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[email protected] 16th Mar 2017 22:32

cncpc - what is puzzling is that they chose to letdown to Black Rock in the first place - it is about 10Nm from the Blacksod refuel site (unless they have moved it).

It wouldn't be unusual for the rearcrew to transmit to the CG that they were landing even if they were a few minutes out.

I can only presume the intention was to let down to the area of Black Rock to get visual underneath the weather and then fly low level into the bay for Blacksod.

I can also only presume that their nav kit was telling them where they actually were as opposed to where they thought they were but I still find it odd that they made a downwind approach to the area of the rock.

We know they were going to Blacksod for refuel but it seems an odd way of going about it. One problem might be a mass of radar contacts in the bay that prevented a better letdown profile - if the bay is anything like the Castletown Bere area, there are hundreds of buoys and fish farms - not actually a hazard unless your SOP is not to overfly a radar contact which then maes life more difficult.

rjsquirrel 17th Mar 2017 00:14

Looking carefully, their path shows a bee-line for Blackrock from takeoff. And their last call said they thought they were approaching Blacksod. One possible explanation of this whole thing is ghastly, that they set 300 foot tall Blackrock as the navigation destination instead of sea level Blacksod.

minimaman 17th Mar 2017 00:27

Navigation to Blackrock not Blacksod given similar names?
 
1 Attachment(s)
Attachment 1920
As can be seen from the picture above, the AIS flight route appears to show
blackrock being the intended destination from a long distance off.This flightpath
appears not consistent with any approach to blacksod LH. Is it possible that the incorrect
LH /was programmed into the navigation system at EIDW given their very similar names ie blackrock instead of blacksod?
Expecting a sealevel letdown west of the intended blacksod lighthouse but with 300ft cliffs there at the actual position of blackrock lighthouse instead. Could this explain the debris found at blackrock?It sounds simple but the map and AIS data is very clear.Why would 2 nearby lighthouses have such similar names surely they should have more unique identifiers?

Red5ive 17th Mar 2017 00:36

CHC statement

Honoring Our Rescue 116 Crew
Honoring Our Rescue 116 Crew | CHC

500 Fan 17th Mar 2017 00:39


Originally Posted by rjsquirrel (Post 9708832)
Looking carefully, their path shows a bee-line for Blackrock from takeoff. And their last call said they thought they were approaching Blacksod. One possible explanation of this whole thing is ghastly, that they set 300 foot tall Blackrock as the navigation destination instead of sea level Blacksod.

According to the press, Dara Fitzpatrick has been based at Shannon, Waterford and Dublin, with possibly the greater portion of her service being at the two east coast bases. As a result, would she have flown to and landed at Blacksod all that often during her career? And the same goes for the other R116 crew members? How often do the east coast crews venture over onto the western seaboard given that there are two machines based on the west coast and are (generally) readily available to support each other?

megan 17th Mar 2017 01:54

Crab, or anyone else with the knowledge, presumably Blacksod does not have a formal approach, so how would one make an approach in dirty weather, what limits apply?

Thanks from the unknowing.

cncpc 17th Mar 2017 02:41


Originally Posted by megan (Post 9708884)
Crab, or anyone else with the knowledge, presumably Blacksod does not have a formal approach, so how would one make an approach in dirty weather, what limits apply?

Thanks from the unknowing.

I would be surprised if the ICG has not had "company" GPS approaches designed for each helipad it would use. These aircraft have to operate in very poor weather, and an instrument approach would seem to be mandatory at those heliport/lighthouse combos.

I would think it would take a series of events before an "approach" thought to be at Blacksod became the Blacksod approach at Blackrock. If that were the case, Blackrock light is likely above Blacksod minimums.

Nobody has denied the Blacksod destination story, but as a poster says above, that may be protocol for any number of good reasons. If something was not right in the boxes, it was not right on liftoff from Dublin. The aircraft flew to the co-ordinates of Blackrock but there are a number of scenarios as to how that might have happened. If it was programmed as a GoTo Direct, and canned approaches aren't used, then you have a single wrong waypoint and approach plates for Blacksod on the clip.

Surely there is a control center somewhere that is always in comms with these machines, and surely someone must have thought What the...watching this aircraft if it wasn't going where it was supposed to?

jimf671 17th Mar 2017 03:39

There's only one Blacksod, which can't be said about Black Rock.

buzz66 17th Mar 2017 04:13

Looks to me like Blackrock was entered into the FMS instead of Blacksod.
The last call was "Landing at Blacksod"
EGPWS doesn't give much warning on a near vertical Cliff.

RIP.....Thoughts are with Fam & Friends

fisbangwollop 17th Mar 2017 07:40

It is hard to believe that this could be CFIT with a bloody great lighthouse showing its bright beam every few seconds (assuming of course it was working).....I am pretty sure even if they had decended below the level of the light and vis was poor the loom of the light would be visible.

[email protected] 17th Mar 2017 07:40

Before the Irish CG got the 92s, any long range jobs were given to the RAF at Valley or Chivenor because we had the better range,

There were only 2 refuel sites on the West coast - Castletown Bere and BlackSOD - I can think of no reason to add another on top of a 300' rock.

We used to organise periodic recces for our crews of the most likely refuel sites, Blacksod for Valley and Castletown for Chivenor so I would think that the Irish crew would at least have had a working knowledge of the sites, it's not like any of them were newbies.

I don't know the CHC SOPs so they may have had a preplanned letdown and a home-grown plate for an IMC approach to the Blacksod area - otherwise it would be similar to how I described it earlier with a combination of radar clearances and the SAR modes of the autopilot to transition down safely beneath the weather.

It is possible they got down on the Westerly track and then turned downwind to transit to the refuel site at low level but I still can't believe they flew into the rock without realising it was there.

Non-PC Plod 17th Mar 2017 08:26

Crab, let me run this possibility by you, and see what you think.
Initial approach on Westerly heading was an attempt to get in visually. Finals checklist includes item "Radar-stby".
This approach - lost visual, go around. Go around checklist does not include include item "radar-on". Second, ARA-style approach conducted with radar at stby, and SA is lost as a result.
I have seen similar in OGP sim training.

Outwest 17th Mar 2017 08:38

Well unless something has changed recently, CHC Finals check ( from memory by PNF) that included Radar-STBY was only after visual with the landing site. So if they never seen the landing site they would still have the radar on in the GA.

cncpc 17th Mar 2017 08:44

From what I can see, that light is not manned, it's some sort of automatic acetylene thing, or was at the time of the article I read. That house is not habitable, there is no slate on the roof on the other side. No sign of fuel tanks there.

If this is a misprogramming of the FMS waypoint for Blacksod, with the waypoint named Blacksod, but carrying coordinates of Blackrock, it may have been there for some time. This machine may never have gone to Blacksod before that night and the error wouldn't have been noticed.

The story of two missed approaches at Blacksod doesn't stand up. A poster above has a good insight when he/she says that they may have tried for the visual westbound, missed and came back the other way.

Thunderbirdsix 17th Mar 2017 09:18

Irish Lights said the light was working as it's monitored from Dublin,their ship "Granuaile" which has a large platform and heavy lifting crane and has the capability to stay on station has arrived at the crash area but weather is very poor until Sunday at least, there will be a minutes silence before Ireland play England in the Rugby match to remember the brave crew of Rescue 116

tistisnot 17th Mar 2017 09:29

Plod

Surely the radar is memory items short finals .... no drama with wow standby mode. How can you contemplate ARA / coastal approach without radar until visual identified?

[email protected] 17th Mar 2017 09:52

NonPCPlod - I think your question has been answered - unless the CG use a SAR helo in a completely different manner to how we used to use ours, the radar would stay on throughout the whole procedure, up to and including any transit below weather to the refuel site.

A simple FMS faff might explain how they ended up initially going towards Blackrock instead of Blacksod but once in the area with all the mapping it should have been blindingly obvious that the terrain was nothing like what they should have been expecting, from even the most cursory glance at a map or a LS directory - big rock in the middle of the sea vs LS at the end of a narrow inlet.

I would emphasise that this happened at 01:30 ish, a poor time physiologically to be flying anyway even if you have been rostered to do so. But, when you have been dragged out of your warm bed in the middle of the night, it can be doubly disorientating and make normal mental processes much more demanding.

212man 17th Mar 2017 10:09


EGPWS doesn't give much warning on a near vertical Cliff.
As a generic statement it's clearly nonsense, as the 'E' means Enhanced and reflects the fact that there is a look ahead function using a terrain/obstacle database. Normally there should be cautions and alerts from about 30 seconds onwards.

However, the look ahead envelope reduces below 100 kias and is inhibited at 70 kias, which is pretty much the speed they were doing, judging by their groundspeed. Also, if Low Alt mode is used, the envelope further reduces and there is also a Terrain Inhibit function inherent in the MK XXII EGPWS but which is not available in the standard S92 - I can't help wondering if it is available in the SAR machines, as there would be good reason for it.

I don't buy the claims that the waypoint entry was a mistake - it looks like a clear cut cloud break procedure using the westerly-most obstacle as a reference.

minimaman 17th Mar 2017 10:23

helis flightpath was direct to blackrock for some time
 
1 Attachment(s)
Is there any scenario where you would route towards blackrock to make an approach towards blacksod?Surely such an obstacle would be avoided with far safer approaches further north available.It appears that the heli tracked directly to blackrock instead of the intended blacksod .Upon seeing the lighthouse one could believe they were already at blacksod especially at night however blackrock is treacherous with its 300ft cliffs and nothing like blacksod.For whatever reason the heli was navigating directly towards blackrock for some time before breaking the irish coast (see AIS data attached).It would appear either blackrock was programmed into the fms from EIDW essentially a typo(unlikely with such highly experienced and capable pilots) or the fms was faulty and as CNPC stated may have had blackrock coordinates in a waypoint called blacksod.If the crew believed they were at blacksod lighthouse but were actually at blackrock lighthouse, at night they would both look the same afterall a lighthouse is a lighthouse but with vastly different surroundings and approaches required.


Attachment 1921

[email protected] 17th Mar 2017 10:26

Why would you choose the Westerly obstacle as a reference? The FMS/AP can do a letdown to anywhere (as I understand it) - just press the button and it does a target let down pattern to the hover. Doing it 10Nm away from your intended landing site doesn't make much sense.

Fareastdriver 17th Mar 2017 10:40

I am reminded by a CFIT in China in the late 90s. This was flying towards the coast, VFR, in a low cloudbase and flew into the steeply rising coastline. The radar was on and from the CVR the crew, being aware of the coastline, had commenced to backtrack towards the sea. From the wreckage the radar was assessed as being on and the tilt was selected at least 5 degrees up.

Flying with the radar tilted is common to avoid ground returns that interfere with returns from cloud formations especially over land. The upwards tilt will mask obstacles directly in front at and below the same height. For example, using the 1/60 rule 1 degree tilt up will hide a 1 foot obstacle 60ft in front; a 100ft obstacle 6,000ft in front. 5 degrees nose up will mask the same obstacle at 1,200ft or under a 1/4 mile. Most radars, when selected to 5 miles or greater, will not define at a 1/4 mile as it will be lost in scanner base scatter. It means that you can fly at a 300ft cliff at 200ft and not be aware of it.

After this event in China we kept the radar at horizontal or lower when operating VFR or at low level. However we still had it cranked up for high level transits to avoid ground returns especially across hilly terrain.

I am not familiar with the S92’s radar or the actions required with it in different procedures but it’s a thought.

minimaman 17th Mar 2017 10:52

unlikely flight track was approach to blacksod LH
 
Yes crab this crew were too experienced to deliberately approach blacksod via such an obstacle and unnecessarily indirect route when time was of the essence.This is a VTOL aircracft afterall.It appears that the approach they actually made was for blackrock Lighthouse and that for whatever navigation system reason they were not at Blacksod.Its late at night ur under time pressure you believe ur at the correct destination the fms says you are and you spot a lighthouse outside this confirms you have arrived and the letdown begins.At night a lighthouse is a lighthouse .

212man 17th Mar 2017 10:54


Why would you choose the Westerly obstacle as a reference? The FMS/AP can do a letdown to anywhere (as I understand it) - just press the button and it does a target let down pattern to the hover. Doing it 10Nm away from your intended landing site doesn't make much sense.
I'm not suggesting it's the optimal method, but given the length of time they operated with S61s it would make sense as a 'legacy technique'. It would be mirroring the standard method of conducting an offshore ARA to a multi-platform field when your destination is in the centre. With the terrain alerts inhibited and the radar tilted up slightly to reduce the sea clutter, and at 10nm or 25nm to give a good view of the bay, it starts to become a little more plausible.

henra 17th Mar 2017 11:16


Originally Posted by minimaman (Post 9709279)
Its late at night ur under time pressure you believe ur at the correct destination the fms says you are and you spot a lighthouse outside this confirms you have arrived and the letdown begins.At night a lighthouse is a lighthouse .


Even if this may be right the Lighthouse is about the highest point of Blackrock. This means they would have had to sink below lighthouse level. Which wouldn't have been a good idea at Blacksod either, the latter one being pretty much at Sealevel.
Even if the track might indicate that the FMS sent them to Black Rock instead of Blacksod it doesn't fully explain why they possibly collided with terrain and definitely collided with the water.

SASless 17th Mar 2017 12:03

Question: Did the Crew have to manually input the coordinates into the FMS or was it already there?

If they had to manually input the data....what was the source of the data?

Was the Black Rock and Blacksod data next to one another?

What is the SOP used by the Crew when manually inputting such data?

If it is preset in the FMS.....what was there?

Again....could Black Rock have been selected in error some how but the crew have thought it being Blacksod?

Second question: Black Rock is a small bit of land surrounded all around by water where Blacksod is on the shore of a large peninsula.....thus Radar returns would have appeared much different prior to beginning the Approach to Land.

Question: As the approach was being made....as MDA was reached....if Alt Hold was being used....what height above the water would the aircraft be at on the final leg of the approach?

If the weather was such the Black Rock Light House was in cloud....would the crew have been able to see it visually?

Question: What was the weather at Black Rock at the time of the accident?

minimaman 17th Mar 2017 12:43

approach differences blackrock vs blacksod
 
1 Attachment(s)
The terrain differences for an approach from the west are very hazardous if you were expecting flat terrain ie blacksod from your chart and you flew heading east towards blackrock lighthouse,in particular its westerley side is very unforgiving.The 2 approaches from the west are illustrated to click on below for comparison.However would the EGPWS not have warned the crew or is it too steep?

Attachment 1922

triskele 17th Mar 2017 12:58

At night a lighthouse is a lighthouse ....but at night a lighthouse has a characteristic signature from the light, and is far more visible than day. Both were sector lights, b'rock 360 degrees and B'sod dark between 018 and 189 degrees, which is the landward sector. Both flash white and red over their sectors as follows..
B'sod red 189 to 210, white 210 to 018, flash 2, 7.5 sec
B'rock red 212 to 276, white 276 to 212, flash, 12 sec.
No one familiar with maritime could confuse these.

212man 17th Mar 2017 13:00


However would the EGPWS not have warned the crew or is it too steep?

Did you see my post above?

tu154 17th Mar 2017 13:05

Weather radar.
 
The offshore fit in the S92 is a Honeywell Primus system which includes 2 ground mapping modes, generally used for ARA type approaches. Generally no faffing with tilt during an approach, it's done automatically.
The SAR fit also has a moving map type display from what I've seen in photographs.
I fly offshore in crew change so not sure what modes they would have been using, but find it hard to believe they didn't know where they were with the kit fitted.

SASless 17th Mar 2017 13:07

Are helicopter Pilots that familiar with light house light codes?

How long would the crew have to visually ID the light house signal that night?

I would suggest the Crew would use other means on-board the aircraft to ID the light house.

minimaman 17th Mar 2017 13:19

yes i see it now 212man thank you so basically the EGPWS is less effective at lower speeds in particular its enhanced or forward facing function

minimaman 17th Mar 2017 13:31

1 Attachment(s)
mitchaa

I think too much is being drawn into this as I can't see anything to point to a navigation error? Unless someone can point to some proof?
This AIS data of the approach appears to show navigation directly to blackrock island.The route taken dosent appear to be useful for a blacksod approach .click to see map below

Attachment 1923

AnglianAV8R 17th Mar 2017 13:34

@ Mitchaa
The talk of possible mix up is due to suggestions they made a transmission stating "landing at Blacksod" and within one minute their position was actually tracked to the immediate vicinity of blackrock.
One of the reports concerning debris being described as found at Blackrock lighthouse attributes a comment to a investigation official to the effect that the debris may have washed up there. So, it must actually have been found at sea level, rather than 300 ft above s/l at the lighthouse.

212man 17th Mar 2017 13:35


Originally Posted by Mitchaa (Post 9709471)
With the Helideck on the far western edge of the blackrock island surely it's a standard approach coming in from the West? You have a great big lighthouse in front of the helideck coming straight at it from the east. As said previously though, seems a very strange place for a refuelling point, where does it get a fresh regular fuel supply to fuel helicopters from?

Where is the talk of getting mixed up with blacksod originating from?

I'm not actually sure there is any evidence of debris actually on the blackrock island by the lighthouse 300ft up, all it says is close to blackrock island in the reports. Go back a couple of days, the rescue vessels were searching an area of sea a good few nm off of the island. Debris may have of course been swept there since.

I think too much is being drawn into this as I can't see anything to point to a navigation error? Unless someone can point to some proof?

Not saying this is a mechanical failure or a CFIT, we don't know yet but if you remember the Norwegian crash last year, the head departed and the debris field was spread far and wide as result, we don't know at this point where the aircraft has broken up. Likely as it impacted the water (or cliffs if it turns out there is actual debris on the actual +300ft island) but it could equally have broken up in the air, we do not know at this stage.

I'm not sure what you are saying. There is no refuelling at Blackrock, it's at Blacksod which is where the crew were intending to land, and announced that they were shortly before contact was lost. However, they were clearly using Blackrock as a navigational reference for some purpose, and I suggest that the last recorded groundspeed and proximity to the rock from the AIS indicates they were not trying to land on it. Similarly, that position indicates that the wreckage did not 'drift there' from another location.

birmingham 17th Mar 2017 13:49

Blackrock is only 12m West of Blacksod, is a potential landmark (lighthouse)/waypoint, hazard (300' cliff) and has a helipad; so is likely to have featured in some way in the approach - but I, like most of us here, have no facts to offer. The crew on the other hand were both highly experienced and presumably knew both these locations/approaches well from many years of practical flying. According to this report they had been there six days earlier

http://www.irishexaminer.com/ireland...er-445271.html

I don't think there is enough information yet to support any theories as to why this happened - there are just too many possibilities and hardly any evidence. It will become clearer in the next days and weeks but, for now this tragedy is simply unexplained.

goosl 17th Mar 2017 14:08

This article confirms part of the wreckage found on Black rock, but also states no significant impact marks on the island or lighthouse.

In 'hostile conditions', searchers find section of Coast Guard helicopter on Black Rock

jimf671 17th Mar 2017 14:59

What were the regulatory requirements for this flight since it was not directly lifesaving flight but top cover? Would this affect the way such an approach was planned and executed? Crab has told us a bit about how a RAF SAR Force aircraft would have handled approach to Blacksod but this was a civilian aircraft and was this regarded as SAR flight?

Democritus 17th Mar 2017 15:28

In respect of the wreckage found on Blackrock by the accident investigators, PPRuNers may find this interview with Jurgen Whyte, Chief Inspector of the Air Accident Investigation Unit who landed on Blackrock of interest. The relevant piece from last night's RTE 'Prime Time' programme starts at 17:30 with the interview starting at 20:00 and lasting just over 4 minutes.

Prime Time - Thursday 16 March 2017 - RTÉ Player

Loquatious 17th Mar 2017 15:56

Even though similarity of waypoint names, callsigns and such-like are recognized as threats in aviation, I don’t see it as plausible that a crew would physically misidentify the two locations whether seen on a map, radar or terrain-mapping mode.

However, unfamiliarity, mindset and the time of day are ever-present threats, perhaps some of these played a part.

Whether it was the intent or not, the track towards the location of Blackrock was established early in the flight. Then at about the correct distance for an ARA, an offset is followed by a further turn to the right for what looks like a go around.

The trace shows that the aircraft continues for some 3 nm and turns left roughly parallel to the GA track but slowly turning more easterly. At approx. 2nm away it turns towards the landing site at Blackrock but with what intent?

The track as depicted does not suggest to me that this was a westerly let down for an approach to Blacksod. If it was, then perhaps the plan changed when the aircraft made for Blackrock after the turn left onto a southeasterly heading. With no altitude data to assist, the picture is particularly unclear.

During the approach and go around there would be good reason to have had the radar on for the entire time, if not in WXR mode then in GMAP. It would be usual to optimize the WXR display with gain and tilt adjustments. With WXR or GMAP modes selected and even Terrain display, there should have been ample overview available unless marred by some significant malfunction.

Regarding the unattributed call of landing at Blacksod. I understand it was given at around the apex of the turn. Other than to overcome possible challenges with comms at low altitude, wasn’t it a tad early with well over 5 minutes flight time to go to Blacksod or was it a part of a clipped call made under duress with a slip of the tongue regards location?

Only time will tell.

[email protected] 17th Mar 2017 16:21

Birmingham - it was the same unit a few days earlier but that doesn't mean it was the same crew.

it seems reasonably clear that the aircraft went into the water rather than the rock since Dara survived the crash, suggesting an impact that allowed her to escape but caused bad enough injuries for her not to survive subsequently. The other crew members may still be in the wreckage having been incapacitated by the impact. If they had hit land, there would be a lot of wreckage available and no survivors.

Loquatious - not unusual t get tha call out early so it doesn't distract from the letdown process.


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