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In-Flight Breakup During Test Flight Scaled Composites Spaceshiptwom N339SS, Near Koehn Dry Lake, California October 31, 2014

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In-Flight Breakup During Test Flight Scaled Composites Spaceshiptwom N339SS, Near Koehn Dry Lake, California October 31, 2014 In-Flight Breakup During Test Flight Scaled Composites SpaceShipTwo, N339SS Near Koehn Dry Lake, California October 31, 2014 Aerospace Accident Report NTSB/AAR-15/02 National PB2015-105454 Transportation Safety Board NTSB/AAR-15/02 PB2015-105454 Notation 8614 Adopted July 28, 2015 Aerospace Accident Report In-Flight Breakup During Test Flight Scaled Composites SpaceShipTwo, N339SS Near Koehn Dry Lake, California October 31, 2014 National Transportation Safety Board 490 L’Enfant Plaza, S.W. Washington, D.C. 20594 National Transportation Safety Board. 2015. In-Flight Breakup During Test Flight, Scaled Composites SpaceShipTwo, N339SS, Near Koehn Dry Lake, California, October 31, 2014. NTSB/AAR-15/02. Washington, DC. Abstract: This report discusses the October 31, 2014, crash involving the SpaceShipTwo (SS2) reusable suborbital rocket, N339SS, which was operated by Scaled Composites LLC. SS2 broke up into multiple pieces during a rocket-powered test flight and impacted terrain over a 5-mile area near Koehn Dry Lake, California. The pilot received serious injuries, and the copilot received fatal injuries. SS2 was destroyed, and no one on the ground was injured as a result of the falling debris. SS2 had been released from its launch vehicle, WhiteKnightTwo, N348MS, about 13 seconds before the structural breakup. Scaled was operating SS2 under an experimental permit issued by the Federal Aviation Administration’s (FAA) Office of Commercial Space Transportation (AST) according to the provisions of 14 Code of Federal Regulations Part 437. Safety issues include the lack of human factors guidance for commercial space operators, the efficacy and timing of the preapplication consultation process, limited interactions between the FAA/AST and applicants during the experimental permit evaluation process, missed opportunities during the FAA/AST’s evaluations of hazard analyses and waivers from regulatory requirements, limited inspector familiarity with commercial space operators, an incomplete commercial space flight database for mishap lessons learned, and the need for improved emergency response planning. Safety recommendations are addressed to the FAA and the Commercial Spaceflight Federation. The National Transportation Safety Board (NTSB) is an independent federal agency dedicated to promoting aviation, railroad, highway, marine, and pipeline safety. Established in 1967, the agency is mandated by Congress through the Independent Safety Board Act of 1974 to investigate transportation accidents, determine the probable causes of the accidents, issue safety recommendations, study transportation safety issues, and evaluate the safety effectiveness of government agencies involved in transportation. The NTSB makes public its actions and decisions through accident reports, safety studies, special investigation reports, safety recommendations, and statistical reviews. The NTSB does not assign fault or blame for an accident or incident; rather, as specified by NTSB regulation, “accident/incident investigations are fact-finding proceedings with no formal issues and no adverse parties … and are not conducted for the purpose of determining the rights or liabilities of any person.” 49 C.F.R. § 831.4. Assignment of fault or legal liability is not relevant to the NTSB’s statutory mission to improve transportation safety by investigating accidents and incidents and issuing safety recommendations. In addition, statutory language prohibits the admission into evidence or use of any part of an NTSB report related to an accident in a civil action for damages resulting from a matter mentioned in the report. 49 U.S.C. § 1154(b). For more detailed background information on this report, visit http://www.ntsb.gov/investigations/SitePages/dms.aspx and search for NTSB accident ID DCA15MA019. Recent publications are available in their entirety on the Internet at http://www.ntsb.gov. Other information about available publications also may be obtained from the website or by contacting: National Transportation Safety Board Records Management Division, CIO-40 490 L’Enfant Plaza, SW Washington, DC 20594 (800) 877-6799 or (202) 314-6551 NTSB publications may be purchased from the National Technical Information Service. To purchase this publication, order product number PB2015-105454 from: National Technical Information Service 5301 Shawnee Rd. Alexandria, VA 22312 (800) 553-6847 or (703) 605-6000 http://www.ntis.gov/ NTSB Aerospace Accident Report Contents Figures ........................................................................................................................................... iii Abbreviations ............................................................................................................................... iv Executive Summary ..................................................................................................................... vi 1. Accident Investigation and Analysis ........................................................................................1 1.1 The Accident ..............................................................................................................................1 1.1.1 Background Information ..................................................................................................1 1.1.2 History of Flight ..............................................................................................................7 1.1.2.1 Analysis of Copilot’s Actions During Flight ...................................................13 1.1.3 Emergency Response .....................................................................................................16 1.1.3.1 Analysis of Emergency Response ....................................................................17 1.1.4 Wreckage and Instantaneous Impact Point Information ................................................20 1.2 Flight Crew Information ..........................................................................................................23 1.2.1 Certifications and Experience ........................................................................................23 1.2.1.1 The Pilot ...........................................................................................................23 1.2.1.2 The Copilot ......................................................................................................24 1.2.1.3 Analysis of Flight Crew Certifications and Experience ..................................25 1.2.2 Medical, Pathological, and Rest Information ................................................................25 1.3 Vehicle Information .................................................................................................................26 1.3.1 Overview ........................................................................................................................26 1.3.2 Feather System ...............................................................................................................26 1.3.2.1 Reasons for Unlocking Feather During Boost Phase .......................................30 1.3.2.2 Feather Moments During Accident Flight .......................................................32 1.3.2.3 In-Flight Breakup Sequence ............................................................................33 1.3.3 Propulsion System .........................................................................................................34 1.3.4 Analysis of Vehicle Information ...................................................................................35 1.3.5 Maintenance and Inspection Information ......................................................................35 1.3.6 SpaceShipTwo Data Sources .........................................................................................36 1.4 Organizational and SpaceShipTwo Program Information .......................................................37 1.4.1 Scaled Composites .........................................................................................................37 1.4.1.1 Simulator and Flight Training ..........................................................................38 1.4.1.2 Written Guidance .............................................................................................39 1.4.1.3 SpaceShipTwo Systems Safety Analysis .........................................................40 1.4.1.4 Design and Operational Considerations...........................................................43 1.4.1.5 Analysis of Scaled Composites’ Consideration of Human Factors in SpaceShipTwo’s Design and Operation ......................................................................45 1.4.2 Federal Aviation Administration ...................................................................................47 1.4.2.1 Experimental Permit Evaluation Process .........................................................48 i NTSB Aerospace Accident Report 1.4.2.2 Safety Inspections ............................................................................................56 1.4.2.3 Analysis of Office of Commercial Space Transportation’s Organizational Information ..................................................................................................................58 1.4.2.4 Commercial Space Flight Lessons Learned Database .....................................61 1.5 Parachute and Emergency Oxygen System .............................................................................62 1.5.1 Forces Needed to Activate
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