Preliminary Reports
Two Deaths in Break-Up Over Pennsylvania
Robinson R66, January 9, 2020, Mechanicsburg, Pennsylvania—The helicopter broke up in flight at about 8:30 p.m. while en route from Baltimore, Maryland, to Buffalo, New York. The pilot and sole passenger were killed. Radar track data showed it flying north-northwesterly at 2,300 feet for the first 25 minutes, then making a left turn to the northwest. Six minutes later, it dropped out of radar coverage, losing 1,150 feet in the 24 seconds between the last two radar hits—a descent rate of 2,875 feet per minute.
South African CAA Jet Destroyed During Air Check
Cessna S550 Citation S/II, January 23, 2020, Outeniqua Mountains, Ruiterbos area, South Africa—All three on board were killed when the business jet, operated by South Africa’s Civil Aviation Authority, crashed in the mountainous Ruiterbos area during a navaid calibration flight. Mist reportedly obscured the mountains, hampering search-and-rescue efforts. George Airport’s tower controllers lost contact with the flight 10 minutes after takeoff; no distress call or emergency locator transmitter signal was received.
Pilots rejected a takeoff from Johannesburg’s Lanseria airport in the same airplane last November when the cabin filled with smoke during the takeoff roll. Both main tires blew during hard deceleration. The January 23 accident flight’s pilot was also reported to have been at the controls during that incident.
Final Reports
Citation Written Off After Low-altitude Upset
Cessna 560 Encore, January 11, 2017, Oslo, Norway—An apparent tailplane stall caused a lightly loaded Cessna 560 to pitch over abruptly while climbing through 1,400 feet, descending within 170 feet of the ground before the crew regained control. Subsequent inspection found multiple deformations on the upper surfaces of both wings, the adjoining section of the fuselage, and both engine nacelles, indicative of airframe damage so extensive as to make repairs economically unfeasible. The flight data recorder showed that the airplane experienced loads of -2.6 g during the initial upset and +6.0 g during the recovery, well beyond its ultimate load factors of -2.1 g and +5.4 g, respectively.
The accident occurred just after takeoff from Oslo’s Gardermoen Airport at about 6:20 p.m. local time. The airplane had been on the ground for 15 minutes to deplane a passenger after a two-and-a-half-hour flight from Bern, Switzerland, in air temperatures estimated at -50 Celsius. Ground temperatures were at the freezing level with light snow under a 700-foot broken layer, and all runway and taxiway surfaces were contaminated with three- to six mm (one-eighth to one-quarter inch) of slush. To expedite the ground stop, the crew left one engine running while the first officer did a walk-around inspection of the other side of the aircraft. They declined de-icing before takeoff.
Flaps were retracted as the jet approached its maximum flap-extension speed of 200 knots. It immediately pitched down and rolled left, leaving the pilots “hanging in their seat belts” before the first officer initiated recovery efforts. The pitch attitude reached 53 degrees' nose-down with the engines still at takeoff thrust; the maximum six-G load was incurred in a 22-degree nose-down attitude as the airplane re-entered visual conditions at about 500 feet above the ground. Following a brief discussion after leveling off, the crew resumed climbing and continued their flight to Sandefjord’s Torp Airport, where they landed without further incident.
No anomalies were found in the Citation’s systems or equipment. After consultation with Textron engineers, the Accident Investigation Board of Norway concluded that the upset was due to a tailplane stall caused by ice accumulation on the horizontal stabilizer. During the ground stop and taxi, snow and spray apparently froze to its supercooled skin in areas not protected by the de-icing boots, which were in operation during the flight.
Harness System Faulted in Doors-off Helicopter Ditching
Airbus Helicopters AS350B2, March 11, 2018, New York, New York—In a full report published on December 19, the NTSB confirmed that the operator-provided harness/tether system used to secure passengers on doors-off photo flights was responsible for both the loss of engine power and the passengers’ inability to evacuate after the subsequent ditching. All five passengers drowned after the helicopter touched down in the East River on partially inflated emergency floats and rolled inverted, becoming fully submerged within 11 seconds of touchdown. The pilot escaped with minor injuries.
The harness/tether system consisted of commercial fall-protection harnesses (of the type used by window washers, ironworkers, etc.) and tethers made of multiple loops of 11-mm webbing made by a climbing gear supplier. The tethers were secured to D-rings on the backs of the harnesses and anchor points within the cabin by locking carabiners that used screw-type threaded sleeves to secure the carabiner gates; unlocking them required multiple turns of the sleeves. The anchor points were secured to the tethers’ ends; the D-rings were clipped through one of the loops to accommodate passengers of different sizes. The remaining loops were allowed to hang loose. Each harness had a seatbelt-cutting tool in a pouch attached to one of its upper shoulder straps.
The flight departed from New Jersey’s Helo Kearny Heliport at about 6:50 p.m. and flew south to the Statue of Liberty, past other landmarks, and then north along the East River. The helicopter climbed to 1,900 feet after the pilot received clearance from La Guardia Airport’s control tower to continue to the north end of Central Park at or below 2,000 feet. Just after 7:06, the pilot heard an alert for low main rotor rpm and saw the engine oil and fuel pressure warning lights illuminate. He immediately lowered collective and entered autorotation, ruled out landing in Central Park due to the number of people on the ground, and turned toward the river. He found the fuel flow control lever secure in its detent and turned the starter, but could not restart the engine. At about 600 feet above the river, he reached down for the fuel shut-off lever to prepare for ditching and found it already turned off. He “slammed it down” and tried the starter again, but though the engine temperature immediately began to rise, the helicopter touched down before the engine caught.
Footage captured by a camera mounted inside the cabin showed that several times during the preceding six minutes the front-seat passenger leaned backwards over the center console so that the tail of his tether hung down near the helicopter’s floor-mounted controls. At 7:06:08, as he pulled himself upright, the tail of the tether pulled taut and then popped loose; the engine noise began diminishing two seconds later. The pilot told investigators that the tether had gotten snagged on the fuel shut-off lever and pulled it up, breaking the safety wire intended to prevent unintended activation.
No passenger was able to extricate him- or herself from the harnesses, and at least two never removed the cutters from their pouches. One harness was not recovered, presumably having been lost during extrication efforts by first responders. Incomplete inflation of the emergency floats was traced to a misadjusted cable that prevented the right-hand air reservoir from activating. The Board also took strong exception to advertising paid sightseeing flights as “photo flights” in order to operate under Part 91 via an exemption intended to cover news gathering, surveying, and the like. Member Jennifer Homendy added a strongly worded statement upbraiding the FAA for continuing to permit this, and the Board reissued its 1995 recommendation that Part 135 be expanded to cover all commercial air tours.
Solo Student Killed on Extended Cross-Country
Eurocopter EC120B, November 19, 2018, Sainte-Agathe-des-Monts, Quebec, Canada—A 100-hour student pilot crashed into trees and died during an authorized solo flight between Rouyn-Noranda and the Montreal/Mirabel Heliport, both in Quebec. The helicopter struck a wooded hillside five nautical miles west of Sainte-Agathe-des-Monts after it slowed to 28 knots, began to descend, and reversed course. Data retrieved from a handheld Garmin Aera 796 GPS indicated a final descent rate of 475 feet per minute at a groundspeed of 68 knots. Low weather in the vicinity of the accident site is believed—but not definitively established—to have been a factor.
Canada’s Transportation Safety Board noted a number of irregularities in both the conduct of the flight and the student’s training program. His instructor had barely half the required 10 hours in type when he began providing instruction in the EC120. The pilot had monocular vision, requiring a flight test to obtain medical certification; his instructor signed this off on the basis of previous dual lessons without the specific evaluation mandated by regulations. The planned route spanned 250 nm, two-and-a-half times the 100 nm required by Transport Canada regulations. Due to the length of the flight, which would have required the use of four different navigational charts, the pilot’s instructor authorized him to use GPS rather than visual references for primary navigation. The pilot’s 7.3 hours of solo time had all been logged on local flights in the vicinity of his home base.
The student, owner of a 'round-the-clock services company in Rouyn-Noranda, bought the helicopter in June 2018. Because of his work schedule, he’d arranged for a Montreal-based instructor to travel in order to provide three to four days of instruction every other week. The instructor had planned to fly back to Rouyn-Noranda with the student to begin another training cycle after a maintenance check on the helicopter’s battery pre-heating system. The TSB’s investigation found that the pilot’s “professional responsibilities interfered with ground instruction,” leaving him “little time to study and review the material required” to prepare for his written test. The investigation also documented multiple “training” flights in which the pilot provided air tours, transported passengers, or otherwise violated the definition established by Canadian Aviation Regulation 400.01.
The student departed at 10:22 local time after another pilot programmed the flight plan into both the Aera portable and a panel-mounted GPS. He contacted his instructor by telephone at 10:45 and 12:08 to report that all was going well. The instructor reported him missing 20 minutes after his filed 1:00 p.m. arrival time. The wreckage was not located for another 25 hours, but the pilot’s injuries from the initial impact were judged unsurvivable.
