Runway's Lack of Lights May Have Caused Confusion

Aug. 29, 2006
It was unclear Monday just when the pilots might have realized they were on a runway too short for their plane.

The pilots of Comair Flight 5191 noticed there were no lights on the runway they were using as they took off from Blue Grass Airport Sunday morning, a National Transportation Safety Board member said Monday night, but from all indications they never tried to stop.

NTSB member Debbie Hersman also confirmed that First Officer James Polehinke was at the controls, and that the flight crew received no communication from the control tower as they headed down Runway 26, which was not the runway they should have been using. Seconds later the plane crashed, and Polehinke was the only survivor among the 50 people on board. He remains in critical condition.

And, as the investigation into the crash continued, Gov. Ernie Fletcher suggested Monday night that Blue Grass Airport permanently close the short runway mistakenly used by the flight when it crashed.

"I think it would be advantageous," the governor said, adding that he would defer the final decision to experts.

Fletcher also asked airport officials, including executive director Michael Gobb, for details about the runway, but declined to say what he found because of the ongoing investigation.

Recent changes at the airport, including the shutdown of some runway lighting and new routes for taxiing aircraft, are among the factors federal investigators are reviewing as they try to learn why Comair Flight 5191 strayed onto the wrong runway and then crashed after takeoff Sunday morning.

The plane slammed into the ground on a farm just west of the airport at about 6:07 a.m., after taking off from Runway 26, a short runway designed for light aircraft, rather than the much longer Runway 22 it should have used.

Hersman said Monday afternoon that an initial analysis of Flight 5191's cockpit voice recorder indicates that preflight procedures were normal and that the crew reported no problems. She said all contacts between the crew and air-traffic control indicated that the crew planned to take off on the airport's main Runway 22, the appropriate one, not the much shorter Runway 26.

It was unclear Monday just when the pilots might have realized they were on a runway too short for their plane. Hersman said recordings indicate the plane never stopped accelerating. There was a similar confusion of runways in 1993, but the mistake was caught before takeoff.

To find out how that happened, Hersman said, investigators will look at multiple factors, such as recent paving and improvements and any changes in lighting, runway and taxiway markings. As a part of that effort, she said, one investigative team at the airport is using an elevated truck that mimics the view from an airplane cockpit, letting them "see what the pilots saw" as they prepared to take off just after 6 a.m. Sunday.

Finding ultimate answers may take a year or more. But Vernon Grose, a former NTSB member, said the answer probably will involve more than one factor.

"The basic premise is that no accident is a single thing, it's a composite of things," said Grose, who served on the NTSB during the Reagan administration.

The one clear thing is that several factors had changed at Blue Grass Airport in recent days.

Gobb confirmed that the center lights on the airport's main runway were not operating Sunday morning, having been shut down in connection with repaving work at the airport Aug. 19-20. However, the side lights on that runway were still in operation, Gobb said.

David Katzman, a Michigan-based airline transport pilot and attorney, noted in an e-mail that Blue Grass Airport's general aviation Runway 26 - the one Flight 5191 ultimately used - has no center lights. Because the center lights on Runway 22 also were not operating, Katzman said, an important visual cue that might have helped pilots distinguish between the two runways was missing.

Katzman added, however, that pilots would have been informed of the lighting situation through what is known as a "notice to airmen." But he called the lighting change "noteworthy."

On Sunday, Gobb confirmed that the route planes at Blue Grass Airport follow in taxiing from the terminal to the runways also had been altered as a result of improvements at the airport on Aug. 20.

Meanwhile, a former Delta Airlines pilot said Monday that flying out of Blue Grass Airport can be confusing and that straying onto the wrong runway would have been "an easier mistake than people generally would think."

"It looks like a no-brainer ... but it is possible to be kind of confused," Russ Whitney said.

Among other things, Whitney said, the main Runway 22 has a crown or hump, so that pilots taking off cannot initially see the southern two-thirds of the runway. As a result, Whitney said, Runway 22 and the shorter Runway 26 can appear to be the same length.

"I've taxied out there and gotten kind of confused, and had to make absolutely sure that I was on the right runway," he said. "I have said to the co-pilot, `Is this the right one?'"

Whitney flew for Delta for 27 years before retiring in 2004, and was a Navy pilot before that. He said he had flown in and out of Blue Grass more than 20 times during his career.

There was an incident at Blue Grass Airport in November 1993 in which a plane mistakenly lined up on Runway 26 instead of Runway 22. The tower caught the error before the plane could take off.

Mary Schiavo, a former inspector general for the U.S. Department of Transportation, said pilots recommended after that incident that an instruction sheet with charts be created because the runway design was confusing. But Schiavo said she found no record that such a sheet was ever developed. Mike Gobb, the airport executive director, said Monday night that he was not aware of that case.

Speaking to a packed press conference at Hilton Suites Monday afternoon, NTSB board member Hersman declined to speculate about what might have happened in the crash, limiting her answers to what is being reviewed in the investigation.

Among other things, she said, investigators are developing a "history of the crew" that was flying the plane. She said that would include everything from toxicology studies that would reveal any alcohol or drug use leading up to the crash to how much rest crew members got before taking off. Essentially, they want to know how the crew spent the 72 hours before the crash, she said.

Comair President Don Bornhorst said the Flight 5191 crew had been "on a legal rest period far beyond what is required," but declined to give specifics. Officials from Comair and the NTSB also declined to say what time the crew arrived to prepare for Sunday morning's flight.

A Lexington hotel shuttle driver who said he drove the three flight crew members - pilot Jeffrey Clay, 35, first officer Polehinke, and flight attendant Kelly Heyer, 28 - on Sunday morning said he noticed nothing unusual.

"It was all pretty normal; it's usually a quiet ride that time in the morning, just small talk," said Jarrod Moore, who works for Lexington's Radisson Plaza Hotel, where the crew stayed.

Hersman said teams were continuing to gather evidence, and were using GPS instruments to locate debris.

Investigators also are looking at the plane's General Electric jet engines. Hersman said indications are that the engines were "in good working order."

Grose, the NTSB member, said psychological factors could be as important as physical evidence. Physical evidence so far indicates that the pilots took off from the wrong runway and ran out of room, Grose said, but does not explain why that happened.

"Did anybody in the tower notice that they didn't go to Runway 22?" Grose asked. "There's a lot of psychological things you look at. ... We would like to think everybody goes by the book, but they don't."

Paul Czysz, professor emeritus of aerospace engineering at Saint Louis University, contended that the control tower should have made sure Flight 5191 was on the right runway before giving it permission to take off. Planes are supposed to be under the tower's control at all times when they are on the ground, he said.

Hersman said one person was on duty in the control tower Sunday morning, which she said was not unusual on the midnight shift at Blue Grass Airport.

The Patriot News in Harrisburg, Pa., reported last November that the FAA sent a directive advising smaller airports to schedule two controllers on the midnight shift. An FAA spokeswoman Monday denied the existence of such a directive.

But David Katzman, the Michigan pilot and attorney, said that a single controller on duty essentially would be doing the work of three people - communicating with other air controllers, coordinating movements on the taxiways, and directing airspace around the airport.

It would be easy to become distracted, Katzman said.

According to FAA spokeswoman Kathleen Bergen, Lexington once had two controllers working the weekend overnight shift. But the FAA reduced that to one four or five months ago after an unexpected drop in air traffic at Lexington, she said.

Bergen said the FAA will return to a two-controller overnight shift at Lexington this weekend. She declined to say whether that is because of Sunday's accident.

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