AN A300 FLC GETS HIGH AND FAST ON THE APCH AND AFTER A RWY CHANGE THE FO EXECUTES A GAR WITH AN OVERSHOOT FROM HIS ASSIGNED MISSED APCH ALT AT SFO; CA.

Date: 2000-04 · Aircraft: A300

Anomalies: deviation-altitude-overshoot|deviation-discrepancy-procedural-clearance|deviation-discrepancy-procedural-published-material-policy|inflight-event-encounter-loss-of-aircraft-control|inflight-event-encounter-unstabilized-approach|other-flc-exp-level

Synopsis

AN A300 FLC GETS HIGH AND FAST ON THE APCH AND AFTER A RWY CHANGE THE FO EXECUTES A GAR WITH AN OVERSHOOT FROM HIS ASSIGNED MISSED APCH ALT AT SFO; CA.

Narrative

A MISSED APCH WAS INITIATED FROM THE QUIET BRIDGE VISUAL APCH TO SFO RWY 28R. THE ACFT WAS BEING FLOWN BY THE FO ON THE LAST LEG OF IOE. THE ACFT WAS HIGH AND FAST APCHING THE RWY 28R GS JUST INSIDE BRIDGE OM. SHORTLY AFTER INTERCEPTING THE RWY 28R LOC; SFO TWR CLRED US TO LAND ON RWY 28L. THE FO EXECUTED A GAR FROM AN ALT OF APPROX 1900 FT AT ABOUT 3 MI FROM THE THRESHOLD OF RWY 28L. TAPPING THE 'GO LEVER' INCREASED THRUST TO GAR AND THE FO MANUALLY PITCHED THE ACFT UP TO VAP SPD DISPLAYED BY THE SRS-SPD REF SYS -- PITCH BAR AND ENGAGED THE AUTOPLT. AFTER SOME INITIAL CONFUSION AS TO THE DIRECTION OF TURN TO BE FLOWN; WE ESTABLISHED THE ACFT ON THE 265 DEG HDG CALLED FOR IN THE NOTES OF THE ARR. THE FO WAS ENGROSSED IN TRYING TO PROGRAM THE AUTOMATED FLT CTL SYS AS I TRIED TO ESTABLISH COM WITH TWR AND DEP CTL. I NOTICED THAT WE WERE RAPIDLY REACHING OUR ASSIGNED ALT OF 3000 FT WITH NO ACTION BEING TAKEN TO LEVEL OFF. I ALERTED THE FO TO THIS AND HE IMMEDIATELY DISCONNECTED THE AUTOPLT AND MANUALLY FLEW THE ACFT BACK DOWN FROM 3400 FT TO 3000 FT AS CLRED. THE FO CORRECTLY DECIDED TO GO AROUND FROM WHAT WAS CLRLY AN UNSALVAGEABLE APCH. HE WAS NOT MENTALLY PREPARED FOR THE GAR PROC. HIS LACK OF EXPERIENCE IN THE ACFT AND LAST MIN LNDG INSTRUCTIONS BY ATC COMPOUNDED THE SUBSEQUENT CONFUSION EXPERIENCED DURING THE GAR. OUR MISSED APCH/GAR PROC UTILIZES THE AUTOMATED FLT CTL SYS IN BOTH INSTANCES. NO DEV OR ALLOWANCE IS MADE PROCEDURALLY IF ONE MISSES AT 100 FT OR WITHIN 500 FT OF THE INITIAL MISSED APCH LEVELOFF ALT. INCREASED AWARENESS AND MORE DETAILED BRIEFINGS ARE REQUIRED IF ONE SEES A POTENTIAL FOR A MISSED APCH OR GAR FROM AN APCH BEING FLOWN MANUALLY AND/OR ON AUTOPLT. AS A CAPT; I AM TOO AWARE OF THE MANY ACCIDENTS RESULTING FROM BOTCHED GAR EXECUTIONS CAUSED BY BEING TOO ENGROSSED IN AUTOMATION. IT MUST BE REMEMBERED THAT THE FIRST AND FOREMOST TASK IT TO 'FLY THE AIRPLANE.'

Source: NASA Aviation Safety Reporting System (public domain). Reports are voluntary submissions and are not verified by NASA.