I am surprised that the TSB posts accident photos on Flikr. I understand ordinary citizens are going to do that but a government agency doing it makes me scratch my head.
Having said that, that's an awfully long trail for a helicopter to make. Interesting.
I never knew Chris, but his name came up a couple weeks ago in conversation with a friend of mine. He had applied to Orgne something like 30 times trying to get hired for the YQT base. Finally the guy gets his break. Very sad to hear.
Ornge Sikorsky Air ambulance accident Northern Ontario
Moderators: sky's the limit, sepia, Sulako, lilfssister, North Shore
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Valkyrie_XB70
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Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Flickr makes sense to me. Use 1 login and password and any employee can log in. It costs nothing to upload and host. Plus less chance of having their own servers bombarded with people lookin for pics.
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Changes in Latitudes
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Re: Ornge Sikorsky Air ambulance accident Northern Ontario
When I saw the wreckage pattern, I figured the media had screwed up and a PC-12 had went in. My heart goes out to the families.
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Lost in Saigon
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Re: Ornge Sikorsky Air ambulance accident Northern Ontario
You can download the original crash site photo here: http://www.flickr.com/photos/tsbcanada/ ... 838887493/
The Exif data says it was shot 2013:05:31 15:45:39 with a BlackBerry 9780
The Exif data says it was shot 2013:05:31 15:45:39 with a BlackBerry 9780
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captcrunch2013
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The Black Hole ast Moosonee
Here we go again, another face saving story to suit insurance claims and political correctness.
The Aviation world rarely ever wants to admit pilot error.
Moosonee is a place that really determines if
a pilot an fly on instruments and if they can avoid optical illusions.
Over 20 years ago, I had a co-pilot who could not fly on instruments, could not land in a cross wind
or snow storm and had difficulty doing an instrument approach. He was next to go captain
according to the seniority list.
I spent dozens of hours making him fly every leg, but could not "fix" his problems and had to go to the
chief pilot and give him the bad news.
It was like I was committing heresy. Suddenly I was the worst person on earth and no-one wanted to me.
That month I hit 150 hours and had to go on leave.
When I returned, some transport inspector had given him a captains PPC and he was flying as captain.
Within a week or so, he flew into the dark terrain near Moosonee and it was blamed
on "Black Hole effect".
There is a trend to save money by using simulators however in the "old days" me real practice was required,
no sane chief pilot would let a new pilot loose unless they their night flying skills checked.
While these two pilots were highly experienced it is obvious something was missing. Just how did
TWO pilots both fall for what is called "the black hole effect".
It needs some other name, that reflects reality.
"Failure to monitor instruments and a failure maintain terrain clearance"
Here is the Toronto Star Story
http://www.thestar.com/news/canada/2013 ... lance.html
ORNGE helicopter crash: “Black hole” effect could have brought down air ambulance
“Black hole” effect, mechanical failure and pilot error among possible causes as probe begins into crash of ORNGE air ambulance in northern Ontario.
By: Bruce Campion-Smith Parliament Hill, Published on Fri May 31 2013
OTTAWA—It’s been called the “black hole” effect, when sky and ground blur into one seamless, disorienting curtain of darkness.
That’s what the crew of the ORNGE chopper would have faced soon after their midnight take-off from Moosonee airport. And it may have been their downfall as the Sikorsky S-76 crashed into the ground just minutes later, killing all four onboard.
It’s a phenomenon that has claimed many pilots, most notably John F. Kennedy Jr., who crashed his light plane into the Atlantic Ocean during a night flight over water in 1999. U.S. investigators later said that Kennedy lost control flying in the dark haze because of “spatial disorientation.”
On Friday, contact was lost with the chopper soon after its departure. So far, there has been no indication that crew signalled they were having troubles. In a statement Friday, ORNGE said it had no indication about what caused the accident.
Investigators from the Transportation Safety Board of Canada were on their way to northern Ontario Friday to begin their on-scene assessment. They will be looking at all elements of the accident, such as human factors, pilot training and the mechanical fitness of the 33-year-old helicopter.
The captain, Don Filliter, had been flying choppers for 20 years; the first officer, Jacques Dupuy, since 1996. With such an experienced crew at the controls, one veteran pilot speculated to the Star that a catastrophic mechanical failure may have caused the wreckage. If so, the position of the bits of wreckage will provide vital clues to investigators about the accident sequence, he said.
ORNGE said Friday it had temporarily grounded its five remaining S-76 helicopters “out of an abundance of caution.”
But investigators will almost certainly be looking at whether this crash fits a pattern they’ve already flagged as a worrisome safety trend in Canada — controlled flight into terrain.
That’s when pilots inadvertently fly into the ground or water, usually at night or in bad weather or poor visibility.
“Such conditions reduce a pilot’s situational awareness of surroundings and make it difficult to tell whether the aircraft is too close to the ground,” according to the safety board, which counted 13 such accidents in 2010 and 14 in 2011.
Visual spatial disorientation was blamed as the cause of a previous air ambulance accident in 2008 when a Sikorsky S-76 crashed into a forest during its night-time approach to a helipad in Temagami. Three of the four crew on board were seriously injured.
Investigators noted the risks of flying over a “featureless landscape” with few lights on the ground, creating a “black hole” effect due to the lack of visual clues for pilots.
“The pilot flying was likely affected by visual spatial disorientation,” the report concluded.
That crash happened even though the aircraft was equipped with an enhanced ground proximity warning system to alert the crew to a possible collision with terrain. And the pilots had received special training in night operations to learn “black hole approach and departure techniques,” according to the report.
On Friday, the weather around Moosonee was “adequate” for flying according to ORNGE, although there were patches of rain and mist.
The Sikorsky pilots would have faced inky darkness soon after lift-off and been relying on their flight instruments for reference, one former air ambulance pilot told the Star.
“Up north, there (are) no visual references, so you’d be right on the instruments right away,” said the pilot.
“You would take off and continue as if you went into cloud right away,” he said. “You wouldn’t be operating visual at all.”
The U.S. National Transportation Safety Board has investigated fatal incidents involving the Sikorsky S-76s and at least twice recommended these helicopters be equipped with terrain awareness and warning system, which would give the crew ample warning that they are danger of crashing into water or land, especially important during visual flight.
An investigation into a 2004 crash in the Gulf of Mexico off Galveston, Texas, determined that had the helicopter been equipped with this warning device the accident may not have happened.
“The flight crew was not adequately monitoring the helicopter’s altitude and missed numerous cues to indicate that the helicopter was inadvertently descending toward the water,” the board’s report stated.
“If a terrain awareness and warning system had been installed aboard the accident helicopter . . . (it) should have provided the flight crew with ample time to recognize that the helicopter was descending toward the water, initiate the necessary corrective actions, and recover from the descent.”
It’s not known whether the aircraft involved in Friday’s crash was equipped with the terrain warning system. A spokesperson for ORNGE said it would be up to safety board investigators to determine the helicopter’s equipment.
With files from Richard J. Brennan and Jim Rankin
The Aviation world rarely ever wants to admit pilot error.
Moosonee is a place that really determines if
a pilot an fly on instruments and if they can avoid optical illusions.
Over 20 years ago, I had a co-pilot who could not fly on instruments, could not land in a cross wind
or snow storm and had difficulty doing an instrument approach. He was next to go captain
according to the seniority list.
I spent dozens of hours making him fly every leg, but could not "fix" his problems and had to go to the
chief pilot and give him the bad news.
It was like I was committing heresy. Suddenly I was the worst person on earth and no-one wanted to me.
That month I hit 150 hours and had to go on leave.
When I returned, some transport inspector had given him a captains PPC and he was flying as captain.
Within a week or so, he flew into the dark terrain near Moosonee and it was blamed
on "Black Hole effect".
There is a trend to save money by using simulators however in the "old days" me real practice was required,
no sane chief pilot would let a new pilot loose unless they their night flying skills checked.
While these two pilots were highly experienced it is obvious something was missing. Just how did
TWO pilots both fall for what is called "the black hole effect".
It needs some other name, that reflects reality.
"Failure to monitor instruments and a failure maintain terrain clearance"
Here is the Toronto Star Story
http://www.thestar.com/news/canada/2013 ... lance.html
ORNGE helicopter crash: “Black hole” effect could have brought down air ambulance
“Black hole” effect, mechanical failure and pilot error among possible causes as probe begins into crash of ORNGE air ambulance in northern Ontario.
By: Bruce Campion-Smith Parliament Hill, Published on Fri May 31 2013
OTTAWA—It’s been called the “black hole” effect, when sky and ground blur into one seamless, disorienting curtain of darkness.
That’s what the crew of the ORNGE chopper would have faced soon after their midnight take-off from Moosonee airport. And it may have been their downfall as the Sikorsky S-76 crashed into the ground just minutes later, killing all four onboard.
It’s a phenomenon that has claimed many pilots, most notably John F. Kennedy Jr., who crashed his light plane into the Atlantic Ocean during a night flight over water in 1999. U.S. investigators later said that Kennedy lost control flying in the dark haze because of “spatial disorientation.”
On Friday, contact was lost with the chopper soon after its departure. So far, there has been no indication that crew signalled they were having troubles. In a statement Friday, ORNGE said it had no indication about what caused the accident.
Investigators from the Transportation Safety Board of Canada were on their way to northern Ontario Friday to begin their on-scene assessment. They will be looking at all elements of the accident, such as human factors, pilot training and the mechanical fitness of the 33-year-old helicopter.
The captain, Don Filliter, had been flying choppers for 20 years; the first officer, Jacques Dupuy, since 1996. With such an experienced crew at the controls, one veteran pilot speculated to the Star that a catastrophic mechanical failure may have caused the wreckage. If so, the position of the bits of wreckage will provide vital clues to investigators about the accident sequence, he said.
ORNGE said Friday it had temporarily grounded its five remaining S-76 helicopters “out of an abundance of caution.”
But investigators will almost certainly be looking at whether this crash fits a pattern they’ve already flagged as a worrisome safety trend in Canada — controlled flight into terrain.
That’s when pilots inadvertently fly into the ground or water, usually at night or in bad weather or poor visibility.
“Such conditions reduce a pilot’s situational awareness of surroundings and make it difficult to tell whether the aircraft is too close to the ground,” according to the safety board, which counted 13 such accidents in 2010 and 14 in 2011.
Visual spatial disorientation was blamed as the cause of a previous air ambulance accident in 2008 when a Sikorsky S-76 crashed into a forest during its night-time approach to a helipad in Temagami. Three of the four crew on board were seriously injured.
Investigators noted the risks of flying over a “featureless landscape” with few lights on the ground, creating a “black hole” effect due to the lack of visual clues for pilots.
“The pilot flying was likely affected by visual spatial disorientation,” the report concluded.
That crash happened even though the aircraft was equipped with an enhanced ground proximity warning system to alert the crew to a possible collision with terrain. And the pilots had received special training in night operations to learn “black hole approach and departure techniques,” according to the report.
On Friday, the weather around Moosonee was “adequate” for flying according to ORNGE, although there were patches of rain and mist.
The Sikorsky pilots would have faced inky darkness soon after lift-off and been relying on their flight instruments for reference, one former air ambulance pilot told the Star.
“Up north, there (are) no visual references, so you’d be right on the instruments right away,” said the pilot.
“You would take off and continue as if you went into cloud right away,” he said. “You wouldn’t be operating visual at all.”
The U.S. National Transportation Safety Board has investigated fatal incidents involving the Sikorsky S-76s and at least twice recommended these helicopters be equipped with terrain awareness and warning system, which would give the crew ample warning that they are danger of crashing into water or land, especially important during visual flight.
An investigation into a 2004 crash in the Gulf of Mexico off Galveston, Texas, determined that had the helicopter been equipped with this warning device the accident may not have happened.
“The flight crew was not adequately monitoring the helicopter’s altitude and missed numerous cues to indicate that the helicopter was inadvertently descending toward the water,” the board’s report stated.
“If a terrain awareness and warning system had been installed aboard the accident helicopter . . . (it) should have provided the flight crew with ample time to recognize that the helicopter was descending toward the water, initiate the necessary corrective actions, and recover from the descent.”
It’s not known whether the aircraft involved in Friday’s crash was equipped with the terrain warning system. A spokesperson for ORNGE said it would be up to safety board investigators to determine the helicopter’s equipment.
With files from Richard J. Brennan and Jim Rankin
Re: The Black Hole ast Moosonee
"The aviation world rarely wants to admit pilot error......."captcrunch2013 wrote:Here we go again, another face saving story to suit insurance claims and political correctness.
The Aviation world rarely ever wants to admit pilot error.
Here is the Toronto Star Story
http://www.thestar.com/news/canada/2013 ... lance.html
ORNGE helicopter crash: “Black hole” effect could have brought down air ambulance
It’s not known whether the aircraft involved in Friday’s crash was equipped with the terrain warning system. A spokesperson for ORNGE said it would be up to safety board investigators to determine the helicopter’s equipment.
With files from Richard J. Brennan and Jim Rankin
"Black hole effect could have brought down air ambulance........" So could any number of things. I didn't realize the Toronto Star was an authority on aircraft accidents. Got to watch that pesky "black hole effect" though. It's also known as CFIT....but at night? Thanks for the education I'm getting here, Toronto Star.
Ornge doesn't know whether or not the helicopter was equipped with a terrain warning system? You're FAVKING kidding me....right? Up to the safety board's investigators to try and find one in the forest, I guess. Guess it wouldn't be listed on the aircraft's EQUIPMENT LIST????
Few things piss me off more than some beef jerky brained reporter pointing fingers at something he has NO clue about! Perhaps it was the YMO Triangle?
Re: The Black Hole ast Moosonee
That YMO triangle is a real killer. I'm not sure what causes it. Just look at all the accidents in between YMO-YQT-YER. There have sure been a lot more accidents than in the YUL-YOW-YYZ triangle. Surely there must be some paranormal phenomenon.Doc wrote: Few things piss me off more than some beef jerky brained reporter pointing fingers at something he has NO clue about! Perhaps it was the YMO Triangle?
Joking aside, is that a clearing they went through or did they knock out a bunch of trees on the way in?
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Captncrunch, and Doc, thanks for really good posts.
I opine, that the clearing in the trees made by a helicopter, could narrow as the rotor diameter is progressively reduced by contact with those trees.is that a clearing they went through or did they knock out a bunch of trees on the way in?
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Lost in Saigon
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- Joined: Wed Jul 21, 2004 9:35 pm
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
There are lots of helicopter crashes on Youtube where the blades contact something. I have never seen a rotor diameter "progressively reduce". They usually disintegrate into many pieces.PilotDAR wrote:Captncrunch, and Doc, thanks for really good posts.
I opine, that the clearing in the trees made by a helicopter, could narrow as the rotor diameter is progressively reduced by contact with those trees.is that a clearing they went through or did they knock out a bunch of trees on the way in?
https://www.youtube.com/watch?v=6qebviC_e_o
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Quad18star
- Rank 1
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- Joined: Wed May 13, 2009 10:08 am
Re: The Black Hole ast Moosonee
I find it highly unlikely that Don was not experienced at flying on instruments. He worked for years with the MNR in which he would have flown in the similar terrain and used similar equipments. I also find it highly unlikely that ORNGE would hire someone who wasn't proficient on instruments and these guys have flown in and out of the area many times before.
Several people have said that the helicopter caught fire/exploded shortly after take off ... unfounded rumors perhaps , but hopefully answers come to light about this.
My wife went to school with Mr Dagenais , and Mr Filliter lives 10 minutes from my place .... this has really had an impact on the communities. May these 4 men Rest in Peace
Several people have said that the helicopter caught fire/exploded shortly after take off ... unfounded rumors perhaps , but hopefully answers come to light about this.
My wife went to school with Mr Dagenais , and Mr Filliter lives 10 minutes from my place .... this has really had an impact on the communities. May these 4 men Rest in Peace
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Yes, I agree. I think the evidence of fire all along that trail, rather than just at the final main wreckage spot, is noteworthy. It appears to be level flight, at cruise speed, but I'm not sure why the fire would be all the way along the wreckage trail.Bede wrote:Having said that, that's an awfully long trail for a helicopter to make. Interesting.
I remember a Long Ranger at Revelstoke years ago that had one of those containment accidents and the cabin was in flames, with the pilot having control for part of the way down.
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
___________________________________________________________
http://www.thestar.com/news/canada/2013 ... lance.html
"ORNGE helicopter crash: “Black hole” effect could have brought down air ambulance
“Black hole” effect, mechanical failure and pilot error among possible causes as probe begins into crash of ORNGE air ambulance in northern Ontario."
By: Bruce Campion-Smith Parliament Hill, Published on Fri May 31 2013
___________________________________________________________
Actually the article is quite good - factual, fair, and well-written. Bruce Campion-Smith is one of the few Canadian reporters that has covered aviation safety-related articles for many years, and seems to take great care and interest in the topic - we should be thankful for this.
It has been well-documented through accident reports over the years that even experienced flight crews are not immune to CFIT. A black hole departure only requires a momentary lapse of attention to quickly turn catastrophic and the point is well taken that pilots in general feel they are immune to making mistakes - surely the cause was mechanical. And maybe it was. The TSB will publish their findings soon enough.
Kirsten B.
http://www.thestar.com/news/canada/2013 ... lance.html
"ORNGE helicopter crash: “Black hole” effect could have brought down air ambulance
“Black hole” effect, mechanical failure and pilot error among possible causes as probe begins into crash of ORNGE air ambulance in northern Ontario."
By: Bruce Campion-Smith Parliament Hill, Published on Fri May 31 2013
___________________________________________________________
Actually the article is quite good - factual, fair, and well-written. Bruce Campion-Smith is one of the few Canadian reporters that has covered aviation safety-related articles for many years, and seems to take great care and interest in the topic - we should be thankful for this.
It has been well-documented through accident reports over the years that even experienced flight crews are not immune to CFIT. A black hole departure only requires a momentary lapse of attention to quickly turn catastrophic and the point is well taken that pilots in general feel they are immune to making mistakes - surely the cause was mechanical. And maybe it was. The TSB will publish their findings soon enough.
Kirsten B.
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RatherBeFlying
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- Joined: Sat Sep 17, 2005 9:27 am
- Location: Toronto
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Black sky without horizontal references has claimed a number of pilots and their passengers over several decades. It's legal VFR, but the record shows instruments are required.
My question is how do you maintain IFR proficiency in a helicopter when the vast majority of your flying is VFR?
We should also remember that instruments do fail on occasion. A failed captain's horizon claimed a 747 out of Mumbai.
Losing a horizon and/or display close to the ground on takeoff in conditions similar to this accident allows precious little time to ensure a safe climb before you hit something.
Then there's illusions. If you think you have adequate visual reference when actually you don't, your luck account is rapidly depleting.
My question is how do you maintain IFR proficiency in a helicopter when the vast majority of your flying is VFR?
We should also remember that instruments do fail on occasion. A failed captain's horizon claimed a 747 out of Mumbai.
Losing a horizon and/or display close to the ground on takeoff in conditions similar to this accident allows precious little time to ensure a safe climb before you hit something.
Then there's illusions. If you think you have adequate visual reference when actually you don't, your luck account is rapidly depleting.
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Have to disagree. The article was written/printed/published, the day after the event. This reporter has ABSOLUTELY no basis to believe that this accident had anything to do with "black hole effect", something that, personally I find to be little more than "excuse" or "reason" or a "cause" if you will to excuse the fact that somebody just forgot to MAINTAIN A POSITIVE RATE OF CLIMB after takeoff. There is NO proof that this indeed occurred. This is NOT the time or place for such an article........the trees are still smouldering!snoopy wrote:___________________________________________________________
http://www.thestar.com/news/canada/2013 ... lance.html
"ORNGE helicopter crash: “Black hole” effect could have brought down air ambulance
“Black hole” effect, mechanical failure and pilot error among possible causes as probe begins into crash of ORNGE air ambulance in northern Ontario."
By: Bruce Campion-Smith Parliament Hill, Published on Fri May 31 2013
___________________________________________________________
Actually the article is quite good - factual, fair, and well-written. Bruce Campion-Smith is one of the few Canadian reporters that has covered aviation safety-related articles for many years, and seems to take great care and interest in the topic - we should be thankful for this.
It has been well-documented through accident reports over the years that even experienced flight crews are not immune to CFIT. A black hole departure only requires a momentary lapse of attention to quickly turn catastrophic and the point is well taken that pilots in general feel they are immune to making mistakes - surely the cause was mechanical. And maybe it was. The TSB will publish their findings soon enough.
Kirsten B.
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
snoopy wrote:The TSB will publish their findings soon enough.
Kirsten B.
Some may consider 18 months to 3 years "soon enough"......I don't.
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
I feel it's hight time we called into question the necessity and urgency of some of these northern medevacs? Personally I've done many that could well have waited for the "light of day". Or, the following month. Frankly, I'll never do another.
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Cat Driver
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Re: Ornge Sikorsky Air ambulance accident Northern Ontario
The cause of this accident may never be known for sure, like so many before it.I feel it's high time we called into question the necessity and urgency of some of these northern medevacs? Personally I've done many that could well have waited for the "light of day". Or, the following month. Frankly, I'll never do another.
Like Doc I can not help but wonder what happened to the patient this flight was dispatched for, did the patient survive long enough to be evacuated?
Immediate guessing as to cause by the media is what the media does.
The top management of these organizations do this.
The helicopter that crashed was built in 1980 and was maintained to Transport Canada standards, Dr. McCallum said.
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hockey2013
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Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Can't agree more Doc, countless times been dispatched for a medivac to pick some one up at 1 in the morning (after being awake all day) with a broken arm from a fight. I'm no doctor but most the time I'm sure they could wait for 6 am when the sun is up and the crews are more rested.
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Bang on. The majority of these medevacs could be done during the day. There is a considerable increase in risk when operating at night. Perhaps there needs to be some sort of guideline. Serious medevacs get done ASAP, the non-urgent wait until the day.Doc wrote:I feel it's hight time we called into question the necessity and urgency of some of these northern medevacs? Personally I've done many that could well have waited for the "light of day". Or, the following month. Frankly, I'll never do another.
On a safety note, it seems like an awfully poor decision for Ornge to ground the remainder of the S76 fleet. Decisions like that demonstrate a complete ignorance of safety management. There is no evidence to indicate that there is a problem with the fleet. A decision to ground a fleet in this case may have serious ramifications: what if an urgent medevac needs to be done but cannot because the fleet is grounded out of an abundance of caution? What if someone dies as a result of the grounding? In this case the probability of loss of life because of grounding half the provinces rotary wing fleet far exceeds the probability of loss of life because of another accident. Lightning never strikes twice.
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Cat Driver
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- Joined: Sun Feb 15, 2004 8:31 pm
Re: Ornge Sikorsky Air ambulance accident Northern Ontario
Doc and I have seen these " Medevacs " dispatched for a very long time.
Nothing seems to have changed over the decades.
One of my most memorial close calls was a " Medevac " I was dispatched out of Great Whale River to Port Harrison in weather that was frightening......at first I refused due to the weather but the people requesting the trip kept claiming it was a matter of life or death....so against my better judgement I went and for sure it became a matter of life or death for me and my crew because I ended up landing in a snow storm so bad I have no idea how I managed to get it on the ground....oh the doctors at the hospital could find nothing wrong with the patient.
This thread will soon be vaporized because it is becoming politically incorrect.
Nothing seems to have changed over the decades.
One of my most memorial close calls was a " Medevac " I was dispatched out of Great Whale River to Port Harrison in weather that was frightening......at first I refused due to the weather but the people requesting the trip kept claiming it was a matter of life or death....so against my better judgement I went and for sure it became a matter of life or death for me and my crew because I ended up landing in a snow storm so bad I have no idea how I managed to get it on the ground....oh the doctors at the hospital could find nothing wrong with the patient.
This thread will soon be vaporized because it is becoming politically incorrect.
