Narrative:

This report is submitted as a result of the failure of fundamental CRM issues that may have begun during the preflight phase and continued to affect crew performance throughout the approach and landing phase. During preflight preparation and WX briefing; the crew was aware of possible turbulence and frontal activity en route. There were small issues within the crew of fuel loading; flight planning; and communications with dispatch. Issues were resolved but perhaps the beginning of CRM breakdown. En route; there was also a discussion of takeoff performance and procedures issues that had occurred. During the discussion; the captain provided documentation from the operations manual which supported this theory of correct procedure and suggested that if there were any questions then perhaps they both could resolve them with help of a check pilot. The captain's explanation was not intrusive; was more than adequate; and was supported by the operations manual. The crew stayed abreast of the frontal movement with continual updates via ACARS and plotted the movement on charts. On initial contact with control tower; we were advised of possible windshear which was reported by a previous aircraft that initiated a go around. The captain revised his initial approach briefing to include additive to reference speed. We continued the approach. Throughout the approach; we received wind data from the INS as well as advisories from the tower. During the landing flare; the tower advised of a windshear alert at the departure end of the runway. At this time the so stated his concern about the landing. At no point was there a call out of 'go around initiated.' due to wind gusts and reference additives; the aircraft touched down approximately 2600-3000 ft down the runway. I believe the PF maintained control of the aircraft throughout the approach and flare and made the correct decision to land the aircraft past the touchdown zone. Safety was not compromised in his decision to land nor was it questioned. While in the flare and with a windshear alert at the departure end of the runway; I believe that landing the aircraft was the correct decision. Subsequently; an aircraft in trail also landed on same runway. Keeping in mind the chain of events; I believe the main problem was breakdown of efficient communication; or CRM skills between all crew members. It was apparent when upon landing at destination where windshear had been reported and so was uncomfortable with the approach. Had there not been a breakdown of communication earlier in the flight; then perhaps the so may have communicated more effectively and the PF and PNF may have initiated a missed approach earlier and avoided any misrepresentation or communication conflicts between crew members. The corrective actions in this case would have been to resolve the communication barriers early on and initiated a 'no fault go around' when it first became apparent that a crew member was uneasy with the approach environment. The human performance considerations were: perceptions and judgments -- the visual perceptions; cues and judgements differ from the PF's seat as compared to the flight engineer's seat. Decisions -- the decisions that were made were based on WX evaluation; interpretation; comfort; ability; and experience. Actions and inactions -- actions that may have affected the CRM were previous discussions of aircraft performance and possibly the inaction to resolve the conflict and open the line of communications. These factors all played a role in the breakdown of communication in an important segment of the flight. To prevent this recurrence; the failure of CRM should have been recognized. In this instance; perhaps the so felt discredited and was not able to clearly communicate his apprehensions early on in the approach. The flying crew members may have been able to interpretation any doubt and initiated a 'no fault go around' in an earlier segment of the approach. Supplemental information from acn 673132: this is a landing that I am not proud of and should not have occurred. I had a personal rule that if any crew member was not comfortable with an approach or landing; I would go around. The flight engineer was clear about this; but I landed anyway.

Google
 

Original NASA ASRS Text

Title: CAPT OF B747 CONTINUES APCH AND LNDG IN WINDSHEAR CONDITIONS DESPITE ADVOCACY FROM FE TO GO AROUND.

Narrative: THIS RPT IS SUBMITTED AS A RESULT OF THE FAILURE OF FUNDAMENTAL CRM ISSUES THAT MAY HAVE BEGUN DURING THE PREFLT PHASE AND CONTINUED TO AFFECT CREW PERFORMANCE THROUGHOUT THE APCH AND LNDG PHASE. DURING PREFLT PREPARATION AND WX BRIEFING; THE CREW WAS AWARE OF POSSIBLE TURB AND FRONTAL ACTIVITY ENRTE. THERE WERE SMALL ISSUES WITHIN THE CREW OF FUEL LOADING; FLT PLANNING; AND COMS WITH DISPATCH. ISSUES WERE RESOLVED BUT PERHAPS THE BEGINNING OF CRM BREAKDOWN. ENRTE; THERE WAS ALSO A DISCUSSION OF TKOF PERFORMANCE AND PROCS ISSUES THAT HAD OCCURRED. DURING THE DISCUSSION; THE CAPT PROVIDED DOCUMENTATION FROM THE OPS MANUAL WHICH SUPPORTED THIS THEORY OF CORRECT PROC AND SUGGESTED THAT IF THERE WERE ANY QUESTIONS THEN PERHAPS THEY BOTH COULD RESOLVE THEM WITH HELP OF A CHK PLT. THE CAPT'S EXPLANATION WAS NOT INTRUSIVE; WAS MORE THAN ADEQUATE; AND WAS SUPPORTED BY THE OPS MANUAL. THE CREW STAYED ABREAST OF THE FRONTAL MOVEMENT WITH CONTINUAL UPDATES VIA ACARS AND PLOTTED THE MOVEMENT ON CHARTS. ON INITIAL CONTACT WITH CTL TWR; WE WERE ADVISED OF POSSIBLE WINDSHEAR WHICH WAS RPTED BY A PREVIOUS ACFT THAT INITIATED A GAR. THE CAPT REVISED HIS INITIAL APCH BRIEFING TO INCLUDE ADDITIVE TO REF SPD. WE CONTINUED THE APCH. THROUGHOUT THE APCH; WE RECEIVED WIND DATA FROM THE INS AS WELL AS ADVISORIES FROM THE TWR. DURING THE LNDG FLARE; THE TWR ADVISED OF A WINDSHEAR ALERT AT THE DEP END OF THE RWY. AT THIS TIME THE SO STATED HIS CONCERN ABOUT THE LNDG. AT NO POINT WAS THERE A CALL OUT OF 'GAR INITIATED.' DUE TO WIND GUSTS AND REF ADDITIVES; THE ACFT TOUCHED DOWN APPROX 2600-3000 FT DOWN THE RWY. I BELIEVE THE PF MAINTAINED CTL OF THE ACFT THROUGHOUT THE APCH AND FLARE AND MADE THE CORRECT DECISION TO LAND THE ACFT PAST THE TOUCHDOWN ZONE. SAFETY WAS NOT COMPROMISED IN HIS DECISION TO LAND NOR WAS IT QUESTIONED. WHILE IN THE FLARE AND WITH A WINDSHEAR ALERT AT THE DEP END OF THE RWY; I BELIEVE THAT LNDG THE ACFT WAS THE CORRECT DECISION. SUBSEQUENTLY; AN ACFT IN TRAIL ALSO LANDED ON SAME RWY. KEEPING IN MIND THE CHAIN OF EVENTS; I BELIEVE THE MAIN PROB WAS BREAKDOWN OF EFFICIENT COM; OR CRM SKILLS BTWN ALL CREW MEMBERS. IT WAS APPARENT WHEN UPON LNDG AT DEST WHERE WINDSHEAR HAD BEEN RPTED AND SO WAS UNCOMFORTABLE WITH THE APCH. HAD THERE NOT BEEN A BREAKDOWN OF COM EARLIER IN THE FLT; THEN PERHAPS THE SO MAY HAVE COMMUNICATED MORE EFFECTIVELY AND THE PF AND PNF MAY HAVE INITIATED A MISSED APCH EARLIER AND AVOIDED ANY MISREPRESENTATION OR COM CONFLICTS BTWN CREW MEMBERS. THE CORRECTIVE ACTIONS IN THIS CASE WOULD HAVE BEEN TO RESOLVE THE COM BARRIERS EARLY ON AND INITIATED A 'NO FAULT GAR' WHEN IT FIRST BECAME APPARENT THAT A CREW MEMBER WAS UNEASY WITH THE APCH ENVIRONMENT. THE HUMAN PERFORMANCE CONSIDERATIONS WERE: PERCEPTIONS AND JUDGMENTS -- THE VISUAL PERCEPTIONS; CUES AND JUDGEMENTS DIFFER FROM THE PF'S SEAT AS COMPARED TO THE FE'S SEAT. DECISIONS -- THE DECISIONS THAT WERE MADE WERE BASED ON WX EVALUATION; INTERP; COMFORT; ABILITY; AND EXPERIENCE. ACTIONS AND INACTIONS -- ACTIONS THAT MAY HAVE AFFECTED THE CRM WERE PREVIOUS DISCUSSIONS OF ACFT PERFORMANCE AND POSSIBLY THE INACTION TO RESOLVE THE CONFLICT AND OPEN THE LINE OF COMS. THESE FACTORS ALL PLAYED A ROLE IN THE BREAKDOWN OF COM IN AN IMPORTANT SEGMENT OF THE FLT. TO PREVENT THIS RECURRENCE; THE FAILURE OF CRM SHOULD HAVE BEEN RECOGNIZED. IN THIS INSTANCE; PERHAPS THE SO FELT DISCREDITED AND WAS NOT ABLE TO CLRLY COMMUNICATE HIS APPREHENSIONS EARLY ON IN THE APCH. THE FLYING CREW MEMBERS MAY HAVE BEEN ABLE TO INTERP ANY DOUBT AND INITIATED A 'NO FAULT GAR' IN AN EARLIER SEGMENT OF THE APCH. SUPPLEMENTAL INFO FROM ACN 673132: THIS IS A LNDG THAT I AM NOT PROUD OF AND SHOULD NOT HAVE OCCURRED. I HAD A PERSONAL RULE THAT IF ANY CREW MEMBER WAS NOT COMFORTABLE WITH AN APCH OR LNDG; I WOULD GO AROUND. THE FE WAS CLR ABOUT THIS; BUT I LANDED ANYWAY.

Data retrieved from NASA's ASRS site as of January 2009 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.