi area,
141
00:09:56,197 --> 00:09:58,622
but I was going too fast.
142
00:09:58,706 --> 00:10:01,709
The pilots are running out of runway.
143
00:10:01,792 --> 00:10:03,412
All I could see is water.
144
00:10:06,873 --> 00:10:12,169
The pilots of PenAir flight 3296
are unable to stop their airplane.
145
00:10:13,066 --> 00:10:16,946
I saw the perimeter road
and I told Paul, go right, go right!
146
00:10:17,646 --> 00:10:19,426
The only option was the road.
147
00:10:21,335 --> 00:10:23,444
The plane crashes through a fence,
148
00:10:23,527 --> 00:10:27,037
strikes a boulder and is
propelled towards the water.
149
00:10:28,493 --> 00:10:30,310
That destroyed our exit plan.
150
00:10:31,184 --> 00:10:33,727
They have only a few seconds to stop.
151
00:10:33,811 --> 00:10:36,776
Now all I kept thinking was
"We're going to go in."
152
00:10:36,860 --> 00:10:40,031
The left engine strikes a
signal post and road sign,
153
00:10:40,114 --> 00:10:43,240
shattering the propellers
into deadly fragments.
154
00:10:46,613 --> 00:10:47,923
Holy crap.
155
00:10:49,220 --> 00:10:50,560
We need to evacuate.
156
00:10:52,056 --> 00:10:55,610
Evacuate right-hand side.
Get out and get away.
157
00:10:55,693 --> 00:10:58,209
In the cabin, it's eerily quiet.
158
00:10:59,540 --> 00:11:06,360
I could feel blood running down my face
and my shoulder was sore and my head hurt.
159
00:11:07,933 --> 00:11:09,853
It was very, very surreal.
160
00:11:10,611 --> 00:11:15,042
a propeller blade has pierced
the cabin and struck Steve Ranney.
161
00:11:15,125 --> 00:11:20,792
There was a propeller blade stuck,
up in the ceiling right up against me.
162
00:11:22,419 --> 00:11:25,322
Jacob, get off the plane!
Don't wait for me!
163
00:11:25,405 --> 00:11:29,459
Steve's son, Jacob, is lucky to
walk away from the accident unharmed.
164
00:11:30,682 --> 00:11:33,700
He would not have survived, in the seat
165
00:11:33,784 --> 00:11:37,508
next to me because the blade
was literally right there.
166
00:11:38,271 --> 00:11:41,126
But a passenger near
him is severely injured.
167
00:11:42,567 --> 00:11:46,253
I had had a fair amount
of training because of my job,
168
00:11:46,336 --> 00:11:51,457
and so it was more or less an automatic
reflex to go over and, you know,
169
00:11:51,540 --> 00:11:54,157
check for his pulse
see if he's still breathing.
170
00:11:55,637 --> 00:11:59,042
Within minutes emergency
responders arrive and transport
171
00:11:59,125 --> 00:12:01,623
ten injured passengers to hospital.
172
00:12:02,933 --> 00:12:07,640
38 year old passenger David
Altman later succumbs to his injuries.
173
00:12:08,810 --> 00:12:11,333
In ten years, he's one of only two people
174
00:12:11,416 --> 00:12:14,582
to be killed on a domestic
flight in the United States.
175
00:12:15,909 --> 00:12:18,596
I was met in the hospital by a doctor.
176
00:12:18,680 --> 00:12:22,434
They told me he hadn't made it,
and that was a, a crushing blow.
177
00:12:24,046 --> 00:12:28,337
Investigators from the NTSB,
the National Transportation Safety Board
178
00:12:28,421 --> 00:12:31,006
are dispatched to the area
as the plane is hoisted
179
00:12:31,089 --> 00:12:33,929
onto a barge and taken
to a secure location.
180
00:12:34,013 --> 00:12:37,423
We weren't able to offload it
the next day because of the weather,
181
00:12:37,506 --> 00:12:40,725
so it took a day,
to get the airplane secured.
182
00:12:43,439 --> 00:12:45,959
We're on record at 5:46 p.m.
183
00:12:47,046 --> 00:12:50,099
Investigators are eager
to interview the pilot.
184
00:12:50,930 --> 00:12:53,790
Memories tend to fade
and they tend to change,
185
00:12:53,874 --> 00:12:57,196
so we want to get to the
information as soon as possible.
186
00:12:57,280 --> 00:13:00,602
I didn't even have any sleep before I
showed up for that interview.
187
00:13:00,686 --> 00:13:03,903
And so you're not, you know,
you're not 100% clear.
188
00:13:03,986 --> 00:13:04,819
Okay.
189
00:13:06,239 --> 00:13:09,276
Take us through the events
leading up to the accident.
190
00:13:09,360 --> 00:13:10,350
Um…
191
00:13:12,286 --> 00:13:16,439
Everything was, normal.
Just a, nice flight.
192
00:13:17,420 --> 00:13:19,986
"Everything was going fine until it wasn't."
193
00:13:20,077 --> 00:13:25,406
And this is pretty common
when we talk to pilots after accidents.
194
00:13:25,490 --> 00:13:29,930
When I went to turn off the anti-ice
I, got out of position on final.
195
00:13:30,895 --> 00:13:33,778
Captain Wells explains
that the plane was hit by
196
00:13:33,861 --> 00:13:37,628
an updraft just as he took
his eyes off the gauges.
197
00:13:41,665 --> 00:13:44,034
-What do you think?
-Go around.
198
00:13:45,512 --> 00:13:46,885
Max power.
199
00:13:50,863 --> 00:13:52,347
We were too high.
200
00:13:52,430 --> 00:13:56,014
And instead of doing
the stabilized approach,
201
00:13:56,098 --> 00:14:00,156
and continue to the runway,
we elected to go around.
202
00:14:00,970 --> 00:14:03,460
So you're now set up for a second landing.
203
00:14:04,580 --> 00:14:07,066
Do you remember your speed at touchdown?
204
00:14:08,116 --> 00:14:09,666
126.
205
00:14:13,933 --> 00:14:15,791
And where did you touch down?
206
00:14:15,875 --> 00:14:19,777
I planted it pretty much on the 1,000,
right on the touchdown zone.
207
00:14:20,720 --> 00:14:25,301
Put it in reverse, and then I
noticed it had stopped decelerating.
208
00:14:25,391 --> 00:14:27,538
I, pushed down as hard as I could.
209
00:14:28,733 --> 00:14:30,896
But there was no response from the brakes.
210
00:14:30,980 --> 00:14:32,072
Brakes!
211
00:14:33,573 --> 00:14:35,346
I got 'em all the way down.
212
00:14:36,726 --> 00:14:38,917
-No response?
-Exactly.
213
00:14:39,000 --> 00:14:42,079
Zero braking. But like on ice.
214
00:14:44,209 --> 00:14:48,131
That was puzzling. We knew we had to
look at the braking system to understand
215
00:14:48,214 --> 00:14:49,494
what was occurring there.
216
00:14:50,599 --> 00:14:53,097
Did you get an update
from the weather observer?
217
00:14:53,201 --> 00:14:58,022
Yes they said,
anywhere from 10 to 20 knots.
218
00:14:58,105 --> 00:14:59,750
The winds were changing.
219
00:14:59,833 --> 00:15:02,479
Any concerns at all
on the second approach?
220
00:15:04,655 --> 00:15:10,263
The winds were dying down on the water.
It looked like a direct crosswind.
221
00:15:10,347 --> 00:15:16,204
I, had no doubt that this was
going to be a fine approach.
222
00:15:16,920 --> 00:15:19,740
The captain said that he
believed that they were flying
223
00:15:19,836 --> 00:15:23,765
into a crosswind and was
confident in that approach.
224
00:15:24,616 --> 00:15:27,040
Your FO did the
pre-flight on the aircraft?
225
00:15:27,123 --> 00:15:28,019
He did.
226
00:15:28,936 --> 00:15:33,626
Did he bring anything to your attention
at all that was out of the ordinary?
227
00:15:34,226 --> 00:15:35,520
He did, actually.
228
00:15:36,352 --> 00:15:39,093
He noticed something
with one of the tires.
229
00:15:48,320 --> 00:15:51,133
-Pre-flight inspection complete.
-Any issues?
230
00:15:51,840 --> 00:15:54,866
Bald spot on the left outboard.
231
00:15:54,950 --> 00:15:59,697
Investigators learn that a
pre-flight inspection of flight 3296,
232
00:15:59,780 --> 00:16:03,416
revealed a worn tire on
the left outboard wheel.
233
00:16:03,500 --> 00:16:07,120
It's not showing any cord.
I'm not worried about it.
234
00:16:08,590 --> 00:16:11,444
It was not down past
the red line on the tire
235
00:16:11,527 --> 00:16:14,177
and didn't, to me, appear
to be of any concern.
236
00:16:14,640 --> 00:16:17,384
I've had maintenance
come to look at tires,
237
00:16:17,467 --> 00:16:20,309
that are in very similar
conditions to this tire.
238
00:16:20,392 --> 00:16:23,218
They've basically said
"It's within serviceable limits,
239
00:16:23,302 --> 00:16:25,285
and you can continue your flight."
240
00:16:26,540 --> 00:16:30,101
Have you reached any
conclusion, just in your own head,
241
00:16:30,184 --> 00:16:33,607
about what you think went
wrong or may have happened?
242
00:16:35,033 --> 00:16:40,493
If I had to make my best guess,
I don't think it was brake failure.
243
00:16:41,820 --> 00:16:46,849
I think more than likely, it was one of
those showers that put down some sleet or
244
00:16:46,932 --> 00:16:51,032
hail on the runway and,
I just couldn't see it.
245
00:16:53,887 --> 00:16:57,135
That's the, only thing I can think of.
246
00:16:59,440 --> 00:17:02,129
Anything else you'd like to add?
247
00:17:08,353 --> 00:17:10,399
I can't be more proud…
248
00:17:12,596 --> 00:17:14,390
I'm sorry.
249
00:17:14,473 --> 00:17:15,752
Take your time.
250
00:17:21,640 --> 00:17:23,925
I couldn't be more proud of my crew.
251
00:17:26,399 --> 00:17:31,418
The captain did get rather emotional,
given his involvement in the accident.
252
00:17:38,279 --> 00:17:43,225
So, they came in on runway
13 and the pilot said his airspeed
253
00:17:43,308 --> 00:17:48,086
was 126 knots and they touched
down at the 1,000 foot mark.
254
00:17:48,176 --> 00:17:52,026
Why did flight 3296 come off the runway?
255
00:17:53,266 --> 00:17:58,113
At that speed, they should have been able
to stop well before the end of the runway.
256
00:17:58,197 --> 00:18:02,370
Specifically for runway overruns,
we're looking at how the airplane was
257
00:18:02,453 --> 00:18:05,946
configured, what those runway lengths were,
258
00:18:06,029 --> 00:18:10,866
as well as what it takes operationally,
to fly that airplane into the airport.
259
00:18:10,963 --> 00:18:12,794
What were the runway conditions?
260
00:18:15,267 --> 00:18:21,360
Was there rain, ice, snow, anything on
that runway that would have prevented the
261
00:18:21,443 --> 00:18:24,440
airplane from stopping on its surface?
262
00:18:25,649 --> 00:18:27,692
No rain. Seven degrees.
263
00:18:28,465 --> 00:18:33,138
-So, hydroplaning is out of the question.
-Too warm for ice to form.
264
00:18:33,876 --> 00:18:37,016
Investigators eliminate
the captain's theory.
265
00:18:37,099 --> 00:18:40,436
Weather conditions did not
make the runway slippery.
266
00:18:41,887 --> 00:18:44,672
In this case, the
runway wasn't contaminated.
267
00:18:44,756 --> 00:18:48,376
But there was plenty of information
that the runway can tell us.
268
00:18:48,460 --> 00:18:52,443
What about debris, skid marks?
Where are we at with the runway survey?
269
00:18:52,527 --> 00:18:53,600
Got it here.
270
00:18:54,955 --> 00:18:58,826
The team looks for any
evidence left behind on the runway.
271
00:19:00,132 --> 00:19:04,493
The runway evidence was critical.
We walked the runway numerous times.
272
00:19:04,576 --> 00:19:07,179
We, documented the heck out of the runway.
273
00:19:08,080 --> 00:19:14,313
Starting at 1,835 feet past the threshold,
we've got a dark 170 foot long skid mark.
274
00:19:14,396 --> 00:19:16,740
Then there's further
skidding down the runway.
275
00:19:16,823 --> 00:19:20,253
Skid marks on the tarmac
are made when the wheels lock.
276
00:19:21,389 --> 00:19:25,892
Then the plane crosses the center line to
the right and then straightens out.
277
00:19:26,560 --> 00:19:28,192
Which tire skidded?
278
00:19:29,790 --> 00:19:34,911
Based on the position of the skid mark,
it's outboard tire, left side.
279
00:19:36,068 --> 00:19:39,995
The Saab 2000 has four
main wheels that brake.
280
00:19:40,078 --> 00:19:42,481
Why would only one of them skid?
281
00:19:47,690 --> 00:19:50,137
Wasn't that the one with the bald spot?
282
00:19:50,220 --> 00:19:51,657
Yup.
283
00:19:51,740 --> 00:19:55,877
The tire mark was a continuous black mark.
It didn't have any tread marks on it.
284
00:19:55,960 --> 00:19:59,851
So we knew, right off
the bat that the tire was
285
00:19:59,934 --> 00:20:02,777
skidding on the bald
spot and not on the tread.
286
00:20:06,160 --> 00:20:11,013
We also found tire fragments, here.
287
00:20:12,510 --> 00:20:15,156
-So the tire blew?
-Yeah.
288
00:20:19,385 --> 00:20:22,846
Hold on. That's one heck of a long skid.
289
00:20:22,930 --> 00:20:25,296
Even a brand new tire would have blown.
290
00:20:25,380 --> 00:20:29,383
The fact that the airplane
was skidding on the bald spot,
291
00:20:29,467 --> 00:20:32,903
may have caused it to burst
a fraction of a second earlier,
292
00:20:32,986 --> 00:20:36,655
but in the end, it
wasn't a contributing factor.
293
00:20:36,739 --> 00:20:39,912
This shouldn't happen.
The plane has an anti-skid system.
294
00:20:41,512 --> 00:20:44,329
The anti-skid system is
activated when one of the
295
00:20:44,412 --> 00:20:47,985
sensors on the four main
wheels detects a skid.
296
00:20:48,068 --> 00:20:52,897
The brake pressure is released, either on
both inboard wheels or both outboard
297
00:20:52,980 --> 00:20:55,813
wheels, ensuring the plane remains stable
298
00:20:55,896 --> 00:20:58,687
while allowing the other two
wheels to slow the plane.
299
00:21:00,259 --> 00:21:05,491
After we first noticed that there was a
flat spot and a hole in the tire,
300
00:21:05,574 --> 00:21:08,408
we were immediately drawn
to the anti-skid system because
301
00:21:08,491 --> 00:21:11,631
that's the purpose of the
anti-skid system, to stop skids.
302
00:21:13,050 --> 00:21:18,351
Did the system fail, causing
flight 3296 to run off the runway?
303
00:21:21,753 --> 00:21:23,063
Any news?
304
00:21:23,146 --> 00:21:25,559
It's going to take some
time for the technicians
305
00:21:25,643 --> 00:21:27,477
to break down and test those brakes.
306
00:21:27,561 --> 00:21:30,926
Like you said, that is a long skid.
307
00:21:31,009 --> 00:21:34,543
Why would they need
to brake so hard for so long?
308
00:21:34,626 --> 00:21:39,712
In the meantime, investigators consider
other theories about the long skid marks.
309
00:21:41,180 --> 00:21:42,657
Overweight?
310
00:21:42,740 --> 00:21:46,571
Could the plane have exceeded its
maximum allowable landing weight,
311
00:21:46,654 --> 00:21:50,108
requiring the pilot to
brake harder than usual?
312
00:21:50,191 --> 00:21:53,556
A heavier airplane
essentially has, more inertia.
313
00:21:53,640 --> 00:21:59,511
So, when a heavier airplane comes in to
land, it would take longer to stop.
314
00:22:00,949 --> 00:22:05,256
According to the manifest, the captain
calculated their landing weight at,
315
00:22:05,395 --> 00:22:07,994
45,213 pounds.
316
00:22:10,853 --> 00:22:12,673
And the maximum allowable?
317
00:22:14,055 --> 00:22:16,448
46,114.
318
00:22:21,993 --> 00:22:26,620
900 pounds under.
Close, but, within the limits.
319
00:22:28,090 --> 00:22:32,733
The airplane was not
overloaded, and we could rule out,
320
00:22:32,816 --> 00:22:37,376
an overweight airplane as a
contributing factor for this event.
321
00:22:37,460 --> 00:22:41,686
What else might cause
a pilot to brake so hard?
322
00:22:41,770 --> 00:22:44,585
The captain said that
they had a crosswind,
323
00:22:44,668 --> 00:22:47,501
but, maybe the direction
changed to a tailwind.
324
00:22:48,445 --> 00:22:51,274
A tailwind during landing
essentially means that you are
325
00:22:51,358 --> 00:22:54,013
moving faster over the ground
than you normally would.
326
00:22:54,096 --> 00:22:57,711
So you would take up more space
on the runway to safely stop.
327
00:22:58,937 --> 00:23:02,354
The automated weather system
only gives hourly reports.
328
00:23:02,437 --> 00:23:05,953
Real-time updates come from a
weather observer at the airport.
329
00:23:06,036 --> 00:23:07,580
I'll deal with that.
330
00:23:07,663 --> 00:23:09,676
I'll go help with the anti-skid system.
331
00:23:11,707 --> 00:23:16,717
Could flight 3296 have been hit
by an unexpected gust of wind,
332
00:23:16,800 --> 00:23:20,848
causing it to land too fast,
and overshoot the runway?
333
00:23:26,679 --> 00:23:28,666
-Thanks for coming in.
-You bet.
334
00:23:29,513 --> 00:23:34,480
Investigators question the on-site
weather observer at Unalaska Airport,
335
00:23:34,563 --> 00:23:39,923
about the wind conditions
when PenAir flight 3296 landed.
336
00:23:40,006 --> 00:23:44,940
So first, um, how early do you start
providing crews with weather data?
337
00:23:45,023 --> 00:23:46,798
About 20 to 30 minutes out.
338
00:23:46,881 --> 00:23:49,872
-And up until when?
-Two to three miles out.
339
00:23:49,955 --> 00:23:52,297
Dutch Harbor is a very unique airport.
340
00:23:52,380 --> 00:23:55,845
The topography around
the runway actually lends
341
00:23:55,928 --> 00:23:59,116
to very rapidly changing
weather conditions.
342
00:23:59,199 --> 00:24:03,160
And so a weather observer on
the ground provides the ability
343
00:24:03,243 --> 00:24:07,787
to get updated information
to pilots as it's happening.
344
00:24:08,665 --> 00:24:12,557
And what was the weather like at the
airport when PenAir was on approach?
345
00:24:12,640 --> 00:24:16,797
There was a storm coming in,
but at the time it was clear.
346
00:24:16,880 --> 00:24:19,420
And what about the wind
on the first attempt?
347
00:24:23,317 --> 00:24:27,889
270 degrees at 10 knots.
348
00:24:27,972 --> 00:24:31,218
Looks like a crosswind.
And second attempt?
349
00:24:31,301 --> 00:24:34,809
About three minutes out
the wind shifted around to,
350
00:24:34,892 --> 00:24:40,061
290 at 16 knots, gusting to 30 knots.
351
00:24:40,830 --> 00:24:43,537
-30 knot tailwind?
-Mm-hmm.
352
00:24:43,620 --> 00:24:45,426
That would be an excessive tailwind.
353
00:24:45,509 --> 00:24:48,926
If a pilot decides to
land with that tailwind,
354
00:24:49,009 --> 00:24:51,023
they essentially become a test pilot.
355
00:24:51,880 --> 00:24:54,833
What about when they landed?
What was the tailwind then?
356
00:24:55,889 --> 00:24:59,149
The winds were, 15 knots.
357
00:25:00,169 --> 00:25:05,228
Investigators confirm their
suspicions about a tailwind on landing.
358
00:25:05,338 --> 00:25:07,478
-Thank you for your time.
-My pleasure.
359
00:25:10,370 --> 00:25:16,407
One danger associated with landing in a
tailwind is, excessive ground speed,
360
00:25:16,490 --> 00:25:19,234
which potentially puts
you in a situation where
361
00:25:19,317 --> 00:25:22,641
you run out of runway to
safely stop the airplane.
362
00:25:30,959 --> 00:25:34,477
What's the Saab 2000
max tailwind for landing?
363
00:25:34,560 --> 00:25:38,732
Was a 15 knot tailwind
too much for the Saab to manage?
364
00:25:40,264 --> 00:25:42,169
15 knots.
365
00:25:42,252 --> 00:25:45,605
Right at the limit.
Why would they risk it?
366
00:25:52,627 --> 00:25:55,090
-Down.
-Okay, you got the yoke.
367
00:25:55,173 --> 00:25:56,826
I got it yeah, we're down there.
368
00:25:56,909 --> 00:26:02,844
Investigators now know the pilots of PenAir
3296 approached a difficult airport in
369
00:26:02,927 --> 00:26:08,736
tricky conditions, touching down with
a tailwind nearing the plane's limits.
370
00:26:08,832 --> 00:26:12,484
-Brakes.
-I got 'em all the way down.
371
00:26:19,112 --> 00:26:25,282
Okay. Weight roughly 45,000 pounds.
Speed at touchdown 126 knots.
372
00:26:25,365 --> 00:26:31,194
Investigators calculate how a 15 knot
tailwind affects the pilot's ability to stop.
373
00:26:32,174 --> 00:26:37,214
Our aircraft performance group developed
several scenarios, to understand whether
374
00:26:37,297 --> 00:26:40,790
an aircraft would be able to
stop given those circumstances.
375
00:26:40,873 --> 00:26:44,710
Tailwind 15 knots, flaps 20.
376
00:26:44,793 --> 00:26:48,636
And let's do a loss of half of the
braking power because of the skid.
377
00:26:49,597 --> 00:26:55,115
When the left outboard tire began to skid,
the Saab's anti-skid system would have
378
00:26:55,198 --> 00:27:01,243
released brake pressure to both outboard
wheels, drastically reducing braking power.
379
00:27:07,890 --> 00:27:09,379
They had room to spare.
380
00:27:10,219 --> 00:27:13,490
With a tailwind of 15 knots
and two working brakes,
381
00:27:13,620 --> 00:27:15,272
the plane could have stopped.
382
00:27:17,484 --> 00:27:18,898
What are we missing?
383
00:27:21,507 --> 00:27:23,433
Let's look at the FDR data.
384
00:27:30,801 --> 00:27:32,838
Hold on a sec.
385
00:27:32,921 --> 00:27:36,142
Just after touchdown,
there's an anti-skid fault caution.
386
00:27:39,124 --> 00:27:43,361
This supports investigators' earlier
suspicions that an anti-skid failure
387
00:27:43,444 --> 00:27:45,564
played a part in the accident.
388
00:27:47,758 --> 00:27:49,271
Hang on, I'm sliding.
389
00:27:59,354 --> 00:28:01,623
We gotta get to the
bottom of that warning.
390
00:28:03,214 --> 00:28:07,530
In this case we did have a fault,
on the flight data recorder,
391
00:28:07,614 --> 00:28:11,042
related to this system
that we couldn't explain.
392
00:28:11,125 --> 00:28:17,618
And so, with that information, uh,
we needed to do a deeper dive, in a lab.
393
00:28:22,704 --> 00:28:26,600
No issues with the control unit.
Wheel sensors.
394
00:28:28,984 --> 00:28:30,434
Same with the control valves.
395
00:28:31,532 --> 00:28:34,939
We tested all the components,
of the anti-skid system.
396
00:28:35,022 --> 00:28:38,855
There were no significant faults.
So, it was a mystery.
397
00:28:40,663 --> 00:28:43,489
There's still the cables
that connect the components.
398
00:28:44,374 --> 00:28:49,113
Investigators focus on the wires that
carry signals from the wheels.
399
00:28:50,002 --> 00:28:53,242
Right here.
Let's take a look at the wiring.
400
00:28:53,325 --> 00:28:56,958
They request that the cables
be removed from the left landing gear,
401
00:28:57,041 --> 00:28:58,865
as that was the side that locked.
402
00:28:58,948 --> 00:29:02,635
Hey there. Can we get those
wire harnesses sent up to the lab?
403
00:29:04,054 --> 00:29:08,934
When the airplane departed the runway,
it hit a ditch and some larger boulders.
404
00:29:09,018 --> 00:29:14,118
And, it collapsed the left main gear,
which caused the wiring to fracture.
405
00:29:17,424 --> 00:29:18,674
These are pretty beat up.
406
00:29:20,837 --> 00:29:25,333
Investigators examine where the
cables were connected to the wheels.
407
00:29:30,861 --> 00:29:34,908
These are identical.
Can't tell the left one from the right.
408
00:29:34,991 --> 00:29:39,648
The team discovers a potential design
flaw within the anti-skid system.
409
00:29:40,611 --> 00:29:44,078
The connectors at the wheels
didn't have any distinguishing features.
410
00:29:44,161 --> 00:29:46,758
So this created potential for miswiring.
411
00:29:46,864 --> 00:29:50,705
Could the brake cables have
been connected to the wrong wheels?
412
00:29:50,788 --> 00:29:54,585
Investigators examine the
wires inside the cables.
413
00:29:54,668 --> 00:30:00,816
Normally, we're able to open up a wiring
bundle and look at the wire numbers on the
414
00:30:00,899 --> 00:30:03,963
wires and compare it
to an electrical diagram
415
00:30:04,047 --> 00:30:06,586
and determine if it's connected properly.
416
00:30:06,670 --> 00:30:08,576
There's no numbering on these wires.
417
00:30:10,499 --> 00:30:15,050
We found the wires were so small, the
manufacturer didn't put wire numbers on them.
418
00:30:15,133 --> 00:30:18,499
So we were concerned
about not being able to
419
00:30:18,582 --> 00:30:21,406
determine if they're correctly connected.
420
00:30:21,489 --> 00:30:25,175
There should be three wires
inside the anti-skid cables.
421
00:30:25,259 --> 00:30:27,143
So we got three here.
422
00:30:27,226 --> 00:30:30,981
Then investigators notice
something out of the ordinary.
423
00:30:31,064 --> 00:30:32,448
There's four wires here.
424
00:30:33,327 --> 00:30:36,120
There's an extra wire on
the top half of this cable.
425
00:30:36,203 --> 00:30:41,585
The wiring inside the top and bottom half
of the outboard cable, doesn't match.
426
00:30:45,648 --> 00:30:47,351
There's four in each of these.
427
00:30:47,434 --> 00:30:53,039
The top outboard cable and the bottom
inboard cable each had an extra wire,
428
00:30:53,122 --> 00:30:55,325
which means only one thing.
429
00:30:57,340 --> 00:31:01,744
They're crossed.
No wonder the anti-skid system failed.
430
00:31:04,674 --> 00:31:07,610
When the left outboard
wheel began to skid,
431
00:31:07,693 --> 00:31:12,504
the anti-skid system mistakenly
released pressure to the inboard brakes.
432
00:31:12,588 --> 00:31:17,225
As a result, the skid continued
and the left outboard tire burst.
433
00:31:17,308 --> 00:31:19,385
That was really the "aha" moment.
434
00:31:20,331 --> 00:31:25,487
When you have crossed wires, the airplane
is then dumping the brake pressure to the
435
00:31:25,583 --> 00:31:30,214
two, perfectly good wheels,
and allowing the other tire to skid.
436
00:31:33,933 --> 00:31:38,085
-Brakes.
-I got 'em all the way down.
437
00:31:38,168 --> 00:31:43,827
Without braking power to the two inboard
wheels, and a blown left outboard tire,
438
00:31:43,911 --> 00:31:47,540
the pilots had a massively
reduced ability to brake.
439
00:31:48,721 --> 00:31:52,669
You're reducing the effective
braking capacity by 75%
440
00:31:52,764 --> 00:31:56,200
and now only the right outboard
tire is providing braking.
441
00:32:10,174 --> 00:32:12,898
The cables have to go through
the entire landing gear.
442
00:32:12,982 --> 00:32:17,354
How did maintenance workers mistakenly
cross the wires of the braking system,
443
00:32:17,437 --> 00:32:21,195
leaving the pilots of PenAir
flight 3296 with only one
444
00:32:21,278 --> 00:32:24,184
of four main landing gear
brakes to stop their plane?
445
00:32:24,268 --> 00:32:26,948
See? It's not a straight line.
446
00:32:27,032 --> 00:32:29,472
And the wheel attachments are identical.
447
00:32:29,555 --> 00:32:31,937
So imagine trying to
feed two wires through
448
00:32:32,021 --> 00:32:34,230
a small hole at the
base of the landing gear.
449
00:32:34,314 --> 00:32:38,097
How do you know which one went to
the left and which one went to the right?
450
00:32:38,181 --> 00:32:40,992
It would just be so easy
to confuse the two.
451
00:32:41,075 --> 00:32:43,404
How long could these have been crossed?
452
00:32:43,488 --> 00:32:49,125
According to the records, there was a full
overhaul of the left main landing gear.
453
00:32:49,208 --> 00:32:53,316
-When?
-January, 2017.
454
00:32:55,274 --> 00:32:59,752
The wires were crossed two and
a half years prior to the accident.
455
00:33:01,275 --> 00:33:04,654
We found out that the
aircraft had been sitting,
456
00:33:04,737 --> 00:33:08,242
uh, for a couple of years, in overhaul.
457
00:33:08,326 --> 00:33:14,352
And there wasn't any sort of procedure, to
check to see if there was any cross wiring.
458
00:33:15,428 --> 00:33:19,431
So how many flights did it make
once it was back in service?
459
00:33:22,122 --> 00:33:23,614
About 500.
460
00:33:24,741 --> 00:33:30,657
They learned that the misrouted anti-skid
wiring went undetected for nearly four months.
461
00:33:31,688 --> 00:33:35,704
So why did 500 flights manage
to stop but not these guys?
462
00:33:37,402 --> 00:33:41,274
Maybe the malfunction was
happening just, on a smaller scale.
463
00:33:41,988 --> 00:33:43,526
The balding tire?
464
00:33:44,477 --> 00:33:46,983
Was the worn left outboard tire,
465
00:33:47,080 --> 00:33:50,326
an indication of the
malfunctioning anti-skid system?
466
00:33:51,230 --> 00:33:55,258
We suspected that there
were events of skidding.
467
00:33:55,341 --> 00:34:00,188
But the difficult thing is, it would have
to skid more than a second and a half,
468
00:34:00,272 --> 00:34:05,170
for the airplane, to display a fault,
that the s-system was malfunctioning.
469
00:34:05,254 --> 00:34:07,417
So this could have been
happening gradually,
470
00:34:07,500 --> 00:34:11,270
with repeated small skids
creating the bald spot on the tire.
471
00:34:11,353 --> 00:34:14,746
Yeah. But when they landed at
that speed with that tailwind,
472
00:34:14,830 --> 00:34:17,833
they braked longer and
harder than in previous flights.
473
00:34:20,023 --> 00:34:24,432
-Brakes!
-I got 'em all the way down.
474
00:34:25,871 --> 00:34:28,858
That's really the
insidious nature of this fault.
475
00:34:28,941 --> 00:34:31,839
You're not going to find out
about this cross wiring until
476
00:34:31,922 --> 00:34:34,624
you really need it when
you're slamming on the brakes.
477
00:34:34,708 --> 00:34:37,441
Ah! Hang on. I'm sliding.
478
00:34:39,163 --> 00:34:41,386
With the hidden anti-skid fault,
479
00:34:41,469 --> 00:34:45,980
investigators conclude
the pilots of PenAir flight 3296
480
00:34:46,063 --> 00:34:49,895
could not have stopped
their plane on runway 13.
481
00:34:53,175 --> 00:34:55,059
There's one thing I'm curious about.
482
00:34:58,961 --> 00:35:03,278
Could they have stopped if they landed
into the wind on runway 31 instead?
483
00:35:08,741 --> 00:35:10,623
It's possible.
484
00:35:10,706 --> 00:35:13,838
Their landing speeds would
have been slower and the drag
485
00:35:13,921 --> 00:35:17,578
caused by the extra wind,
would have stopped it in time.
486
00:35:19,521 --> 00:35:23,784
Then why did they choose
runway 13 and the tailwind?
487
00:35:23,867 --> 00:35:30,151
Did the pilots of PenAir flight 3296,
ignore crucial information about the wind
488
00:35:30,234 --> 00:35:32,293
and execute a risky landing?
489
00:35:32,377 --> 00:35:39,080
The decision to land on runway 13 with the
reported tailwind was an inappropriate decision.
490
00:35:39,163 --> 00:35:44,359
This was an experienced crew and, we
weren't sure what exactly had happened.
491
00:35:44,442 --> 00:35:48,362
Investigators turn to the
cockpit voice recorder for answers.
492
00:35:49,474 --> 00:35:51,601
Pull up from the go around onward.
493
00:35:54,711 --> 00:35:57,317
-What do you think?
-Go around.
494
00:35:58,623 --> 00:36:00,016
Max power.
495
00:36:02,578 --> 00:36:05,818
Dutch Harbor traffic,
Peninsula 3296, going around.
496
00:36:05,902 --> 00:36:08,575
We're going to come
back around for a visual.
497
00:36:08,658 --> 00:36:13,728
Yeah, we're just going to get out of here,
do a 180, and come back in.
498
00:36:13,811 --> 00:36:16,391
Roger, all right. You're at 1,000 feet.
499
00:36:16,475 --> 00:36:17,931
Pause for a second.
500
00:36:18,848 --> 00:36:24,443
So the captain says that he's doing a 180,
which would line him up with 31.
501
00:36:24,526 --> 00:36:26,302
But that's not what he does.
502
00:36:26,385 --> 00:36:31,754
He takes a sweeping 360 degree
turn around the mountain to 13.
503
00:36:36,604 --> 00:36:37,705
Why?
504
00:36:41,691 --> 00:36:47,255
We're at 1,200, coming back around
for a one, uh, for a visual 13.
505
00:36:47,338 --> 00:36:50,148
31. 31.
506
00:36:50,238 --> 00:36:52,104
31? I thought we were doing 13.
507
00:36:52,187 --> 00:36:57,735
Uh, okay. Sure. I'll try it again.
508
00:36:57,818 --> 00:36:59,313
Stop the tape.
509
00:37:00,971 --> 00:37:05,357
So the captain wants to go to 31,
but the first officer questions it.
510
00:37:06,997 --> 00:37:11,591
There was a back and forth between the
captain and first officer in terms of
511
00:37:11,675 --> 00:37:12,992
which runway to use.
512
00:37:13,076 --> 00:37:16,809
I would categorize the
captain's leadership, as poor.
513
00:37:16,910 --> 00:37:19,158
Okay. Get a wind check from her again.
514
00:37:19,248 --> 00:37:24,061
As the crew finalizes the second approach,
the captain stays on top of the wind reports.
515
00:37:24,145 --> 00:37:26,864
Dutch weather 3296, another wind check.
516
00:37:28,020 --> 00:37:34,394
Right now, midfield winds
at 300 at 24 knots.
517
00:37:34,477 --> 00:37:37,095
-Oh, God.
-Oh, crap.
518
00:37:37,178 --> 00:37:38,428
Stop the tape.
519
00:37:39,718 --> 00:37:42,279
Sounds like they're not
happy with that tailwind.
520
00:37:42,362 --> 00:37:44,508
And yet, they kept going.
521
00:37:44,591 --> 00:37:49,844
The CVR raises questions about
the captain's report of a crosswind.
522
00:37:49,927 --> 00:37:54,202
They were surprised of the,
wind direction and speed,
523
00:37:54,314 --> 00:38:01,130
but the interesting thing is is that,
they were aware of the tailwind limitation,
524
00:38:01,213 --> 00:38:03,494
for that particular aircraft.
525
00:38:03,578 --> 00:38:06,196
But they continued on
with the decision to land.
526
00:38:10,237 --> 00:38:13,315
-Try it again?
-Keep talking to weather.
527
00:38:13,398 --> 00:38:17,041
Why would the pilots of PenAir flight 3296
528
00:38:17,124 --> 00:38:22,304
decide to land with a tailwind on a
short runway in Dutch Harbor, Alaska?
529
00:38:22,387 --> 00:38:23,781
…at 24 knots.
530
00:38:23,865 --> 00:38:26,322
-All right, we'll try it again.
-All right.
531
00:38:26,405 --> 00:38:28,371
-Last try.
-Rog.
532
00:38:30,911 --> 00:38:35,138
It's like the captain's just going along
with what his first officer's saying.
533
00:38:35,221 --> 00:38:37,482
He needs to take on more leadership.
534
00:38:37,565 --> 00:38:43,156
The captain suspected 31 was the better
option, but he never stated his preference.
535
00:38:44,304 --> 00:38:51,020
The captain's capitulation to land
on 13 does show ineffective leadership,
536
00:38:51,104 --> 00:38:57,949
and, that he did not fully, evaluate the
circumstances at hand in order to make,
537
00:38:58,032 --> 00:38:59,947
a-an objective decision.
538
00:39:01,163 --> 00:39:03,297
Maybe he was fixated on landing.
539
00:39:10,911 --> 00:39:15,393
Instead of communicating their options,
they continue their approach.
540
00:39:16,538 --> 00:39:18,877
-Give me speed.
-Plus 15.
541
00:39:19,930 --> 00:39:24,537
Investigators conclude the pilot's
decision to land on runway 13,
542
00:39:24,621 --> 00:39:27,362
was intentional, and inappropriate.
543
00:39:28,884 --> 00:39:33,531
By making that decision,
they put themselves at risk,
544
00:39:33,614 --> 00:39:36,032
but they also put the passengers at risk.
545
00:39:36,115 --> 00:39:42,529
Crossed wires, tailwind,
some poor leadership, it all added up.
546
00:39:42,612 --> 00:39:45,463
And very little margin for
error at such a tricky airport.
547
00:39:50,391 --> 00:39:57,065
The pilots of PenAir flight 3296 defend
their decision to land on runway 13.
548
00:39:58,531 --> 00:40:03,515
We're at 1,200, coming back
around for a one, uh, the visual 13.
549
00:40:03,598 --> 00:40:06,197
31. 31.
550
00:40:06,281 --> 00:40:08,508
31? I thought we were doing 13.
551
00:40:08,591 --> 00:40:12,414
Uh, okay, sure. We'll try again.
552
00:40:12,497 --> 00:40:16,602
After the first landing attempt,
the captain claims his first officer saw
553
00:40:16,685 --> 00:40:19,570
no change in wind
conditions on the runway.
554
00:40:20,795 --> 00:40:24,534
He called my attention to it, so I looked
again to evaluate the situation.
555
00:40:24,618 --> 00:40:27,335
He was correct, it was a crosswind.
556
00:40:27,418 --> 00:40:31,418
If the conditions hadn't changed,
I didn't see a reason to change the plan.
557
00:40:31,502 --> 00:40:34,321
Dutch weather 3296 another wind check.
558
00:40:35,511 --> 00:40:41,331
Right now, midfield winds
at 300 at 24 knots.
559
00:40:42,057 --> 00:40:44,331
-Oh God.
-Oh crap.
560
00:40:45,418 --> 00:40:50,888
What we were seeing, was not what she
was, uh, reporting at that point in time.
561
00:40:50,972 --> 00:40:53,977
Those winds were clearly a crosswind.
562
00:40:54,884 --> 00:40:58,997
We could see the white caps, and then the
windsock itself was showing a crosswind.
563
00:41:00,084 --> 00:41:04,654
Commercial pilot and passenger
Steve Ranney saw something different.
564
00:41:06,385 --> 00:41:09,561
I saw a direct tailwind, 20 to 30 knots.
565
00:41:09,644 --> 00:41:13,673
As a commercial pilot, that is something
that I would not have attempted.
566
00:41:13,790 --> 00:41:16,059
When you get conflicting
information from what
567
00:41:16,142 --> 00:41:19,674
you're seeing, that is
a tough call for a pilot.
568
00:41:25,884 --> 00:41:26,788
Down.
569
00:41:26,871 --> 00:41:30,381
-Okay, you got the yoke.
-I got it yeah, we're down there, 80 knots.
570
00:41:30,464 --> 00:41:34,587
When the brakes malfunction,
the captain is unable to slow the plane.
571
00:41:35,704 --> 00:41:38,681
-Brakes.
-I got 'em all the way down.
572
00:41:38,764 --> 00:41:40,564
We had no braking power at all.
573
00:41:40,648 --> 00:41:45,031
If we had one operational brake still,
it would have locked up and blown as well.
574
00:41:45,115 --> 00:41:48,038
This particular aircraft didn't
have an emergency brake.
575
00:41:48,121 --> 00:41:50,709
So in the event that the
main system failed,
576
00:41:50,792 --> 00:41:54,254
there's no way to bring
this aircraft to a brake stop.
577
00:41:55,405 --> 00:41:57,401
Hang on. I'm sliding.
578
00:41:57,485 --> 00:42:00,468
Quick thinking and turning
the plane towards a road,
579
00:42:00,551 --> 00:42:03,595
avoids a full plunge into Dutch Harbor.
580
00:42:03,678 --> 00:42:04,858
Go right. Go right.
581
00:42:06,317 --> 00:42:10,165
The key to not go into the water
was our decision to land on 13.
582
00:42:10,248 --> 00:42:14,717
We had the perimeter road.
There was a lot more room on the 13 side.
583
00:42:19,935 --> 00:42:24,185
Tragically, fragments of the left
propeller ripped through the fuselage,
584
00:42:24,268 --> 00:42:25,928
killing a passenger.
585
00:42:28,171 --> 00:42:31,510
You never want to lose
a passenger, for any reason.
586
00:42:31,593 --> 00:42:33,165
Um…
587
00:42:33,267 --> 00:42:35,351
That's, that's been very hard for me.
588
00:42:37,221 --> 00:42:40,827
Investigators conclude the
probable cause of the accident,
589
00:42:40,910 --> 00:42:44,544
is incorrect wiring
of the anti-skid system.
590
00:42:44,627 --> 00:42:48,974
Contributing to the accident is the
pilot's inappropriate decision to land on
591
00:42:49,057 --> 00:42:52,026
a runway with a
powerful reported tailwind.
592
00:42:57,153 --> 00:42:59,439
That, troubles me because,
593
00:42:59,523 --> 00:43:02,660
are we supposed to just blindly
rely on our weather observers?
594
00:43:02,743 --> 00:43:05,029
Or are we supposed to
make a decision as the
595
00:43:05,112 --> 00:43:08,898
pilots on what the best course of
action is, based on what we see?
596
00:43:08,981 --> 00:43:13,479
Saab released a service bulletin,
advising operators to inspect
597
00:43:13,562 --> 00:43:16,301
the anti-skid system for crossed wiring.
598
00:43:17,308 --> 00:43:23,371
You know you can't afford for human
error, to be, allowed in connecting wires.
599
00:43:23,455 --> 00:43:29,224
That's a very basic thing, especially on a
critical safety system such as the brakes.
600
00:43:30,221 --> 00:43:34,538
For Steve Ranney, the ordeal
changed his attitude about flying.
601
00:43:35,607 --> 00:43:38,247
It took quite a while for
myself to be comfortable
602
00:43:38,330 --> 00:43:42,347
again, but we live in a
place where we have to fly.
603
00:43:42,430 --> 00:43:44,845
There's no choices about it.
604
00:43:44,928 --> 00:43:50,496
I would hope that there are lessons here
as far as, uh, weather and maintenance
605
00:43:50,579 --> 00:43:54,002
that can keep accidents
like this from happening, again.
606
00:43:55,920 --> 00:43:57,600
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