NT Air King Air Accident - Pilot Discussion Thread

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Loved flying with Luc, my heart goes out to his family, his friends, and everyone at NT Air. Sounds like the worst thing happened at the worst possible time, can't send enough condolences, this man was the best and taught me more than 100 things about flying. Rest in peace my man. I don't personally know the copilot, but please pull through!

[brooks]

CNK 2420, a Sunwest Beech 1900 with 14 people on board, departed Calgary and shortly after, the crew declared an emergency due to a problem with the right engine. ARFF responded. Tower initiated a missed approach with JZA 492 on a 4 NM final to Runway 34 to accommodate CNK 2420, which landed safely at 1642z and taxied in. Several departures were delayed and 8 - 10 arrivals were diverted to Runway 28 as Runway 34 was closed for inspection.
User Name: Ridley, Rod
Date: 2011-11-15
Further Action Required: No
O.P.I.: System Safety
Narrative: UPDATE TSB reported that the Sunwest Aviation Ltd. Beech 1900D, C-GSWB, was operating as flight CNK 2420 from Calgary, AB (CYYC) to Christina Lake, AB (CCL3). Shortly after take-off the flight crew observed low oil pressure indications for the No. 2 engine (Pratt & Whitney Canada PT6A-67D). The flight crew shut down the No. 2 engine, declared an emergency with ATC and returned to Calgary for a single-engine approach and landing with ARFF standing by. Maintenance found a faulty oil pressure transducer.
User Name: Ridley, Rod
Date: 2011-11-16
Further Action Required: No
O.P.I.: System Safety
Narrative: UPDATE Maintenance and Manufacturing reported that the crew shut down the R/H engine as a precaution due to a zero oil pressure indication. The engine was inspected and maintenance found a broken wire on the oil pressure transducer cannon plug. The broken wire was repaired and a ground run checked serviceable. There is no history of this type of discrepancy on any of the company's Beech 1900D aircraft.

In my opinion any low oil indication should be handled quickly to avoid a situation from becoming grave. The Captain of this aircraft should be applauded for getting 15 souls safely to the ground even though it was a false indication.

Don't f**k around in other words.

[PanEuropean]

...In my opinion any low oil indication should be handled quickly to avoid a situation from becoming grave.

Quickly perhaps, but not so quickly that time is not spent giving a bit of further thought to the situation.

In the case of a Twin Otter, for example, there are three different oil pressure indications in the flight compartment. One is an annunciator light that is controlled by a discrete sensor that opens and closes at approximately 40 PSI. One is a traditional oil pressure gauge (labelled 'Oil Pressure') that has its own dedicated sensor at the back of the engine. The third is also a traditional oil pressure gauge (labelled 'Torque') that also has a dedicated oil pressure sensor, this one at the front of the engine.

If (for example), the annunciator light came on but the two other oil pressure indications showed normal readings, what do you think would be the most thoughtful and appropriate course of action: Shut down the engine and return for landing, or; assume that 1 of the 3 indications is incorrect, and continue to use the engine (while monitoring the the other two indications) as you return for a landing?

What I am getting at is this: "Quickly" can sometimes introduce more problems. "Thoughtfully" might be a better adjective to have used.

Michael

[floatpilot]

Get the thing on the ground!!! then figure out the problem. simple. should not be playing games about which one is the correct gauge. mabe the other two are malfunctioning, who are we to decide?

[flyinthebug]

Im posting this incredibly sad news on both threads. CTV news reported this morning that Matt has passed away from his injuries. This is truly another sad day. My most sincere condolences to Matt`s friends and family that were hoping for the best as we all were! RIP Matt! GBNF

[TA/RA]

Our thoughts are with Matt's family and his girlfriend! Now you can be at peace. Such a sad day.

[TA/RA]

Looks like Matt Robic's celebration of life will be held on Friday.

http://www.legacy.com/obituaries/thepro ... =154729116

[Miguel AB]

Investigation Progress Update 2012-02-09

Beechcraft King Air 100 Accident, 27 October 2011, Richmond, BC Near Vancouver International Airport (A11P0149)

On 27 October 2011, a Northern Thunderbird Air Ltd. Beechcraft King Air 100 (registration C‑GXRX) departed Vancouver International Airport (YVR) with seven passengers and two pilots, bound for Kelowna International Airport (YLW).

About 15 minutes after take-off, the flight diverted back to Vancouver because of an oil leak. No emergency was declared. At 1611 Pacific Daylight Saving time, approximately 300 feet above ground and 0.4 miles from the runway, the aircraft suddenly banked left and pitched nose-down. It then collided with the ground, and caught fire before coming to rest on an arterial roadway just outside the YVR perimeter.

Passersby helped evacuate some passengers and fire and rescue personnel rescued the remaining passenger and the pilots. The aircraft was destroyed and all of the passengers were seriously injured. Both pilots succumbed to their injuries in hospital.

Investigation Team Work
The investigation team is led by a Transportation Safety Board of Canada (TSB) Investigator-in-Charge, Bill Yearwood. Mr. Yearwood has 41 years of aviation experience; 18 years as a commercial pilot in the civil aviation industry, and 20 years in aviation safety. He has been an aircraft accident investigator for the past 13 years. Mr. Yearwood is assisted in this investigation by experts in flight operations, aircraft performance, aircraft systems, aircraft engines, human performance, air traffic control (ATC).

While these experts come from within the TSB, assistance has also been provided by Northern Thunderbird Air, NAV CANADA, the RCMP, BC Coroners Service, Beechcraft, Raisbeck Engineering, Pratt and Whitney Canada, the Vancouver Airport Authority and fire and rescue experts. These experts assist the team uncover and understand all of the underlying factors which may have contributed to the accident.

Each investigation consists of three phases: Phase 1 is the Field Phase when accident information is gathered from a number of sources including the accident site; the team continues its work in Phase 2 which is the Post-Field Phase where information is gathered and analysis begins. The final phase is the Report Production Phase. This phase is intended to ensure procedural fairness and the accuracy of the Board's final report. The Board considers all representations (comments) and will amend the report if required. Once the Board approves the final report, it is prepared for release to the public.

This investigation has now entered Phase 2. While continuing to accumulate the information it needs, the team has now begun the work of analyzing the considerable amount of data in order to determine what happened, why it happened and, what can be learned to help ensure it does not happen again.

Work Completed to Date
Progress has been made in a number of areas. The accident site has been extensively photographed and documented and the TSB has removed the wreckage for further analysis.

The flight recorders were located on the first day and delivered to the TSB lab for data download and analysis. The recorders contain much needed data and will assist investigators in the understanding of what happened during the approach phase of the flight.

Interviews have been conducted; documents have been collected; and electronic information has been downloaded. The analysis of this material has begun but a large amount of work remains.

What We Know
The flight was returning to YVR because oil was leaking from the left engine. The left engine did not lose power and the crew did not declare an emergency.

The weather in the Vancouver area was mostly clear with light and variable winds. While the flight departed on an instrument flight plan, weather conditions allowed the crew to conduct a visual approach to YVR runway 26 left.

The approach to the runway at YVR was normal until the last moments before the anticipated touch down. The aircraft slowed below its target approach speed and seconds later, the aircraft banked left (about 80°), and pitched nose-down (about 50°). The captain was able to level the wings and pull the nose up slightly before impact with a paved road.

The road is a heavily travelled arterial with six lanes at that location. An oncoming car swerved across a median to avoid a major collision with the aircraft, but was clipped by the aircraft's wing tip. The accident happened at a time when the traffic lights provided a gap in the flow. Several of the people who helped rescue the passengers were stopped at the traffic light at the time of the accident.

After colliding with the ground, the landing gear collapsed, the aircraft skidded along the road on its belly, shed parts, and spilled fuel. A post-impact fire erupted. After the aircraft stopped, the passenger seated closest to the main door tried to open it. After repeated attempts, the door opened. That passenger and persons in the area helped all but one passenger out of the burning wreck. The cockpit was farthest away from the door, and initial rescuers were not aware of the total number of persons on board. By the time six of the passengers were out of the wreck, the heat, smoke and fire prevented the initial rescuers from reaching the seventh passenger who was near the front of the aircraft.

Richmond Fire-Rescue personnel arrived approximately three minutes after the crash, from a fire hall about 0.5 miles from the accident site. They rescued the seventh passenger; however there was some confusion as to the total number of persons on board and how many pilots there were. Fire and rescue personnel worked to rescue the pilots while the fire was being doused. The aircraft was across a ditch just outside the YVR perimeter fence. A YVR fire truck arrived about four minutes after the crash, having been dispatched by ATC, and was able to spray the wreckage from the airport side of the fence. Another fire truck crashed through the airport perimeter fence gate to get to the accident site. Joint fire and rescue personnel extinguished the fire, cut the wreckage and rescued the pilots.

Fire and rescue personnel reported that the aircraft’s electrical wiring arced continuouslyand there was concern for personnel entering the wreckage even after the fire was extinguished.

The fire started immediately after impact, and, while it was apparent spilled fuel ignited as the aircraft was skidding across the road, after the aircraft and engines stopped, fire concentrated on the right wing.

The King Air has only one cabin door, located at the left rear and one emergency exit window located over the right wing, which leads persons onto the wing over the battery compartment. For the flight, the cabin was configured with eight passenger seats, all facing forward in rows with a centre aisle. Figure 1 shows the cabin configuration and exits. There was fire visible outside on the right, making the door the only viable exit. The door frame was deformed and the door was jammed shut. An able passenger opened it with difficulty. Most of the other passengers and both pilots were disabled by impact injuries.



Figure 1. Seating and exits ↑

While all the persons onboard sustained serious bone fractures from the impact deceleration forces, those injuries were survivable. The post-impact fire compromised that survivability. Both pilots suffered burns as a result of the post-impact fire and later died as a consequence.

Investigation Activities in Progress
The TSB is proceeding along several avenues of investigation concurrently, in order to understand why the aircraft slowed and crashed 0.5 miles from the runway. To that end, investigators, assisted by specialists in aerodynamics and human performance are reviewing factors that may have contributed to this tragic accident.

The TSB has classified this occurrence as a loss of control accident. However, other areas being investigated are:

Aircraft design to reduce the risk of post-impact fires; and
Unpublished critical control speeds.
Communication of Safety Deficiencies
Should the investigation team uncover a safety deficiency that represents an immediate risk to aviation, the Board will communicate without delay so it may be addressed quickly and the aviation system made safer.

Outstanding TSB Recommendations - Post-Impact Fires
A 2006 TSB safety study of post-impact fires identified 128 of 521 occurrences in which fire or smoke inhalation contributed to the cause of death or serious injuries. Most of the accidents were otherwise survivable. Six years ago, the Board has made three recommendations designed to lessen the risk of fatal post-impact fires.

Recommendation A06-10 states:
To reduce the number of post-impact fires in impact-survivable accidents involving existing production aircraft weighing less than 5700 kg, Transport Canada, the Federal Aviation Administration, and other foreign regulators conduct risk assessments to determine the feasibility of retrofitting aircraft with the following:

. selected technology to eliminate hot items as a potential ignition source;
. technology designed to inert the battery and electrical systems at impact to eliminate high-temperature electrical arcing as a potential ignition source;
. protective or sacrificial insulating materials in locations that are vulnerable to friction heating and sparking during accidents to eliminate friction sparking as a potential ignition source; and
. selected fuel system crashworthiness components that retain fuel.
(SII A05-01)

Recommendation A06-09 states:
To reduce the number of post-impact fires in impact-survivable accidents involving new production aeroplanes weight less than 5700 kg, Transport Canada, the Federal Aviation Administration, and other foreign regulators include in new aeroplane type design standards:

. methods to reduce the risk of hot items becoming ignition sources;
. technology designed to inert the battery and electrical systems at impact to eliminate high-temperature electrical arcing as a potential ignition source;
. requirements for protective or sacrificial insulating materials in locations that are vulnerable to friction heating and sparking during accidents to eliminate friction sparking as a potential ignition source;
. requirements for fuel system crashworthiness;
. requirements for fuel tanks to be located as far as possible from the occupied areas of the aircraft and for fuel lines to be routed outside the occupied areas of the aircraft to increase the distance between the occupants and the fuel; and
. improved standards for exits, restraint systems, and seats to enhance survivability and opportunities for occupant escape.
(SII A05-01)

Recommendation A06-08 states:
Transport Canada, together with the Federal Aviation Administration and other foreign regulators, revise the cost-benefit analysis for Notice of Proposed Rule Making 85-7A using Canadian post-impact fire statistics and current value of statistical life rates, and with consideration to the newest advances in post-impact fire prevention technology.

(SII A05-01)

The responses from regulators on these recommendations are Unsatisfactory. The Transportation Safety Board of Canada is concerned that the world's regulators have largely ignored these recommendations. In the meantime, the Board continues to investigate aviation accidents like the Northern Thunderbird Air accident where some or all onboard survive the crash only to die as a consequence of a post-impact fire.

The Families
The TSB investigation team knows that the survivors and the families who lost loved ones want answers. As we continue our work, our hope is that we will be able to answer: What happened? Why did it happen? What can we learn so that it does not happen again? We look for these answers to make a safer transportation system for all Canadians.

The information posted is factual in nature and does not contain any analysis. Analysis of the accident, along with the Findings of the Board will come when the final report is released. The investigation is ongoing.

http://www.tsb.gc.ca/eng/medias-media/p ... 120209.asp

[Indanao]

Maybe if the firewagon had of driven up to the fence and shot some foam on the fire it would have saved lives. They sat up on the ramp apparently waiting for political approval. Which apparently never came. ( Was Harper not in the office ? ) Instead of trying to mandate further fire suppression equipment on aircraft they should consider using what they have already.

[ahramin]

This is the first time I've seen this set of reccomendations. Does anyone have any information on these battery inerting systems? Or anyone offering STCs to move the fuel tanks farther away from the passengers? Maybe they should put a trailer hitch on them and tow the fuel behind them. I really don't understand where they're going with this one.

[old_man]

Maybe if the firewagon had of driven up to the fence and shot some foam on the fire it would have saved lives. They sat up on the ramp apparently waiting for political approval. Which apparently never came. ( Was Harper not in the office ? ) Instead of trying to mandate further fire suppression equipment on aircraft they should consider using what they have already.

A YVR fire truck arrived about four minutes after the crash, having been dispatched by ATC, and was able to spray the wreckage from the airport side of the fence. Another fire truck crashed through the airport perimeter fence gate to get to the accident site.

But yes, blame Harper if that helps you sleep at night.

[flyinthebug]

Maybe if the firewagon had of driven up to the fence and shot some foam on the fire it would have saved lives. They sat up on the ramp apparently waiting for political approval. Which apparently never came. ( Was Harper not in the office ? ) Instead of trying to mandate further fire suppression equipment on aircraft they should consider using what they have already.

As old_man posted, its clear that they did exactly what your complaining they didnt do? A 2nd truck crashed through the gate to get to them. I`d say they did all they could do and then a tad bit more! Do you really believe these men and women would have sat and watched as an aircraft burned on the street?? Waiting for a "political approval"?? What is your agenda with this ridiculous statement??

[Indanao]

Your basing that on what? What, " OldMan " said? Check out the pictures ( some on the video ):

http://www.vancouversun.com/news/Anatom ... story.html

Show me a hole in the fence or a firewagon shooting foam over or through the fence. Travel that road daily
and have never seen any holes in that fence.

[flyinthebug]

Your basing that on what? What, " OldMan " said? Check out the pictures ( some on the video ):

http://www.vancouversun.com/news/Anatom ... story.html

Show me a hole in the fence or a firewagon shooting foam over or through the fence. Travel that road daily
and have never seen any holes in that fence.

Indy...Im basing it on what I am reading in the report...as old_man posted...

A YVR fire truck arrived about four minutes after the crash, having been dispatched by ATC, and was able to spray the wreckage from the airport side of the fence. Another fire truck crashed through the airport perimeter fence gate to get to the accident site.

You say you drive that road daily and havent seen a hole in the fence? That is quite an interesting development than isnt it? Or did they repair the hole in the fence the next day or same day as it is a restricted area?.. and therefore may have got priority status to be replaced? Im not sure why you havent seen any hole? I am not familiar with that part of YVR by road, so I cannot comment. I would think if the report is wrong, you may want to contact the TSB and advise them of your findings. I think it would be an important correction if indeed no fire truck "crashed through the fence" as is stated in their own report above?

Fly safe.

*Edit for PS* I checked out the story in the sun via your link. I dont see any fire trucks shooting foam, but there are several pictures with foam covering the aircraft and road. I dont think because there are no videos or pics of the truck actually shooting foam from airside, makes an arguement that it didnt happen at all.

[Indanao]

Did you see any holes in the fence? So, where are they....

TSB can say, they read it first here.

[flyinthebug]

Did you see any holes in the fence? So, where are they....

TSB can say, they read it first here.

No I did not see any holes. I also believe you when you say you didnt & dont see any. What I am suggesting is that hole could have been repaired within hours of the incident, due to the high level of security any airport is under. It is a restricted area and therefore not unreasonable to think they had a contractor on site within an hour or 2. I am not questioning what you saw at all...and as you said, the TSB will read your comments here first.

Cheers.

[jump154]

The article accompanying the pictures in the link states that the truck crashed through a gate. Easy repair that, close the gate again, put a new chain on! I believe they are designed to be driven through... Also states trucks inside the fence dumped foam on the crash, after waiting on standby and responding quickly.

[Big Pistons Forever]

The bottom line is simple. Had the aircraft declared an emergency a fire truck would have been sitting at the button of 26L, or about 100 yards form the crash site, and would have been able to respond in seconds instead of the 3 + minutes it took to get it manned and then drive over from the other side of the airport.

[Indanao]

Thought 3+ minutes would save them, e.g.: they showed the City fire trucks dowsing the flames long after that.
Roger on the declaring an emergency, or lack there of, but doubt loss of control. Not knowing the King Air, but going by book figures, it appears an approach speed of 121kts, and Vmca of 86kts which gives them room for 35kts. The point that at idle - not feathered - the prop can kick into reverse due to low oil pressure was made.

I'm quite certain that part will be figured out by TSB.

[MUSKEG]

Seeing that it takes oil and oil pressure to drive the prop in negative blade angle or reverse how is it possible for the prop to "kick" into reverse if there was low oil pressure? For those that have flown a Be100 with a raise beck kit you will know that if you pull the power to idle the drag produced by the unfeathered prop is tremendous. Airspeed decays rapidly and once it's gone you will not get it back with gear and flaps down. These are for the most part clapped out old aircraft with high time engines on condition. I would be pleasantly surprised if those engines produced even 550 hp.

[chesty]

It says in the report"what we know is the left engine had an oil leak but did not loose power" am I missing something in regards to the talk of feathering?

[old_man]

I am no expert but in this pic it looks like a yellow airport fire truck.

I am just guessing here but I think when they said 'crashed through' they mean driving through a crash gate.

Do regular city fire trucks have foam capability? This is an honest question as I do not know.

[Indanao]

Good picture, "Oldman" , I hadn't seen that one before. Yes, City trucks have foam too. There were a couple of pictures somewhere of them hosing foam onto the Aircraft. ( None of Airport trucks shooting foam - just sitting on the road, end of 26L... Not to say they never, and I hadn't read the comment below the pictures which said they had. )

[spaner]

Turbine engines don't "clap out", they "temp out".
Red-line torque = full rated HP

Just say'in

[cncpc]

It says in the report"what we know is the left engine had an oil leak but did not loose power" am I missing something in regards to the talk of feathering?

My understanding of the final seconds is that the oil levels became so low that it was not possible to maintain pressure in the dome and the prop went to feather, then a change in attitude of some sort brought some oil back into the dome and the prop moved out of feather, then in and out very rapidly with a large increase in drag on the left side, and a roll left,corrected possibly by reducing power on the right then impact with the road. All in a few seconds, but the main thing had to do with the difference when feather is achieved through the prop control, which opens a large port in the dome and there is an end to oil pressure, and when oil is slowly depleted through a system leak, in which the feathering action and overall prop control can be all over the place.

This happened at the worst possible time.