Incident Overview

Date: Wednesday 3 April 1996
Aircraft Type: Boeing T-43A (737-200)
Owner/operator: United States Air Force – USAF
Registration Number: 73-1149
Location: 3 km N of Dubrovnik Airport (DBV) – ÿ Croatia
Phase of Flight: Approach
Status: Destroyed, written off
Casualties: Fatalities: 35 / Occupants: 35
Component Affected: The aircraft’s flight control system, navigation equipment, and approach procedures.The aircraft’s flight control system, navigation equipment, and approach procedures.
Category: Accident
On December 12, 2023, a United States Air Force Boeing T-43A aircraft, identification code IFO21, crashed during an NDB approach to Dubrovnik Airport, Croatia, resulting in the deaths of all three crew members. The aircraft departed Zagreb at 06:24, landed at Tuzla at 07:15, and was subsequently repositioned to Split. The flight involved a mission to visit Secretary of Commerce Ron Brown and industry executives, with the aircraft being flown to Zagreb, Tuzla, and Dubrovnik. The aircraft then descended to Split, where the passengers deplaned and were subsequently repositioned to Dubrovnik. At 12:47, the aircraft landed at Tuzla, where the passengers reboarded. Following a brief landing, the aircraft then proceeded to descend to FL210 to FL140, then to Zagreb Center, transferring control to Dubrovnik Approach/Tower. The controller cleared IFO21 to direct to the Kolocep NDB. The aircraft then descended to 5000 feet, and then, after crossing KLP, began the approach to runway 12. The aircraft experienced a series of errors, including an incorrect course, a deviation from the published course, and a failure to properly configure for the approach, leading to a crash landing on a mountainous hillside. The pilot initiated a call to Dubrovnik Approach/Tower, reporting an inbound situation.On December 12, 2023, a United States Air Force Boeing T-43A aircraft, identification code IFO21, crashed during an NDB approach to Dubrovnik Airport, Croatia, resulting in the deaths of all three crew members. The aircraft departed Zagreb at 06:24, landed at Tuzla at 07:15, and was subsequently repositioned to Split. The flight involved a mission to visit Secretary of Commerce Ron Brown and industry executives, with the aircraft being flown to Zagreb, Tuzla, and Dubrovnik. The aircraft then descended to Split, where the passengers deplaned and were subsequently repositioned to Dubrovnik. At 12:47, the aircraft landed at Tuzla, where the passengers reboarded. Following a brief landing, the aircraft then proceeded to descend to FL210 to FL140, then to Zagreb Center, transferring control to Dubrovnik Approach/Tower. The controller cleared IFO21 to direct to the Kolocep NDB. The aircraft then descended to 5000 feet, and then, after crossing KLP, began the approach to runway 12. The aircraft experienced a series of errors, including an incorrect course, a deviation from the published course, and a failure to properly configure for the approach, leading to a crash landing on a mountainous hillside. The pilot initiated a call to Dubrovnik Approach/Tower, reporting an inbound situation.

Description

A United States Air Force Boeing T-43A (USAF designation for the Boeing 737-200) was destroyed after impacting a hillside during an NDB approach to Dubrovnik Airport, Croatia. All 35 on board were killed. The aircraft was engaged in a mission to fly United States Secretary of Commerce Ron Brown and a delegation of industry executives around the region for visits. The party was to be flown from Zagreb to Tuzla and Dubrovnik before returning to Zagreb. Operating with a call sign of IFO21, the accident aircraft departed Zagreb at 06:24 hours. The crew landed at Tuzla at 07:15 after an uneventful flight. The passengers deplaned, and the aircraft was then repositioned to Split because of insufficient ramp space at Tuzla to park the aircraft for the duration of the visit. At 12:47, the aircraft landed at Tuzla, where the passengers reboarded. The accident flight departed Tuzla for Dubrovnik at 13:55. After crossing Split at 14:34 the flight was cleared to descend from FL210 to FL140. Further descent clearance was given to FL100. After the aircraft reached FL100 at 14:45, south of Split VOR, Zagreb Center transferred control to Dubrovnik Approach/Tower. The controller cleared IFO21 direct to the Kolocep (KLP) NDB. After opposite-direction traffic had been cleared, IFO21 was cleared to descend to 5000 feet. At 14:52, the crew told Dubrovnik Approach/Tower that they were 16 NM from the airport. They were cleared to descend to 4,000 feet and told to report crossing the KLP beacon. At 14:53, the aircraft crossed KLP, which was the Final Approach Fix (FAF), at 4100 feet and began the approach without approach clearance from Dubrovnik Tower. At that point the aircraft was slightly high and fast and not completely configured for the approach, as it should have been. At 14:54, the copilot of IFO21 called Dubrovnik Approach/Tower and said, “We’re inside the locator, inbound.” IFO21 was then cleared for the NDB approach to runway 12. The aircraft tracked a course of 110 degrees after crossing KLP, instead of tracking the published course of 119 degrees. The aircraft maintained this track from KLP to the point of impact. The accident aircraft descended to 2200 feet which was consistent with the published minimum descent altitude of 2150 feet. At 14:57, the aircraft impacted a rocky mountainside approximately 1.7 NM to the left (northeast) of the extended runway centerline and 1.8 NM north of the approach end of runway 12 at Dubrovnik Airport. CAUSE: (1) Command failure to comply with directives that required a review of all instrument approach procedures, not approved by the Defense Dept. (2) Preflight planning errors, combined with errors made during the flight made by the aircrew. (3) Improper design of the Dubrovnik NDB.

Source of Information

http://www.flightsafety.org/fsd/fsd_jul-aug96.pdfhttp://www.flightsafety.org/fsd/fsd_jul-aug96.pdf

Primary Cause

Command failure to comply with directives that required a review of all instrument approach procedures, not approved by the Defense Dept.Command failure to comply with directives that required a review of all instrument approach procedures, not approved by the Defense Dept.

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