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AW139 Crash in Bahamas - 7 Killed

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AW139 Crash in Bahamas - 7 Killed

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Old 21st Jul 2019, 17:36
  #361 (permalink)  
 
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one would have to question the adequacy of current regulations to ensure safety.
We will have to agree to disagree on that then. Sensible decision making and being aware of your own limitations is not something that can be legislated.
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Old 21st Jul 2019, 18:16
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Originally Posted by rumline
Extreme thread heading drift over the minutia of departure heading control.... enough already.
Thank you!!! I'm sure when the final NTSB report is issued the probable cause will be "failure to maintain +/- 5 deg heading on initial climb."
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Old 23rd Jul 2019, 22:32
  #363 (permalink)  
 
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Originally Posted by SASless
Megan is right....another large oil company that on its face maintained high standards but once you got to looking it was another. matter.

The management evolved from a Gulf of Mexico operator and brought over that same old attitude with them.

The FAA sets VFR minimums based upon "Weather" (Ceiling and Visibility)....not what you can see out the windows.

So right next to 412's with Sperry Helipilot systems with Flight Directors....you had 212's with no SAS of any kind flying the same routes at the same time of day as the 412's.

Offshore, particularly on an overcast and hazy night....about the only thing you could see sometimes was two very big white shiny eyes looking back at you from your Windscreen.

But...hey...it was VFR right!

You had a thousand and three, right?

That is where I elected to use the room name of ..... Sasless!

I was not impressed as you might guess.




Originally Posted by RL77CHC
I think Malabo hit the nail on the head........

This departure is completely routine for the Offshore / EMS / Military guys. The CAT A helipad departure profile that needs to be flown in the AW139 does not change whether it's day or night, engine failure or not. The second that aircraft hits TDP and the pilots starts their rotation it's a pure instrument procedure after that. The flying pilot manually flies the profile and acknowledges the non flying pilots callouts while the non flying pilot make his standard calls and monitors for any deviations. If the deviation callout isn't acknowledged and or corrected by the flying pilot, the non flying pilot immediately takes control of the aircraft. This is standard two crew, multi ifr operations anywhere in the world.

I would guess that the departure SOPS's and callouts would look similar to this from 99% of the AW139 Multi Pilot, IFR operators out there

Flying Pilot "Lifting"
Applies collective to pull into hover

Non Flying Pilot "Two AP's"
Ensures both autopilots are on before the aircraft is pulled into the hover

Fly Pilot "C of G okay Hover Checks"
Calls for hover checks in a stable 5' hover

Non Flying Pilot "Flight Instrument Checked, Temperatures and Pressure in the green, CAS messages checked, you are hovering at XX PI, Target PI XX, Hover Checks Complete"

Flying Pilot "Departing"
Smoothly applies target takeoff power

Non Fly Pilot "Target PI Set"
Monitors PI and ensures the correct takeoff power is set

Flying Pilot "Check"

Non Flying Pilot "TDP"
Calls takeoff decision point, TDP, at the briefed radalt for the CAT A profile selected

Flying Pilot "Rotating"
Rotates to -10 degrees for one second and then levels the wings with the horizon on instruments

Non Flying Pilot "Two positive Rates of Climb"

Flying Pilot "Check"

Non Flying Pilot "Airspeed Alive"
Calls airspeed alive when it begins to move

Flying Pilot "Check"

Non Flying Pilot "VTOSS"
Calls VTOSS at 40 KIAS

Flying Pilot "Check"
Adjusts pitch to +5 degrees nose up

Non Flying Pilot "VY - Select 100NR"
Calls VY at 80 KIAS

Flying Pilot "Check - 100NR Selected Confirm?"

Non Flying Pilot "I confirm 100NR Selected"

Flying Pilot "Setting Climb Power"

Non Flying Pilot "Check Climb Power Is Set"

Etc, Etc, Etc


If a loss of power were to occur nothing changes with the calls or the profile. There might be a bit of NR droop initially but it wouldn't be below the minimum limitation if you did nothing with the collective at max gross weight. You would have to regain the NR to 100% passing VTOSS but this would only take a slight downward correction on the collective. The non flying pilot not only has to make the dozen or standard calls within the first 20-30 seconds of flight but also has to monitor for any deviations and be quick to take control if the calls aren't met with an immediate correction or acknowledgement. The list of standard deviation calls that most two crew, multi-ifr helicopter operators use is way more comprehensive than the standard SOP calls listed above on a CAT A helipad departure. The bottom line is this stuff is not hard at all when you train to proficiency. All of us can have our internal gyros toppled departing into a blackhole but if the monitoring, standard calls, deviation calls and a means to take control are all clearly defined this should be a non event. I'm interested to see how accurately the CAT A profile was flown and what calls were made between the flying pilot and non flying pilot from the hover point through the departure. The CVR and FDM data should sort that out extremely quickly. Does the NTSB issue a preliminary finding to rule out a mechanical issue or pilot error like we do in the UK? I know there are several operators that are crossing their fingers the fleet of AW139's isn't grounded due to a mechanical issue. This is still sounding like a classic CFIT(W) case with a flight crew that wasn't given the opportunity to maintain proficiency.
Whatever the investigation result will be, (system failure or CFIT or loss of control due to disorientation...) I would like to share the following considerations and hear your opinions.
After the G-LBAL accident I red the final report and felt as my duty to send a note to the AAIB web team via email ([email protected]) in august 2016.
I was furthermore convinced after I found my self during what most of you call a "black-hole departure" as PM and I had to call the PF to correct deviations in pitch and power, excess in nose down and power index attempting to get IAS alive after TDP and loss of visual references.
The posts quoted above are getting some points which are the key to these hybrid departures on AW139s.
Hybrid because "The FAA sets VFR minimums based upon "Weather" (Ceiling and Visibility)....not what you can see out the windows"
About the other post, put it together with the body of the email I pasted below.
After two more years and 500 more hours on type and some more black-hole departures, I would add also in the sim training some details about the collective force trim, the power index spontaneous variation management after TDP/rotation, and enphasys about IAS limits of engaging/disengaging of GA, TU, etc. for the different phases, 5 to 7. Moreover the difference in engaging GA in phase 7 from previous ones. The difference between engaging LNAV and HDG, especially when magnetic field is abnormal. Also the AW169 Wing Level function should be considered by the constructor for AW139 as well.
Forgive my english. Even in my own language I'm not very good in writing.

The body of my email:


I disagree with:

1) “a slight tailwind may have affected the

helicopter during its departure; this would be one cause of a late registering of airspeed

in comparison with other, into-wind, departures”


In my experience, late registering of airspeed happens in all confined/vertical/short-field procedures, with front wind, and with a maximum 10° nose down pitch as indicated by the RFM.

Attitude recovering from -10° to 0° is commanded by time (2 seconds) and not by airspeed, ground speed or outside visual references.

The manual dictates then that the 0° pitch must be maintained till Vtoss is reached.

Several seconds with 0° pitch are necessary before suddenly airspeed gets “alive” and goes, in a very short time and sometimes instantly, from zero to 40/50Kts IAS.

During night VFR departures from coastal helipads, visual references are actually lost at TDP.

Take-off procedure is then performed from TDP with the sole reference to instruments till modes can be engaged (Phase 5 software) only at 60Kts IAS.

Experience in these procedures during day VFR operations integrates the type rating training, giving the pilot the absolute trust in the effectiveness of the sequences, even during the zero kts IAS phase.

Moreover, cues for pitch and power index are available (when set) in the PFD during all the sequence from hover to Vtoss, no matter if day or night operations.

Therefore, Cat A take-off procedures are actually performed with reference to instruments even during day VFR operations.

RFM and TRI should emphasize that

- Category A take-off procedures are actually performed with reference to instruments even during day VFR operations

- Delay in IAS is usual in these procedures and should be ignored till it gets “alive”



In my opinion, to be discussed:



“Safety Recommendation 2015-025

The European Aviation Safety Agency should amend its definition of Vmini, to

provide a clear definition that reflects the legitimacy of flight under instrument

flight rules by reference to external visual cues at speeds below Vmini.”



AW139 RFM can not reflect this recommendation: external cues are not utilized to perform a correct Cat A vertical/confined/short-field take-off

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Old 24th Jul 2019, 05:41
  #364 (permalink)  
 
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Originally Posted by vaibronco
Hybrid because "The FAA sets VFR minimums based upon "Weather" (Ceiling and Visibility)....not what you can see out the windows"
The definition of visibility is the ability to see prominent unlit objects by day and lit objects by night.
If there are no objects to be seen (or can't be seen) then it's not VMC.
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Old 24th Jul 2019, 05:47
  #365 (permalink)  
 
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Vaibronco,

Of course we refer to instruments to make sure we are on the profile for Cat A takeoffs. But I disagree that external cues are not utilised, and if anyone is teaching this, they should not be.
It is in fact essential that the pilot flying is looking outside during the takeoff, because the chances of a successful reject are severely diminished if he is not looking out. It is also during the initial stages of the departure that collision avoidance by means of lookout is most critical. There are more foreign objects, birds, wires, tv masts etc below 200 ft than there are above.
If there are 2 crew, then the pilot monitoring should be assisting by looking inside and ensuring that the departure is according to the profile.
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Old 24th Jul 2019, 06:07
  #366 (permalink)  
 
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Absolutely agree Non-PC Plod - the power of peripheral vision is greatly underestimated in flying an instrument/visual balance in its ability to provide good visual cues. Actually looking out of the window helps a whole lot more.
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Old 24th Jul 2019, 16:42
  #367 (permalink)  
 
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The definition of visibility is the ability to see prominent unlit objects by day and lit objects by night.
If there are no objects to be seen (or can't be seen) then it's not VMC.
If there are no "Lit Objects" at night?

You might speak to a Lawyer familiar with Air Law to explain why there is a problem with your offering.

Do not confuse Part 135 Rules for Part 91 Rules.

I do not disagree with the import of your statement....just the way you arrived at it as we both agree about if there is nothing to see outside....you are surely flying purely on Instruments.
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Old 24th Jul 2019, 17:20
  #368 (permalink)  
 
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Originally Posted by SASless
If there are no "Lit Objects" at night?

You might speak to a Lawyer familiar with Air Law to explain why there is a problem with your offering.

Do not confuse Part 135 Rules for Part 91 Rules.

I do not disagree with the import of your statement....just the way you arrived at it as we both agree about if there is nothing to see outside....you are surely flying purely on Instruments.
all regulations are underpinned by the definition of terms that span all parts.
If you start with your region of choice, lookup the definition of visibility. Then go from there.

Visual flying is bound to the reference of ground objects and a visible horizon (among other minima) and being clear of cloud, unless on/over the top is accommodated.
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Old 24th Jul 2019, 17:39
  #369 (permalink)  
 
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So all the above begs the question, were both pilots either CPL/IR or ATP and current?

I know at least Geoff was an ATP holder but unsure of currency. I know Geoff was relatively new to the 139, but had a decent amount of time on a newer 109 as well as experience at night/IMC. He had adequate experience and for what he was doing (maybe not a lot of time on type but the type of operation and environmental conditions weren’t new to him), no idea of recency though.

Secondly was that particular 139 single pilot IFR or was it legally required to be flown two pilot? I’m just too lazy to look up the regs and the pilot data on the second pilot.

Pilot experience aside I’m just curious as to whether the flight could have legally launched with the pilot/aircraft combo at the time.
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Old 24th Jul 2019, 19:22
  #370 (permalink)  
 
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There is no single pilot IFR for AW139 under FAA regs, only multi.
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Old 24th Jul 2019, 19:38
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The aircraft is certified SP IFR so is it just FAA regs that don't allow SPIFR on all aircraft or just the 139?
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Old 24th Jul 2019, 19:41
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Originally Posted by Non-PC Plod
There is no single pilot IFR for AW139 under FAA regs, only multi.
Any idea if the second pilot had a current instrument rating whether it was a CPL/IR or an ATP and typed on type and had a current IPC being part 91 operations?

taking out all emotion out of the whole scenario, and second guessing whether Geoff had adequate recency or experience (he was legally and appropriately qualified). I’m simply curious whether the flight could legally launch in the first place based on the second pilots quals.

Given that Bahamas requires IFR ops at night, they would have had to have both been FAA IFR qualified and recent (ie IPC or meet the recent approach and holding requirements etc).
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Old 24th Jul 2019, 20:14
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NTSB prelim

Location:
Date & Time:
Aircraft:
Flight Conducted Under:
Big Grand Cay, Bahamas 07/04/2019, 0154 EDT
Agusta AW139
Part 91: General Aviation - Personal
Accident Number: Registration: Injuries:
ERA19FA210 N32CC
7 Fatal
National Transportation Safety Board Aviation Accident Preliminary Report
On July 4, 2019, about 0154 eastern daylight time, an Agusta AW139, N32CC, owned and operated by Challenger Management LLC, was substantially damaged when it impacted the Atlantic Ocean near Big Grand Cay, Abaco, Bahamas. The commercial pilot, airline transport pilot rated copilot, and five passengers were fatally injured. The helicopter was being operated under the provisions of Title 14 Code of Federal Regulations Part 91 as a personal flight. Night visual meteorological conditions prevailed at the time and an instrument flight rules flight plan was filed for a flight from Walker's Cay Airport (MYAW), Walker's Cay, Bahamas, to Fort Lauderdale/Hollywood International Airport (FLL), Fort Lauderdale, Florida. The flight departed from a concrete pad at Big Grand Cay, which was located about 5 nautical miles (nm) southeast from MYAW, about 1 minute prior to the accident.
The purpose of the accident flight was to transport two of the passengers to FLL for medical treatment.
The helicopter departed from Palm Beach International Airport (PBI), West Palm Beach, Florida, about 0057, and a witness reported that it landed on the concrete pad at Big Grand Cay between 0130 and 0145. After landing, the helicopter remained on the ground with the engines operating, while the passengers boarded. During the subsequent takeoff to the east, the witness reported that the helicopter climbed to about 30 to 40 ft and accelerated while in a nose-down attitude. He did not notice anything unusual while he observed the helicopter depart.
Another witness, who was located about 1.6 nm southwest of the accident site reported seeing the helicopter lift off and climb to between 40 and 50 ft above ground level; then shortly thereafter, he noted blue and white lights spinning to the left at a rate of about 1 to 2 seconds between rotations while descending. He estimated that the helicopter rotated to the left three to four times. He then heard a "whoosh whoosh whoosh" sound, and lost sight of the helicopter, which was followed by the sound of an impact. The witness reported what he had heard to the "caregiver" of Big Grand Cay. The witness went out on his boat about 0205 and used spotlights to search the area where he thought the helicopter had crashed but was unable to locate it.
Page 1 of 3 ERA19FA210
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.

The Federal Aviation Administration issued an alert notice for the overdue flight about 1521. The helicopter was subsequently located by local residents sometime between 1600 and 1700, in about 16 ft of water about 1.2 nm north-northeast of the departure point.
The helicopter was found inverted and the tailboom was separated from the aft fuselage and was recovered in multiple pieces. All five main rotor blades were separated but recovered. The tail rotor assembly, which was also separated was subsequently recovered. All four tail rotor blades were separated, and one tail rotor blade was not recovered. The recovered wreckage was retained for further examination, to include examination of the airframe, engines, flight controls, seats and restraints.
The helicopter was equipped with a multi-purpose flight recorder, an enhanced ground proximity warning system and several additional components capable of storing non-volatile memory, which were retained for evaluation and data download.
The accident investigation was initially under the jurisdiction of the Air Accident Investigation Department (AAID) of the Bahamas. On July 6, 2019, in accordance with Annex 13 to the Convention on International Civil Aviation, the AAID requested delegation of the accident investigation to the NTSB, which the NTSB accepted on July 8, 2019.
Aircraft and Owner/Operator Information
Aircraft Make: Agusta Registration: N32CC
Model/Series: AW139 No Series Aircraft Category: Helicopter
Amateur Built: No
Operator: Challenger Management LLC Operating Certificate(s) None Held:
Meteorological Information and Flight Plan
Conditions at Accident Site: Visual Conditions Condition of Light: Night/Dark
Observation Facility, Elevation: MYGF, 8 ft msl Observation Time: 2000 EDT
Distance from Accident Site: 46 Nautical Miles Temperature/Dew Point: 29°C / 25°C
Lowest Cloud Condition: Few / 2500 ft agl Wind Speed/Gusts, Direction: 4 knots / , 160°
Lowest Ceiling: Broken / 25000 ft agl Visibility: 10 Miles
Altimeter Setting: 29.95 inches Hg Type of Flight Plan Filed: IFR
Departure Point: Big Grand Cay, FN Destination: Fort Lauderdale, FL (FLL)
Page 2 of 3 ERA19FA210
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.

Wreckage and Impact Information
Crew Injuries: 2 Fatal Aircraft Damage: Substantial
Passenger Injuries: 5 Fatal Aircraft Fire: None
Ground Injuries: N/A Aircraft Explosion: None
Total Injuries: 7 Fatal Latitude, Longitude: 27.238056, -78.304444
Administrative Information
Investigator In Charge (IIC): Timothy W Monville
Additional Participating Persons:
Patrick D Lusch; FAA AVP-100; Washington, DC
Giorgio Dossena; Leonardo Helicopters (Technical Advisor); Cascina Costa, Merryn Spielman; Pratt & Whitney Canada (Technical Advisor); Longueuil, QC Delvin R Major; Air Accident Investigation Department; Nassau N.P.,
Marc Hamilton; TSB of Canada (Accredited Representative); ON
Alvaro Neves; EASA (Technical Advisor); Cologne,
Mikael Amura; ANSV (Accredited Representative)
Note: The NTSB traveled to the scene of this accident.
Page 3 of 3 ERA19FA210
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.
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Old 24th Jul 2019, 20:46
  #374 (permalink)  
 
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Originally Posted by A109drvr

The commercial pilot, airline transport pilot rated copilot, and five passengers were fatally injured. The helicopter was being operated under the provisions of Title 14 Code of Federal Regulations Part 91 as a personal flight.
Thanks. My bolding. Any idea if the CPL pilot was instrument rated and current per Part 61? It doesn’t mention anything in the pre-lim. You would assume so with an IFR flight plan, but just curious if it was the case.
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Old 24th Jul 2019, 21:15
  #375 (permalink)  
 
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Well that sounds more like a mechanical failure if one TR blade hasn't been recovered yet.
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Old 24th Jul 2019, 22:28
  #376 (permalink)  
 
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And wreckage found 1.2 miles away from the departure site doesn’t sound to me like LOC soon after TDP and before Vy was established - the critical time if ground refs were lost before stabilising airspeed had been established.

It seems unlikely the concrete departure helipad was not pretty well lit too, which would have reduced the chance of pilot disorientation before transition. This was a permanent base of a wealthy owner, after all. And the pilot had just successfully flown in there.

So seems to me early fingers pointing to some sort of mechanical failure - with the tail being the focus.
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Old 25th Jul 2019, 03:16
  #377 (permalink)  
 
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The eye witness report of the helicopter seen spinning out of control seems pretty conclusive that it was a loss of directional control mechanical problem.
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Old 25th Jul 2019, 03:32
  #378 (permalink)  
 
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Originally Posted by gulliBell
The eye witness report of the helicopter seen spinning out of control seems pretty conclusive that it was a loss of directional control mechanical problem.
If the eyewitness was 1.6 nm from the helicopter and it was a pitch black night, seems it would be difficult for a non-aviator to determine that the fuselage was "spinning". 1.6 miles is a long way.
​​​​​​​I would think all he would see is flickering lights.
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Old 25th Jul 2019, 03:50
  #379 (permalink)  
 
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Originally Posted by [email protected]
Well that sounds more like a mechanical failure if one TR blade hasn't been recovered yet.
That's a bold statement crab.

Just because a blade is missing doesn't mean it came off before impact. The fact that all blades came off would suggest that power was still being applied at impact.

Let's see what the MPFDR says. And the vibration monitoring system, if it was active (the accident aircraft does not have HUMS but rather VXP).
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Old 25th Jul 2019, 05:15
  #380 (permalink)  
 
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Nooby, the fact that all 4 blades came off but only 3 have been recovered might imply that one departed early and caused the crash - it's only a supposition but it is as likely as any other cause at the moment without FDR data.
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