Eastern Air
Lines flight 401, operated on the evening
of December 29, 1972 by a four months old
Lockheed L-1011, was approaching Miami
from New York City. Captaining that
night's flight was Robert Loft, a senior
pilot with nearly 30,000 hours. Along with
Loft, First Officer Albert Stockstill and
Flight Engineer Don Repo occupied the
flight deck with a company technician
riding in the jump seat.
162 passengers and 10
flight attendants were also on board. It
was just after 11:30pm when 401 was
instructed to join the ILS for runway 9L
and call the tower. As 401 was turning
onto final, Loft called the tower and
instructed Stockstill to lower the landing
gear. As Repo read off the pre-landing
checklist, Loft checked each item as
Stockstill flew. When Repo reached the
gear down item, Loft noticed that only the
two main gear lights had illuminated.
He then asked
Stockstill to confirm that the handle had
been moved into place. Stockstill checked
the handle and then replied "No nose
gear!" The crew then attempted to recylce
the gear, but the nose gear light remained
unlit. Loft then called the tower and told
them of the problem, requesting to orbit
to the west of the airport while they
checked further on the problem. 401 was
handed off to approach and instructed to
turn northbound at 2,000ft. Meanwhile,
Repo was attempting to jiggle the nose
gear indicator light to determine if the
problem lay in the light circuit itself,
but he was unable to get a proper grip on
the light. Loft then instructed Stockstill
to engage the autopilot so that he could
access the light, being that it was on his
side of the panel.
401 was then instructed to turn to a
heading of 300 and then Stockstill and
Loft returned their attention to the gear
light. After another few minutes, Loft
instructed Repo to go down to the avionics
bay and try to determine the nose gear's
position visually. Meanwhile, Stockstill
successfully removed the light cover and
is now attempting to remove the bulb. The
company technician in the jump seat has
now also joined in the effort. 401 was
then instructed to turn westbound, taking
them back out over the Everglades. The
crew works on the light for another few
minutes and then decided to give up on it.
At this point, Repo returns from the bay
saying he cannot determine the gear's
position. The technician then got up and
both he and Repo returned to the bay for
another look.
At this point, 401 is
well out over the Everglades and Approach
said to 401 "How are things coming along
out there?" Loft replied that they would
like to turn back in towards the airport.
401 was then instructed to turn
southbound. Stockstill began to turn the
aircraft south as he notices that the
altitude seems to have decreased even
though the "ALT" light was still
illuminated, indicating that the autopilot
was still engaged. At this point, he said
"We did something to the altitude!" to
which Loft replies "What?" Stockstill then
said "We're still at 2,000...right?" Loft
looked at the instruments which prompt him
to say "Hey...what's happening here?" The
radio altimeters began to beep followed by
impact of the port wing bringing the whole
aircraft down in the swamps of the
Everglades. 98 people were killed in the
crash, including all three crew members.
The company technician in the avionics bay
with Repo survived with serious injuries.
......The crash of flight 401 was the
first accident involving the new
generation of "jumbo" jets and brought
about questions of the safety of the
aircraft design and the new automated
systems. Clearly the crew had no clear
indication of a critical situation prior
to impact as they made no radio
communications declaring an emergency or
requesting assistance. When investigators
were able to access the instrument panel,
the reason for the unsafe gear indication
became clear. The light bulb for the nose
gear light had simply burned out. Recovery
of the FDR showed that all systems were
functioning normally until the time of the
accident.
The question that
remained was what caused the aircraft's
descent from 2,000ft without the crew
being aware. The L-1011 is equipped with
two autopilot computers, one for the
Captain's side and one for the First
Officer's side. The systems were designed
so that any force on the control column
exceeding 15 pounds would disengage the
autopilot's Altitude Hold function. It was
found that, in the case of 401, the
Captain's computer was set properly, while
the First Officer's computer was set to be
disengaged by a force greater than 20
pounds.
It was therefore
possible that, with the Captain's
autopilot engaged, a 15 pound force could
be applied, disengaging the autopilot, but
leaving the "ALT" light on the First
Officer's side illuminated. The FDR
recorded a slight negative acceleration at
the same time Loft told Repo to go down
into the avionics bay, initiating a
descent of about 200 feet per minute for
the next 30 seconds. It's possible that,
in turning to speak to Repo, Loft applied
an inadvertent force on the control
column, disengaging it. Three minutes
later, the CVR recorded an altitude chime,
alerting the crew that they had deviated
250 feet from the selected altitude.
The chime sounds near
the Flight Engineer's panel, but because
Repo was in the avionics bay and the other
pilots were wearing headsets, it's thought
that no one heard the chime. At the time
the Approach controller asked 401 "How are
things coming along out there?", the
aircraft was down to 900ft. Clearly the
controller was concerned with the altitude
readout for 401 on his radar, but Loft's
reply that they were returning to land
indicated no signs of trouble. It is clear
from the CVR that Loft failed to delegate
someone to be the flying pilot, who's only
responsibility would be to monitor the
aircraft. Instead, Stockstill was
responsible for setting the autopilot, but
he was also involved in working on the
light, being that it was on his side. Loft
was also assisting Stockstill and it was
not evident that he monitored the aircraft
at all.
These factors led to a
complete breakdown of situational
awareness, made even more surprising by
Loft's impressive flight background.