3

NATIONAL TRANSPORTATION SAFETY BOARD

PILOT/OPERATOR AIRCRAFT ACCIDENT/INCIDENT REPORT
This form to be used for reporting civiI and pubIic use aircraft accidents and incidents
BASIC INFORMATION
Accident/Incident Location
Nearest City/Place: _________________________________________ State: ________
ZIP: ________________ Country: ___________________________________________
Latitude: _____________ (dd:mm:ss N/S) Longitude: _____________ (ddd:mm:ss E/W)
Date/Time
Date: ______________________ Local Time: _________________
mm/aa/yyyy
Time Zone: _________________
Phase of Operation
Standing TakeoII (incl. initial climb) Cruise Hover
Taxi Climb Maneuvering Other
Descent Landing Approach Unknown
Collision with Other Aircraft
Midair
On-ground
None
Altitude of In-Flight
Occurrence
It MSL
AIRCRAFT INFORMATION
Manufacturer: _________________________________________________________
Model: _________________________________________________________________
Serial Number: _____________________________
Registration Number: __________________ Amateur-built: Yes No
Max Gross Weight: _______________ lbs
Weight at Time of Accident/Incident: ______________ lbs
Location of Center of Gravity at Time of Accident/Incident:
_____________ inches Irom nose or datum
-or- _____________ Percent Mean Aerodynamic Cord ( MAC)
Category of Aircraft
Airplane
Balloon
Blimp/Dirigible
Glider
GyrocraIt
Helicopter
Powered liIt
Ultralight
Unknown
Type of Airworthiness Certificate
(Check all that apply)
Standard Special
Normal Restricted
Utility Limited
Acrobatic Provisional
Transport Experimental
Special Flight
Light Sport
Number of Seats: ___________

II Large AircraIt, how many seats Ior:

Flight Crew: ________________
Cabin Crew: ________________
Passengers: _________________

Landing Gear Retractable
Check any additional landing gear
conIiguration that applies:
Tricycle Tailwheel
Amphibian High Skid
Emergency Float Skid
Float Ski
Hull Ski/Wheel
Unknown
Date Last Inspection: ________________
mm/aa/yyyy
Type of Maintenance Program
Annual
Conditional (Amateur-built only)
ManuIacturer`s Inspection Program
Other Approved Inspection Program (AAIP)
Continuous Airworthiness
Other, speciIy: _____________________________
Last Inspection Type
100 Hour Continuous Airworthiness
AAIP Conditional Inspection
Annual Unknown
Airframe Total Time: __________________hrs
hours measured at (check one)
Last Inspection Time oI Accident/Incident
IFR Equipped
Yes No Unknown
Stall Warning System Installed
Yes No Unknown
Type of Fire Extinguishing System
None
SpeciIy ___________________________________
ELT Installed
Yes No
ELT Activated
Yes No
ELT Aided in Locating Accident/Incident
Yes No
ELT Manufacturer: ______________________________________
Model/Series: ___________________________________________
Serial Number: __________________________________________
Battery Type: _____________________________ Battery Exp. Date: _____________
Engine Type
Reciprocating Turbo Jet
Turbo ShaIt Turbo Fan
Turbo Prop Unknown
Reciprocating Fuel
System Type
Carburetor
Fuel Injected
Propeller

Fixed Pitch
Controllable Pitch


ManuIacturer: ________________________________________
Model: _______________________________________________
Engine Engine Manufacturer
Engine
Model/Series
Manufacturer`s
Serial Number
Date
of Mfg.
mm/aa/yyyy
Engine Rated
Power Measured
as (check one)
Horsepower or
lbs oI Thrust
Total
Time
(hours)
Time
Since
Inspection
(hours)
Time
Since
Overhaul
(hours)
Eng. 1
Eng. 2
Eng. 3
Eng. 4
New York
NY
USA
10/19/2011 2248
EDT

22,600
Boeing
767-2B7
24894
N253AY
351,000
216
4
8
204

13,828
7,492
7,492
13,828 81,792
81,648 51638
51451

4/28/1988
3/2/1988
690229
690258 CF6-80C2B2
CF6-80C2B2 GE
GE

86,519

Halon
4
OWNER/OPERATOR INFORMATION
Registered Aircraft Owner
Name: __________________________________________________________________
Fractional Ownership AircraIt: Yes No
Owner Address
City: ____________________________________
State: ___________ ZIP: ____________
Country: _________________________________
Operator of Aircraft Same As Registered Owner
Name: __________________________________________________________________
Doing Business As: _______________________________________________________
Air Carrier/Operator Designator (4 Character Code): _______________
Operator Address Same As Registered Owner
City: ____________________________________
State: ___________ ZIP: ____________
Country: _________________________________
Revenue Sightseeing Flight
Yes No
Regulation Flight Conducted Under
FAR 91 FAR 129 FAR 91 Special Flight Public Use (select type)
FAR 103 FAR 133 Non-US, Commercial Feaeral State Local
FAR 121 FAR 135 Non-US, Non-commercial Unknown
FAR 125 FAR 137 Armed Forces
Air Medical Flight
Yes No
Revenue Operation
for FAR 121, 125, 129, 135 (Select one)
Scheduled or Commuter
Non-Scheduled or Air Taxi

Domestic or International
Domestic International
Type of Commercial Operating Certificate Held
(Check all that apply)
None
Flag Carrier Operating CertiIicate (121)
Supplemental
Air Cargo
Foreign Air Carriers (129)
Commuter Air Carrier (135)
On-Demand Air Taxi (135)
Large Helicopter (127)

RotorcraIt External Load (133)
- or -
Agricultural AircraIt (137)
Purpose of Flight
for FAR 91, 103, 133, 137 (Select one)
Personal
Business
Executive/Corporate
Other Work Use
Instructional
Ferry
Positioning
Aerial Application
Aerial Observation
Air Drop
Air Race / Show
Flight Test
Public Use
Unknown
Cargo Operation
Passenger/Cargo
Passenger ____________How many?
Cargo ______________ lbs
Mail Other Operator oI Large AircraIt
OTHER AIRCRAFT - COLLISION (If air or ground coIIision occurred, compIete this section for RWKHU aircraft)
Aircraft Registration Number
_________________________
Manufacturer: ___________________________________________________
Model: __________________________________________________________
Damage to Other Aircraft
Destroyed Minor
Substantial None
Registered Owner of Other Aircraft
First Name: ___________________________________________________
Middle Initial: _________
Last Name: ___________________________________________________

City: _________________________________________________
State: ___________ ZIP: ____________
Country: ______________________________________________
Pilot of Other Aircraft
First Name: ___________________________________________________
Middle Initial: _________
Last Name: ___________________________________________________

City: _________________________________________________
State: ___________ ZIP: ____________
Country: ______________________________________________
MECHANICAL MALFUNCTION/FAILURE (If more space is needed, continue on separate sheet)
Total Time/Cycles
On Part

______________ Hours

______________ Cycles
Was there Mechanical Malfunction/Failure? Yes No Unknown
(If yes, list the name of the part, manufacturer, part no., serial no., ana aescribe the failure.)







Time Since This Part
Inspected/Overhauled

______________ Hours
DAMAGE TO AIRCRAFT AND OTHER PROPERTY
Aircraft Damage
None Substantial
Minor Destroyed
Aircraft Fire
None Both Ground and In-Flight
In-Flight Unknown Origin
On-Ground
Aircraft Explosion
None Both Ground and In-Flight
In-Flight Unknown Origin
On-Ground
SALT LAKE CITY
Utah 84111
USA
111 W. RIO SALADO PARKWAY
AZ 85281
USA

WELLS FARGO BANK NORTHWEST NA TRUSTEE

US AIRWAYS, INC.
US Airways
USAA

5
Description of Damage to Aircraft and Other Property (use aaaitional sheet if necessary)










AIRPORT INFORMATION (If the accident/incident occurred on approach, takeoff or within 3 miIes of an airport, compIete this section)
Airport Identifier: ________________________________________
Airport Name: __________________________________________________
Proximity to Airport OII Airport/Airstrip On Airport On Airstrip
Distance From Airport Center: __________________SM
Direction From Airport: ________________ degrees MAG
Airport Elevation: __________________________ It. MSL
Approach Segment (Select one)
On Instrument Approach Landing Base leg Final Go Around
Crosswind Downwind Low Approach Aborted Landing (aIter touchdown)
IFR Approach (Check all that apply)
None PAR MLS Practice
ADF/NDB Sidestep LDA GPS
SDF ILS ASR Loran
VOR/TVOR Localizer Only Visual Unknown
VOR/DME LOC-back course Contact
TACAN RNAV Circling
VFR Approach (Check all that apply)
None Stop and Go
TraIIic Pattern Touch and Go
Straight-In Simulated Forced Landing
Valley/Terrain Following Forced Landing
Go Around Precautionary Landing
Full Stop Unknown
Runway Information
Runway ID: ____________(L/R/C) Length: ____________It Width: ____________It
Runway/Landing Surface (Check all that apply)
Asphalt Grass/TurI Macadam Water
Concrete Gravel Metal/Wood Unknown
Dirt Ice Snow
Condition of Runway/Landing Surface (Check all that apply)
Dry Snow-Compacted Water-Calm
Holes Snow-Crusted Water-Choppy
Ice Covered Snow-Dry Water-Glassy
Rough Snow-Wet Wet
Rubber Deposits SoIt Unknown
Slush Covered Vegetation
FLIGHT ITINERARY INFORMATION
Last Departure Point
Airport ID: _______________
City: ________________________________
State: ____________________
Country: _____________________________
Time of Departure

Time: _____________

Time Zone:_________
Destination
Airport ID: ___________________
City: _________________________________
State: ________________________
Country: ______________________________
Type Flight Plan Filed
None VFR/IFR
Company VFR IFR
Military VFR Unknown
VFR
Activated? Yes No
Type of ATC Clearance/Service (Check all that apply)
None Special VFR Special IFR VFR Flight Following Cruise
VFR IFR VFR On Top TraIIic Advisory Unknown / NA
Airspace where the accident/incident occurred (Check all that apply)
Class A Class E Prohibited Area Jet Training Area Special
Class B Class G Restricted Area TRSA Air TraIIic Control Area
Class C Demo Area Military Operations Area (MOA) FAR 93 Unknown
Class D Warning Area Airport Advisory Area
Aircraft Load Description (Check all that apply)
None Towing Glider Parachutists Livestock
Passengers Towing Banner Water Unknown
Cargo Other External Chemical/Fertilizer/Seeds
FUEL & SERVICES INFORMATION
Fuel on Board at Last Takeoff
(convert from pounas, as necessary)
____________________________ Gallons
Fuel Type
80/87 115/145 JP3 Other, speciIy _________________________
100 Low Lead Jet A JP4
100/130 Automotive JP5
Other Services, if Any, Prior to Departure




KPHL
Philadelphia
PA
USA
2033
EDT
EDDF
Frankfurt
Hesse
Germany

13,522

6
EVACUATION OF AIRCRAFT

Was an emergency evacuation of the aircraft performed? Yes No
Method of Exit Describe how the occupants exited and how many occupants evacuated each location










WEATHER INFORMATION AT THE ACCIDENT/INCIDENT SITE
Weather Observation Facility
Facility ID: ___________________________________
Observation Time:
Time Zone: ___________________________________
Distance Irom Accident Site: __________________ NM
Direction Irom Accident Site: _______________ degrees MAG
Source of Weather Information
(Check all that apply)
National Weather Service Company
Flight Service Station Military
TV/Radio Internet
Automated Report Unknown
Commercial Weather Service (DUATS)
Method of Briefing
(Check all that apply)
In Person
Teletype
Telephone/Computer
AircraIt Radio
TV/Radio
Unknown
Briefing Type/Completeness
Full Abbreviated
Partial / Limited By Pilot Unknown
Partial / Limited By BrieIer Not Pertinent
Light Condition
Dawn Dusk
Day Night

Dark Night
Bright Night
Not Reported
Visibility

__________ miles
Sky/Lowest Cloud Condition
Clear Thin Broken
Few Thin Overcast
Partial Obscuration Unknown
Scattered
Ceiling
None (clear) Obscured
Broken IndeIinite
Overcast Unknown
Lowest Cloud Condition Height
It AGL
Ceiling Height
It AGL
Restriction to Visibility (Check all that apply)
None Fog
Blowing Dust Ground Fog
Blowing Sand Haze
Blowing Snow Ice Fog
Blowing Spray Smoke
Dust Unknown
Wind Direction
Indicated:
_________degrees MAG

Variable
Wind Speed
Velocity: __________KTS
-or-
Calm
Light and Variable

Wind Gusts
Velocity: KTS

Gusting
Not Gusting

Type of Turbulence (Check all that apply)
None In Clouds
Clear Air Vicinity oI Thunderstorm
Severity of Turbulence
Extreme Moderate Light
Severe Moderate Chop
NOTAMs (D, L and FDC), AIRMETs, SIGMETs, PIREPs in effect at the time of the accident/incident



Icing Forecast
Amount Type
None Moderate Rime
Trace Severe Clear
Light Mixed
Type of Precipitation (Check all that apply)
None Drizzle
Rain Ice Pellets
Snow Snow Pellets
Hail Snow Grains
Rain Showers Ice Crystals
Freezing Rain Ice Pellets Shower
Snow Shower Freezing Drizzle

Temperature: _________ (C)
or _________ (F)
Altimeter Setting: ________ in. HG
or ________ MB
Density Altitude: ________________ It
Dew Point: _________ (C)
or _________ (F)
Icing Actual
Amount Type
None Moderate Rime
Trace Severe Clear
Light Mixed
Intensity of Precipitation
Light Moderate Heavy
Normal exit through passenger boarding door

JFK
2051
EDT
10
060

700

70
14

1,100
21

63
29.49
60

5
7
PILOT "A" INFORMATION
Pilot ~A Responsibilities at the Time of Accident/Incident
Pilot Co-Pilot Student Pilot Flight Instructor Check Pilot Flight Engineer Other Flight Crew
Pilot ~A Identification
First Name: ___________________________________________________
Middle Initial: _________
Last Name: ___________________________________________________
City: _________________________________________________
State: ___________ ZIP: ____________
Country: ______________________________________________
Age at time oI Accident/Incident: ________ Date oI Birth: __qqqqqg_____ CertiIicate Number: Dqqqqqqqqg____________________________
mm/aa/yyyy
Degree of Injury
None Fatal
Minor Unknown
Serious
Seat Occupied
LeIt Front Unknown
Right Rear
Center Single
Seat Belt
Used Yes No
Available Yes No
Shoulder Harness
Used Yes No
Available Yes No

Pilot Certificate(s) (Check all that apply)
None Student Recreational Commercial Flight Engineer Foreign
Private Flight Instructor Sport Airline Transport U.S. Military
Principal Occupation
Pilot
Other
Unknown
Medical Certificate
None Class 3
Class 1 Driver`s License (Sport Pilot only)
Class 2 Unknown
Medical Certificate Validity
Without limitations/waivers
With limitations/waivers
Unknown
Date of Last Medical

____________
mm/aa/yyyy
Medical Certificate Limitations
Medical Certificate Waivers
Date of Last Flight Review
or Equivalent, Including
FAR 121/135 Checks: __________________
mm/aa/yyyy
Flight Review Aircraft
Make: ______________________________________________________________________________
Model: ______________________________________________________________________________
Airplane Rating(s)
(Check all that apply)
None
Single-Engine Land
Single-Engine Sea
Multiengine Land
Multiengine Sea

Other Aircraft Rating(s)
(Check all that apply)
None
Airship
Free Balloon
Glider
Gyroplane
Helicopter
Powered LiIt
Instrument Rating(s)
(Check all that apply)
None
Airplane
Helicopter
Powered LiIt

Instructor Rating(s)
(Check all that apply)
None Instrument Airplane
Airplane Single-Engine Instrument Helicopter
Airplane Multi-Engine Helicopter
Gyroplane Glider
Powered LiIt Sport
Type Ratings

Student Endorsements (Incluae aates)

Instrument
Flight Time (enter appropriate
number of hours in each box)
All
Aircraft
This Make
& Model
Airplane
Single
Engine
Airplane
Multiengine Night Actual Simulated Rotorcraft Glider
Lighter
Than Air
Total Time
Pilot in Command (PIC)
Time as Instructor
This Make/Model
Last 90 Days
Last 30 Days
Last 24 Hours

Phillip
H
Mershon
LAKE WYLIE
SC 29710
USA
51 ------- /1960
-----------

09/07/2011
None
05/08/2011
Boeing
767

F-28, F-100, B-737, DC-9, A-320, B-767

14,301
6,200
130
40
0
1,917
1,370
130
40
8
PILOT "B" INFORMATION
Pilot ~B Responsibilities at the Time of Accident/Incident
Pilot Co-Pilot Student Pilot Flight Instructor Check Pilot Flight Engineer Other Flight Crew
Pilot ~B Identification
First Name: ___________________________________________________
Middle Initial: _________
Last Name: ___________________________________________________
City: _________________________________________________
State: ___________ ZIP: ____________
Country: ______________________________________________
Age at time oI Accident/Incident: ________ Date oI Birth: __qqqqqg_____ CertiIicate Number: qqqqqqqqqqg_________________________
mm/aa/yyyy
Degree of Injury
None Fatal
Minor Unknown
Serious
Seat Occupied
LeIt Front Unknown
Right Rear
Center Single
Seat Belt
Used Yes No
Available Yes No
Shoulder Harness
Used Yes No
Available Yes No

Pilot Certificate(s) (Check all that apply)
None Student Recreational Commercial Flight Engineer Foreign
Private Flight Instructor Sport Airline Transport U.S. Military
Principal Occupation
Pilot
Other
Unknown
Medical Certificate
None Class 3
Class 1 Driver`s License (Sport Pilot only)
Class 2 Unknown
Medical Certificate Validity
Without limitations/waivers
With limitations/waivers
Unknown
Date of Last Medical

____________
mm/aa/yyyy
Medical Certificate Limitations
Medical Certificate Waivers
Date of Last Flight Review
or Equivalent, Including
FAR 121/135 Checks: __________________
mm/aa/yyyy
Flight Review Aircraft
Make: ______________________________________________________________________________
Model: ______________________________________________________________________________
Airplane Rating(s)
(Check all that apply)
None
Single-Engine Land
Single-Engine Sea
Multiengine Land
Multiengine Sea

Other Aircraft Rating(s)
(Check all that apply)
None
Airship
Free Balloon
Glider
Gyroplane
Helicopter
Powered LiIt
Instrument Rating(s)
(Check all that apply)
None
Airplane
Helicopter
Powered LiIt

Instructor Rating(s)
(Check all that apply)
None Instrument Airplane
Airplane Single-Engine Instrument Helicopter
Airplane Multi-Engine Helicopter
Gyroplane Glider
Powered LiIt Sport
Type Ratings

Student Endorsements (Incluae aates)

Instrument
Flight Time (enter appropriate
number of hours in each box)
All
Aircraft
This Make
& Model
Airplane
Single
Engine
Airplane
Multiengine Night Actual Simulated Rotorcraft Glider
Lighter
Than Air
Total Time
Pilot in Command (PIC)
Time as Instructor
This Make/Model
Last 90 Days
Last 30 Days
Last 24 Hours

Carson
Lacquement
Oak Ridge
NC 27310
USA
63
------- /1948 ---------------

9/6/11
NOT VALID FOR ANY CLASS AFTER.
HOLDER SHALL POSSESS GLASSES FOR NEAR & INTERMEDIATE VISION.
10/15/2011
Boeing
767

CE-500, B-707, B-720, B-727, B-737, B-767

24,130
11,712
0
0
0
1,142
1,142
9
ADDITIONAL FLIGHT CREW MEMBERS (ExcIusive of cabin attendants, compIete the foIIowing information)
Pilot Name and Address
First Name: _______________________________________
Middle Initial: _________
Last Name: _______________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: _______________________________
Degree of Injury
None Fatal
Minor Unknown
Serious
Pilot Certificate(s) (Check all that apply)
None Student Recreational Commercial Flight Engineer Foreign
Private Flight Instructor Sport Airline Transport U.S. Military
Type Rating/Endorsement for
Accident/Incident Aircraft? Yes No
Total Flight Time at the Time
of this Accident/Incident: ____________hrs
Seat Occupied
LeIt Front
Right Rear
Center Single
Unknown
Pilot Name and Address
First Name: _______________________________________
Middle Initial: _________
Last Name: _______________________________________
City: _____________________________________
State: ___________ ZIP: ___________
Country: _______________________________
Degree of Injury
None Fatal
Minor Unknown
Serious
Pilot Certificate(s) (Check all that apply)
None Student Recreational Commercial Flight Engineer Foreign
Private Flight Instructor Sport Airline Transport U.S. Military
Type Rating/Endorsement for
Accident/Incident Aircraft? Yes No
Total Flight Time at the Time
of this Accident/Incident: ____________hrs
Seat Occupied
LeIt Front
Right Rear
Center Single
Unknown
Pilot Name and Address
First Name: _______________________________________
Middle Initial: _________
Last Name: _______________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: _______________________________
Degree of Injury
None Fatal
Minor Unknown
Serious
Pilot Certificate(s) (Check all that apply)
None Student Recreational Commercial Flight Engineer Foreign
Private Flight Instructor Sport Airline Transport U.S. Military
Type Rating/Endorsement for
Accident/Incident Aircraft? Yes No
Total Flight Time at the Time
of this Accident/Incident: ____________hrs
Seat Occupied
LeIt Front
Right Rear
Center Single
Unknown
PASSENGER(S) / OTHER PERSONNEL (IncIude fIight attendants; continue on separate sheet if necessary)
Name and Address S
e
a
t

C
r
e
w

N
o
n
-
R
e
v
e
n
u
e

R
e
v
e
n
u
e

N
o
n
-
O
c
c
u
p
a
n
t

F
A
A

F
a
t
a
l

S
e
r
i
o
u
s

I
n
j
u
r
y

M
i
n
o
r

I
n
j
u
r
y

N
o

I
n
j
u
r
y

U
n
k
n
o
w
n

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ZIP: ____________
Country: __________________________________

____

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: __________________________________

____

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: __________________________________

____

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: __________________________________

____

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: __________________________________

____

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: __________________________________

____

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: __________________________________

____

First Name: _________________________________________
Middle Initial: _________
Last Name: _________________________________________
City: _____________________________________
State: ___________ ZIP: ____________
Country: __________________________________

____

Ronald
Lamontagne
Dublin
NH 03444
USA

30,384

DORIEE
EVANS
Cheltenham
PA
19012
USA
A-FA

Valeska
Weyman
22E

10
NARRATIVE HISTORY OF FLIGHT (PIease type or print in ink)
Describe what occurred in chronological order, including circumstances leading to and nature oI accident/incident. Describe terrain and include
wreckage distribution sketch iI pertinent. Attach extra sheets iI needed. State time and point oI departure, intended destination, and services obtained.




































RECOMMENDATION (How couId this accident/incident have been prevented?)
Operator/Owner SaIety Recommendation































On October 19th, 2011 at approximately 2048 EDT, Flight 702, operated by N253AY, from Philadelphia, PA (PHL) to Frankfurt, Germany (FRA), encountered
moderate turbulence during departure. A 41 year old female passenger, seated at 22E, was exiting the lavatory at the time of the encounter and reported an
injury to her ankle. Flight attendants and an onboard doctor attended to the passenger and the flight returned to PHL where paramedics met the flight and
removed the passenger.
The flight crew reported that they were climbing through FL226 at the time of the event. There were no indications of turbulence on the weather radar and
there was no turbulence indicated on the flight plan prior to departure. The seat belt sign was illuminated. After the turbulence encounter, the flight attendants
informed the Captain of the passenger injury. The Captain directed the International Relief Officer (IRO) to contact Medlink while the flight attendants paged
for medical personnel. An orthopedic doctor was onboard and attended the passenger with the flight attendants. Medlink advised the Captain to return to
PHL for medical assistance. The flight performed a return to field and an overweight landing. Paramedics met the flight at the gate and removed the
passenger.
11
ADDITIONAL INFORMATION (Please type or print in ink)
Use this space iI additional space is needed Ior any answers.

































I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE
Date of this Report
______________
mm/aa/yyyy
Signature and Name of Pilot/Operator
Signature:________________________________________________________________________________________
Type or Print Name: ________________________________________________________________________________
Signature and Name of Person Filing Report if Other than Pilot/Operator
Signature: ______________________________________________________________________________________________________________________
Type or Print Name: ______________________________________________________________________________________________________________
Title: __________________________________________________________________________________________________________________________
FOR NTSB USE ONLY
NTSB Accident/Incident No.

Reviewed by NTSB Regional Office

Name of Investigator

Date Report Received

10/31/2011
Tom Lulkovich
Director, Flight Safety & Regulatory Compliance
ERA12CA044 ERA (NJ) Gretz 11/1/11
.FWID: CaptairrPhU Mershon
US AJnvays Check Airman B157l761
Wbile cJimbi:ng out of FL220. tlortheast iJf JFK, encountered moderate tul'bl.ilence for . .'.,. '"
.pprl:ndlnately2() occtmed at tSmil1ute!) int(} the flight, ..
A. eOupte llf minutes later, a Hight aand;liI1't caJled thi.l: cockpit llndreportcd a WflS conting
lavti{)ry durin,g the turbulence Ind had hint ankle, ScalBdt was still on during
this tirne, i directed the IRO t() oontactJ?tiedUnk and dispatch to relay the inforrnati(m,
an orthopedic dootorw(;'!s oi:ib{)ard and intended torhe injured passcngcr(41 !/car old
Val.esKa Weymann, Seat DoctorrerX)r1ed. tCLti1emght attendahttlla1 the
brokelt; IvledHllk tiS to to KPH,L,) dcC'lnred 11 Medical to center and
started iO return to KPH1 .. ,JE:EMK"lh'tls for l:Iltd,.to make Qven;,1eight. btnding in
PHL (126.400 Ibsl ttink ratc 280 fpm), rnet at hy.parameciics and
hospital.
SiltCercty,
-
Captai 11 Phil Mershon
AOL Mail - Message View Page 1 ofl
Soot
IMs
$poIIm (1)
Trash
Calendar
MY' Foldel'$
3am __ + )
: Date: October 20; 2011
: To: National Transportation Safety Board
. 490 L'Enfant Plaza SW
Washington DC 20594
,r,ao-,<I.e : From: Captain Carson Lacquement
B757fl67
i Subject: Passenger Injury on USAirways Flight 702
: October 19, 2011
: On October 19 FL T 702 was climbing through 22,000 feet when we
: suddenly hit 20 seconds of moderate turbulence. The F/A called the
i cockpit to tell us that a woman hd fell going back to her seat during the
: turbulence. Her ankle was twisted and appeared broken_ It was later
: confirmed by an on board Orthopedic Doctor. The seat belt sign was on
: the entire time. We called Medlink and returned to KPHL as a medical
. emergency_ Paramedics and maintenance met the aircraft to take care of :
: the injured passenger and perfonn necessary inspections due to the
: overweight landing and the use of the EEMK. )
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http://mail.aol.coml34290-2111aol-6/en-USlLiteJMsgRead.aspx?folder=Sent&uid=284853... 10/2112011
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NTSB
490 L 'Enfant Plaza. SW
Washington, DC 20594
To Whom It May Concern:
On 10/19/20 II, I was the International Relief Officer on Flight 702 from Philadelphia to
Frankfurt, Gennany. As we were climbing out ofFL220, we encountered moderate
turbuience for a span of approximately 20 seconds. Our radar gave us no indication of
any adverse weather or the possibility of any impending turbulence. The seat belt sign
was illuminated at time of the occurrence. After the event, we were informed by the
B Flight Attendant that a female passenger was lying in the aisle with an apparent
traumatic injury to one of her ankles. We instructed her to make an announcement for
any medical personnel who could assist the injured woman. We did have an orthopedic
surgeon on board who was able to assist. After we were made aware of the injury, we
contacted MedLink through our company dispatch whereupon they instructed us to return
to Philadelphia in order to provide proper medical attention to the injured passenger.
Upon our return to Philadelphia, we had to make an overweight landing in compliance
with all FAA regulations and US Airways policy and procedures for a normal landing.
Please let me know if you require any additional information.
Sincerely,

US Airways Check Pilot B7571767
National Transportation Safety board
490 l'ensant Plaza SW
Washington, DC 20594
To whom it may concern,
UUI'<;.U:.i:. WJ.LLJ.HIYI::'
Doriee D. Evans
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October 19, 2011
The following narrative depicts actual facts, as they unfolded, on Fit 702 from Philadelphia to
Frankfurt, Germany on October 19, 2011.
Shortly after passing through 10;000 ft, the captain extinguished the PED sign and the flight
crew as well 1 or 2 passengers started moving about in the cabin. The fasten seat belt sign was
still illuminated since we were stili ascending. Approximately 5-10 minutes thereafter, we
started to experience some moderate turbulence that lasted approximately 2-5 minutes. I was
approximately around row 9, when I had to Immediately sit in the isle to keep from falling over
on passengers. Just after the turbulence subsided, one of the FA's in the rear of the aircraft
used the PA system to call for a physician. At this time, t preceded to the aft galley, by the rear
lavatory, aircraft right and found Valeska Weyman sitting on the floor complaining of right (1)
ankle pain. During my initial assessment, I noticed Ms. Weymanis foot had an unnatural bone
protrusion with distal rotation, swelling and skin discoloration. While I was obtaining her
demographic information, past medical history, seat assignment and etc, Or. Richard Mandel
Identified himself as an orthopedic surgeon and stated he could and would assess the
passenger, since this is his field of expertise. I immediately relinquished care to the physician
and called the captain to inform him of the situation. I provided the captain with the passengers
name, agei seat assignment, solitary traveler, final destination, extent of Injury, on board
treatment plan, attending physician and credentials, use of EEMK equipment, asked him to call
Med link and suggested we return to PHl or divert to the nearest airport, due to the severity of
the injury and requested that an ambulance be present upon landing to take Ms. Weyman to
the hospital for immediate treatment. We then splinted the passengers' foot with pillows and
sterile gauze pads and moved her to the last row of seats and monitored her until we arrived
back in Philadelphia. I also relocated the physician to the last row of seats as well so he could
assist wIth monitoring her condition. Once we landed In Philadelphia, the paramedics met the
aircraft and took Ms. Weyman off the aircraft.
Witness: Dr. Richard Mandel
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UUI'(.lt:.t:. W.lLL.lAM::'
D. E'lans A Flight Attendant
C. Marla Kolins E Flight Attendant
C. Tomasian-Himmel C Flisht Attendant
If I can provide additional Information concerning this incident, please do not hesitate to
contact me at ----------------- during regular business hours.
Sincerely,

Dotlee D. Evans, PHl Flight Attendant
cc: Wesley Rogers, In-fllsht Supervisor, PHl