AOPA Turbine Pilot Magazine - December 2018 - 76

At no point in the flight was the crew practicing
procedures and standards that lead to shared situational awareness. The CVR recorded no pretakeoff
briefing, no clear description of the duties each would
assume during the flight and upon arrival, and no
approach briefing. These are compulsory in professional flying environments.
En route, on multiple occasions, the crew
exceeded speed limitations. In the busy airspace they
were kept lower than preferred, and when the controller explained her rationale for the lower altitude,
they cursed her on intercom, exclaiming, "It's like she
doesn't like us."

During the approach, the co-pilot attempted-more
than once-to start down the ILS before capturing the
glideslope, with the captain correcting the error.
Fixated on speed and altitude controls, confused
by the alignment of the runway and localizer guidance,
frustrated by missed radio calls, and annoyed by turbulence, the crew-and importantly, the captain-got well
behind the airplane. Two miles beyond the normal circling point, the tower reminded them to start the circle.
Surprised, perhaps embarrassed, they immediately began
a turn-and they may not have anticipated the effect on
groundspeed when they turned from a crosswind of
16, gusting to 32, to a direct tailwind. The high-bank
turn, initiated late, likely with
above-normal G onset probably
contributed to a loss of control
and ground impact.
The Teterboro tragedy
offers several sobering lessons.
The crew's freewheeling cockpit overlooked procedures and
company policy designed to provide safeguards that could have
helped them retain situational
awareness. It's likely this attitude was fortified by the nature
of the flight: a repositioning run,
third flight of the day, and without passengers. It must have felt like a relaxed mission
compared to their two previous flights that day. The
level and extent of profanity in the cockpit-much of it
aimed at others outside the cockpit-indicates a lack of
professionalism that perhaps further contributed to an
undisciplined cockpit.
Additionally, the captain's decision to permit an
unqualified co-pilot to fly a quick, intense leg into one
of the most demanding regions of the country clearly
contributed to the accident. Allowing the co-pilot to
fly any leg was a breach of company policy. Allowing
him to fly this leg indicates the captain underestimated the complexity of the operation.
The art of good instruction is letting students go
far enough to see the consequences of their mistakes
and their shortcomings, without going so far that
safety of flight is endangered. This flight is a reminder
to all instructors and captains of how quickly things
can deteriorate; you cannot allow a student to
continue when you, the instructor, begin losing situational awareness and getting behind the airplane.
You must take control until your task saturation subsides and you regain control of the environment.
Finally, it's helpful to realize when things aren't
going your way and you're just not on your game. Use

THE CO-PILOT, WHO FLEW MOST OF THE
FLIGHT, WAS RATED 0 ON A TRANSPACIFIC RATING SCALE FROM 0-4. SUCH
A RATING PREVENTED THE CO-PILOT
FROM FLYING THE AIRPLANE UNDER ANY
CIRCUMSTANCES.
They became so distracted by what they perceived as a lack of respect for them and their Learjet
that it began to have an impact on their situational
awareness, and they began to get behind the airplane. The degrading situational awareness and
advancing task saturation resulted in numerous
missed radio calls from controllers. At one point
the co-pilot aligned with Newark airport, mistaking it for Teterboro. It took several minutes for the
crew to comprehend why the localizer for Teterboro
Runway 6 was not aligning with their visual picture.
But by then, the tracon had to issue them a modified clearance.
Throughout the flight, external radio traffic was busy,
and rapid, as is common in New York's Class B airspace.
Even with the captain providing frequent coaching on
airspeed and heading checks, the co-pilot's skills were
overwhelmed. Uncoordinated actions between the crew
created confusion in responsibilities, in one case causing a late localizer intercept, as neither pilot realized the
autopilot remained in the wrong mode. Task saturation
continued to build, and situational awareness kept eroding in a high-workload airplane, in strong turbulence,
during one of the most challenging airport arrivals in
the National Airspace System.
76 | AOPA PILOT December 2018

AOPA Turbine Pilot Magazine - December 2018

Table of Contents for the Digital Edition of AOPA Turbine Pilot Magazine - December 2018