Pilot Debrief

BOEING 737-724 near Winnie, TX — 2012-06-13

Final reportDCA12LA091
Sign in to save
Date
2012-06-13
Location
Winnie, TX, USA
Aircraft
BOEING 737-724
Registration
N16709
Category
Airplane
Highest injury
Serious
Fatalities
0
Phase of flight
Climb

Probable cause

the flight crew's penetration of a rapidly developing thunderstorm cell in an area of forecasted convective activity. The serious injuries were the result of a misunderstanding between the captain and cabin crew regarding the potential for turbulence.

NTSB narrative

The flight encountered an area of severe turbulence during the climb at about flight level 221 on departure that seriously injured two flight attendants (FA). The flight crew was aware of the forecasted convective conditions and potential for turbulence forecast along their route of flight. The captain and FAs differed in their recollection about the turbulence discussion during the pre-flight briefing. The FAs were not aware of the turbulence potential during the flight and began their service before the captain instructed them as he intended. The weather radar tilt setting of +1 degree used by the flight crew would be useful for detecting the tops of medium range and distant storms but would not be useful in detecting the rapidly developing nearby cells below and in front of the airplane. A negative tilt setting on the weather radar was recommended by the company to detect cells building in front of the airplane. As a result, the flight penetrated a rapidly developing area of "extreme" convective activity that produced severe convectively induced turbulence.

Analysis

Primary failure mode
Environmental
First missed decision gate
Flight crew could have avoided severe weather by adjusting flight path earlier.

NTSB coding

Evidence available

  • 2 docket documents
View NTSB final reportView NTSB docket

Docket documents2

Related mishaps