Sunday, May 22, 2016

University of Mississippi Medical Center unveils Columbus-based helicopter

Jay Langford shows his daughter, River Langford, 3, the pilot's seat in AirCare 3, a helicopter that the University of Mississippi Medical Center is basing in Lowndes County. The helicopter was unveiled at Airbus on Thursday.



The University of Mississippi Medical Center on Thursday unveiled its newest transport helicopter -- AirCare 3 -- at Airbus Helicopters in Columbus. 

AirCare 3, which was built by Airbus, began operations out of the Golden Triangle on April 1. It is UMMC's third transport helicopter. 

The helicopter does not just transport patients to UMMC in Jackson, said Sam Marshall, operations manager for helicopter transport at both the Meridian base and the new base in Columbus. It it designed to provide critical care for patients in rural areas of the state, only transporting those patients to Jackson if necessary. 

Not every rural hospital can afford to have the newest drugs or equipment that doesn't need to be used often, Marshall said. AirCare 3 has equipment and drugs that many hospitals don't so patients can get care even when they're miles from Jackson's medical center, according to Marshall. 

"Everything that our emergency center ... can do, our guys can do," he said. 

Those "guys" include crews with a critical care nurse and a critical care paramedic, as well as medical professionals with 90 days of training specifically for performing procedures and administering drugs to patients while in the back of a helicopter, Marshall said.  

Marshall added that keeping the patient in the area is a primary goal and that the helicopters will not take patients to UMMC if there's a better medical option closer to home.  

"If we can keep the patient in this area, that's exactly what we're going to do," he said. 

Since it began operating in the Golden Triangle in April, AirCare 3 has been used at least 40 times. 

At the unveiling, several people cut the ribbon for the helicopter, including 11-year-old Abby Williams of Mathiston. Last November, Abby had a brain tumor removed at UMMC. The next month she was transported back to UMMC via the helicopter based in Meridian when she began having seizures which doctors now think were a side effect of the surgery. 

Abby's mother, Melinda Williams, spoke at the new helicopter's unveiling. She praised the helicopter for being able to fly in bad weather and the crew for helping her daughter. 

"The crew is amazing," she said. "Not only are they knowledgeable and take care of the patients, but they take care of the families, too."

Original article can be found here: http://www.cdispatch.com

Loss of Engine Power (Partial): Czech SportCruiser, N1111X; accident occurred May 22, 2016 at Santa Monica Municipal Airport (KSMO), Los Angeles County, California













































Aviation Accident Final Report - National Transportation Safety Board

Investigator In Charge (IIC): Simpson, Eliott

The National Transportation Safety Board traveled to the scene of this accident.

Additional Participating Entities:
Federal Aviation Administration / Flight Standards District Office; Los Angeles, California
Air Accidents Investigation Institute; FN
Rotech Flight Safety Inc; Vernon, British Columbia, Canada

Investigation Docket - National Transportation Safety Board:

Registered to and operated by Santa Monica Flyers Inc under the provisions of Title 14 Code of Federal Regulations Part 91 as an instructional flight.

https://registry.faa.gov/N1111X

Location: Santa Monica, CA
Accident Number: WPR16FA115
Date & Time: 05/22/2016, 1332 PDT
Registration: N1111X 
Aircraft: CZECH AIRCRAFT WORKS SPOL SRO SPORTCRUISER
Aircraft Damage: Substantial
Defining Event: Loss of engine power (partial)
Injuries: 1 None
Flight Conducted Under: Part 91: General Aviation - Instructional 

Analysis

The student pilot had just completed two uneventful takeoffs and landings in the light-sport airplane. As he approached the runway's hold-short line to wait for the third takeoff clearance, a pilot from another aircraft in the traffic pattern declared an emergency. The student remained in the airplane with the engine running for about 20 minutes before receiving a takeoff clearance. Data from the airplane's engine monitor indicated that, while the airplane was waiting, multiple engine temperature limits were exceeded, and the fuel flow became erratic. The student did not notice the exceedances, and shortly after takeoff, the engine lost partial power, and the airplane began to descend. The student then initiated a 180° turn back toward the airport. The airplane landed long, and the student was unable to slow the airplane before it departed the elevated section of the runway and fell 10 ft. The airplane sustained substantial damage to the firewall and lower fuselage structure.

The engine monitor data revealed that, during the first two previous takeoffs and landings, the fuel flow indications were normal. However, as stated previously, after the airplane had been holding short for about 20 minutes awaiting clearance for the next takeoff, multiple engine temperature limits were exceeded, and the fuel flow indications began to oscillate. Once the takeoff began, the fuel flow continued to oscillate, indicating that the fuel flow to the engine was experiencing intermittent interruptions, which was consistent with the fuel system experiencing vapor in the fuel lines (vapor lock). The vapor lock was likely caused by the engine bay becoming hot during the extended ground hold after the airplane had previously being flown for two flights, which resulted in heat-soaking of the fuel system.

About 4 years before the accident, the engine manufacturer amended its engine installation manual to recommend the installation of a fuel return line, which was designed to prevent engine malfunctions caused by the formation of vapor in the fuel system. Examination of the airplane's fuel system revealed that a fuel return line had not been installed. 

The airplane manufacturer did not mandate the installation of a fuel return line until about 17 months after the accident, at which time, it issued a safety alert mandating the installation of the fuel line in accordance with the updated engine installation manual. Ten months later, the airplane manufacturer issued another alert, recommending updates to the Pilot's Operating Handbook by adding a warning that contained procedures to follow to limit the possibility of vapor lock. However, although the lack of a fuel return line could have contributed to the development of vapor lock, it more likely occurred because the student allowed the engine to overheat during the ground hold.

Probable Cause and Findings

The National Transportation Safety Board determines the probable cause(s) of this accident to be:
A partial loss of engine power during takeoff due to vapor lock. Contributing to the accident was the student pilot's failure to notice that the engine had exceeded multiple temperature limits and that the fuel flow had become erratic during an extended ground hold, which led to the vapor lock.

Findings

Aircraft (general) - Failure
Personnel issues Identification/recognition - Pilot
Aircraft (general) - Not installed/available

Factual Information

History of Flight

Prior to flight Miscellaneous/other
Takeoff Loss of engine power (partial) (Defining event)
Emergency descent Collision with terr/obj (non-CFIT)
Landing Landing area overshoot
Landing Runway excursion

On May 22, 2016, at 1332 Pacific daylight time, a Czech Aircraft Works SPOL SRO, SportCruiser, N1111X, departed the runway after a loss of engine power during the initial climb from Santa Monica Municipal Airport (SMO), Santa Monica, California. The student pilot was not injured, and the airplane sustained substantial damage. The light-sport airplane was registered to and operated by Santa Monica Flyers, Inc., under the provisions of Title 14 Code of Federal Regulations Part 91 as an instructional flight. Visual meteorological conditions prevailed, and no flight plan had been filed. The local flight departed SMO at 1330.

The student pilot had just completed two uneventful takeoffs and landings while remaining within the traffic pattern. As he approached the hold short line for runway 21 in preparation for his third takeoff, an airplane in the traffic pattern declared an emergency, and tower controllers temporarily suspended all takeoffs. The pilot remained in the airplane with the engine still running at idle. He stated that while waiting, the airplane was on a heading of about 350°, and he monitored the engine's cylinder head temperatures and intermittently increased engine speed in an attempt to keep the engine cool.

After holding short for 20 minutes the pilot was given a takeoff clearance. The takeoff roll and initial climb were uneventful, however, once the airplane reached an altitude of about 500 ft above ground level (agl), the engine began to lose power, and the airplane began descending. The pilot stated that he did not have sufficient altitude to perform trouble shooting steps, and immediately initiated a 180o right turn in an effort to land back on runway 3. The airplane became realigned with the runway centerline about midfield, and after touchdown the pilot applied full brake pressure, but was unable to slow the airplane down sufficiently. The airplane passed through the northeast run-up area and taxiway, and departed the elevated section of the runway, dropping down onto the airport perimeter road 10 ft below.

Both the nose and main landing gear struck the curb, and the airplane came to rest on a grassy knoll within the airport perimeter, about 180 ft beyond the threshold of runway 21. The airplane sustained substantial damage to the firewall and lower fuselage structure during the accident sequence, and both wings, along with their integral fuel tanks, were intact and undamaged.

Student Pilot Information

Certificate: Student
Age: 50, Male
Airplane Rating(s): None
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used: 4-point
Instrument Rating(s): None
Second Pilot Present: No
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Sport Pilot None
Last FAA Medical Exam:
Occupational Pilot: No
Last Flight Review or Equivalent:
Flight Time:  46 hours (Total, all aircraft), 46 hours (Total, this make and model), 17.6 hours (Pilot In Command, all aircraft), 9 hours (Last 90 days, all aircraft), 2.5 hours (Last 30 days, all aircraft), 0.9 hours (Last 24 hours, all aircraft)

Aircraft and Owner/Operator Information

Aircraft Make: CZECH AIRCRAFT WORKS SPOL SRO
Registration: N1111X
Model/Series: SPORTCRUISER
Aircraft Category: Airplane
Year of Manufacture: 2008
Amateur Built: No
Airworthiness Certificate: Special Light-Sport
Serial Number: 08SC176
Landing Gear Type: Tricycle
Seats: 2
Date/Type of Last Inspection: 04/08/2016, 100 Hour
Certified Max Gross Wt.: 1320 lbs
Time Since Last Inspection: 61 Hours
Engines: 1 Reciprocating
Airframe Total Time: 3423.7 Hours as of last inspection
Engine Manufacturer: Rotax
ELT:  C91A installed, activated, did not aid in locating accident
Engine Model/Series: 912ULS
Registered Owner: SANTA MONICA FLYERS INC
Rated Power: 100 hp
Operator: SANTA MONICA FLYERS INC
Operating Certificate(s) Held: None

The airplane was manufactured in 2008, and equipped with a 4-cylinder, liquid-/air-cooled, Rotax 912-ULS engine. 

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: KSMO, 174 ft msl
Distance from Accident Site: 0 Nautical Miles
Observation Time: 1351 PDT
Direction from Accident Site: 223°
Lowest Cloud Condition: Clear
Visibility:  10 Miles
Lowest Ceiling: None
Visibility (RVR):
Wind Speed/Gusts: 10 knots / 19 knots
Turbulence Type Forecast/Actual: /
Wind Direction: 250°
Turbulence Severity Forecast/Actual: /
Altimeter Setting: 30.02 inches Hg
Temperature/Dew Point: 18°C / 11°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: SANTA MONICA, CA (SMO)
Type of Flight Plan Filed: None
Destination: SANTA MONICA, CA (SMO)
Type of Clearance: VFR
Departure Time: 1330 PDT
Type of Airspace: Class D

Airport Information

Airport: SANTA MONICA MUNI (SMO)
Runway Surface Type:Asphalt 
Airport Elevation: 177 ft
Runway Surface Condition: Dry
Runway Used: 03
IFR Approach: None
Runway Length/Width: 4973 ft / 150 ft
VFR Approach/Landing: Forced Landing

Wreckage and Impact Information

Crew Injuries: 1 None
Aircraft Damage: Substantial
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 1 None
Latitude, Longitude: 34.021111, -118.445278 

Post-accident examination at the accident site by the NTSB investigator-in-charge (IIC) revealed that the left- and right-wing fuel tanks both contained fuel, along with both carburetor bowls. A follow up examination was performed; there was no evidence of oil or coolant loss, and no anomalies with the airframe or engine were found which would have precluded normal operation.

The engine was then removed and transported to the facilities of Rotech Flight Safety (Rotax Aircraft Engines) for further examination and an engine test run. No anomalies were noted, and the engine performed nominally at all speeds in an engine test cell.

A complete examination report is contained in the public docket.

Engine Monitor

The airplane was equipped with a Dynon EMS-D120 engine monitoring system, mounted on the right side of the instrument panel, which was configured to record engine parameters including oil pressure and temperature, fuel pressure and flow, manifold pressure, engine speed, and the cylinder and exhaust gas temperatures (CHT, EGT) for cylinders one and two. The unit also recorded the airplane's GPS position and ground speed.

Examination of the data revealed that for both prior takeoffs and landings, the fuel flow remained at about 1 gallon per hour (gph) during the ground idle phase, and climbed to about 6.5 gph during the takeoff and initial climb. Oil temperatures remained at about 175° F throughout, and cylinder head temperatures averaged about 175° F on the ground, and 230° F during takeoff. Engine speed during takeoff was about 5,100 rpm, and manifold pressure dropped from 29.1 to 27.8 inches of mercury as the climb progressed.

For the first ten minutes while the airplane was holding short and waiting for the takeoff clearance of the accident flight, the CHT's began to climb, with cylinder 2 reaching an average of about 330° F. During that period, the oil temperature climbed to 222° F while the oil pressure began to drop from about 46 to 30 lbs per square inch (psi). Fuel flow and pressure remained constant at about 1 gph and 5 psi respectively.

During the next 10 minutes, the oil temperature continued to rise with an accompanying drop in oil pressure, while the fuel flow began to oscillate, varying between 0 and 3 gph. About two minutes before takeoff, the oil temperature reached its highest average level of 270° F, with intermittent readings reaching as high as 337° F, while the oil pressure had dropped to 22 psi. The takeoff then began, but the fuel flow, rather than reaching 6.5 gph as before, began to oscillate between 5.4 and 9.1 gph. The engine speed reached 4,800 rpm for about 30 seconds, and then dropped to about 4,300 rpm; the manifold pressure remained steady at 30.03 inches of mercury throughout the takeoff and initial climb, until the data ended.

During the ten minutes while the airplane was holding short just before takeoff, two distinct increases in engine speed of about 400 rpm were observed, lasting 30 and 60 seconds respectively. These changes appeared consistent with the pilot's attempt to keep the engine cool. The speed changes did not make any appreciable difference to the average engine temperatures. 

Additional Information

The engines temperature operating limitations, documented in both the flight manual and on the EMS-D120 gauges (through green, yellow, and red display bands), indicated the following:

Normal operating range for oil temperature was between 194 and 230 °F, with a caution range of 230 to 266 °F and a maximum (red-line) limit of 266 °F. The normal cylinder head temperature operating range was between 167 and 230 °F, the caution range was 230 to 275 °F, and the maximum limit was 275 °F.

The EMS-D120 was capable of displaying discrete alerts in the event of engine temperature exceedances, however the alert feature had not been enabled.

The SportCruiser pilot operating handbook (POH) warned that takeoff is prohibited if engine instrument values are above operational limits.

Fuel Flow Sensors

The airplane was equipped with a FloScan 200 series fuel flow transducer. The unit's design incorporated an internal rotor mounted within a chamber. As fuel passed through the chamber, the rotor spun, interrupting an opto-electronic pickup, which created a pulsed electrical signal - the period of which was proportional to the fuel flow rate.

According to technical representatives from FloScan, the introduction of air into the fuel supply lines can cause the unit to read higher than normal fuel flow rates.

According to technical representatives from Electronics International Inc. (EI) (who manufacture the FT-60 fuel flow transducer, installed on later models of the SportCruiser), when air inadvertently enters a rotor style flow transducer through the fuel lines, the rotor is free to spin at the velocity of the air that passes over it. This velocity is higher for air than it is for fuel, and as such "vapor lock" is often represented as spikes in fuel flow. Additionally, with air in the system, pulses of air from the fuel pump can cause the rotor to spin back and forth in both directions. Under these conditions, the pickup still measures flow irrespective of direction, resulting in "jumping" fuel flow readings.

Fuel and Fuel Testing

Although the engine was capable of operating on 100 low-lead aviation gasoline, Rotax Engines recommended the use of automotive gasoline, because the lead in aviation fuel can cause stress on the valve seats, as well as create excessive lead deposits within the combustion chamber. The SportCruiser POH made similar recommendations, with the caveat that aviation gasoline should only be used, "in case of problems with vapor lock or when other types of gasoline are unavailable".

Both Rotax Engines and Czech Aircraft Works recommended using automotive gasoline which meets the American Society for Testing and Materials (ASTM) standard D4814. The Rotax operating manual, and placards mounted throughout the airplane, indicated that fuel with a minimum research octane number (RON) of 95 and anti-knocking index (AKI) of 91 can be used. Rotax further stated in the engine operating manual, "Use only fuel suitable for the respective climatic zone", and "Risk of vapor formation if using winter fuel for summer operation".

According to representatives from Santa Monica Flyers, their Rotax-equipped fleet was fueled with premium-grade automotive fuel purchased from a local automotive gasoline station, and then transported to the airport in a fuel truck. The last fill-up occurred the morning of the accident, and the accident airplane used fuel from that delivery.

Fuel from the left wing fuel tank (the tank selected for the flight) was recovered from the airplane at the accident site, and analyzed at a petroleum testing laboratory. The results revealed that the fuel was the appropriate blend for the region and time of year, and had a RON value of 95.8.

Fuel System

An amendment to the Rotax 912-ULS installation manual was added on August 1, 2012. The amendment required the installation of a fuel return line, designed to prevent engine malfunctions caused by the formation of vapor in the fuel system. The amendment stated that compliance was mandatory. It further stated:

"If the fuel distributor piece with regulator from Rotax is not available, the fuel pressure must be regulated by a restriction in the fuel return line, which ensures that the fuel pressure is under all operation condition within the operating limits specified by Rotax."

Examination of the airplane's fuel system revealed that the fuel return line had not been installed. According to representatives from Czech Aircraft Works, the installation of a fuel return line was made standard on all SportCruiser airplanes manufactured after September 2010.

A series of safety alerts were issued by Czech Aircraft Works during the two-year period following the accident, in response to limiting the possibility of vapor lock, specifically:

Safety Alert SA-SC-006, issued on October 16, 2017 mandated the installation of a fuel return line in accordance with the updated recommendations in Chapter 73-00-00, of the Rotax installation manual. The alert was applicable to all SportCruiser airplanes manufactured before May 14, 2009 (The accident airplane was manufactured in 2008).

Safety Alert SA-SC-011, issued on August 31, 2018, provided a set of updates to the POH regarding engine operation. One of the updates required the following addition to all sections of the POH that mentioned fuel:

WARNING

"Use only fuel formulated for the specific climate zone.
Pay special attention to the current outside air temperature.
Do not use winter MOGAS blends in warmer than normal temperatures.
RISK OF VAPOR FORMATION IF WINTER FUEL IS USED FOR SUMMER OPERATION."

The Pilot's Handbook of Aeronautical Knowledge (FAA-H-8083-25A) defines vapor lock as, "A problem that mostly affects gasoline-fueled internal combustion engines. It occurs when liquid fuel changes state from liquid to gas while still in the fuel delivery system. This disrupts the operation of the fuel pump, causing loss of feed pressure to the carburetor or fuel injection system, resulting in transient loss of power or complete stalling. Restarting the engine from this state may be difficult. The fuel can vaporize due to being heated by the engine, by the local climate, or due to a lower boiling point at high altitude."

NTSB Identification: WPR16LA115
14 CFR Part 91: General Aviation
Accident occurred Sunday, May 22, 2016 in Santa Monica, CA
Aircraft: CZECH AIRCRAFT WORKS SPOL SRO SPORTCRUISER, registration: N1111X
Injuries: 1 Uninjured.

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. NTSB investigators may have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.

On May 22, 2016, at 1332 Pacific daylight time, a Czech Aircraft Works SPOL SRO, Sportcruiser, N1111X, departed the runway after a loss of engine power during takeoff from Santa Monica Municipal Airport, Santa Monica, California. The light-sport airplane was registered to, and operated by, Santa Monica Flyers, Inc., under the provisions of 14 Code of Federal Regulations (CFR) Part 91. The student pilot was not injured, and the airplane sustained substantial damage. The local flight departed Santa Monica at 1330. Visual meteorological conditions prevailed, and no flight plan had been filed.

The student pilot had just completed two uneventful takeoffs and landings while remaining within the traffic pattern. As he approached the hold short line for runway 21 in preparation for his third takeoff, an airplane in the traffic pattern declared an emergency, and tower controllers temporarily suspended all takeoffs. The pilot remained in the airplane with the engine still running at idle. While waiting, he monitored the engine's cylinder head temperatures and intermittently increased the engine speed to keep the engine cool.

After holding short for 20 minutes the student pilot was given a takeoff clearance. The takeoff roll and initial climb were uneventful, however, once the airplane reached an altitude of about 500 ft agl, the engine began to lose power, and the airplane began descending. The pilot stated that he did not have sufficient altitude to perform trouble shooting steps, and immediately rolled the airplane into an 180-degree right turn for a landing back on runway 3. The airplane became realigned with the runway centerline about midfield, and after touchdown the pilot applied full brake pressure, but was unable to slow the airplane down sufficiently. The airplane passed through northeast run-up area taxiway, and departed the elevated section of the runway, dropping down onto the airport perimeter road 10 ft below.

Both the nose and main landing gear struck the curb, and the airplane came to rest on a grassy knoll within the airport perimeter, about 180 ft beyond the threshold of runway 21. The airplane sustained substantial damage to the firewall and lower fuselage structure during the accident sequence, and both wings, along with their integral fuel tanks, were intact and undamaged.



At 1:34 PM Santa Monica Fire Department was notified of a single engine private aircraft crash, at the east end of the Santa Monica Airport Runway.

4 Engines, a Ladder Truck, a Hazardous Materials Unit, and a Chief Officer responded. The first arriving unit found the aircraft of the end of the runway, fairly intact, with no ensuing fire.

The pilot was out, and uninjured. Santa Monica Fire Units remained on scene, along with Santa Monica Police, awaiting an NTSA representative, to investigate the cause of the crash. --Dale Hillock, Public Affairs Officer, Santa Monica Fire Department.

Santa Monica airport is controversial. Many neighbors who want to shut down the century old airfield, complain that in case of such events, the runway is just too close to housing.

It has been said that no U.S. airport is as close to housing as Santa Monica airport. Historically, dense housing was constructed near the airport hurriedly in the 1940's, to house wartime employees of Douglas Aircraft.

After World War II ended, Douglas continued to produce DC-3's and DC-10's at Santa Monica's Cloverfield, until the company merged with McDonnell Douglas in 1970. Santa Monica's largest employer folded shop and moved to St. Louis, leaving high density housing right next to the 227 acre airport.

Small plane aviation periodically produces crashes. Noise and crashes equal a local political movement to permanently close the airport, and turn it into a park.

Original article can be found here: http://www.smobserved.com

Spirit Airlines Passenger Cited For Assault: Denver International Airport (KDEN), Colorado

DENVER (CBS4)– A Spirit Airlines passenger was cited after allegedly striking a crew member while boarding a flight at Denver International Airport on Sunday afternoon.

The man was cited by Denver police for disturbing the peace and assault.

The man boarded a Spirit Airlines flight with a child in a car seat. Police told CBS4 when directed toward the seat compatible with the child seat, he refused to move, started shouting and would not get off the plane.

That’s when he allegedly struck a crew member in the back.

Officers responded and the man walked off the plane with the child. He was not detained but cited for his behavior.

Spirit Airlines did not issue the man another ticket and the plane departed DIA without him.

The man has not been identified.

Original article can be found here: http://denver.cbslocal.com

Loss of Control in Flight: Zenith CH750 STOL, N925PS; accident occurred May 22, 2016 at Lawrenceburg-Lawrence County Airport (2M2), Tennessee

The National Transportation Safety Board did not travel to the scene of this accident.

Additional Participating Entity:

Federal Aviation Administration / Flight Standards District Office; Nashville, Tennessee

Aviation Accident Final Report - National Transportation Safety Board: https://app.ntsb.gov/pdf


Investigation Docket - National Transportation Safety Board: https://dms.ntsb.gov/pubdms

Location: Lawrenceburg, TN
Accident Number: ERA16LA191
Date & Time: 05/22/2016, 1330 CDT
Registration: N925PS
Aircraft: SIKES Zenith CH750 STOL
Aircraft Damage: Substantial
Defining Event: Loss of control in flight
Injuries: 2 Minor
Flight Conducted Under: Part 91: General Aviation - Personal

Analysis

The sport pilot, who was the owner of the light sport airplane that he had partially assembled, was conducting the airplane's first test flight and had a passenger on board. He stated that, after takeoff, he applied right rudder to maintain runway heading, but the airplane continued to the left. As he applied more right rudder, the severity of the turn increased. The airplane departed the left side of the runway and the airport property and struck trees and terrain before it came to rest. Postaccident examination of the wreckage revealed that the rudder was rigged backward, which would have resulted in a left turn upon right pedal application and vice-versa. Examination of maintenance receipts and interviews with the pilot revealed that the pilot purchased the airplane partially assembled. The pilot and mechanics who he hired completed the assembly; however, after the work by other mechanics, the pilot would at times change or redo their work. Although it could not be determined when the rudder was improperly rigged, a preflight inspection would have revealed the discrepancy; therefore, it is unlikely that the pilot conducted a proper preflight inspection before departing on the flight. Additionally, no documentation was found that suggested the pilot had performed planning for the test flight in accordance with Federal Aviation Administration-issued guidance. 

Probable Cause and Findings

The National Transportation Safety Board determines the probable cause(s) of this accident to be:
The pilot's failure to perform an adequate preflight inspection, which resulted in a loss of control due to an improperly-rigged rudder. Contributing to the accident was the pilot's failure to implement and follow proper flight-testing plans. 

Findings

Aircraft
Rudder control system - Incorrect service/maintenance (Cause)

Personnel issues
Incorrect action performance - Owner/builder (Cause)

Factual Information 

On May 22, 2016, about 1330 central daylight time, a Sikes Zenith CH-750 STOL, N925PS, was destroyed during collision with trees and terrain after takeoff from Lawrence County Airport (2M2), Lawrenceburg, Tennessee. The sport pilot and passenger were seriously injured. Visual meteorological conditions prevailed, and no flight plan was filed for the personal flight, which was conducted under the provisions of Title 14 Code of Federal Regulations Part 91.

In an interview with a Federal Aviation Administration (FAA) aviation safety inspector, the pilot reported that it was the airplane's first test flight. He stated that after liftoff, he applied right rudder to maintain runway heading, but the airplane continued to the left. As he applied more right rudder, the severity of the turn increased. The airplane departed the left side of the runway and airport property, and struck trees and terrain before it came to rest.

According to FAA records, the pilot held a sport pilot certificate with a rating for airplane single engine land. He did not possess an FAA medical certificate, nor was he required to. The pilot reported 40 total hours of flight experience, which he accrued while training for his pilot certificate. A review of his pilot logbook by the FAA inspector revealed that the pilot had not flown in the nearly 12 months prior to the accident flight.

The pilot held no other FAA certificates. Specifically, he did not hold a repairman certificate for the accident airplane.

The two-seat, single-engine, high-wing airplane was manufactured in 2016 and was equipped with a Continental O-200 series engine. Examination of maintenance logbooks for the airplane revealed only two entries; the condition inspection signed by the pilot and an airworthiness inspection signed by an FAA designated airworthiness representative. The airplane's most recent condition inspection was completed March 16, 2016. The hobbs meter displayed 4.1 total aircraft hours at the accident site.

There were no other articles or documents offered or found with regard to the construction of the airplane. There was no construction plan/log, no manufacturer's flight testing instructions or flight testing data, and no flight test plan. There was no additional pilot program for the testing of the airplane. There was no weight and balance data and neither was there taxi-testing data. No operator's checklist was found in the wreckage.

Examination of the wreckage by the FAA inspector revealed that the rudder control cables had been rigged backward.

Aircraft History

FAA inspectors conducted lengthy, detailed interviews with the pilot/owner, his colleagues, and mechanics who had performed work on the airplane during its construction, who learned that the airplane was purchased partially assembled from its original owner.

Approximately 13 months prior to the accident flight, a maintenance facility had performed a considerable amount of construction and modification on the airplane, including "installation" of the rudder. After that, the pilot/owner decided that the work performed did not meet his liking or the kit specifications, and undid or modified the work performed by the maintenance facility. It could not be determined who performed the most recent work on the rudder and rudder control system prior to the accident flight.

FAA Advisory Circular 90-89A, AMATEUR-BUILT AIRCRAFT AND ULTRALIGHT FLIGHT TESTING HANDBOOK

This AC's purpose was the following:

"(1) To make amateur-built/ultralight aircraft pilots aware that test flying an aircraft is a critical undertaking, which should be approached with thorough planning, skill, and common sense."

"(2) To provide recommendations and suggestions that can be combined with other sources on test flying (e.g., the aircraft plan/kit manufacturer's flight testing instructions, other flight testing data). This will assist the amateur/ultralight owner to develop a detailed flight test plan, tailored for their aircraft and resources."

The advisory circular provided guidance on preparing a plan for each phase of the amateur-built airplane's production. The areas for which guidance was provided included preparing for the airworthiness inspection, weight and balance, taxi test, flight testing, and emergency procedures. The suggested flight testing regimen was separated into 10-hour segments for the 40-plus hour flight testing requirement.

Suggested guidelines for the experience level of the test pilot for the recently-completed amateur-built airplane were also provided. Among the guidelines, was the following:
"A minimum of 50 recent takeoffs and landings in a conventional (tail wheel aircraft) if the aircraft to be tested is a tail dragger."

"If appropriate, have logged a minimum of 10 tail wheel take-off and landings within the past 30 days."

According to FAA Order 8130.2H, Airworthiness Certification of Products and Articles,

"An experimental aircraft builder certificated as a repairman for this aircraft under 65.104, or an appropriately rated FAA-certificated mechanic, may perform the condition inspection required by these operating limitations." 

History of Flight

Prior to flight
Aircraft maintenance event

Takeoff
Loss of control in flight (Defining event)

Uncontrolled descent
Collision with terr/obj (non-CFIT) 

Pilot Information

Certificate: Sport Pilot
Age: 55, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used: 4-point
Instrument Rating(s): None
Second Pilot Present: No
Instructor Rating(s): None
Toxicology Performed:
Medical Certification: Sport Pilot
Last FAA Medical Exam:
Occupational Pilot: No
Last Flight Review or Equivalent:
Flight Time:  40 hours (Total, all aircraft), 4 hours (Total, this make and model)

Aircraft and Owner/Operator Information

Aircraft Make: SIKES
Registration: N925PS
Model/Series: Zenith CH750 STOL
Aircraft Category: Airplane
Year of Manufacture: 2016
Amateur Built: Yes
Airworthiness Certificate: Experimental
Serial Number: 75-8805
Landing Gear Type: Tricycle
Seats: 2
Date/Type of Last Inspection: 03/16/2016, Condition
Certified Max Gross Wt.: 1320 lbs
Time Since Last Inspection:
Engines:  Reciprocating
Airframe Total Time: 4.1 Hours at time of accident
Engine Manufacturer: Continental
ELT: Not installed
Engine Model/Series: O-200
Registered Owner: On file
Rated Power: 200 hp
Operator: On file
Operating Certificate(s) Held: None

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: KMRC, 681 ft msl
Distance from Accident Site: 19 Nautical Miles
Observation Time: 1315 CDT
Direction from Accident Site: 11°
Lowest Cloud Condition: Clear
Visibility: 10 Miles
Lowest Ceiling: None
Visibility (RVR):
Wind Speed/Gusts: 9 knots /
Turbulence Type Forecast/Actual: / None
Wind Direction: 40°
Turbulence Severity Forecast/Actual: / N/A
Altimeter Setting: 30.04 inches Hg
Temperature/Dew Point: 24°C / 6°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Lawrenceburg, TN (2M2)
Type of Flight Plan Filed: None
Destination: Lawrenceburg, TN (2M2)
Type of Clearance: None
Departure Time: 1330 CDT
Type of Airspace: Class G

Airport Information

Airport: LAWRENCEBURG-LAWRENCE COUNTY (2M2)
Runway Surface Type: Asphalt
Airport Elevation:936 ft 
Runway Surface Condition: Dry
Runway Used: 35
IFR Approach: None
Runway Length/Width: 5003 ft / 100 ft
VFR Approach/Landing: None

Wreckage and Impact Information

Crew Injuries: 1 Minor
Aircraft Damage: Substantial
Passenger Injuries: 1 Minor
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 2 Minor
Latitude, Longitude: 35.234444, -87.258056 (est)

Preventing Similar Accidents 

Prevent Misrigging Mistakes

Incorrect rigging of flight control and trim systems has led to in-flight emergencies, accidents, and even deaths. Maintenance personnel who serviced or checked the systems did not recognize that the control or trim surfaces were moving in the wrong direction. Pilots who flew the airplanes did not notice the control anomalies during their preflight checks. Anyone can make mistakes. In some cases, the mechanics who performed the work incorrectly were highly experienced.

Maintenance personnel should first become familiar with the normal directional movement of the controls and surfaces before disassembling the systems. It is easier to recognize "abnormal" if you are very familiar with what "normal" looks like. Carefully follow manufacturers' instructions to ensure that the work is completed as specified. Always refer to up-to-date instructions and manuals--including airworthiness directives, maintenance alerts, special airworthiness information bulletins, and unapproved parts notifications--when performing a task.

Be aware that some maintenance information, especially for older airplanes, may be nonspecific. Ask questions of another qualified person if something is unfamiliar.

Well-meaning, motivated, experienced technicians can make mistakes: fatigue, distraction, stress, complacency, and pressure to get the job done are some common factors that can lead to human errors. Learn about and adhere to sound risk management practices to help prevent common errors.

Ensure that the aircraft owner or pilot is thoroughly briefed about the work that has been performed. This may prompt them to thoroughly check the system during preflight or help them successfully troubleshoot if an in-flight problem occurs.

See http://www.ntsb.gov/safety/safety-alerts/documents/SA_042.pdf for additional resources.


The NTSB presents this information to prevent recurrence of similar accidents. Note that this should not be considered guidance from the regulator, nor does this supersede existing FAA Regulations (FARs).

NTSB Identification: ERA16LA191
14 CFR Part 91: General Aviation
Accident occurred Sunday, May 22, 2016 in Lawrenceburg, TN
Aircraft: SIKES Zenith CH750 STOL, registration: N925PS
Injuries: 2 Minor.

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.

On May 22, 2016, about 1330 central daylight time, an experimental amateur-built Zenith CH-750 STOL, N925PS, was destroyed during collision with trees and terrain after takeoff from Lawrence County Airport (2M2), Lawrenceburg, Tennessee. The sport pilot/owner/builder and a passenger were seriously injured. Visual meteorological conditions prevailed, and no flight plan was filed for the personal flight, which was conducted under the provisions of Title 14 CFR Part 91.

In an interview with a Federal Aviation Administration (FAA) aviation safety inspector, the pilot reported this was the first flight for the airplane. He stated that after liftoff, he applied right rudder to maintain runway heading, but the airplane continued to the left. As he applied more right rudder, the severity of the turn increased. The airplane departed the left side of the runway, the airport property, and struck trees and terrain before it came to rest.

According to FAA records, the pilot held a sport pilot certificate with a rating for airplane single engine land. He did not possess an FAA medical certificate. The pilot reported 40 total hours of flight experience, which he accrued while training for his pilot certificate.

The two-seat, single-engine, high-wing airplane was manufactured in 2016 and was equipped with a Continental O-200 series engine. The maintenance logbooks for the airplane were not immediately available, but the airplane's most recent condition inspection was completed March 16, 2016. The hobbs meter displayed 4.1 total aircraft hours at the accident site.


Examination of the wreckage by the FAA inspector revealed that the rudder was 180-degrees out of rig. A right-pedal application resulted in a left-rudder input and vice-versa.




LAWRENCEBURG, TN (WSMV) -  A single-engine plane crashed just feet away from the Lawrenceburg-Lawrence County Airport, sending two people to the hospital.

Sunday was the first day in a year of working on the plane that it was finally going to take off.

Unfortunately, something went terribly wrong, and the plane crashed just feet from the runway.

James Fleeman, who has been flying for more than 50 years, was there along with several others watching at the airport.

"We don't know what happened," Fleeman said.

The pilot, Phil Sikes, and his friend were testing out the new plane.

Fleeman said the plane appeared to be about 50 feet up in the air before it came crashing down into a field just outside the barbed wire fencing surrounding the airport.

"We got a boat cutter, cut the fence, and one of the pieces flew right into my nose. I was bleeding," he said.

Fleeman said Sikes was stuck in the plane while his passenger was walking around.

"I think he's gonna be alright," Fleeman said.

The FAA and the NTSB will be investigating the cause of the crash.

Story and video:  http://www.wbrc.com


A small aircraft has crashed after takeoff from the Lawrenceburg-Lawrence County Airport.

The incident happened when the plane crashed into a field upon departure around 1:30 p.m. Sunday.

Authorities with the Federal Aviation Administration said the STOL CH750 aircraft had two people on board.

Their identities had not been released. No word had been given on any possible injuries.

The crash was being investigated by the FAA and the National Transportation Safety Board.

Original article: http://www.lawrenceburgnow.com

LAWRENCEBURG, Tenn. - A small aircraft has crashed after takeoff from the Lawrenceburg-Lawrence County Airport.

The incident happened when the plane crashed into a field upon departure around 1:30 p.m. Sunday.

Authorities with the Federal Aviation Administration said the STOL CH750  aircraft had two people on board.

Their identities had not been released. No word had been given on any possible injuries.

The crash was being investigated by the FAA and the National Transportation Safety Board.  

Original article: http://www.newschannel5.com