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United Airlines Flight 585

United Airlines Flight 585 was a scheduled passenger flight on March 3, 1991 from Denver to Colorado Springs, Colorado, carrying 20 passengers and 5 crew members on board. The plane experienced a rudder hardover while on final approach to runway 35 at Colorado Springs Municipal Airport, causing the plane to roll over and enter an uncontrolled dive. All 25 people onboard were killed.

United Airlines Flight 585
A United Airlines Boeing 737-200, similar to the one involved in the crash
Accident
DateMarch 3, 1991 (March 3, 1991)
SummaryLoss of control due to rudder hardover[1]
SiteWidefield Park, El Paso County
near Colorado Springs Municipal Airport, Colorado Springs, Colorado,
United States
38°44′09.4″N 104°42′42.4″W / 38.735944°N 104.711778°W / 38.735944; -104.711778Coordinates: 38°44′09.4″N 104°42′42.4″W / 38.735944°N 104.711778°W / 38.735944; -104.711778
Total fatalities25
Total injuries1
Aircraft
Aircraft typeBoeing 737-291
OperatorUnited Airlines
IATA flight No.UA585
ICAO flight No.UAL585
Call signUNITED 585
RegistrationN999UA
Flight originGreater Peoria Regional Airport
StopoverQuad City International Airport
Last stopoverStapleton International Airport
DestinationColorado Springs Municipal Airport
Occupants25
Passengers20
Crew5
Fatalities25
Survivors0
Ground casualties
Ground injuries1

The NTSB was initially unable to resolve the cause of the crash, but after similar accidents and incidents involving Boeing 737 aircraft, the crash was determined to be caused by a defect in the design of the 737's rudder power control unit.[1]: ix 

Aircraft and flight crew

Flight 585 was operated by a Boeing 737-291, registered N999UA[2].[1]: 7  The 737 was originally manufactured for the "old" Frontier Airlines in 1982 and was acquired by United Airlines in 1986 when the former went out of business (a new airline company with the same name formed eight years later).[1]: 7  On the date of the accident, the aircraft had accumulated approximately 26,000 flight hours.[1]: 7 

The flight crew consisted of Captain Harold Green (52), First Officer Patricia Eidson (42), and 3 flight attendants. The captain, who had over 10,000 hours as a United Airlines pilot (including 1,732 hours on the Boeing 737), was regarded by colleagues as a conservative pilot who always followed standard operating procedures.[1]: 5  The first officer had accumulated over 4,000 flight hours (including 1,077 hours on the Boeing 737), and she was considered by Captain Green to be a very competent pilot.[1]: 6 

On February 25, 1991, the aircraft was flying at 10,000 feet when the rudder abruptly deflected 10 degrees to the right. The crew onboard reduced power and the aircraft returned to normal flight. A similar event occurred two days later. Four days later, the aircraft crashed.[3]

Accident

Flight 585 was a regularly scheduled United Airlines Flight from General Wayne A. Downing Peoria International Airport in Peoria, Illinois to Colorado Springs, Colorado, making intermediate stops at Quad City International Airport in Moline, Illinois and the now-decommissioned Stapleton International Airport in Denver, Colorado. On March 3, 1991, the flight operated from Peoria to Denver without incident.[1]: 1 

At 09:23 AM Mountain Standard Time, Flight 585 departed Denver with 20 passengers and 5 crew members on board and was scheduled to arrive in Colorado Springs at 09:46 AM.[1]: 2  At 09:37 AM, the aircraft was cleared for a visual approach to runway 35.[1]: 2  The aircraft then suddenly rolled to the right and pitched nose down. The crew tried to initiate a go-around by selecting 15-degree flaps and an increase in thrust. The altitude decreased rapidly and acceleration increased to over 4G until the aircraft crashed into Widefield Park, less than four miles (6 km) from the runway threshold, at a speed of 245 miles per hour (215 kn; 395 km/h). The aircraft was destroyed on impact and fire in the crater was fed by the fuel released from the ruptured wing tanks. According to the accident report, the crash carved a crater 39 by 24 feet (12 m × 7.3 m) and 15 ft (5 m) deep.[1] Everyone on board was killed instantly.

Investigation

Initial investigation

The National Transportation Safety Board (NTSB) commenced an investigation, which lasted for 21 months.[4]

Although the flight data recorder (FDR) outer protective case was damaged, the data tape inside was intact and all of the data were recoverable.[1]: 38  Five parameters were recorded by the FDR: heading, altitude, airspeed, normal acceleration (G loads), and microphone keying. The FDR did not record rudder, aileron or spoiler deflection data, which could have aided the NTSB in reconstructing the plane's final moments.[4]: 100  The data available proved insufficient to establish why the plane suddenly went into the fatal dive.[4]: 102  The NTSB considered the possibilities of a malfunction of the rudder power control unit servo (which might have caused the rudder to reverse) and the effect that powerful rotor winds from the nearby Rocky Mountains may have had, but there was not enough evidence to prove either hypothesis.[4]: 102 

The cockpit voice recorder (CVR) was also damaged, but the data tape inside was also intact. However, the data tape had creases in it, resulting in the playback quality being poor.[4]: 40  The CVR determined that the pilots made a verbal (and possible physical) response to the loss of control.[4]: 102 

The following is an excerpt of the last two minutes Flight 585 CVR, starting two minutes before impact (the full CVR recording started before Flight 585 took off from Stapleton):

Transcript of the last two minutes of United Airlines Flight 585's Cockpit Voice Recorder (Times are expressed in MST)
# = Expletive deleted; * = Unintelligible word; () = Questionable text; [] = Commentary; - = Break in continuity; Shading = Radio communication
Time Source Content
09:41:20 Captain Twenty five flaps.
09:41:23 Colorado Springs

tower control

United five eighty-five, after landing hold short of runway three zero for departing traffic on runway… three zero.
09:41:25 [Sound similar to that of an engine power increase]
09:41:30 Captain Starting on down.
09:41:31 First officer (to Colorado Springs tower) We'll hold short of three zero, United five eighty five.
09:41:33 First officer That's all the way to the end of our runway not * doesn't mean a thing.
09:41:39 Captain No problem.
09:42:05 [Sound of "CO" ident on radio channel two]
09:42:08 First officer The marker's identified now it's really weak.
09:42:11 Captain No problem.
09:42:29 First officer (We had a) ten-knot change here.
09:42:31 Captain Yeah, I know… awful lot of power to hold that… airspeed.
09:42:38 First officer Runway is ah eleven thousand feet long
09:42:42 Captain Okay.
09:43:01 First officer Another ten knot gain.
09:43:03 Captain Thirty flaps.
09:43:03 [Sound similar to that of flap lever actuation]
09:43:08 First officer Wow.
09:43:09 [Sound similar to that of an engine power reduction]
09:43:28 First officer We're at a thousand feet.
09:43:32 First officer Oh god (flip)-
09:43:33 Captain Fifteen flaps.
09:43:34 First officer Fifteen.
09:43:34.4 First officer Oh.
09:43:34.7 Captain Oh! [Exclaimed loudly]
09:43:35.4 First officer #.
09:43:35.5 [Click sound similar to that of a flap lever actuation]
09:43:35.7 Captain #.
09:43:36.1 [Click sound similar to that of a flap lever actuation]
09:43:36.5 Captain No! [Very loud]
09:43:37.4 [Click sound similar to that of a flap lever actuation]
09:43:37.5 First officer Oh #.
09:43:38.2 Captain Oh #.
09:43:38.4 First officer Oh my god... [unidentifiable click sound] oh my god! [A scream]
09:43:40.5 Captain Oh no (#). [Exclaimed loudly]
09:43:41.5 [Sound of impact - end of tape]

Thus, the first NTSB report (issued on December 8, 1992) did not conclude with the usual "probable cause". Instead, it stated:[4]: 102 

The National Transportation Safety Board, after an exhaustive investigation effort, could not identify conclusive evidence to explain the loss of United Airlines Flight 585.

Intervening events

Following the failure to identify the cause of Flight 585's crash, another Boeing 737 crash occurred under very similar circumstances when USAir Flight 427 crashed while attempting to land in Pennsylvania in 1994.[5]

Renewed investigation and probable cause

The NTSB reopened its investigation into Flight 585 in parallel with the USAir Flight 427 investigation, due to the similar nature of the circumstances.[5]

During the NTSB's renewed investigation, it was determined that the crash of Flight 585 (and the later Flight 427 crash) was the result of a sudden malfunction of the aircraft's rudder power control unit. Another incident (non-fatal) that contributed to the conclusion was that of Eastwind Airlines Flight 517, which had a similar problem upon approach to Richmond on June 9, 1996.[6] On March 27, 2001, the NTSB issued a revised final report for Flight 585, which found that the pilots lost control of the airplane because of a mechanical malfunction. The renewed investigation concluded with a "probable cause" that stated:[1]: 114 

The National Transportation Safety Board determines that the probable cause of the United Airlines flight 585 accident was a loss of control of the airplane resulting from the movement of the rudder surface to its blowdown limit. The rudder surface most likely deflected in a direction opposite to that commanded by the pilots as a result of a jam of the main rudder power control unit servo valve secondary slide to the servo valve housing offset from its neutral position and overtravel of the primary slide.

In popular culture

The Discovery Channel Canada / National Geographic TV series Mayday dramatized the crash of Flight 585 and the subsequent 737 rudder investigation in a 2007 episode titled Hidden Danger.[7]

The crash is dramatized in the episode "Fatal Flaws" of Why Planes Crash.

See also

References

  1. ^ a b c d e f g h i j k l m Aircraft Accident Report: Uncontrolled Descent and Collision With Terrain, United Airlines Flight 585, Boeing 737-200, N999UA, 4 Miles South of Colorado Springs Municipal Airport, Colorado Springs, Colorado, March 3, 1991 (PDF). National Transportation Safety Board. March 27, 2001. NTSB/AAR-01/01. (PDF) from the original on October 2, 2015. Retrieved January 17, 2016.
  2. ^ "FAA Registry (N999UA)". Federal Aviation Administration.
  3. ^ Kaye, Ken; Staff, Writer (February 28, 1993). "Mystery Crash". South Florida Sun-Sentinel. from the original on June 29, 2021. Retrieved December 19, 2021.
  4. ^ a b c d e f g Aircraft Accident Report: United Airlines Flight 585, Boeing 737-291, N999UA, Uncontrolled Collision With Terrain for Undetermined Reasons, 4 Miles South of Colorado Springs Municipal Airport, Colorado Springs, Colorado, March 3, 1991 (PDF). National Transportation Safety Board. December 8, 1992. NTSB/AAR-92/06. (PDF) from the original on March 3, 2016. Retrieved January 17, 2016.
  5. ^ a b Aircraft Accident Report: Uncontrolled Descent and Collision With Terrain, USAir Flight 427, Boeing 737-300, N513AU, Near Aliquippa, Pennsylvania, September 8, 1994 (PDF). National Transportation Safety Board. March 24, 1999. NTSB/AAR-99/01. (PDF) from the original on October 14, 2012. Retrieved January 17, 2016.
  6. ^ Byrne, Gerry (2002). Flight 427: Anatomy of an Air Disaster. New York: Copernicus Books. pp. 207–210. ISBN 0-387-95256-X.
  7. ^ "Hidden Danger". Mayday. Season 4. 2007. Discovery Channel Canada / National Geographic Channel.

  This article incorporates public domain material from websites or documents of the National Transportation Safety Board.

External links

  • [Usurped!] ()
  • Accident description at the Aviation Safety Network
  • Boeing 737 Rudder Design Defect July 7, 2011, at the Wayback Machine
  • Airliners.net Pre-crash photos
  • Recording of the air traffic control transmissions between the aircraft and Colorado Springs


united, airlines, flight, scheduled, passenger, flight, march, 1991, from, denver, colorado, springs, colorado, carrying, passengers, crew, members, board, plane, experienced, rudder, hardover, while, final, approach, runway, colorado, springs, municipal, airp. United Airlines Flight 585 was a scheduled passenger flight on March 3 1991 from Denver to Colorado Springs Colorado carrying 20 passengers and 5 crew members on board The plane experienced a rudder hardover while on final approach to runway 35 at Colorado Springs Municipal Airport causing the plane to roll over and enter an uncontrolled dive All 25 people onboard were killed United Airlines Flight 585A United Airlines Boeing 737 200 similar to the one involved in the crashAccidentDateMarch 3 1991 March 3 1991 SummaryLoss of control due to rudder hardover 1 SiteWidefield Park El Paso Countynear Colorado Springs Municipal Airport Colorado Springs Colorado United States 38 44 09 4 N 104 42 42 4 W 38 735944 N 104 711778 W 38 735944 104 711778 Coordinates 38 44 09 4 N 104 42 42 4 W 38 735944 N 104 711778 W 38 735944 104 711778Total fatalities25Total injuries1AircraftAircraft typeBoeing 737 291OperatorUnited AirlinesIATA flight No UA585ICAO flight No UAL585Call signUNITED 585RegistrationN999UAFlight originGreater Peoria Regional AirportStopoverQuad City International AirportLast stopoverStapleton International AirportDestinationColorado Springs Municipal AirportOccupants25Passengers20Crew5Fatalities25Survivors0Ground casualtiesGround injuries1The NTSB was initially unable to resolve the cause of the crash but after similar accidents and incidents involving Boeing 737 aircraft the crash was determined to be caused by a defect in the design of the 737 s rudder power control unit 1 ix Contents 1 Aircraft and flight crew 2 Accident 3 Investigation 3 1 Initial investigation 3 2 Intervening events 3 3 Renewed investigation and probable cause 4 In popular culture 5 See also 6 References 7 External linksAircraft and flight crew EditFlight 585 was operated by a Boeing 737 291 registered N999UA 2 1 7 The 737 was originally manufactured for the old Frontier Airlines in 1982 and was acquired by United Airlines in 1986 when the former went out of business a new airline company with the same name formed eight years later 1 7 On the date of the accident the aircraft had accumulated approximately 26 000 flight hours 1 7 The flight crew consisted of Captain Harold Green 52 First Officer Patricia Eidson 42 and 3 flight attendants The captain who had over 10 000 hours as a United Airlines pilot including 1 732 hours on the Boeing 737 was regarded by colleagues as a conservative pilot who always followed standard operating procedures 1 5 The first officer had accumulated over 4 000 flight hours including 1 077 hours on the Boeing 737 and she was considered by Captain Green to be a very competent pilot 1 6 On February 25 1991 the aircraft was flying at 10 000 feet when the rudder abruptly deflected 10 degrees to the right The crew onboard reduced power and the aircraft returned to normal flight A similar event occurred two days later Four days later the aircraft crashed 3 Accident EditFlight 585 was a regularly scheduled United Airlines Flight from General Wayne A Downing Peoria International Airport in Peoria Illinois to Colorado Springs Colorado making intermediate stops at Quad City International Airport in Moline Illinois and the now decommissioned Stapleton International Airport in Denver Colorado On March 3 1991 the flight operated from Peoria to Denver without incident 1 1 At 09 23 AM Mountain Standard Time Flight 585 departed Denver with 20 passengers and 5 crew members on board and was scheduled to arrive in Colorado Springs at 09 46 AM 1 2 At 09 37 AM the aircraft was cleared for a visual approach to runway 35 1 2 The aircraft then suddenly rolled to the right and pitched nose down The crew tried to initiate a go around by selecting 15 degree flaps and an increase in thrust The altitude decreased rapidly and acceleration increased to over 4G until the aircraft crashed into Widefield Park less than four miles 6 km from the runway threshold at a speed of 245 miles per hour 215 kn 395 km h The aircraft was destroyed on impact and fire in the crater was fed by the fuel released from the ruptured wing tanks According to the accident report the crash carved a crater 39 by 24 feet 12 m 7 3 m and 15 ft 5 m deep 1 Everyone on board was killed instantly Investigation EditInitial investigation Edit The National Transportation Safety Board NTSB commenced an investigation which lasted for 21 months 4 Although the flight data recorder FDR outer protective case was damaged the data tape inside was intact and all of the data were recoverable 1 38 Five parameters were recorded by the FDR heading altitude airspeed normal acceleration G loads and microphone keying The FDR did not record rudder aileron or spoiler deflection data which could have aided the NTSB in reconstructing the plane s final moments 4 100 The data available proved insufficient to establish why the plane suddenly went into the fatal dive 4 102 The NTSB considered the possibilities of a malfunction of the rudder power control unit servo which might have caused the rudder to reverse and the effect that powerful rotor winds from the nearby Rocky Mountains may have had but there was not enough evidence to prove either hypothesis 4 102 The cockpit voice recorder CVR was also damaged but the data tape inside was also intact However the data tape had creases in it resulting in the playback quality being poor 4 40 The CVR determined that the pilots made a verbal and possible physical response to the loss of control 4 102 The following is an excerpt of the last two minutes Flight 585 CVR starting two minutes before impact the full CVR recording started before Flight 585 took off from Stapleton Transcript of the last two minutes of United Airlines Flight 585 s Cockpit Voice Recorder Times are expressed in MST Expletive deleted Unintelligible word Questionable text Commentary Break in continuity Shading Radio communicationTime Source Content09 41 20 Captain Twenty five flaps 09 41 23 Colorado Springs tower control United five eighty five after landing hold short of runway three zero for departing traffic on runway three zero 09 41 25 Sound similar to that of an engine power increase 09 41 30 Captain Starting on down 09 41 31 First officer to Colorado Springs tower We ll hold short of three zero United five eighty five 09 41 33 First officer That s all the way to the end of our runway not doesn t mean a thing 09 41 39 Captain No problem 09 42 05 Sound of CO ident on radio channel two 09 42 08 First officer The marker s identified now it s really weak 09 42 11 Captain No problem 09 42 29 First officer We had a ten knot change here 09 42 31 Captain Yeah I know awful lot of power to hold that airspeed 09 42 38 First officer Runway is ah eleven thousand feet long09 42 42 Captain Okay 09 43 01 First officer Another ten knot gain 09 43 03 Captain Thirty flaps 09 43 03 Sound similar to that of flap lever actuation 09 43 08 First officer Wow 09 43 09 Sound similar to that of an engine power reduction 09 43 28 First officer We re at a thousand feet 09 43 32 First officer Oh god flip 09 43 33 Captain Fifteen flaps 09 43 34 First officer Fifteen 09 43 34 4 First officer Oh 09 43 34 7 Captain Oh Exclaimed loudly 09 43 35 4 First officer 09 43 35 5 Click sound similar to that of a flap lever actuation 09 43 35 7 Captain 09 43 36 1 Click sound similar to that of a flap lever actuation 09 43 36 5 Captain No Very loud 09 43 37 4 Click sound similar to that of a flap lever actuation 09 43 37 5 First officer Oh 09 43 38 2 Captain Oh 09 43 38 4 First officer Oh my god unidentifiable click sound oh my god A scream 09 43 40 5 Captain Oh no Exclaimed loudly 09 43 41 5 Sound of impact end of tape Thus the first NTSB report issued on December 8 1992 did not conclude with the usual probable cause Instead it stated 4 102 The National Transportation Safety Board after an exhaustive investigation effort could not identify conclusive evidence to explain the loss of United Airlines Flight 585 Intervening events Edit Main article Boeing 737 rudder issues Following the failure to identify the cause of Flight 585 s crash another Boeing 737 crash occurred under very similar circumstances when USAir Flight 427 crashed while attempting to land in Pennsylvania in 1994 5 Renewed investigation and probable cause Edit The NTSB reopened its investigation into Flight 585 in parallel with the USAir Flight 427 investigation due to the similar nature of the circumstances 5 During the NTSB s renewed investigation it was determined that the crash of Flight 585 and the later Flight 427 crash was the result of a sudden malfunction of the aircraft s rudder power control unit Another incident non fatal that contributed to the conclusion was that of Eastwind Airlines Flight 517 which had a similar problem upon approach to Richmond on June 9 1996 6 On March 27 2001 the NTSB issued a revised final report for Flight 585 which found that the pilots lost control of the airplane because of a mechanical malfunction The renewed investigation concluded with a probable cause that stated 1 114 The National Transportation Safety Board determines that the probable cause of the United Airlines flight 585 accident was a loss of control of the airplane resulting from the movement of the rudder surface to its blowdown limit The rudder surface most likely deflected in a direction opposite to that commanded by the pilots as a result of a jam of the main rudder power control unit servo valve secondary slide to the servo valve housing offset from its neutral position and overtravel of the primary slide In popular culture EditThe Discovery Channel Canada National Geographic TV series Mayday dramatized the crash of Flight 585 and the subsequent 737 rudder investigation in a 2007 episode titled Hidden Danger 7 The crash is dramatized in the episode Fatal Flaws of Why Planes Crash See also Edit Colorado portal Aviation portal 1990s portalBoeing 737 rudder issues Eastwind Airlines Flight 517 USAir Flight 427 Alaska Airlines Flight 261 American Airlines Flight 1 Northwest Airlines Flight 85References Edit a b c d e f g h i j k l m Aircraft Accident Report Uncontrolled Descent and Collision With Terrain United Airlines Flight 585 Boeing 737 200 N999UA 4 Miles South of Colorado Springs Municipal Airport Colorado Springs Colorado March 3 1991 PDF National Transportation Safety Board March 27 2001 NTSB AAR 01 01 Archived PDF from the original on October 2 2015 Retrieved January 17 2016 FAA Registry N999UA Federal Aviation Administration Kaye Ken Staff Writer February 28 1993 Mystery Crash South Florida Sun Sentinel Archived from the original on June 29 2021 Retrieved December 19 2021 a b c d e f g Aircraft Accident Report United Airlines Flight 585 Boeing 737 291 N999UA Uncontrolled Collision With Terrain for Undetermined Reasons 4 Miles South of Colorado Springs Municipal Airport Colorado Springs Colorado March 3 1991 PDF National Transportation Safety Board December 8 1992 NTSB AAR 92 06 Archived PDF from the original on March 3 2016 Retrieved January 17 2016 a b Aircraft Accident Report Uncontrolled Descent and Collision With Terrain USAir Flight 427 Boeing 737 300 N513AU Near Aliquippa Pennsylvania September 8 1994 PDF National Transportation Safety Board March 24 1999 NTSB AAR 99 01 Archived PDF from the original on October 14 2012 Retrieved January 17 2016 Byrne Gerry 2002 Flight 427 Anatomy of an Air Disaster New York Copernicus Books pp 207 210 ISBN 0 387 95256 X Hidden Danger Mayday Season 4 2007 Discovery Channel Canada National Geographic Channel This article incorporates public domain material from websites or documents of the National Transportation Safety Board External links EditAirDisaster com Special Report United Airlines Flight 585 Usurped Archive Accident description at the Aviation Safety Network Boeing 737 Rudder Design Defect Archived July 7 2011 at the Wayback Machine Airliners net Pre crash photos Recording of the air traffic control transmissions between the aircraft and Colorado Springs Retrieved from https en wikipedia org w index php title United Airlines Flight 585 amp oldid 1133722734, wikipedia, wiki, book, books, library,

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