McDonnell Douglas DC-9-33F N931F

Summary

On 18 March 1989 at about 08:16 local time, a McDonnell Douglas DC-9-33F registered N931F was involved in an accident near Saginaw, Texas, United States. 2 people were on board and 2 died. The aircraft was destroyed. The NTSB has published a probable cause for this accident; it is quoted in full below.

Date

18 March 1989 at 08:16

Classification

Accident

Location

Saginaw, Texas, United States

Nearest airport

Carswell Afb (FWH)

Coordinates

Not recorded

Aircraft

McDonnell Douglas DC-9-33F

Registration

N931F

Category

Airplane

Engines

2

Operator

Not recorded

Operating rule

Part 121: Air Carrier

Phase of flight

Not recorded

Route

Unknown → Oklahoma City

Aircraft damage

Destroyed

Weather

VMC

Light

Night/Dark

NTSB number

DCA89MA035

2 people died.

THE LOSS OF CONTROL OF THE AIRPLANE FOR UNDETERMINED REASONS FOLLOWING THE INFLIGHT OPENING OF THE IMPROPERLY LATCHED CARGO DOOR. CONTRIBUTING TO THE ACCIDENT WERE: INADEQUATE PROCEDURES USED BY EVERGREEN AIRLINES AND APPROVED BY THE FAA FOR PREFLIGHT VERIFICATION OF CARGO DOOR SECURITY, EVERGREEN'S FAILURE TO MARK PROPERLY THE AIRPLANE'S EXTERNAL CARGO DOOR LOCKPIN MANUAL CONTROL HANDLE, AND THE FAILURE OF MCDONNELL DOUGLAS TO PROVIDE FLIGHTCREW GUIDANCE AND EMERGENCY PROCEDURES FOR AN INFLIGHT OPENING OF THE CARGO DOOR. ALSO CONTRIBUTING TO THE ACCIDENT WAS THE FAILURE OF THE FAA TO MANDATE MODIFICATION TO THE DOOR-OPEN WARNING SYSTEM FOR DC-9 CARGO-CONFIGURED AIRPLANES, GIVEN THE PREVIOUS KNOWN OCCURRENCES OF INFLIGHT DOOR OPENINGS.

Quoted verbatim from the NTSB record. This site does not paraphrase or interpret it.

Read the full NTSB narrative

AS THE ACFT ROTATED FOR TKOF, THE CARGO DOOR (CD) OPENED. THE CREW CONTD TKOF & TURNED TO A DWNWND LEG TO LND ON RWY 17.THEY ANSWERED TWR INSTRNS TO RPRT 'BASE.' THIS WAS THE LAST TMTN THEY RCVD, THO THEY TRIED SVRL TIMES TO CTC TWR OR APCH CTL. AS THE ACFT TURNED ON BASE LEG (WITH A TAIL WND AT TFC PATTERN ALT), RADAR DATA INDCD ACFT WOULD CROSS THE RWYCENTERLINE. RADAR CTC WAS THEN LOST; THE ACFT CRASHED IN A STEEP DSCNT. THERE WAS EVIDENCE THAT BFR FLT, THE 1ST OFFICERMISINTERPRETED THE EXTERNAL LOCKPIN MANUAL CTL HANDLE PSN TO MEAN THE CD WAS LOCKED (AS A RESULT OF INCORRECT MARKINGS).ALSO, THERE WAS A MALFUNCTION OF A CD OPEN WARNING LGT SW, PREVENTING OPN OF THE WARNING LGT. ADDITIONALLY, SVRL SVC BULLETINS (SB'S) CONCERNING THE CD HAD NOT BEEN COMPLIED WITH. THESE SB'S WOULD HAVE PROVIDED AN EXTRA SAFETY FEATURE OF THE CD WARNING LGT SYS, A DOOR VENTING SYS & A LOCKPIN VIEWING WINDOW FOR THE DOOR. THERE WAS NO EMERG PROC OR SPECIFIC GUIDANCE TO AID DC-9 CREWS FOR THIS SITUATION, THOUGH SVRL CD OPENINGS HAD OCCURRED. (SEE: NTSB/AAR-90/02)

Quoted verbatim from the NTSB record.