Accident Embraer EMB-120RT Brasilia 5N-BJY, Thursday 3 October 2013
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Date:Thursday 3 October 2013
Time:09:32
Type:Silhouette image of generic E120 model; specific model in this crash may look slightly different    
Embraer EMB-120RT Brasilia
Owner/operator:Associated Aviation
Registration: 5N-BJY
MSN: 120174
Year of manufacture:1990
Total airframe hrs:27362 hours
Cycles:34609 flights
Engine model:Pratt & Whitney Canada PW118A
Fatalities:Fatalities: 16 / Occupants: 20
Other fatalities:0
Aircraft damage: Destroyed, written off
Category:Accident
Location:Lagos-Murtala Muhammed International Airport (LOS) -   Nigeria
Phase: Take off
Nature:Passenger - Non-Scheduled/charter/Air Taxi
Departure airport:Lagos-Murtala Muhammed International Airport (LOS/DNMM)
Destination airport:Akure Airport (AKR/DNAK)
Investigating agency: AIB Nigeria
Confidence Rating: Accident investigation report completed and information captured
Narrative:
An Embraer EMB-120RT Brasilia turboprop aircraft was destroyed in an accident during takeoff from Lagos-Murtala Muhammed International Airport (LOS), Nigeria. The airplane impacted the ground near the airport fuel depot and broke up. A fire erupted. There were 20 people on board the plane. Seven occupants initially survived the accident. Three later died in hospital.
Associated Aviation flight SCD-361 was on a chartered flight from Lagos to Akure, Nigeria. The airplane was carrying the body of a former Governor of Ondo State, Dr. Olusegun Agagu, for burial in Akure.
At 09:07 hours local time, start-up of the aircraft was granted by the controller. Engine no.2 was started first, followed by engine no.1. At this point, the crew observed that the No. 1 engine torque indicator was stuck at 76% which prompted the Pilot Monitoring (PM) to conduct an Electronic Engine Controls (EEC) test; however, the indicator remained at 76%. The PM invited the engineer who was a crew member, into the cockpit to ascertain the job done on the EEC. The job done could not be determined as the engineer reported he was not part of the team that worked on the aircraft. The engineer then requested that the PM test the EEC, but the PM responded that this had already been done several times previously. Nonetheless, the PM repeated the EEC test.
At 09:20 the PM requested taxi clearance from Lagos Tower. The flight was cleared to taxi to the holding point for runway 18L. During the taxi, the crew continued with further discussions on the state of the aircraft without briefing or referring to any document. Considering that the No. 1 torque indicator remained stuck at 76%, the crew decided to set power using T6.
At 09:26 SCD361 was cleared to Akure on airway A609, climb Flight Level 190, squawk 0504 and to line-up and wait. SCD361 acknowledged. The flight crew agreed to perform a flapless take-off "again", if the flap configuration warning came on. At 09:28 the Tower controller re-cleared SCD361 to route via airway R778, Flight Level 190. The crew carried out the "Cleared into position" checklist. At about 09:29 flight 361 was cleared for takeoff on runway 18L; wind was calm. Approximately 4 seconds after engine power was advanced to commence the takeoff roll, the crew received an automated aural warning "Takeoff Flaps.. Takeoff Flaps." as the flaps had not been set for takeoff. The copilot noted that the aircraft was moving slowly. Four seconds later, the aural warning sounded: "Takeoff Flaps.. Auto feather." The flight data recorder shows that at this time the right hand engine appeared to be producing considerably less thrust than the left engine.
The no. 2 prop had feathered and during the takeoff the fire handle for that engine was activated.
Some 12 seconds after announcing the '80 knots' call the first officer asked if the take-off should be aborted. Airspeed at the time would have been about 95 knots. The captain indicated that they should continue. The crew did not make a V1 or Vr call. During the rotation, the first officer stated "gently". The First Officer indicated that the aircraft was not climbing and advised the captain who was flying not to stall the aircraft. Immediately after lift-off, the aircraft slowly veered off the runway heading to the right and was not climbing properly. Ten seconds after rotation the stall warning sounded. An aerodynamic stall occurred and the airplane impacted the ground in a nose down near 90 degree right bank attitude.

Causal Factor
i. The decision of the crew to continue the take-off despite the abnormal No. 2 Propeller rpm indication.
ii. Low altitude stall as a result of low thrust at start of roll for take-off from No. 2 Engine caused by an undetermined malfunction of the propeller control unit.
Contributory Factors
i. The aircraft was rotated before attaining V1.
ii. The decision to continue the take-off with flap configuration warning and auto- feather warning at low speed.
iii. Poor professional conduct of the flight crew.
iv. Inadequate application of Crew Resource Management (CRM) principles.
v. Poor company culture.
vi. Inadequate regulatory oversight.

Accident investigation:
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Investigating agency: AIB Nigeria
Report number: ASSOC/2013/10/03/F
Status: Investigation completed
Duration: 4 years and 6 months
Download report: Final report

Sources:

This Day 10-10-2013

Statistics

  • 8th worst accident in 2013
  • 6th worst accident of this aircraft type
  • 6th worst accident of this aircraft type at the time

Location

Images:


photo (c) AIB Nigeria; Lagos-Murtala Muhammed International Airport (LOS); 05 October 2013


photo (c) AIB Nigeria; Lagos-Murtala Muhammed International Airport (LOS); 05 October 2013


photo (c) AIB Nigeria; Lagos-Murtala Muhammed International Airport (LOS); 05 October 2013


photo (c) AIB Nigeria; Lagos-Murtala Muhammed International Airport (LOS); 05 October 2013


photo (c) Clive Hindmarch; Lagos-Murtala Muhammed International Airport (LOS/DNMM); 26 August 2013

Revision history:

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