Contributor - Safety

David Jack Kenny

<h1><b>Preliminary Reports</b></h1>
<h2><b>No Survivors in Alaskan Caravan Crash</b></h2>
<h3>Textron Aviation Cessna 208B, Feb. 6, 2025, Nome, Alaska</h3>
<p>The pilot and all nine passengers were killed when the scheduled Part 135 flight from Unalakleet (PAUN) to Nome (PAOM) went down on an icepack floating in Norton Sound about 12 miles offshore. Search-and-rescue efforts were delayed by weather, and the wreckage was not located until the following afternoon.</p>
<p>The flight departed PAUN at 14:37 on an IFR clearance with a cruising altitude of 8,000 feet. After establishing radar contact, the Anchorage Air Route Traffic Control Center (ARTCC) controller advised the Nome Alaska Flight Service Station (AFSS) of an estimated arrival time of 15:35. At 15:11 the aircraft descended to 6,000 feet at the pilot’s discretion; the pilot reported having current weather and airport information for PAOM. At 15:12, airport operations advised the AFSS that Runway 10/28 would be closed for an estimated 10 to 15 minutes for de-icing; that information was relayed to the pilot via the ARTCC.</p>
<p>At 15:19:20, the Caravan levelled off after another pilot’s discretion descent to 4,000 feet. Airspeed gradually slowed from 112 knots. At 15:19:35, the autopilot disconnected. The airspeed was 99 knots and decreased to 70 knots over the next 19 seconds as the aircraft descended to 3,100 feet and turned from a westerly to a southerly heading. This was the last data point captured by its avionics.</p>
<p>The TKS ice protection system required a minimum airspeed of 95 knots and restricted gross takeoff weight to 8,870 pounds for flight into known or forecast icing conditions. Examination of the airplane’s contents indicated that it may have been as much as 1,058 pounds heavier, also making it 803 pounds over the maximum gross weight authorized by the supplemental type certificate for its aircraft payload extender cargo pod.</p>
<h2><b>Wire Strike Ends Wildlife Observation Flight</b></h2>
<h3>Bell 505, Feb. 21, 2025, Rexburg, Idaho</h3>
<p>Although the upper static lines were marked with orange visibility balls, the passenger said that neither he nor the pilot saw the power lines stretching across the frozen Ririe Reservoir until just before impact. The pilot attempted to dive beneath them, but the main rotor blades severed one of the three-phase lines, and the helicopter crashed onto the ice. The pilot was killed. The passenger, who’d been harnessed in the back seat to film a large herd of elk, was able to extricate himself from the wreckage. The main rotor blades “were widely disbursed about the main wreckage.” The power lines ran east-west about 160 feet above ground level.</p>
<h2><b>High Sink Rate Noted in Toronto Upset</b></h2>
<h3>Bombardier CRJ900LR, Feb. 19, 2025, Toronto, Ontario, Canada</h3>
<p>Winds were gusting to 35 knots and the emergency locator transmitter (ELT) did not activate when an Endeavour Air (dba Delta Connection) Bombardier jet crashed on February 17 at Toronto Pearson Airport (CYYZ), and a high sink rate was noted in preliminary data gathered by the Transportation Safety Board of Canada (TSB).</p>
<p>According to the report, the approach to Runway 23 was conducted at an increased airspeed of 149 knots due to gusty wind conditions. At 500 feet agl, the autopilot was disconnected. At 153 feet agl, a wind gust caused the airspeed to increase, leading the pilot flying to reduce engine thrust from 64% to approximately 43% N1, where it remained until touchdown.</p>
<p>As the aircraft descended, the rate of descent increased, triggering an enhanced ground proximity warning system “sink rate” alert.</p>
<p>Investigators have conducted preliminary interviews and recovered data from the cockpit voice recorder, flight data recorder, and other electronic components, which are being analyzed at the TSB Engineering Laboratory in Ottawa. The aircraft wreckage has been moved to a hangar at CYYZ for further examination.</p>
<p>While landing on Runway 23, the right main landing gear of the Endeavor Air CRJ&nbsp; fractured, causing the landing gear to collapse and the wing root to detach from the fuselage when the wing struck the ground. The wing separated, releasing jet fuel that ignited a fire. After the aircraft inverted and slid along Runway 23, it came to rest inverted near the intersection of Runway 23 and Runway 15L.</p>
<p>The right wing detached completely and slid about 215 feet further along the runway. Two flight crewmembers, two cabin crewmembers, and 76 passengers were on the flight.</p>
<p>According to the report, “Although the emergency locator transmitter was armed, it did not activate during the accident sequence.”</p>
<p>Following the accident, passengers and crew evacuated the aircraft. The right forward door and one right emergency exit window were used for evacuation. With the cockpit door jammed, the pilots had to exit through the emergency hatch in the cockpit ceiling, but only with the assistance of passengers since the hatch was partially blocked as the aircraft lay upside down. Twenty-one of the 80 occupants sustained injuries, with two suffering serious injuries.</p>
<h1><b>Final Reports</b></h1>
<h2><b>Autopilot Recovery Overridden Before Fatal Stall</b></h2>
<h3>Piper PA-46-350P JetProp DLX, Jan. 17, 2023, Yoakum, Texas</h3>
<p>Data recovered from the autopilot showed that after pitching up to a 20-degree nose-high attitude and rolling 47 degrees right during what may have been an attempted missed approach procedure, the pilot engaged the system’s unusual attitude recovery (UAR) mode—only to fight the control inputs that would have returned the airplane to straight-and-level flight before eventually turning the system off. One of three passengers survived with serious injuries after the single-engine turboprop crashed into a cattle pasture after another rapid climb precipitated a stall. The other two passengers, the pilot, and the copilot were all killed.</p>
<p>The IFR business flight from Memphis (Tennessee) International Airport (KMEM) was cleared for the GPS approach to Runway 31 of non-towered Yoakum Municipal Airport (T85). A Center Weather Advisory for low IFR conditions was in effect. Although the autopilot was engaged during the approach, the passenger recalled that the airplane was “off course…and the pilot was struggling to get it back on course.” About one mile southeast of the runway threshold, the pilot disconnected the autopilot and began a steep, climbing right turn. Tracking data showed that after a brief descent, the airplane entered another steep climb, slowing to a recorded airspeed of 16 knots before a second rapid descent.</p>
<p>The 64-year-old commercial pilot had an estimated 3,295 hours of flight experience. His son-in-law, an airline pilot, described him as “very competent,” but he had made no logbook entries in the two years before the accident, making it impossible to determine his currency or recent experience. The 33-year-old copilot was a 700-hour flight instructor whose wife said that he only flew a few times a year.</p>
<h2><b>Malaysian Premier Crash Caused by Spoiler Deployment</b></h2>
<h3>Beech 390 Premier I, Aug. 17, 2023, Subang, Malaysia</h3>
<p>A catastrophic loss of control on final approach to the Subang airport was triggered by the first officer’s in-flight deployment of the ground spoilers at an altitude too low to allow recovery. The cockpit voice recording showed that after the captain, flying in the right seat, called for unlocking the spoilers as part of the before-landing checklist, the first officer deployed them instead. Neither pilot noticed the error before aircraft control was lost.</p>
<p>All eight on board the charter flight and two motorists on the ground were killed when the jet abruptly turned right and plunged to the ground at an average rate of 3,500 feet per minute. The investigation found that the 41-year-old captain had 6,275 hours of flight experience and the required type rating but only 36 hours in type. The 44-year-old first officer had 9,298 hours but was not type-rated, having flown the Premier for the first time the previous day for a total of 3 hours.</p>
<h2><b>Low Weather Claimed Three in Quebec</b></h2>
<h3>Airbus AS350B2, Aug. 18, 2024, Lac d’Elvert, La Vérendrye Wildlife Refuge, Quebec</h3>
<p>The pilot’s decision to press on under ceilings as low as 300 feet with negligible forward visibility ended with the helicopter crashing into the surface of the lake, killing all three on board. The wreckage was found submerged and inverted the following morning, at least 14 hours after the presumed time of the accident. An examination by TSB engineers showed that the main rotor blades were turning when the craft hit the water in a nose-low, no-roll attitude, pitching it forward and blowing out the roof, doors, windscreen, instrument panel, and central console.</p>
<p>The helicopter departed from a private property in Mirabel at 09:57 local time on a visual flight rules (VFR) flight to Launey, landing at the Mont-Laurier Aerodrome at approximately 10:50. It was refueled while the occupants visited a private residence. On returning to the airport, the pilot declined an offer of ground transportation and took off at 15:30, following Route 117. A commercially operated helicopter remained at the airport because its pilot cancelled his afternoon flight due to weather. Witnesses in the wildlife refuge saw the AS350 “following the highway north at very low altitude” in “heavy rain and strong winds.”</p>
<p>At about 16:00, he made a precautionary landing at the Le Domaine rest stop. A passenger’s cell phone photograph taken before landing showed near-zero forward visibility in heavy rain. A staff member at Le Domaine offered them accommodations, but the 3,175-hour private pilot declined, saying that he was “used to this kind of weather.” He departed again at 16:15; at 16:50, they crossed the Lac-Rapide campground in what witnesses described as “heavy rain.” A search began at 20:35 after friends of the pilot notified the Quebec Flight Information Centre that the helicopter had not arrived. ζ</p>
<p><i>—</i><i>Amy Wilder </i><i>contributed to this report</i></p>


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