Toronto plane crash report includes new video, details about what went wrong

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A second-by-second accounting of last month’s spectacularly bad landing and subsequent evacuation of the passenger jet that flipped upside down at Toronto airport says an alarm warning of a rapid rate of descent sounded seconds before touchdown.

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The preliminary report by the Transportation Safety Board of Canada into the Feb. 17 crash of a Delta Air Lines regional jet at Pearson International Airport does not disclose a specific cause for the crash — that is expected at the conclusion of its probe — but it does reveal details of the ill-fated landing and the unusual struggles of passengers and crew who were stuck in the wreckage of an upside-down airplane.

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The report reveals that a passenger had to help the two flight crew pilots, a man and a woman, escape because damage blocked the cockpit door and the escape hatch on the cockpit ceiling couldn’t fully open because the plane landed on its roof.

Because the escape hatch was so close to the ground a passenger needed to pull them out to safety, says the report, released Thursday.

Although there were no deaths and everyone escaped, 21 of the 80 aboard were injured; two of them seriously.

While there was praise for the evacuation at the time, it did not all go smoothly.

“Passengers were hanging upside down in their seats, suspended by their safety belts, and many of the carry-on baggage and other items ended up on the aircraft ceiling,” the report says.

“Some passengers had difficulty releasing the buckles on their safety belts due to being inverted. Some of the injuries sustained by the passengers occurred when they unbuckled their safety belts and fell to the ceiling.”

A forward toilet door was partially unhinged, blocking the view of the rear of the cabin for the flight attendant until a passenger tore the door all the way off to clear a line of sight.

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Jet fuel was running down one of the over-wing emergency exits, forcing most of the rear passengers to exit through one door, with some of them getting covered in fuel as the fled.

Rescue and firefighting crews arrived about five minutes after the crash and some passengers were sprayed by fire retardant foam.

The report says that two additional airline employees who were on the flight as passengers as they travelled to Toronto in anticipation of crewing a future flight, helped evacuate the rear of the cabin.

The report gives a detailed accounting of flight, the flight crew, the hard landing, the weather, and the damage that is being examined for additional answers.

THE FLIGHT

The flight was run by Endeavor Air, a regional service by Delta Air Lines, and it took off from Minneapolis-St. Paul International airport in Minnesota at 12:47 p.m., one of several daily flights between the airports. The trip takes around two hours and 15 minutes, which usually beats a 14-hour drive over 1,473 kilometres.

There were two flight crew members, two cabin crew members, and 76 passengers on board. There were two other airline employees travelling on the flight as passengers — one a pilot and the other a flight attendant.

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THE CREW

The two-person flight crew was a captain seated in the left seat and monitoring for the flight, and the first officer who was seated in the right seat and was the pilot.

The first officer at the controls had been with Endeavor Air for 13 months at the time of the crash. She holds an airline transport pilot certificate issued by the U.S. Federal Aviation Administration, and at the time of the crash had accumulated 1,422.3 hours total flight time, including 418.7 hours on the same type of aircraft that crashed, the report says.

She was on the last day of her five-day work cycle.

Her day started in Cleveland, on an 8:19 a.m. flight to Minneapolis that takes about two hours. That left her an hour and 48 minutes before her ill-fated trip to Toronto.

In the previous 30 days before the crash, she had conducted three round-trip flights into and out of Pearson. She had flown 56.3 hours in the previous 30 days, the report says.

The captain of the plane, who was not at the controls, has been with Endeavor since October 2007.

He also holds an airline transport pilot certificate issued by the FAA. He is also a flight simulator instructor. He had 3,570 hours total flight time, including 764 hours on the same aircraft type before the crash.

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His day started in Minneapolis and the flight to Toronto was his first of the day. It was also his first flight in seven days; he had worked three days as an instructor and had flown just 3.5 hours in the previous 30 days.

The flight attendant at the front of the plane had three years of experience, all with Endeavor; the attendant in the back had 11 years of experience, five of them with Endeavor.

Their flight was uneventful until the last moments, the report says.

THE CRASH

The pilot received clearance to land on Runway 23 at Pearson airport at 2:12 p.m., using an automated runway approach assistance tool that sends information from the ground to give accurate vertical and horizontal guidance while landing.

According to the Endeavor Air flight manual for that type of aircraft, the airspeed for the final approach to landing should be set at 144 knots. The manual provides a formula for increasing the airspeed “in gusty wind conditions.”

The pilot set the airspeed to 144 knots. “Given the reported wind gusts, the approach was flown at 149 knots,” the report says.

At one second past 2:12 p.m., the plane descended to 500 feet above ground level at 150 knots. Five seconds later the pilot turned off the autopilot.

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At 2:12 and 26 seconds, when the plane descended past 175 feet above ground level, the plane’s airspeed was 144 knots. Four seconds later, at 153 feet above the ground, its airspeed was 154 knots.

The pilot pulled back the thrust levers, reducing its thrust, and over the next five seconds, the airspeed began to decrease.

At 12:12:40 — that’s 3.6 seconds before touchdown — the aircraft was 50 feet above the runway, which sets off an alert for flight crews that the plane is 50 feet from ground. It’s an audible alert simply saying “Fifty.” Its airspeed was 145 knots and the rate of descent had increased.

Just one second later, the enhanced ground proximity warning system, an alarm that the plane is in danger, went off, warning of the plane’s “sink rate,” meaning it was going down too fast. The plane’s indicated airspeed was 136 knots.

The plane banked slightly to the right by 4.7 degrees.

The next second, at 2:12:42, the plane was slightly below the automated recommended glide path, but it was tracking the centre line of the runway, the report says.

The descent had increased and so did the banking to the right. It had twisted up to 5.9 degrees.

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Less than a second before landing, the plane’s airspeed had dipped to 134 knots but the bank angle had grown to 7.1 degree and its nose was facing one degree up from the ground.

It touched the ground at 2:12:43.6 — a remarkably fine delineation of time. Because the plane was banking to the right, now at 7.5 degrees, it was the right main landing gear that hit the runway first.

A lot happened then, and investigators are not yet precisely sure in what order events occurred.

After contacting the runway, the side-stay attached to the right main landing gear broke, leaving it to fold back into its retracted position.

The wing root, an important part of the wing where it attaches to the airplane’s fuselage, fractured between the fuselage and where the landing gear extends from. Wing roots tend to bear the highest bending force in flight and in landing.

The wing detached from the plane, releasing a cloud of jet fuel, which caught fire.

Jolted and missing a wing, the plane slid along Runway 23. The left wing, still attached, would be still creating lift, the force that pushes a plane up. Without the balanced lift on the right, the plane rolled to the right, completely flipping it upside down.

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Once inverted, a large portion of the plane’s tail detached.

The rest of the plane slid off the right side of the runway, travelling about 23 metres into snow-covered grass until it stopped on Runway 15L.  The right wing and landing gear kept on going for another 65 metres.

The inverted landing left passengers and crew upside down and disoriented inside the wrecked plane, still, an evacuation began.

THE PLANE

The jet was made by Bombardier in 2008 as part of its Regional Jet Series 900. It was registered to Delta on Dec. 31, 2009.

It had a total of 35,335 hours in the air before its destruction in Toronto.

WEATHER

The meteorological information at the airport issued at 2 p.m. shortly before the crash was listed as winds at 28 knots, gusting to 35 knots, with blowing snow giving a visibly of six statute miles.

The temperature was -9 degrees C.

The runway had been plowed to a width of 160 feet; the full runway width is 200 feet.

Soon after the crash, at 2:32 p.m., the weather was listed as winds at 20 knots, gusting to 32 knots. Visibility was the same, but the temperature had risen a degree.

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THE WRECKAGE

The plane ended up in three main pieces: the fuselage filled with the passengers and crew, the right wing and the tail.

The tail was found about 72 metres from the main wreckage and the wing about 65 metres beyond the main wreckage.

The right main landing gear was found with the severed wing. There was only minor damage to the tires.

There was minor damage to the right landing gear strut and marks on the lower portion of its outer cylinder showed evidence of the strut bottoming out.

Normally, a side-stay locks the landing gear in place once extended to keep it from collapsing during a normal landing, but this was not a normal landing. When the landing gear hit the runway, the side-stay fractured where it connected to the landing gear strut, and the landing gear then folded back inward while the side-stay remained in the down and locked position.

A close-up photo in the report shows the metal shorn fairly sharply through the triangular shaped metal piece.

Various pieces of the land gear assembly were found scattered along the runway.

There was no damage found on the other two landing gears, on the left wing or on the nose.

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Various flight control systems were found to have no pre-existing damage or faults. No abnormalities were found with the two engines.

However, before the crash, “the right engine integrated engine-driven generator had been disconnected and a minimum equipment list deferral was in effect for the repair. The auxiliary power unit was running during the entire occurrence flight to provide an additional power source, per the minimum equipment list. This was the only deferred item in the journey log.”

The right wing was a mess after the crash, both from impact and the subsequent fire. Both wings are still undergoing examination at the TSB Engineering Laboratory.

Although its connection as potential cause seems remote, the report says the plane’s emergency locator transmitter did not activate during the crash sequence, although it was armed. That too was sent for examination.

THE “BLACK BOXES”

The flight data recorder and cockpit voice recorder were sent to the TSB’s lab. Both were operational during the crash.

The information is being further examined and the report did not release any details of the cockpit communications or utterances before, during or after the crash.

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EMERGENCY RESPONSE

An upside-down airplane on a runway is an alarming sight, and must have caused significant chaos and fear after the plane came to a stop.

Although some of the injuries came from falling when released from their seat, there were no known safety belt or seat failures during the crash, the report says.

After the passengers and crew had got out, fire crews entered the wreckage and shortly after there was an explosion outside the plane near the left wing root. The cause of the explosion is not yet known.

THE INVESTIGATION

The crash investigation continues with 11 areas of focus before a final report with findings and analysis is expected.

The focus areas are: a metallurgical exam of the left wing; the certification of the landing gear and wings structure; the evacuation procedures; the flight deck door structure and design; land techniques; cabin impediments in an upside down plane; the flight deck escape hatch; organization and management factors; flight attendant training; coordination in emergencies; and the ground emergency response.

“It is important to note that at this stage in the investigation, it is too early to draw conclusions as to the causes of this accident,” the TSB said when releasing the report. “The information in the preliminary report may be incomplete, may change during the investigation or new relevant facts may become known that have not yet been considered.”

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Delta officials declined to comment on the report.

“For everyone at Endeavor Air and Delta, nothing is more important than the safety of our customers and our people. That’s why we remain fully engaged as participants in the investigation led by the Transportation Safety Board of Canada,” the company said in a statement.

“Out of respect for the integrity of this work that will continue through their final report, Endeavor Air and Delta will refrain from comment.”

• Email: ahumphreys@postmedia.com | X: AD_Humphreys

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