Fatal T-38C Mishap in Montgomery, AL Accident Investigation Board Report Analysis

On February 19, 2021, a T-38C assigned to Columbus Air Force Base crashed just before Danly Field in Montgomery, Alabama, claiming the life of Lt. Scott Ames Jr., first IP assignment in Columbus and a student pilot from the Japanese self-defense air force today. Let's take a look at the

accident

investigation

board

's final

report

, but first a little about lieutenant ames. This was published by the Fall Wings Foundation. You can check them out on Facebook. They also have the website Fallwingsfoundation.org. Tennis Scott Ames Jr. First task. instructor pilot station columbus air force base grew up in indiana from the age of three scott looked to the skies and wanted to be a pilot after completing pilot training he was selected to join the instructor corps at columbus air force base columbus because of his extraordinarily high proficiency and skill in the jet scott not only performed on his own but inspired and encouraged everyone around him to become the best guy in the room dedication to his craft passion for learning a contagious positivity and standing up for his colleagues where scott's daily standard scott was involved in a tragic

fatal

mishap

on february 19, 2021 outside of

montgomery

alabama, scott will be remembered for the pillars he upheld every day, hard work, love, laughter and capturing any room he entered with his family's permission.

Please join the Fall Wings Foundation in supporting the Lt. Scott Ames Jr. Memorial Fund, as always, 100 of the memorial funds will go to the family, he truly was the best of us, an amazing guy and an even better Airman, the team from fwf would also like to pay our respects to the jasdf student who was lost. I also lost from this

mishap

in Alabama, two nickels in the grass, as always with these Aib

report

s. This is not a judgment on any of the pilots involved. This is just a factual review and breakdown of what happened. I'll try to explain things as best I can.

Can you have flown the t-38c and currently fly the t-38a? I always point out that you know, but by the grace of God, this can happen to anyone. People make mistakes. It was a very tragic loss of life. However, I think there are We can always learn some good lessons when things like this happen, so let's take a look at the Aib report that just came out well, so this is the official Aib report of t38c tail 688099 from the 50th Flying Training Squadron 14 Flying Training Wing in Columbus. The Air Force Base occurred at Danley Field, Montgomery, Alabama, on February 19, Maj.

Gen. Laura Linderman was the chairman of the

board

. Here's the summary, so I'll leave chapter links in the description. You can skip them if you like the way they usually start. We just give them an overview of what happened and then talk about how it happened. On the afternoon of February 19, around 4:40 p.m. m. local time, the T-38c impacted terrain near Runway 2-8 while conducting an instrument approach at Montgomery Regional Airport, Montgomery, Alabama. The instructor pilot in the mishap was a first-assignment instructor pilot. The student pilot in the mishap was a student. Japanese pilot Both pilots were assigned to the 14th Flight Training Wing in Mississippi It was the first leg of a cross-country for students off-station mission Due to a recent winter storm mishap, the student was also the first brotherhood of women flew by the ip mishap and the student pilot mishap in nine days, so they hadn't flown in a while due to the weather and were doing off-station crank training. which is very common, it's customary, it's not uncommon, that's where you get a lot of your instrumental training in pilot training, getting off station and seeing new fields and things like that, the mishap crew were planning to fly to Danley Field, run an instrument in circles. approach and then continue to Tallahassee International Airport, Tallahassee, Florida, to come to a complete stop.

The student pilot flew the downwind leg of the circular approach configured with the landing gear down and flap locked 60 and offset 1.9 nautical miles from the runway. The student pilot in the

accident

was 18 knots above the end. turn speed and 0.4 nautical mile wide when the end began to turn due to not reaching the end, the ip ordered the student pilot to conduct an intercept of approximately 40 degrees in the direction of final approach and ordered an msp to reduce speed. MSP retracted the throttles to idle and began a 30- to 35-degree turn to the left to align with the runway as the accident airplane decelerated to 164 knots, which is 8 knots below its final approach speed.

What they calculated was that the accident ip took control of the plane with the rotary wings level up and then advanced the throttle to maximum afterburner at which point the throttles had been at idle for 18 seconds the accident the plane had decelerated to 155 knots 17 knots below the final approach speed and was descending to 250 feet a.s.l. at 1,100 feet per minute at the accident descent speed. The aircraft impacted the ground seconds later, approximately eighteen hundred feet from the approach end of the runway. two eight, both the PI and the student pilot were

fatal

ly injured. I found out who the president of the board is.

By the preponderance of the evidence, the cause of the mishap was the PI. loss of situational awareness by failing to take timely and necessary actions as the dangerous situation further develops, I find by a preponderance of the evidence that the student pilot contributed substantially to the mishap after becoming over task in the traffic pattern and placing and leave the accelerators in position. idle as the circling approach progressed, the IP was unable to recognize the deterioration in the accident airplane's performance caused by an excessive period of time the throttles were idle. This undetected and uncorrected action, along with the accident, additional flight control inputs from the student pilots to align with the runway resulted in insufficient airspeed. and altitude and higher angle of attack and sink rate and they placed the accident airplane outside the parameters for safe flight, so that's what happened, that's the summary, they were basically doing an instrument approach with a circle to land , he went fast and shallow to intercept final and then uh, to correct, he left the throttles at idle and they stayed there until the ip took over, in which case they were below final approach speed. uh, in a high drop rate situation that was unrecoverable at that point, okay, summary of the facts, here's, uh, the authority. purpose of the summary um the background of what all the different wings and training wings do and stuff um t-38c uh t-38t is a very old trainer it's a swept wing fighter very stubby wings 25 foot wingspan and these airplanes aren't the most forgiving uh especially in end turn situations especially when you're loaded with a high angle of attack uh slow airspeed you know it's going to talk to you you're going to get the buffett on the wings and then the buffett will start to receive the and then once you have the elephants in the wings, if you don't recover, you are now in a lose situation, so it is definitely not something to be taken lightly, it is not an easy airplane to fly. , that's where you go around in circles in the t-38c.

On an instrument approach, they do not descend below the minimum circling altitude, which is slightly higher than the normal minima for the runway. You're in a flat 60 setting, so the T38 has three flap settings. We use up to 60 flaps, full flaps, 60 flaps. is what you would use for these 60 flaps also for a single engine approach or a single engine operation, things like that. Do not descend below the minimum descent altitude until you are basically on a normal glide path to land once aligned with the runway and in a safe landing position the pilot reduces final approach speed select full flaps if desired pods must remain alert for stall conditions have discipline execute to turn around or recover from stall uh when the required circle approach presents a potential sink rate problem in The t-38c may not go accompanied by a bank stall warning during a circle approach, which creates an insidious descent that increases the potential danger, so basically what a circle approach is is that you are approaching a runway, let's say you are going to a field . which has only an instrument approach, well, you don't want to land on that runway because maybe it's too short or maybe the winds aren't favorable or whatever, so you make the approach, you get out of the weather and now you're doing an visual maneuver around the field to align with the intended track, so it's like entering the pattern once you're already established, so you have specific details, that's why higher minimums because you know you want, you have to maintain a visual with the runway you have to be able to make that final turn, it can be tricky honestly we don't do them much in the t-38a and what i do flying in the air i mean i've never done one since i'm flying the t-38a the The last time I did a circle approach in any military aircraft was probably pilot training, it's just not something we do very often, but once you're training you do it a few times so you can get comfortable. okay, here is the sequence of events, it was the first stage of a cross-country student mission off the station using a training profile found in the syllabus, the mishap crew completed flight planning before the mishap, departure according to the rules, actions acquired included mission planning, review of training records. nodums observe the condition forecast all of that nothing seems out of order they made an orm profile which we have talked about in many mishaps operational risk management uh the following risk factors uh were not familiar field uh mission over water unknown uh cloud ceilings predicted less than 1500 with three miles of visibility at the final landing base temperature less than four degrees one takeoff a light rhyme icing instructor inexperienced international student 8 to 14 days from last flight 7 to 14 days from instructor's last flight prompted a high level of risk and required the squadron commander approved the sortie the call sign was mafia 5 7 was the first sortie in the advanced instrument training block a student pilot was in the front seat of the forward cockpit and the ip he was in the back uh he was the cross instructor The country flew to meet the requirements due to the impact of a recent storm.

It was the first sortie made by the accident crew in nine days, so they were only open to essential mission personnel from the 14th to the 17th doing the weather they were likely testing. to get it back on the road because you can get a lot of training doing cross country, go to a lot of different courses, get a lot of different approaches, so the morning of the mishap there were other cross country too, the ip was completed. a semi-annual test the morning of the mishap he didn't attend the weather briefing due to seeing a text message about the meeting time, but he checked the weather with another instructor pilot so I assume they did a mass briefing as well due to climate change.

Accident conditions The crew modified the cross-country mission plan several times with other aircrews. They were initially going to go to McDill, but due to icing they planned to go to Danley Field for the instrument approach and then go to Tallahassee. Cross-country aircrews also discussed They postponed their mission one day and took off on Saturday as the airfield was scheduled to open for training, but improved during the morning based on forecasted ceilings at 1,400 feet of the Tallahassee alternative. It was required that they were going to Valdosta Regional for the alternative. did not calculate the fuel required for the alternative fuel registration as required, that is irrelevant to what happened, although other cross country t-38s did calculate the fuel required for the alternative tournament, they did not have enough fuel to leave it in a Danley Field, therefore, the other cross country student planned to fly directly to Tallahassee if the weather forecast did not improve when they hit the accident.

The crew was the only cross country student who didn't accurately feed the plan for an alternative and didn't fly directly to Tallahassee. It is not clear to the other aircrew why they did not do so. plan a fieldalternate to make it sound like you start in mission planning, where you basically know you have to be able to fly to your intended destination, make an approach, and then divert fuel to go to a different airport if the weather is bad. certain minimums, so what they said was we don't have enough gasoline with the alternative fuel that we need to carry to go to Tallahassee or go to Danley Field first, so we're going directly to Tallahassee for whatever reason.

He didn't take that into account and they still went to Dan Lee's camp, probably not causal or contributory, but it shows the chain of errors in how they were planning the mission and some of the things the student may have missed. mission briefing as required by flight guide plan to fly to Danley Field execute a circle approach then continue to Tallahassee for a full stop before flight receive a top three briefing receive go no go items obtain assignment of the aircraft and put on their gear, boarded their originally signed aircraft, however, they aborted before taxing due to high fuel indications during engine start in accordance with their cold weather guidance limiting our crew's exposure. at cold temperatures.

They return to position 50 for 30 minutes to warm up. got up before moving to the spare during the 30 minutes inside reperformed their step procedures recalculated their orm confirmed with ops soup that the orm score remained high but did not require a higher level of approval authority other than the commander and then they took a step to the mishap, the plane reviewed the accepted forms, the plane completed the start of a taxi, fact of influence, so again it's not causal, but you can see the things that are starting to accumulate. um, you know the weather is bad, they haven't flown in a while, they missed this.

In mission planning they needed to go directly to the destination instead of stopping at Danley Field due to alternative requirements and now they have to move on to a spare, but due to cold weather procedures it is not as simple as aborting the plane, leaving , go to the new plane, which is already a little worn out, but they have to abort the plane, get in, wait 30 minutes. due to exposure requirements in cold weather, then come back before flying the plane again, turn the plane on again and then taxi again, so now you know a lot of things cause you can see where this is. of perhaps leading to some stress accident summary they took off at 2204 zulu time approximately two hours after the originally scheduled takeoff time while en route to danley field cockpit recordings revealed that the student pilot had difficulty understanding and responding to the atc ip radio assisted the msp several times and intervened directly with atc on one occasion to ensure flight safety.

Communication problems with atc continue to challenge the student pilots during the rest of the sorties, so the Japanese student's English is not his first language, he has difficulty and does not understand the communications that you know when they say that when you are saturated with the homework, listening is actually one of the first things to pass channeled attention, auditory exclusion, so the students who have some kind of helmet shoot, the ip is trying to push it, so the ip is now distracted. a bit with having to work this student through his cross country and get him the desired training he needs in 2213 atc passed the mishap crew for one shift and held the initial approach position followed by the alpha instrument approach and high tack uh msp flew one turn holding on initial approach set at sixteen thousand feet, which means approach initiated level at twenty 22-28, so this is more of a training, this is when you're training for instrument approaches, you do things like that, so basically you practice going into hold because it's not the easiest thing in the world to do, it's actually a little difficult, but what you'll do is practice a turn and hold and perform the entire procedure In real life, in the tactical world, it is usually like this. vectors at the end if you have to keep them it is by exception, but normally they are vectors to finally apply the final part of whatever approach you are doing, but for a sorority like this they do it because it is more difficult because it is part of the training, so You're probably struggling a little bit figuring out how to enter the hold, enter the hold, and then fly the entire procedure, so it adds to the things you have to do as a student pilot in 2237, the loop portion of the approach began by instruments. probably configured with the linear down and locked at 60 flaps so it escapes and starts to spin uh and then remained at 1200 feet masl due to an altitude restriction of one thousand one hundred and eighty feet masl two point five miles from the end of the The zero steam runway one pilot turned to a heading one eight zero for 45 seconds to achieve the proper runway offset for the downwind leg of the circular maneuver and began descending to the minimum descent altitude of 860 feet m.a.s.l.

This type of aircraft was a beam track. 2-8 approach and threshold heading 095 930 feet masl flying 207 knots and displaced 1.9 nautical miles from the runway threshold the aircraft was approximately 70 feet above the mda, which is good 15 knots above the speed of the air in the final turn of 192 knots bad and 0.4 nautical mile wider than desired Runway displacement of 1.5 nautical miles. The msp began a 40 degree left bank level turn at 210 knots, so it now accelerated from 207 knots and, because the normal runway offset was wider, it did not reach the end, so it did not exit aligned. went out, missed the turn due to ending under range as it passed the heading of 328 and 830 feet, the ip indicated that you can taxi right here so it's trying to intercept the heading, do you know if the heading is right here on instead of you know, 90 off, okay or it ended like this, okay, you can taxi here so they can eventually intercept uh ms and the student pilot went out on a heading of 316 212 knots and now it's even faster and it descends to 850 feet per minute. slow down to green speed, directed the stack of students to decelerate from 209 to a final approach speed of 172 knots, so 172 knots tells me they are heavy or a little heavy, uh no, you know the patterns normals of about 155 knots or So just so you know, it's your first landing so faster and heavier speeds are more likely to stall so it's also another thing that they are making this weight heavier at this point , when the student pilot reduced both throttles to idle and they stay there for the next 18 seconds, which is an eternity, a couple of seconds is an eternity, 18 seconds is a lifetime, I mean, I just can't, it's hard First of all, you almost never go into idle in the pattern. much less idle for 18 seconds unless you're cooking, I mean on break, that's the only time it would be idle for any given period of time.

I indicated that I leveled off and the student pilot began to reduce the descent rate to 600 feet per minute, so uh. IP is training them through IP is training the student pilot through the approach IP then said hold that cable well so the cable is um it's really what you call it there's a cable that you intercept for the glide path that you want to catch and he's basically saying hold that fly. Those daddies, the precision approach indicator is the red, white, red and white lights, uh, next to the runway, directing the stack of students to fly the crashed airplane and a two-degree glide path and middle to three, clue two eight approaching the threshold, so he's talking to him. and the ip is probably looking over his shoulder looking forward trying to gauge the sight picture and not necessarily inside the cockpit at this time, ip said, see the runway, there you go and this student pilot started a turn of 30 to 35 degrees to the left to align. with runway 28 when the plane decelerated to 192 knots, so they are still not doing too bad 192 knots 400 feet per minute to sink.

However, the sink rate throttles are still idling and that's the problem is that they are trapping it. but the accelerators are still at idle. Ip said calmly a little and cut off the end of his statement. At this point, the airplane was on a heading of 278,450 feet msl and approximately 36 degrees left bank. The throttles are inactive, decelerating to 164 knots, so we are now below the calculated final approach speed of 1400 feet per minute. Very high drop rate. Additionally, at this time of day, on a heading of 278, the setting sun was in the cruiser's field of view, likely affecting the student's ability to discern the information displayed. on the hud and the crew's ability to acquire the runway, so the sun is low, the sun is in your face, it's probably washing out the hud and making it difficult to see the runway, so all your attention is probably out there trying to see uh where the runway is what is the glide path and none of them are caught, they just decelerated below final approach speed with the throttle still at idle with a sink rate uh at 22 39, the ip indicated that we would start climbing , which according to the technical

analysis

was the last point. at the time when safe ejection was possible, these are zero zero seats, however, even with a zero zero seat you cannot eject with a high sink rate at low altitude, you are out of range, it just won't work, so when he took the plane at this point uh basically the only option was to eject the AIB determined the ip to control the plane at 22 39 56 uh so half a second after saying that and he simultaneously rolled the wings level and tried to recover the plane after of recognizing excessive synchronization speed and slow airspeed, so you can see here, it's very difficult to see, but 164 knots is approaching stall, so they haven't gotten there yet 0.72 that's the aoa indicator, that's your heading g meters altitude all that stuff we'll get better photos here in a second, the ip advanced the throttles to maximum on our afterburner as the recovery attempt continued.

At this point, the engines were accelerating from idle to 66 rpm with the airspeed at 155 knots and 1,750 feet are men at the same rate, a huge sink rate, a huge sink rate. Now you can also see 155 knots still below full afterburner speed and just below a stall here. And you can see, I don't know if you can see. that so you can see the kind of glare from the sun in that image, but the flight path marker is still buried and the flight path marker shows where your plane will go at any point in space, so if you need it above from the horizon line to rise to 2240 o2, the ip continued to approach to recover the saw, but the plane continued to descend due to its power deficient state, it is just sinking, I mean, the engines have to start , the afterburners have to turn it on.

I know you have seven seconds per engine for the nozzles to spin, I mean it's not fast and seconds count here. Airspeed remained low with the engines continuing to accelerate. Airspeed was 153 knots, 11 degrees, pitch up attitude, 5 degrees down, flight path. I've reduced the distinctive speed to a thousand feet per minute, two degrees on the right angle of the bank throttle in maximum speed a b down, I unlock 60 flaps and you can see now that we are in a stall 1.07 are you getting it, they are getting the buffet uh they are putting elephants on the wing, it's because the wings are swinging, it's most likely too much drag, they have the travel boat, so they have a lot going against them, they have the travel module on the plane, which we'll talk about here in a moment about the configuration: you have the gear down, you have flaps, you know, all those things create drag, you already had a high sink rate, you were close to the ground, um, it's just not like that.

It's not a good recoverable situation when you already have such a high drop rate, it's just not going to work, so now it's like, "Hey, you're stalling" and he gets the stall warning on the earpiece beep, uh, 157 knots. five degree nose pitch attitude five degree downward flight path 1100 feet per minute sink rate so now we're going to bring the sink rate back up and now the pitch angle is increasing because now we're in full operation, the wings are doing this, I mean. It's just that the plane is no longer flying, the stall is 1.09, I mean the angle of attack, so we are well beyond the stall regime here, and there is nothing they can do at this point, a second later , I think the impact sequence of theplane.

She probably reported back even more on the lever because she starts to realize that they are about to hit the ground. The airplane sequence malfunctioned and began at 2,300 feet from the approach end of runway two eight during the impact sequence, the airplane struck power lines at 70 feet. tall a 50-foot-tall approach lighting system tower entered a stand of trees before impacting the ground 1,800 feet from the approach end of the runway ground impact at 138 knots 5 degrees low bank attitude of the nose 80 degrees flight path downward 1700 feet per minute to slow down and 50 degrees right angle bank throttles at maximum speed a b down unlock 60 flaps both were fatally injured on impact uh looked at the ejection seats there were no no ejection attempt um they didn't fire me for either one, they did I tried to pull the handles so that the student pilot's recovery parachute had two quarter inch holes.

The ip personal locator beacon was packed with an insufficient knot and would not have activated if I had ejected it, so the others besides the two quarter inch holes and the locator. the beacon doesn't work, they think everything would have been fine if they had actually tried to eject, okay then, crew ratings, from everything I've heard, I've talked to people who actually know him, in fact, I think he came and He flew with us, at one. period, great instructor, great guy, very smart, very, and his record reflects that, so he was respected by the leaders and fellow instructors.

Great relationship with students. The reputation of being one of the best and hardest working vaporizers in the squadron was recently selected for the third quarter uh vape of the third quarter instead and best ip twice by lots of students very well liked good pilot to fly looking at his training records was among average and above average did well in pilot training above average in transition and instrument blocks began pitt in January 2020, a year prior to this he flew 69 sorties, 75 hours, once again was excellent in the transitional instrument blocks, I needed to offer the document, however, I needed to offer the student more specific directive instruction during the flight and intervene earlier. when a simulated dangerous situation was developing, I mean, we see that in some of the things he said he was a little vague, not necessarily directive, uh, he kind of let things progress a little more than they should, he was present , all events had a total of three uh, 297 hours in the t38c with 185 instructor hours, he was considered an inexperienced instructor pilot, so his weather was 301 for his minimums, there student pilot, uh, he's a student Japanese pilot, went to the language course, uh, actually had a little difficulty.

Little in the language course, initially he was not satisfactory, but after an additional month of training he was able to achieve the required score for the next language training. He entered the specialized English required for aviation, navigation and communication on June 24, 2019 and then scored average to slightly above average, so he turned around, he had a reputation for being a very respectful, hard-working and diligent student who studied long hours in preparation for departures. He began t6 training in 2019 and in 2024 he had to move back one class due to the low availability of aircraft he was assessed for.

On average he completed June 29, 2020 and then entered T-38C training, he was evaluated there with two different aircraft slightly below average to below average. He had completed 66 outings, 27 syllabus simulations, 46 of them were good or excellent. A sorority that is too fair, that is really above failing, you will probably have to see a lot of that over and over again nine outings to subpar that's a ton that's a ton 10 ungraded training records indicated that she performed 26 events similar to a good or excellent level and one ungraded performed very well during ground training in academics received A's in all of his classes, I don't remember them, they didn't even get A's and b, he also performed well in simulator training , had difficulties during flight training in the T-38C, most of the stories documenting he had difficulty speaking and understanding English, which directly affected his ability to receive and process instruction, as well as listen and speak on the radio , this challenge was exacerbated during instrument sorties that required more frequent communications with air traffic control.

The pilot students. Instructors noted that communication problems often cause the student pilot to move behind the aircraft. That means he loses situational awareness, which caused even more task management problems, oversaturation, and a failure to cross-check his instruments during critical phases of the flight. Additionally, several instructors documented that msp had a tendency to overcontrol the aircraft, making large corrections, and failing to make corrections. it comes out in a timely manner, so if you're controlling too much, you know it's a bullwhip effect, right? uh, full afterburner, oh god, I'm too fast, now I'm going to idle, you know I need, I need to turn, okay, well.

Instead of just going 10 degrees bank, which is what you need, he goes, you know, 45 degrees bank and then leaves it there, so he has this tendency to control the airplane too much, it's not very smooth as he says. which they are documenting in their big sheep, moved the backup class to 2107 due to low availability of aircraft and fell behind the training schedule, so remember that the aircraft are suffering in maintenance, so this is happening in pilot training bases on november 23, 2020, failed his transition check due to a misunderstanding in atc communication. the transition is just learning how to use the plane by doing basic aerobatics, takeoffs and landings, stuff like that, they're not instruments, uh, it failed in communications with the atc during the entire sortie and didn't take overtakes into account during an approach with a single engine which he again successfully achieved and passed on November 24 with a normal study program, so from the month of the accident until November 2021, he was included in the commander's awareness program during the training block training due to two consecutive unsatisfactory outings on February 1 and 2.

International students are allowed up to 10 additional flight hours and after being placed in the cap, the msp flew three sorties without classification. MSP flew these stories with the squadron's most experienced instructor pilots who documented that MSP performance improved from below average to just average for this stage of the training formation block. He then flew two sorties with other experienced pilots. and he received a good rating on both outings, then successfully passed his formation check and was removed from the limit, so he had to fight a little, but he got through it. This is just the training phase.

His most recent flight and landing before the mishap. The brotherhood was a training category verification. He traveled on February 10, his last instrument approach to the aircraft was on January 25, and his last two similar events, low-level instruments and navigation, were on February 11. Before the sorority mishap, he had not flown a circle approach in the t-38c or wow simulator, plus the student pilot flew the last 13 duel sorties before the crash with experienced instructors, so again We see things starting to compare to this flight. This is a student who has trouble understanding instructions and has had problems in the past. been in the commander's awareness program, he has had problems in the transition phase, especially with excessive control of the aircraft.

You are doing a completely new maneuver, a circular maneuver with an inexperienced instructor pilot. The first time, an unfamiliar field where you're already two hours late and the weather is it's a problem where you're trying to follow this, so maybe you're thinking about the next thing, so there's a lot of human factors that build up. against this, as to why the IP had the reputation of being one of the best and hardest workers. vapes at this 50th fts was respected by his fellow leadership instructors and had a great relationship with the students. He recently he was selected as the squad vaper of the quarter and was voted by students as the best ip witness testimonials confirmed that the iep loved to fly before getting lost happy. who is on track to win the High Fire award of the quarter having flown 82.7 hours in the previous 90 days the week of the mishap the ip's operating rate was well below normal had not flown in nine days due to the recent winter storm described ips relaxed well - I was rested and excited to fly cross country student missions due to the winter storm and forecast weather conditions.

Most of the planning for the cross-country mission happened the morning of the flight, so everything is happening very fast, fast, fast, fast, there were some irregularities. during mission planning and ground operations that were inconsistent with IP reputation and trajectory performance one, was not present at weather briefing two, did not take into account airfield alternative fuel requirement three , did not recognize that the accident plane was restricted to a non-exit location into the country after reviewing the forms, although these emissions did not directly contribute to the mishap, they point to the IP's lack of attention to details on the day of the flight and perhaps a lack of appreciation for the high risk associated with cross-country student mission. indicate that the ip may also have lost some competence in the days he was out of the cockpit the mishap occurred while the accident airplane was on final approach at dantly field this approach was the student pilot's first circular maneuver at 38c and the turn to final .4 wider than desired 18 knots above final turn speed.

I was unable to determine whether the ip was aware of the aircraft's displacement and increase in speed before the student file began turning in the final or whether the ip was giving him the opportunity to identify and correct the discrepancies himself. ip did not provide any instruction to the student pilot during the first 30 seconds of the turn, at which point the ips data you can display right here flew off 20 nights above airspeed and temporarily abandoned the eyepiece cross-check while he and The student pilot was concentrating on acquiring the runway by lining up the final approach by reducing speed to green speed, so I will stop here because this is a good point for this student and this is my opinion, the student pilot talks about it.

He had never done this in the simulator and he had never done it in real life, so all his knowledge of a circling approach in a t-38c was academic, what he had read and what he had been told, so maybe Maybe something and I don't know. I don't know what the EPT syllabus is. A lot of things we do are demos because the IP shows you and then you do one, maybe because of the fuel requirements and maybe because you know the schedule and how behind they were and things like that, maybe it's just hey , look, we'll just check the square and do it, but it seems like this would be one of those things where the IP would show him and then show him one and then he would do one against him trying to train him. through this and then he's not even training through it so the students up there already have a helmet shot because he doesn't speak English very well, he's struggling and he's trying to do this maneuver for the first time, um having never done it.

I saw on the plane, so I think that doesn't really help, it contributes a lot to the loss of situational awareness of both pilots. After reviewing the flight data, I find that the preponderance of the evidence indicates that the PI was not aware that he temporarily lost the situation. The awareness that the student pilot pressed the throttles at idle while training the student pilot during final approach and trying to help him locate the runway and capture a two and a half degree glide path through the performance characteristics of the 38 seed It's very unusual. for an ip to allow a student to place thrall as an idol in the traffic pattern for an extended period, this painting was shared by the lead test pilot verified that most final turns are performed with power above 80 Additional sample of experience with our 50-foot instructorThe pilots confirmed that they would feel very uncomfortable if that happened.

IP may have focused too much on aligning with the runway due to the final angled turn, which allowed airspeed and other critical parameters to slip out of their cross-check, in addition to mishap adjustments to the aircraft's field of view. ocular may have further affected its ability to acquire the runway even though as the final approach progressed the iep comments were confident that they relaxed and applied only a minor correction was necessary as the aircraft's airspeed now sf was rapidly decreasing and the angle of attack and sink rate increasing, this provides further evidence that the IP was unaware of the dangerous situation developing when he recognized that he had passed the recovery point, there was a delay of 0.5 seconds between the level of the rotary wings and the advancement of the throttles to maximum ab, this indicates that the ip may not have had his left hand in position for immediate action on the throttles during this critical phase of the fight, which may also explain why the ip was not aware that the accelerators remained inactive.

Oh, that's interesting. By preponderance of evidence, I find that IP loses situational awareness as a circular approach. Progresó did not perceive the importance of the accelerator being inactive for an excessive amount of time and did not take the necessary measures, which contributed substantially to the oversaturation of the student pilot during mission planning. He attended the weather report and based on the forecast weather conditions, they knew they needed an alternative. however, he did not take into account the alternate airfield requirements. I was unable to determine whether this error was due to a communication language barrier between the student pilot and the PI who did not attend the weather briefing, a lack of knowledge and understanding by the student pilot, or simply an oversight, although fuel planning did not contribute. to the mishap, this error highlighted lack of crew coordination, possible lack of communication between the PI and the student pilot, yes they are talking in a brief, everyone else has decided that we are going directly to Tallahassee and the student was in the report but still decided to follow the original plan as they headed to Dan Lee's camp.

Cockpit recordings revealed that the student pilot was having difficulty understanding and responding to ATC radio calls. The PI helped him several times. He intervened directly with ATC on one occasion. to ensure the safety of the flight communication problems with atc continued to challenge the student pilot for the remainder of the brotherhood and directly contributed to the mishap student pilots becoming overloaded with tasks in the pattern during the final turn, allowed the space several reasons why his skills are perishable in a training environment, it was the first flight in nine days, his first instrument approach in three and a half weeks and his first t-38c circular engine I talked about a while ago, in addition, it is common for The students stood behind the aircraft and were overwhelmed in the pattern.

This area error was a particular trend for the student pilot through training during his previous sorties and similar events. It was observed that his cross-checking deteriorated. The task in the pattern was saturated. The instructors attributed the mishap to the student pilot. part of the tax saturation, communication language challenges, as well as the mechanical piloting skills of the student pilot. uh, as he became more saturated, the ip is now training and motivating him, trusting that uh, his aerial skills seemed to be overwhelmed by the task of lining up with the runway. which led to other equally imported airworthiness priorities, such as speed, altitude, descent, braking, glide path, engines and power trim, not being addressed.

His inability to align with the runway may have been exacerbated by the effects of sunset after he departed on his intercept course. totally slow to finish in place and left the throttles at idle, which is unnecessarily low and dangerous power setting for the critical phase of flight indicates that he was simply overwhelmed. um yeah, so I was fined by a preponderance of the evidence that the student's saturation was contributing substantially, so she finds out that it was caused by the IP's lack of situational awareness and I hate doing this, you know, there's, you know. , you read this and as you read the report you say, yes, you can see the Swiss, you can see the Swiss. cheese model and the holes line up and say oh yeah, of course, how do you see it?

We're doing this at zero knots and one g. We were judging these two airmen based on the information we now have, which is the full picture of what they have. It was very different and what they had was seconds, I mean you can see it, 18 seconds, that's how long they basically had to survive and unfortunately in 18 seconds things went really wrong, so you know, we learned from this, you know what? we can learn yes? you're an instructor, you have to do it, you can't improve if you're a pilot, you know, I talked about that when I had my helicopter, I settle for powerful things, complacency, task overload, loss of situational awareness, those things will kill You know, if you become complacent and you think you have it like you know if you take your hands off the accelerator when you have student homework overload, where is the IP now. training the student the student has a helmet on fire because he has trouble speaking the language.

I mean, I can't imagine if she went to Japan trying to translate everything I have in my head into Japanese while trying to learn a new plane. a new way to fly, especially a plane like the t-38, the t-38 is a relentless beast, it's not an easy plane to fly, it's killed a lot of people over the years, you know, and it's been around for 60 years, I mean, that's what. a 60 year old airplane, so you know it's definitely very outdated, you know it doesn't represent anything we currently fly in the inventory, it doesn't fly like anything we have, it's a very difficult airplane to fly, so it's one of those things. that will bite you if you get behind us we saw that in the preview of the formation landing mishap, you know it takes seconds for things to go wrong and for people to die, so the instructor, uh, lieutenant ames, great instructor and this It's just a reminder that you know that even if you're highly respected and at the top of your game for the most part, all it takes is a little disaster one bad day and you know it could be, I've been lucky or in In this case, you know we're doing a tribute, which is very sad, for both of us, I mean the student too, and you know the student had just overcome some adversity and was doing better, but you know what you can say, the factors just They lined up. and it's just a very tragic accident, so my thoughts are with the family of both airmen and it's just very difficult, but we learned some things from it, you know, about complacency, about task overload, about not letting situations they develop, and you know.

For the instructor side, you know it's about being assertive and not letting situations develop, you know, if you recognize that they're developing, then, you know, and that's what happened in the Vance mishap. He also let the situation develop a little more. than I should have, so, you know, for those of you who are going to pilot training things like that, you have to be willing to talk when you have the helmet, fire, don't play, I have a secret, um, you. knowing if you're not comfortable doing something or if your helmet is shot and you're behind the jet, you know, let the instructor know and let's work together to get back to the green, so you're not in a situation. where you know neither of them are really for 18 seconds no one was worried about the throttle you know none of the pilots had two people on that plane and none of them were worried about where the engine control was I mean that's one of those things that I know it's 2020 in hindsight, but again it comes back to you know and it's hard to say, speak up because sometimes you don't know when you've lost awareness of the situation, but only for those of you who know are in the process. or you go in the process, you just, you know, you realize that you know one of the first things that happens is auditory exclusion.

You know when you start missing radio calls or you don't understand radio calls, that's like one of the first signs that you're starting to get overwhelmed and you're starting to lose situational awareness, so, at the end of the day , fly the plane and, you know, it spins, you know, if it looks bad like that, it just spins, try again, you know, there's no reason for me to have to force a bad situation, so anyway, but like I said, but by the grace of God, it could happen to anyone, it can happen to me, it can happen to, you know, any airman, anyone can have a bad day, any Sunday. as it is anyway, that will do for this breakdown, I'm not going to say I hope you enjoyed it because I don't enjoy it, but I hope you know that we learned something from it and got something from it. thanks for watching see you next time