[Kharon]

Just a side bar – I was wondering how much time and money ATSB will spend investigating the SAAB event; which could actually be handled by the internal company SMS. Essentially, this has probably been a 'system/human factors ' failure. Many, many SAAB aircraft floating about the planet, how many loading and unloading events take place everyday, without incident?– Lots is a reasonable answer.

But, there's not too many mid-air events; and yet ATSB refuse to waste 'resources' on the second mid-air in recent history and provide any sort of 'advice' or recommendation to prevent another. Six deaths; two separate events; similar airspace and no answers to prevent a repeat.

Watch the video below; this is how fast and final a mid-air collision is. Clear skies; experienced crew, radio control, air show protocols and yet – it's all over in seconds; just like that. NTSB will investigate this event; ATSB will poodle about seeking answers to what is probably a human/systematic cock-up; signifying nothing more than that, yet six people dead in two collisions – and they've no resources? BOLLOCKS.

[Kharon]

Darwin Awards Nominee perhaps??

Via Popinjay central:

In-flight break-up accident highlights dangers of VFR pilots encountering IMC

Key points


Pilot likely entered instrument meteorological conditions before becoming spatially disorientated, resulting in loss of aircraft control;

Aircraft broke-up in-flight after airspeed limitations were exceeded;

During the 11 years from January 2011 to December 2021, the ATSB investigated 14 fatal accidents involving VFR into IMC.

A Van’s RV-7A light aircraft broke up in-flight after entering instrument meteorological conditions and its pilot became spatially disorientated, resulting in the loss of control of the aircraft, an ATSB investigation report details.

The amateur-built RV-7A two-seater, with the pilot the sole occupant and owner of the aircraft, was conducting a private flight under the visual flight rules (VFR) from Winton to Bowen, Queensland, on 23 April 2021. The pilot had been on a multi-day tour in company with three other pilots, each operating their own aircraft.

About 100 km into the flight, overhead Catumnal Station, the pilot most likely entered instrument meteorological conditions (IMC) and lost control of the aircraft several times, recovering control within 50 ft of the ground, before turning back towards Winton, recorded data shows.

However, about 11 km into the return leg, the pilot then resumed tracking to Bowen, climbing to above 10,000 ft and then operating at multiple altitudes between 10,000 ft and 500 ft above the ground, most likely to avoid weather along the track.

At about 90 km south of Charters Towers, the pilot again likely entered instrument weather conditions before becoming spatially disorientated, resulting in a loss of control of the aircraft. This led to exceeding the aircraft’s airspeed limitations, leading to the catastrophic failure of the airframe and the in-flight break-up.

“The ATSB found that the pilot departed Winton with a high risk of encountering adverse weather conditions along the planned route,” said ATSB Director Transport Safety Dr Mike Walker.

“There were no operational reasons for the pilot to continue the flight to Bowen, and the pilot probably had a self-imposed motivation or pressure to continue the flight.”

For a non-instrument rated pilot, even with basic attitude instrument flying proficiency, maintaining control of an aircraft in IMC by reference to the primary flight instruments alone entails a very high workload that can result in a narrowing of attention and the loss of situational awareness.

“The ATSB urges VFR pilots to avoid flying into deteriorating weather by conducting thorough pre-flight planning to ensure you have alternate plans in case of an unexpected deterioration in the weather, and to pro-actively decide to turn back, divert or hold in areas of good weather.”

Entering poor weather without the training and experience to do so can rapidly lead to spatial disorientation when the pilot cannot see the horizon.

“The brain receives conflicting or ambiguous information from the sensory systems, resulting in a state of confusion that can rapidly lead to incorrect control inputs and a resultant loss of control of the aircraft,” Dr Walker said.

Weather often does not act as the forecast predicts. Pilots must have alternatives available and be prepared to use them—even if it means returning to the departure point.

“Developing a ‘personal minimums’ checklist is an effective defence against what pilots often term as ‘push-on-itis’ or ‘get-home-itis’,” Dr Walker noted.

“A personal minimums checklist aids identifying and managing flight risks such as marginal weather conditions. It is an individual pilot’s own set of rules and criteria for deciding if and under what conditions to fly or to continue flying based on your knowledge, skills and experience.”

The ATSB’s Avoidable Accidents publication Accidents involving Visual Flight Rules pilots in Instrument Meteorological Conditions discusses a range of VFR into IMC accidents and details advice to pilots regarding how to the risk of being involved in such accidents.

Additionally, the Civil Aviation Safety Authority (CASA) has produced a number of educational resources including Weather to fly, an education program which focused on topics such as the importance of pre-flight preparation, making decisions early, and talking to ATC, and ‘178 seconds to live’, a campaign on highlighting the dangers of VFR flight into IMC.

Read the report: AO-2021-017 VFR into IMC and in-flight break-up involving Van's Aircraft RV-7A, VH-XWI 90 km south of Charters Towers, Queensland, on 23 April 2021

Publication Date
09/11/2022

This bit...

"..About 100 km into the flight, overhead Catumnal Station, the pilot most likely entered instrument meteorological conditions (IMC) and lost control of the aircraft several times, recovering control within 50 ft of the ground, before turning back towards Winton, recorded data shows.."

..an accident waiting to happen perhaps?? 

MTF...P2 

Darwin Awards..

P2's Darwin Award nomination _ ABOVE _ is worthy of some serious consideration by those who operate under the Visual Flight Rules (VFR). Almost every safety authority on the planet have had to deal with similar events; the basic 'story line' similar in nearly every case; as are the warnings and the advice. All good solid stuff and quite correct in essentials.

One of the 'big' messages is how quickly spatial disorientation kicks in and how rapidly  control can be lost; this is very real and dangerous in the extreme. The warnings very valid. But I wonder if a little more, in the way of 'education' could be included in the message. No criticism intended of the official 'beware' publications, non at all; however there are a couple of items which could (IMO) stand a little more 'publicity' (if you will).

For example; George pushes his luck and ends up in cloud; loses the aircraft and emerges very close to Terra Firma; stop the video right there at that moment. We cannot know (not exactly) what is going on in George's head at that precise moment; but we may take an educated guess. For sure the Adrenalin and self preservation mechanisms have kicked in; heart rate, breathing responding to fear, we may add a dollop of self doubt to the mix. At the very instant George sees the ground again, we may reasonably ask just how 'competent' is George to be in control of an aircraft – 'shock' must be an included factor. I wonder if anyone has studied that particular moment; is George capable of making sensible decisions at that point in time? But, he must, there's much to do and it must be done 'correctly' in short order; jig time even.

Losing control of the aircraft 'in cloud' is just the beginning of a Daisy chain of events which leads the way into those famous slices of cheese. It is unlikely that George exits the cloud in good working order; chances are there will be obstacles to avoid; can a quick 360 reveal a sensible exit route? Is that pathway leading to even more obstacles and more weather? How good is George's 'situational awareness' at this point in time. We don't know; but just for the sake of discussion, let's say it is somewhat reduced. Yet every single decision and action taken now must be correct; the slim margin between walking away (chastened) and hitting something disinclined to move aside is considerably reduced. What George needs is a cup of coffee and a few moments to 'sort himself out' – he ain't got that luxury; now is the moment.

So slightly shocked, probably frightened and feeling guilty, George levels off, gets the aircraft going forward and seeks redemption; this is where pure luck plays a part. Kissed on the head by the gods – an easy escape path lays ahead; but, if Murphy takes a hand, then there is some serious work to do and a fight on your hands for survival.

Let's say lady Luck takes a hand and an exit route appears – tight but valid if your low flying skills are up to date. Ag pilots do this type of flying all day, everyday; but only 'on site'. They know the lay of the land, topography and geography; wind and thermal; where to turn, how to turn and at what height to turn. Highly skilled are those who earn their keep 'in the weeds' or with their wheels in the crop after dark. George has no such skills; now faced with two options; neatly trapped between the proverbial rock and a hard place. Risky low flight or back into the cloud and murk.

Now had George done his homework and read the weather correctly before deliberately entering IMC (inadvertent is not a valid argument) then he could head back the way he came; provided nothing had changed and Lady Luck beat Murphy to the trump, then a scared, humbled George could make a hands and knees exit toward repentance. However, it could have just as easily gone the other way; low flight, poor visibility, surround by the 'bricks' trapped in a valley. What then? Consider the decisions needed and the residual mental condition; both stacked against our man, operating the aircraft. If you now add in a predisposition to 'pushing his luck' and past experience of a Houdini like escapes perhaps a touch of arrogance due to multiple escapes; George may get to tell another tale of 'derring-do' at the bar. But, the average mug is in a world of trouble, trapped, shocked, frightened and disoriented, without the skills, training, equipment or similar experience required to sort it all out, quickly and effectively.

“A superior pilot uses his superior judgment to avoid situations which require the use of his superior skill”.

Just the stray thoughts of one who wonders why, despite the best efforts of universal advice some pilots persist when there is no valid escape route available. Sure, take a look, test it out, but never, not ever, allow the back door to slam closed when you have left your keys and brains back at the shed...

Toot – toot...

[Wombat]

I am concerned that there is one subject missing from consideration: that is the role potentially played by the aircrafts EFIS system. The report states the aircraft was fitted with a Dynon HDX and autopilot. This system is capable in experienced and qualified hands of providing IFR flight control when coupled to a suitable GNSS system.

This system represents both an increased safety benefit and a temptation. It can potentially get you out of trouble by flying in instrument conditions for you. However it represents a temptation to enter instrument conditions when you are not qualified. Bar chatter indicates that some people experiment with  this "claytons IFR" and get away with it. If you were to try this, then if the system fails or you push the wrong button in IFR conditions and accidentally disconnect then you are done for.

[P7_TOM]

Side bar M'lud...

There is a small wrinkle there; which could stand a little further examination.

“It is unlikely that George exits the cloud in good working order; chances are there will be obstacles to avoid; can a quick 360 reveal a sensible exit route?”

Fair enough – however much will depend on not only where the aircraft exits the cloud; but how. Is George in any condition to coordinate a 360 and evaluate position and situation? This must be a consideration from a thinking POV.  Recovery from an 'unusual attitude' takes time and space; identifying the attitude and applying the correct recovery technique takes time and practice. The dangers clear and present. The 'wrong' recovery and/or rapid application of excess force and/or power (or both) could cause damage or even failure of the airframe. Recovery from unusual attitudes is routine for IR pilots; tested often. Those who operate solely in the 'VFR' regime, at PPL level without aerobatic or low flying training could easily fall into one of the many 'traps for young players'. These 'traps' are well documented : the Ag folks know all about them; aerobatic pilots know about them; they form part of the training regimen. So, when poor Ol' George falls out of the bottom of the cloud, over 'terrain' the recovery from whichever 'attitude' his aircraft ended up in, must be 'sorted' first and foremost. Get the thing flying properly.:- Then;

Orientation – 'where' is the aircraft in relation to the bricks, tree tops and power lines etc. Don't want to bump into anything like that; but which direction to turn? George is a very busy fellah about now and unless the path straight ahead is clear for a while then more decisions must be made; fast as you like; Left? Right? Up? Down? Steady as she goes? Then:-

George needs to find a way out of the weather and the terrain; lay in a course which will avoid both; or find a paddock: either way he must gather his scattered wits and get back to 'flying' now in very demanding conditions.

All of this must happen, as stated, in short order. I wonder how many have seriously considered the ramifications of pushing the boundaries, without considering the 'escape' clauses. But imagine; over the hills in crappy VFR; pushing on into cloud (not reduced visibility) but wet, bumpy, dark cloud, then loosing the aircraft in a turn back and popping out the bottom over a high hill or in a small valley; simple enough question - “whatcha gunna do now Mate??. 

Good point Wombat; only one thing to say to the 'Clayton s' brethren; they are not pilots, they are a liability not only to themselves (about whom I could, if I tried, care a lot less) but a real danger to legitimate IFR operations. They are like the idiot who nearly cleaned me up one dark night; sneaking in no radio to avoid the landing fee. There are words in the common vernacular to describe these types; but AP is a family show and such words are 'discouraged' from daily use.

Ah; my Ale has just arrived and it is, most definitely, time for a sundowner....Thank you M' boy. Cheers.

[Peetwo]

Popinjay's bollocks excuse for not investigating Gympie midair?? - 

Via the Yaffa: 

We won't investigate Gympie Crash: ATSB

18 November 2022



The Australian Transport Safety Bureau (ATSB) this week has clarified when they do and don't get involved in recreational accident investigations.

A statement given to Australian Flying was prompted by the release of an investigation report into the loss of a propeller off a Jabiru that resulted in no injuries and little damage, and news that the ATSB would not investigate a mid-air collision at Kybong near Gympie that cost two lives.

Aviation commentators have queried the apparent inconsistency especially after the ATSB denied Recreational Aviation Australia's request for an investigation into the Kybong crash, which was between an RAAus-registered powered aeroplane and a glider.

ATSB Chief Commissioner Angus Mitchell told Australian Flying the decisions were in line with the ATSB's normal procedures.

“We understand the perceived inconsistency regarding the ATSB’s response to these occurrences, and I welcome this opportunity to clarify these decisions, which are in line with our Ministerial Statement of Expectations," he said.

“The propeller loss occurrence related to the manufacture, design and/or maintenance of the aircraft itself. As Australia is the state of design and state of manufacture for the Jabiru aircraft, and there are aircraft of the same type on the VH register, and operating overseas, the ATSB investigated the occurrence to determine if there were broader lessons for the aircraft type.

“In contrast, the Kybong mid-air collision was an operational event, involving an RA-Aus registered kit plane manufactured in the Czech Republic, and a VH-registered–but unpowered–glider, which was also not designed or manufactured in Australia.
"Neither of these aircraft therefore fall under the ATSB’s standard remit for investigation.

"The ATSB would only investigate accidents such the Kybong mid-air collision on an exception basis, as its resources permit, where conducting such an investigation has the potential to highlight wider safety issues."

Maxine Milera, acting CEO of RAAus, told members that the investigation into the Gympie crash would instead be down to the Queensland Police despite the organisation's direct approach to the ATSB.

"On Thursday I spoke to the ATSB Chief Commissioner to convey that RAAus would like the ATSB to independently investigate the accident, however, I was informed they would not." Milera wrote in a communique to members on 12 November.

"The Queensland Police will therefore conduct the investigation in order to provide information to the Queensland Coroner. RAAus will continue to support the Queensland Police with their investigation."

Angus Mitchell said that the ATSB would support recreational accident investigations conducted by sport aviation bodies when possible.

“Sport aviation bodies conduct their own investigations into accidents involving their members' aircraft. Where requested and as resourcing permits, the ATSB may assist sport and recreation aviation organisations' investigations through providing technical assistance, such as a metallurgical examination of aircraft components or data recovery.

“Investigator representatives from recreational aviation organisations are also able to attend the ATSB’s transport safety investigator graduate certificate course, which is delivered jointly by the ATSB and RMIT University.

“The ATSB continues to empathise with the next of kin who have lost loved ones in this accident and are seeking answers as to how the accident occurred.”

UFB! - 

Hmm...so where in the SoE does it state anything like "Thou shalt not...investigate recreational aircraft fatal midair accidents...especially if the aircraft involved are a kit plane made in the Czech republic and a unpowered, foreign manafactured glider -   
  
All the SoE says is this:

"..(b) give priority to transport safety investigations that have the highest risk or potential to deliver the greatest public benefit through systemic improvements to transport safety;.."

The current SoE also says:

..I expect the ATSB to perform its functions consistent with Australia's international obligations where appropriate, including the requirements of the International Civil Aviation Organization.

I also expect the ATSB to implement any recommendations of the Australian National Audit Office and continue to work towards the timely finalisation of investigations to support continuous improvement in transport safety...

Over on the 'search 4 IP' thread we will continue to prosecute the case that neither of the above promised commitments and findings from both the ANAO and ICAO audits (by 1st HVH and now Popinjay) have been honoured. In fact IMHO there is now overwhelming evidence of the key performance issues (highlighted in both audits) as having worsened since 2017-18.       

MTF...P2 

PS Quote from this week's LMH:

..So many forceful opinions expressed in aviation have finished with the epithet "it's only a matter of time before someone gets killed." They're not always right, but sometimes that is in fact the tragic truth that follows a long-expressed fear. Glider operators at SE QLD glider havens like Kingaroy and Gympie have been worried about the potential for a mid-air collision for some years. This year, it happened. Two people dead. Queensland Police and RAAus will head-up the investigation after the ATSB decided it was not within their sphere of interest, and we should wait for the final report as if the ATSB were conducting it before making our own declarations about what happened. But I will say this: the glider community has been fearful of a mid-air because of poor radio and circuit entry practices from powered pilots who seem to be either oblivious to glider ops, or not professional enough to take them into account. We can't say definitively that this is what happened near Gympie. We can say that the investigators will be taking a close look at why such fears have been held for so long..

Hmm...sounds like there are some potential serious systemic issues here?? 

"..(b) give priority to transport safety investigations that have the highest risk or potential to deliver the greatest public benefit through systemic improvements to transport safety;.."

[Wombat]

This is another disgrace. i say "another" because the police seem to suffer from "juristictionitis"

Case in point: A trike pilot who conducted a low level aerobatic display over water on a Victorian lake - watched by a dozen or so boats. he had his beautiful young niece as passenger.The number of aviation regulations broken was huge.

The inevitable happened and the rotax ran dry. over water The pilot was rescued suffering from no more than hypothermia, the niece drowned still strapped in.

The divers reported her features were frozen in a look of terror. The high end trike was undamaged apart from water impact and the prop was most definitely stationary when it hit.

No CAA investigation, no ATSB. Nothing heard from RAA.

The pilot, who has "form" from previous drug related escapades, is now , I'm told, living in Queensland. shacked up with his ex wife. Meanwhile people get 2 + years for manslaughter and this prick is still walking around scot free. The nieces family virtually disintegrated and some left the district.

[Sandy Reith]

All can be traced back to the fact that the ATSB, having been hived off and out of direct Ministerial control by Albanese in 2009, has no imperative to conform to Statements of Expectations.

Similarly CASA and Air Services.

If Parliament would put some teeth into the SoE system, say, make Statements of Directions, or far better put these instrumentalities into Departments of Government where they should be, then might we see some improvements.

[Kharon]

Both a blessing and a Curse.

Quick whip around question:- how many times have you, as a pilot, actually had to actively arrange separation between your aircraft and a glider? Odds on bet - “not too many”  (if at all) would be the answer. Bankstown was for many years a very busy aerodrome; next door to Camden another busy port, which also hosted a fair squadron of gliders. Yet the number of recorded 'conflicts' is very low. Across the country, the same ratio applies. One could, reasonably, add in parachute operations, essentially the same type of activity, bodies descending from altitude, no radio heading back to the airfield. When such operations are being conducted; as at sea, power gives way to sail (more or less). The National Maritime College have some excellent, common sense material which makes 'right of way' very clear. The 'Brits' have (or had) an excellent course and examination known as 'the Lights Paper' (100% pass required) which taught and tested ' airborne conflict and collision avoidance'. In short, in the air, on the water, even on the roads it must be absolutely clear and easily understood - who has right of way.

Much depends, in primus, on some form of 'sighting' – one must know where the opposition is; easy as on the road; not too difficult at sea – but airborne: that, is often an entirely different matter. But I digress...

Consider two items; one, the reduction in GA flight hours over the last say two decades. Two – the incidence of GA  mid-air collisions; outside controlled air. It is a strange ratio. In a very short space of time, we have had two fatal mid-air collisions; six deaths and four aircraft lost, despite the 'ratio'. Very Serious Stuff.

W. B. Popinjay.    “In contrast, the Kybong mid-air collision was an operational event, involving an RA-Aus registered kit plane manufactured in the Czech Republic, and a VH- registered–but un powered–glider, which was also not designed or manufactured in Australia. "Neither of these aircraft therefore fall under the ATSB’s standard remit for investigation.” -

Aye well; that may be dismissed out of hand for the Bollocks it is; whatever the motivation to speak such dribble. The bit that 'gets my goat' is that there are some valid, sensible reasons for ATSB not to become involved – unless invited. RA Oz has (or claims to have) qualified investigators; RA Oz is an autonomous, self governing, self administering body; and, have a remit to do their own 'investigation' alongside a 'safety' obligation. The Qld police have an excellent crash investigation crew and record; and, have done much good work over the years. Of the Gliding Federation 'investigation' powers and ability I am uncertain. No matter; had ATSB come out and said that it was happy to assist any of these bodies with the task, but would not become directly involved until asked; I doubt anyone would object. But to trot out the rubbish published – well. Really?

Passing strange it be; oodles spent on routine matters like a bird strikes without a skerrick of 'advice'. I know there is a long list of time and money wasted while providing little in the way of anything worth the costs; or anything that actually improved 'safety'. That business in Tasmania – the investigation elevated to 'systemic' – why?  The ATR incident which should have been a very serious investigation and escalated to 'systemic'  – poof – nothing to see here:: really? I could go on, it is an extensive list.

ATSB have lost their way; lost their credibility, lost any respect earned along with a bunch of their marbles. Beaker an amiable half wit; Hood an incorrigible spin doctor and our latest 'guru', five minutes into his watch has the whole world shaking its head in disbelief.  Believe it or not -  don't care. BUT this little man, this rescuer of paddling Kangaroos' with many other follies and foibles will bring great changes to the ATSB. He'll bugger it up so badly and completely that even the government will be forced to act, sort it out and return it to the same level of sanity AMSA have managed to provide for decades.

My brothers and comrades in exile stand firm on this – he, the Popinjay is the final straw - he has to go; now would be good. ..-. -.. …  Amen...

Toot – toot.....

[Kharon]

Australian Flying – from Hitch.

Hitch - “It's hard to blame RAAus for bailing out on fatal accident investigations. At first read this looks like an ASAO shirking their responsibilities, but if you go deeper into it, you'll find a lot more.

Good point; and to the 'innocent' mind it would seem fair enough, even a good idea. But to other minds, in say a legal brawl, the first argument any competent opposition would launch would be along the lines of - “the foxes investigating a chook shed slaughter”.

Hitch - “Like many others, I frowned when RAAus declared that accident investigations weren't a "core activity", but then realised that an ASAO is an administrative organisation not unlike CASA, and CASA isn't the lead organisation in accident investigation either.

Fair call; at first glance. But, despite CASA being at 'arms length' from the ASAO it was they who signed off on the approvals – all the approvals. If a flaw was uncovered in the 'operating system' then, if push came to shove, any holes in the knitting could, and probably would cause, at very least, some headaches and awkward questions.

Hitch - “Accident investigation is solely the domain of the Australian Transport Safety Bureau (ATSB), which is the way it should be. The sort of accidents that plague recreational aviation are the same ones that plague VH- registered aeroplanes, and so the causes and contributing factors are very similar if not exactly the same.

Correct; the intriguing element is the casual use of the word 'accident'. After any sort of 'prang' or bingle' particularly when death or property damage is involved; the insurance companies become involved: deeply involved. Take a few moments to read through this article – HERE -. Food for thought and explanation of why the ATSB and only the ATSB should investigate and produce a report..

Hitch - “The problem is not so much one of the registration on the side, but the fact that there are so many accidents and incidents in aviation that the ATSB doesn't have the budget to look at them all.

OK; but these events are 'scale-able'. Wheels up landing? Insurance job. Lost control on landing – insurance; VFR crashed into a mountain in IMC – does that really need much more to be said? From an operational POV – yes; lots and much more; but from the 'legal' standpoint – with / without passengers involved – that will probably end up in court; after the coroner. BUT – the next part will depend very much on the unbiased  report provided by an 'independent' agency i.e. the ATSB. Where any sort of 'blame' and liability are involved; the ATSB report is a critical, must have, unimpeachable, independent document. In short; once any accident becomes 'fatal' – it goes 'legal' and the ATSB investigation is a core element from then. Budget is a poor excuse; air safety is, we are often told, paramount. There are savings and efficiency options available to the ATSB – and they can always say “Please sir, I want some more'....

Hitch - “They were relying on RAAus to do their own under their own budget. This ramped-up the risk for RAAus given that they have no protection under the Transport Safety Investigation Act they way the ATSB does. With RAAus demurring on leading fatal accident investigations, it falls to the state police and coroners to decide what happened, which is unlikely to lead to a safety outcome as much assigning blame. The only answer is for the Federal Government to properly fund the ATSB so we can learn more from every accident that happens, not just the VH-registered ones.

Hear, hear: but first there must be a long hard look taken at what the ATSB is 'supposed' to be and do. Look back to Pel-Air; the ATR; Essendon; the Conquest in SA Par Avion in Tasmania and many many other 'reports' which took far too long and provided little except for top cover for CASA and little else that mattered. The MoU needs to be destroyed, ATSB must be independent of all external influence. Dolan began the decline; Hood made certain the rot set in and now we have a new face at the helm; the jury is still out on that face – but the auguries are not good. He seems more interested in capturing the OTSI budget and building an empire – than two dead when Gliders mix it with powered aircraft. Far removed from the BASI 'vision splendid'. BASI was a world class outfit – gold plated – what has morphed from the ashes of that once fine, highly esteemed operation is almost beyond contempt; almost..

Cheers Hitch, well said..(Choc Frog).

Toot – toot.

[Sandy Reith]

Karon:-“ ATSB must be independent of all external influence.”
Rightly so except it should be within a Department of Government as a special unit just as it was forever until in 2009 Minister Albanese declared it shouldn’t be subject to politics and shoved out of his department to become yet another rudderless creature of the Can’tberra bureaucracy. Yes I hear that it shouldn’t be a matter of party politics but, for all the faults, all of government is subject to “politics.” Someone has to call the shots and, at times, demand of the ATSB value for the taxpayer dollar and for the edification of the aviation community.
The ATSB being pushed off, just as was the independent CASA in 1988, quickly showed the same malaise as our much venerated CASA and that other independent government monopoly business, and paragon of cost saving efficiency, Air Services Australia.

[Peetwo]

Mid-Air 'learnings'?? -   

Ref: Popinjay's bizarre 'no learnings' mantra continues on Gympie midair??

STATEMENT FROM ATSB CHIEF COMMISSIONER ANGUS MITCHELL

In accordance with long-established government policy, the ATSB is funded and directed to prioritise its resources on transport safety investigations that have the potential to deliver the greatest public benefit through systemic improvements to transport safety, and would only investigate accidents involving recreational aviation aircraft on an exception basis where a particular third-party risk is identified.

In the Kybong mid-air accident, both aircraft were operating in non-controlled airspace. Procedures for operating in non-controlled airspace are long established, mid-air collisions in uncontrolled airspace are rare, and any ATSB transport safety investigation would be unlikely to yield new safety learnings for the aviation industry.

The ATSB notes that the self-administration arrangements for the recreational aviation sector specifically provide for self-administration bodies to undertake accident investigation, and that the safety learnings from accidents in the sector are usually limited because the causal factors are generally well-understood. 

Where requested and as resourcing permits the ATSB may assist sport and recreation aviation organisations’ investigations through providing technical assistance, such as a metallurgical examination of aircraft components or data recovery.

Investigator representatives from recreational aviation organisations are also able to attend the ATSB’s transport safety investigator graduate certificate course, which is delivered jointly by the ATSB and RMIT University.

The ATSB empathises with the next of kin who have lost loved ones in the Kybong accident and are seeking answers as to how the accident occurred.

-- END

Ironically (in a parallel universe) the Flight Safety Detectives, in their latest episode, discuss the learnings of the NTSB's final report into a midair fatal accident...

See & Avoid – Episode 144
December 7, 2022/in Episodes /

“See and Avoid” is widely recognized as a method for avoiding collision. This accident shows that approach has limits.

The term “See and Avoid” is part of Federal Aviation Administration (FAA) Regulation 14 CFR Part 91.113 (b), calling for pilots to actively search for potentially conflicting traffic. John and Todd discuss a 2014 accident where two planes crashed because they were not able to see one another in time.

The accident involved a Cessna 172 and a Searey homebuilt participating in a Experimental Aircraft Association Young Eagles program. The Cessna was overtaking the Searey as it descended and the two collided. Two people in the Searey were able to land. The Cessna crashed and the passenger and student onboard died.

The NTSB probable cause cited failure to “see and avoid.” The Flight Safety Detectives explore the importance and limitations of relying on being able to see everything from the cockpit. They discuss how better preplanning by the two pilots involved could have avoided the collision.

Related documents:

NTSB Final Report (PDF)

 
 
Next the following TSBC Final Report into a midair accident between a glider and a tug was bought to my attention (with comments) by a fellow IOS/BRB member... :

I thought the ATSB benchmark themselves with the Canadians?? They spruke that to the ANAO, yet there's this...!

https://www.tsb.gc.ca/eng/rapports-repor...w0099.html

Safety messages

In this occurrence, there was no procedure to follow if visual contact was lost after the tow was released. It is important that operators have procedures in place for the safe operation of their aircraft, and that personnel follow those procedures.

Neither pilot saw the other aircraft in time to avoid a mid-air collision, partly owing to the inherent limitations of the see-and-avoid principle. Relying solely on visual detection increases the risk of collision while in uncontrolled airspace. Pilots are encouraged to broadcast their intentions to maintain the situational awareness of other aircraft.

Airborne collision avoidance systems (ACAS) offer the potential to significantly reduce the risk of mid-air collisions. If an aircraft is equipped with an ACAS, it is important that the system be maintained in a serviceable condition.

This report concludes the Transportation Safety Board of Canada’s investigation into this occurrence. The Board authorized the release of this report on 05 February 2020. It was officially released on 10 February 2020.

This report is the result of an investigation into a class 4 occurrence. See the Policy on Occurrence Classification.

To make it worse, there's lots more gliding investigations in Canada!

Hmm...definitely no learnings here - FFS! 

MTF...P2 

[Peetwo]

Popinjay to the rescue with tragic Appin Glasair crash??- 

Via Illawarra Mercury:

Chief Commissioner of the Transport Safety Bureau Angus Mitchell addresses the media after the fatal plane crash at Appin on Boxing Day.

Video by Rosie Bensley

Also via the other Aunty: https://www.abc.net.au/news/2022-12-27/i.../101809910

Hmm...perhaps shades of his predecessor HVH but why the hell is Popinjay being the media front man to this accident?

..Mr Mitchell said it had been a particularly tragic Christmas for a number of families after his team were called out to another fatal small plane crash.

"This is the second fatal aircraft accident we have deployed to in as many days," he said.

"Unfortunately this year has been one of the worst years on record for light plane fatalities, we're up to 23 fatal accidents this year."

I totally agree with the decision for the ATSB to investigate this accident. Maybe the penny has dropped with Popinjay that the ATSB has some serious credibility issues in regards to the inconsistencies in prioritising aviation accident investigation and the fact they now have a mini epidemic occurring in fatal light aircraft accidents?

Remember that Popinjay said this in relation to refusing to investigate the Gympie midair collision accident:

“We understand the perceived inconsistency regarding the ATSB’s response to these occurrences, and I welcome this opportunity to clarify these decisions, which are in line with our Ministerial Statement of Expectations," he said.

“The propeller loss occurrence related to the manufacture, design and/or maintenance of the aircraft itself. As Australia is the state of design and state of manufacture for the Jabiru aircraft, and there are aircraft of the same type on the VH register, and operating overseas, the ATSB investigated the occurrence to determine if there were broader lessons for the aircraft type.

“In contrast, the Kybong mid-air collision was an operational event, involving an RA-Aus registered kit plane manufactured in the Czech Republic, and a VH-registered–but unpowered–glider, which was also not designed or manufactured in Australia.

"Neither of these aircraft therefore fall under the ATSB’s standard remit for investigation.

Let's unpack that? To begin we all now that Popinjay's reference to the Ministerial SoE is a furphy and in reality if the ATSB required extra funding to conduct investigations into an unforeseen series of fatal light aircraft crashes then the Minister of the day will facilitate that funding:

I expect that in performing its functions, the ATSB will provide timely advice to Government when the costs of necessary investigation activities are likely to exceed established ATSB budget levels, so that consideration can be given to the need for budget supplementation.

I expect that the Chief Commissioner will keep the Secretary of the Department of Infrastructure, Transport, Regional Development and Communications (Department) and myself informed of the ATSB's actions in relation to the requirements stated in this SOE and promptly advise about any events or issues that may impact on the operations of the ATSB, including through the provision of timely quarterly progress reports against the Corporate Plan and this SOE.

I expect the ATSB to perform its functions consistent with Australia's international obligations where appropriate, including the requirements of the International Civil Aviation Organization.

 

Next the bollocks statement about the Jabiru accident..

"..As Australia is the state of design and state of manufacture for the Jabiru aircraft, and there are aircraft of the same type on the VH register, and operating overseas, the ATSB investigated the occurrence to determine if there were broader lessons for the aircraft type.."

Hmm...so why has Popinjay refused to investigate the Caiguna Jabiru fatal accident? Popinjay flips the bird (again) at RAAus Pilot fatal

Finally..

"..involving an RA-Aus registered kit plane manufactured in the Czech Republic, and a VH-registered–but unpowered–glider, which was also not designed or manufactured in Australia..."

Hmm...so what's the difference here?

IMO it's high time that the Government legislated that any fatal or serious injury aviation accident shall be at least preliminary investigated IE to a 30 day prelim/interim report &/or discontinue statement.

MTF...P2 

[Peetwo]

Popinjay to the rescue: Part II 

In search of further details of the NT and Appin fatal crashes, I note that as yet there has been no accident occurrence (AO-****-***) numbers issued for both these investigations: Refer - https://www.atsb.gov.au/aviation-investigation-reports.

To be fair this is probably because most of the office staff normally responsible for inputting these notifications are on Xmas/New Year leave.  

However Popinjay (again to the rescue) did issue two media releases on the 26th with some limited details about both these tragic accidents:    

Appin NSW aircraft accident

Released: 26 December 2022

The following statement can be attributed to ATSB Chief Commissioner Angus Mitchell:

“The Australian Transport Safety Bureau (ATSB) has commenced an investigation into a collision with terrain involving a foreign registered Glasair Super II aircraft near Appin, NSW which occurred shortly before 3.00pm on Monday.

“The aircraft came down in bushland in the vicinity of Appin Road, where on-site emergency services confirmed the two occupants on board were deceased.

"A team of transport safety investigators from the ATSB's Canberra and Brisbane offices are deploying to the accident site to commence the on-site phase of the investigation.

"The initial ATSB safety investigation will include an examination of the wreckage, assessment of aircraft and pilot records, weather information and any available recorded data.

"The ATSB’s evidence collection will define the size and scope of the investigation and determine the expected timeframe for the completion of a final report.

“The ATSB asks anyone who may have seen the aircraft in any phase of its flight, or who may have footage of any kind, to please make contact via our website - www.atsb.gov.au/witness

"A report will be published at the completion of the investigation. However, should a critical safety issue be identified during the course of the investigation, the ATSB will immediately notify relevant parties."

// Ends

NOTE: The ATSB will not be providing any further statements in relation to this accident until the release of the preliminary report in about 6 - 8 weeks time.



Background: The ATSB, Australia’s national transport safety investigator, conducts 'no blame' aviation, rail and marine transport safety investigations to help prevent the occurrence of similar future accidents.

The ATSB does not investigate for the purpose of taking administrative, regulatory or criminal action. Details on the ATSB’s investigation process can be found here: http://www.atsb.gov.au/about_atsb/investigation-process

Date
26/12/2022

And:

Arnhem Land aircraft accident

Released: 26 December 2022

The following statement can be attributed to ATSB Chief Commissioner Angus Mitchell:

"The Australian Transport Safety Bureau (ATSB) has commenced an investigation into a collision with terrain involving a Cessna 210N single-engine light aircraft near Bulman, Northern Territory about 240 km north-east of Katherine.

"The flight, with a pilot and one passenger on board, was reported missing to authorities after the aircraft failed to arrive at its Katherine destination on Christmas Eve.

"A search, coordinated by the Australian Maritime Safety Authority, located the aircraft in the afternoon on Christmas Day with a debris field scattered over a large distance. Both occupants were confirmed deceased by Northern Territory Police.

"A team of transport safety investigators from the ATSB's Brisbane and Canberra offices are preparing to deploy to the accident site where they will commence the on-site phase of the investigation.

"Given the remote location, the ATSB is liaising with Northern Territory Police to determine the best way for investigators to access the accident site over the coming days.

"The initial ATSB safety investigation will include an examination of the wreckage, assessment of aircraft and pilot records, forecast and actual weather information, and any available recorded data.

"The ATSB’s evidence collection will define the size and scope of the investigation and determine the expected timeframe for the completion of a final report.

"A report will be published at the completion of the investigation. However, should a critical safety issue be identified during the course of the investigation, the ATSB will immediately notify relevant parties."

// Ends

NOTE: The ATSB will not be providing any further statements in relation to this accident until the release of the preliminary report in about 6 - 8 weeks time.



Background: The ATSB, Australia’s national transport safety investigator, conducts 'no blame' aviation, rail and marine transport safety investigations to help prevent the occurrence of similar future accidents.

The ATSB does not investigate for the purpose of taking administrative, regulatory or criminal action. Details on the ATSB’s investigation process can be found here: http://www.atsb.gov.au/about_atsb/investigation-process

Date
26/12/2022

Hmm...this bit?? "..The ATSB will not be providing any further statements in relation to this accident until the release of the preliminary report in about 6 - 8 weeks time..."

Umm...so what the hell was Popinjay doing yesterday?? Plus we now get a further confession from Popinjay that the ATSB no longer adheres to ICAO Annex 13 SARPs...  :

Dispatch

7.4 The Preliminary Report shall be sent by facsimile, e-mail, or airmail within thirty days of the date of the accident unless the Accident/Incident Data Report has been sent by that time. When matters directly affecting safety are involved, it shall be sent as soon as the information is available and by the most suitable and quickest means available

While on the subject of Annex 13, I note that Popinjay says this in regards to the Appin Glasair fatal accident: “The Australian Transport Safety Bureau (ATSB) has commenced an investigation into a collision with terrain involving a foreign registered Glasair Super II aircraft near Appin, NSW which occurred shortly before 3.00pm on Monday..." 

Not confirmed as yet (ATSB has no details officially published yet??) but word is that the Glasair was "N" registered IE A USA FAA registered aircraft.

This means that Annex 13 para 5.18 comes into play:

Rights

5.18 The State of Registry, the State of the Operator, the State of Design and the State of Manufacture shall each be entitled to appoint an accredited representative to participate in the investigation.

This should automatically mean that the US NTSB should be invited to participate in this investigation, much like the NTSB did for the ATSB (State of Manufacture) with this accident investigation :

Accredited Representative to the NTSB - Collision with terrain involving an Arion Lightning aircraft, registered N60MY, near Zamperini Field Airport, California, United States on 30 November 2022



Summary

On 30 November 2022, at 1315 Pacific Standard Time (2115 Coordinated Universal Time), an Arion Lightning aircraft, registered N60MY, departed controlled flight on approach to Zamperini Field and collided with terrain short of the runway. The two occupants were fatally injured.

The US National Transportation Safety Board (NTSB) is investigating this occurrence. As Australia was the State of Manufacture of the engine, the NTSB requested appointment of an Accredited Representative from the ATSB.

To facilitate this request, the ATSB as the Accredited Representative has initiated an external investigation under the provisions of the Transport Safety Investigation Act 2003.

Perhaps this is another reason why Popinjay made a personal appearance to the Appin crash? 

Finally from the UP I note the following post by Cloudee:

Media reports a witness saying the aircraft was revving out of control and not climbing. Another report that the aircraft had a Subaru engine. Aircraft fitted with Subaru engines that I have seen have had belt driven reduction gearboxes.

If this aircraft had a similar set up, a belt failure would result in symptoms reported by the witness.

https://www.aap.com.au/news/doomed-sydne...ental-kit/

https://7news.com.au/news/disaster-and-e...-c-9285544

Personally I hope the NTSB and the FAA do send some accredited reps to this AAI - 

MTF...P2 

[Peetwo]

Appin crash update: 30/12/2022

Still no notified AO (aviation occurrence) investigation number on the ATSB aviation accident webpage and therefore no further details/known facts, pilot details etc..etc

However the Kathryn's report has published some basic details (copied and pasted from a ABC article):

The Australian Transport Safety Bureau (ATSB) Chief Commissioner Angus Mitchell says the investigation has begun.

Investigators are probing how a experimental aircraft crashed killing two on board in Sydney's south-west on Monday, as one of the worst years for light plane crashes draws to a close. 

The Australian Transport Safety Bureau (ATSB) Chief Commissioner Angus Mitchell said his crew had just arrived at the bushland crash site near Appin Road. 

The plane came down on Monday, when emergency services responding to reports of a scrub fire confirmed the two fatalities. 

Pilot Leigh Cunneen, 67, and his passenger, Steve Donoghue, 68, died in the crash.

"It's not a mass-production aircraft it was built essentially from a kit we know it came initially registered from the US," Mr. Mitchell said. 

"How many years it's been out here in Australia we are yet to determine.

"It's what we refer to as an experimental aircraft."

Initial inquiries suggest the aircraft took off from Temora in the state's Riverina region, according to NSW Police.

The foreign-registered  Stoddard-Hamilton Glasair Super II FT collided with terrain shortly before 3pm on Monday. 

Safety investigators were sent to the scene to examine the wreckage of the single-engine aircraft, flight information and weather conditions.

The crash sparked a 5-hectare bushfire that has since been extinguished.

Mr. Mitchell said it had been a particularly tragic Christmas for a number of families after his team were called out to another fatal small plane crash. 

"This is the second fatal aircraft accident we have deployed to in as many days," he said.

"Unfortunately this year has been one of the worst years on record for light plane fatalities, we're up to 23 fatal accidents this year."

Aviation expert Geoffrey Thomas said "do-it-yourself planes" are not uncommon, and are favored by sport enthusiast pilots.

"Are they as safe as a 747? No," Mr. Thomas said.

"They don't have all the electronics or landing aides or anything that a full-blown commercial aircraft has."

There have been 1,200 light-plane kits built in Australia in the last three decades.

The aircraft was severely damaged by the blaze, limiting the amount of physical evidence and electronic data for analysis.

Using a drone, the ATSB will map the site, creating a 3D picture to assist the investigators to better understand the flight profile of the aircraft just before the collision.

Investigators hope to recover any electronic equipment, such as iPhones and iPads, to help build a picture of what had occurred.

The ATSB said the available evidence would determine the size and scope of the investigation and the timeframe for completing its final report.

A report will be published after the investigation is completed, however should a critical safety issue be identified the ATSB will immediately notify relevant parties, Mr. Mitchell said. 

Transport safety investigators are expected to be at the site for at least the next few days, gathering evidence and interviewing witnesses.

Anyone who may have seen the aircraft, or has relevant footage, can contact atsb.gov.au/witness or Crime Stoppers by calling 1800 333 000 or visiting nsw.crimestoppers.com.au.

https://www.abc.net.au

---

Plus via 9 News:



A experimental aircraft crashed in Sydney's south-west killing two people on board initially registered for the United States, according to the Australian Transport Safety Bureau.

An ATSB investigation is now underway to determine why the Stoddard-Hamilton Glasair Super II FT crashed in thick bushland near a private airport near Appin Road at Appin in Macarthur at 3pm on Boxing Day.

Pilot Leigh Cunneen, 67, and his passenger, Steve Donoghue, 68, died in the crash.

Cunneen was an accountant and landlord from Annandale in Sydney's inner west and was well known for his love of aviation.

News of his death has rocked the neighborhood where the father of four lived his whole life.

One neighbor, David Gardner, said he saw Cunneen a few days ago.

https://www.9news.com.au

Also helpful was the Kathryn's report also provided a link for the FAA registration page for the Glasair aircraft - see HERE.

MTF...P2 

[Kharon]

Three 'mid-air' collisions in very recent history; all involving fatalities. Perhaps its time to bring back, brushed off and published some 'old school' advice, provided without spin or artifice, free of charge back when we actually had folk at ATSB who knew what they were supposed to be doing.. - Scroll down to  6 through 10 and compare the difference between today's waffle and yesterdays advice.

- HERE -.

10 - “Could it happen to me?”
Over a 10 year period, the Bureau of Air Safety Investigation has record ed over 1,000 break-down in separation occurrences. Of these, over 600 were in controlled airspace. For the 10years to 1989, BASI recorded 22 mid-air accidents. Five of these involved General Aviation aircraft operating in or near aerodromes and not engaged in display type flying.

[Peetwo]

Sea World midair update: 5/01/22

Unbelievable footage here, via Channel 7 news:

 

Next via the Oz:

Questions over Gold Coast helicopter crash pilot’s view

By JAMIE WALKER
ASSOCIATE EDITOR
@JamieWalkerOz and CHARLIE PEEL RURAL REPORTER @charliepeeled and MACKENZIE SCOTT REPORTER @MackenzieJScott
12:18PM JANUARY 4, 2023


Sea World Helicopters chief pilot Ash Jenkinson.

Crash investigators will consider whether the veteran pilot killed with three people in a mid-air helicopter collision at the Gold Coast had his view obstructed by passengers seated next to him.

The configuration of the downed $2.4m Eurocopter EC130 put Sea World Helicopters chief pilot Ash Jenkinson on the left of the cockpit, with the two people strapped in beside him potentially limiting his ability to see the oncoming chopper.

As Australian Transport Safety Bureau experts continued to comb the crash scene on Tuesday, the tragedy reached across the globe with the naming of the other victims as holidaying British couple Ron and Diane Hughes, aged 65 and 57 respectively, and Sydney woman Vanessa Tadros, 36, whose 10-year-old son, Nicholas, was critically injured.

The boy underwent his fourth round of surgery while the remaining passengers in Mr Jenkinson’s aircraft, Winnie De Silva, 33, of Geelong, and her son Leon, 9, were in a serious but stable condition.

The pilot and five passengers in the second Sea World helicopter escaped with minor injuries after the crippled machine was landed safely.

ATSB chief commissioner Angus Mitchell said the death toll would have been “far worse” had it not been for the skill of surviving pilot Michael James, who put the crippled chopper down on a sandbank in the Southport Broadwater, metres from the crushed wreckage of the other aircraft. It too was an EC130.

Mr Mitchell said the ATSB would pursue multiple lines of ­inquiry, including the weather, tasking of flights, how long the two helicopters had been operating on Monday and the time the pilots had spent at the controls.


Pilot Michael James walks away from, the wreckage.

“We have a reasonable understanding of what the two helicopters were doing … in those critical phases of flight,” he said. “But exactly why this occurred, what was the range of visibility from both the pilots, what was happening in the cabins at the time – they’re the things that will help us piece together potentially what may have been a contributing factor here.”

Queensland Police Commissioner Katarina Carroll said an open mind would be maintained on criminal charges, though it was early days in the investigation.

“All of the evidence will form part of the investigation and at the end of the day, there will be conclusions … and that (charges) may be the case,” she said.

The collision happened within 20 seconds of Mr Jenkinson lifting off one of the northernmost of three Sea World helipads on the Broadwater in sunny and near-cloudless conditions about 2pm with all six passenger seats filled.

The main rotor was torn off when the chopper struck the front left underside of the descending one, causing Mr Jenkinson’s aircraft to plummet to earth. Mr Mitchell said the altitude at which the crash happened was yet to be ­established but it would have been more than 200m.

With mechanical failure or the weather unlikely to have been ­involved, crash investigators would examine Sea World Helicopter’s procedures, communication lines between the pilots and factors that could have impeded their performance in the critical moments leading up to the head-on collision, aviation experts said.

Ron Bartsch of Avlaw Aviation Consulting and a director of ­regional carrier Rex Airlines said the cabin seating configuration would likely be looked into.

In the EC130, the “pilot is located in the left-hand seat and there is availability of two passengers to sit adjacent to that pilot,” he told the ABC. “So … that may have been a consideration in terms of what happened.”



Other factors such as potential pilot fatigue and workload would also form part of the investigation, aviation sources said. Civil Aviation and Safety Authority records show that in addition to the single-engined EC130s, Sea World Helicopters also operated two AS350 Squirrel helicopters.

In a 2021 interview with a blog published by aviation company Spidertracks, which makes a GPS locating system used by Sea World Helicopters, Mr Jenkinson, 40, indicated that the joy flight service often carried 600 passengers a day pre-Covid.

Assuming all four choppers were in the air on Monday, the height of the Christmas-New Year tourism peak on the Gold Coast, each machine would have made a minimum of three flights an hour on that basis. Tickets started at $69 a person for the popular family package of up to four adults and three children to take a five-minute sightseeing flight.

The volume of the traffic over the Broadwater had angered some residents, with the Main Beach ­Association campaigning for helicopters from Sea World to be redirected away from apartment buildings and parks.

CASA, however, was not aware of any change to flight routes in the unregulated airspace around the famed resort and theme park operated by the Village Roadshow group. “Helicopters flying under visual flight rules in non-controlled airspace are authorised to determine their own flight routes,” a spokeswoman for the regulator said.

Writing on the professional ­pilots’ blog PPRuNE on Tuesday, a correspondent claiming to be “on that part of the water frequently” said operations seemed to be “orderly and safe” on any given day.

“Tragically, what may have happened is a deadly cocktail of commercial pressure, complacency and long days of flying,” the person said. “Keep in mind this would have been one of the busiest days ever for this operation coming out of Covid with a 100 per cent fleet increase.

“The challenge was to get through as many flights in a day. The descending helicopter would have had the departing one on the left below it, thus obscured. The ­departing one likely would have been able to see the other one on his right and above, but with no ‘relative motion’ likely would not have been picked up in his peripheral vision.

“These guys do this dozens of times an hour so radio calls are likely to be perfunctory as all pilots expect they know what the others are doing. Throw in complacency from doing the job repeatedly day in day out and it’s a very tragic outcome.”

Sea World Helicopters did not respond to questions.

MTF...P2 

[Peetwo]

ATSB publish AO numbers finally - 

I guess the Popinjay admin crew are back to work, here is the last three AAI numbers with summary:

Ref:  https://www.atsb.gov.au/publications/inv...o-2022-068

Collision with terrain involving Stoddard Hamilton Aircraft Glasair Super II FT, N600, near Wedderburn, New South Wales, on 26 December 2022

Summary

The Australian Transport Safety Bureau (ATSB) has commenced an investigation into the collision with terrain involving a Stoddard Hamilton Aircraft Glasair Super II FT, registered N600, near Wedderburn, New South Wales, on 26 December 2022.

While operating in the vicinity of the Wedderburn airstrip, New South Wales, the aircraft collided with terrain. The two occupants were fatally injured and the aircraft destroyed by a post-impact fire. The investigation is continuing.

A final report will be released at the conclusion of the investigation. Should a critical safety issue be identified during the investigation, the ATSB will immediately notify relevant parties, so that appropriate safety action can be taken.

Note on the above, for some reason this investigation is yet to receive an 'investigation level' IE Short, Defined, Systemic etc..

Next:  https://www.atsb.gov.au/publications/inv...o-2022-067

Collision with terrain involving Cessna Aircraft Company 210N, VH-TFT, near Bulman, Northern Territory, on 24 December 2022

Summary

The Australian Transport Safety Bureau (ATSB) is investigating the collision with terrain involving a Cessna Aircraft Company 210N, registered VH-TFT, near Bulman, Northern Territory, on 24 December 2022

The aircraft collided with terrain and the two occupants sustained fatal injuries. The aircraft was destroyed. The investigation is continuing.

A final report will be released at the conclusion of the investigation. Should a critical safety issue be identified during the investigation, the ATSB will immediately notify relevant parties, so that appropriate safety action can be taken.

Finally: https://www.atsb.gov.au/publications/inv...o-2023-001

Mid-air collision involving two helicopters near Main Beach, Gold Coast, Queensland, on 2 January 2023

Summary

The Australian Transport Safety Bureau (ATSB) has commenced an investigation into the mid-air collision between VH-XKQ and VH-XH9 helicopters below 500 feet above ground level in the vicinity the Seaworld Helipad, QLD at about 1400 hrs EST on 2 January 2023.

VH-XKQ subsequently collided with terrain and VH-XH9 made an emergency landing. Four people were fatally injured, six sustained serious injuries, and four sustained minor injuries. The investigation is continuing.

A final report will be released at the conclusion of the investigation. Should a critical safety issue be identified during the investigation, the ATSB will immediately notify relevant parties, so that appropriate safety action can be taken.

I am glad to see that both of the above 2 AAIs (especially the Gold Coast Seaworld chopper midair) the investigation level is defined. This suggests that the evidence collected so far (at this stage at least) points towards a fairly straight forward investigation which should be concluded fairly promptly.

It is a concern however that with all three of the above investigations it was stated that the prelim report would be released in somewhere between 6 to 8 weeks time - WTD??

MTF...P2 

[Peetwo]

AO-2023-001 media update: 7/01/23

Via the Oz:

Hero chopper pilot leaves hospital as three remain, one critical

By ROBYN IRONSIDE
AVIATION WRITER
@ironsider
10:41AM JANUARY 6, 2023


Pilot Michael James has been released from hospital after the Sea World crash.

Hero chopper pilot Michael James has left hospital after Monday’s horrific mid-air crash on the Gold Coast, leaving three people including two children still in care.

Nicholas Tadros, 10, remains in a critical condition in the Gold Coast University Hospital still unaware his mother Vanessa died in the tragedy.

Leon de Silva, 9, is listed as stable in the Queensland Children’s Hospital after awaking from a coma yesterday and giving a thumbs up to his injured mother Winnie, in a video call.

Ms de Silva is also stable at the Gold Coast University Hospital after suffering multiple fractures in the crash.

Mr James who was hailed a hero after managing to land his helicopter following the collision, was released from hospital late Thursday along with two of his passengers, Elmarie Steenberg and Marle Stewart.

Ms Steenberg confirmed her involvement in the helicopter crash to Facebook friends on Wednesday, adding “thank you to God for sparing all of us”.

Four people in the other helicopter were killed, including Sea World Helicopters’ chief pilot Ashley Jenkinson, 40.

British couple Ron and Dianne Hughes also died, along with Ms Tadros.

Mr Jenkinson was taking off from the Sea World helipad as Mr James’ helicopter approached for landing in clear conditions on Monday afternoon.

Video footage released days after the deadly collision appeared to show passengers frantically trying to alert Mr James to the approaching danger, moments before impact.

The footage and numerous other recordings filmed by onlookers at Sea World have been provided to the Australian Transport Safety Bureau to assist with the investigation.

A preliminary report on the disaster is expected by the end of next month, with a final report now anticipated in the third quarter of 2024.

Investigators are expected to focus on Sea World Helicopters’ takeoff and landing procedures, and communication between pilots.

It was not unusual for pilots to undertake multiple sightseeing trips a day over the theme park and surrounds, some as short as 5-minutes duration.

Sea World Helicopters is closed until further notice, but the Sea World theme park is continuing to operate throughout the busy summer holiday period.

Clinton McKenzie, via the UP:

..And yet another tragedy arising from a collision between two aircraft in G. The pilots in command of the aircraft involved were the subject of the same rules of the air and see and avoid obligations as those to which the pilots in command of the aircraft involved in the collision near Gympie were subject.[/font][/color]

The rules of the air and see and avoid obligations do not distinguish between aircraft on the basis of whether there happen to be pax on board or not. A moment’s reflection reveals why: The aircraft don’t ‘know’ whether there are pax on board or not, the pilot of one aircraft wouldn’t necessarily know whether there happen to be pax on board another aircraft and, most importantly - a collision is precisely that: A collision to be avoided, no matter who or what is involved.

Either these collisions are “rare” “operational” events from which nothing new can be learnt, or they aren’t.

Quote:

But exactly why this occurred, the range of visibility from both the pilots, what was happening inside the cabins the time – they’re the things that will help us piece together potentially what may have been a contributing factor here. But it’s still very early stage in the investigation to start speculating.

Indeed, Mr ATSB. And precisely the same durr-obvious statement would be made in the wake of a collision between an RPT aircraft and a ‘light’ aircraft in the vicinity of an aerodrome in G. (Perhaps some investigation into who said what and who heard what on what frequency/ies could highlight a contributing factor, too...)

If ATSB is really concerned about “systemic improvements to transport safety”, ATSB should be investigating all mid-air collisions. ATSB can’t know if there’s a systemic problem which can be improved to the benefit of transport safety if the only mid-air collisions it’s going to investigate are those which coincidentally involve fare paying passengers.

MTF...P2

[Peetwo]

AO-2023-001 update - "Just the facts Juan!"  

Here is how it is done Popinjay: Juan (blancoliro) conducts a Youtube interim factual presentation of Sea World midair from the other side of the world...

ASN Wikibase Occurrence # 305478

Narrative:
Two Eurocopter EC 130B4 helicopters of Sea World Helicopters suffered a mid-air collision near Sea World Heliport (YSWD), Main Beach, Queensland.
VH-XKQ was departing Sea World Heliport when it was struck by the approaching VH-XH9 and it crashed nose down onto a sand bank and VH-XH9 made an emergency landing on the same sand bank with severe damage to the cockpit section.
Four of the seven occupants died and three received critical injuries. Five of the six occupants of the VH-XH9 received minor injuries by cockpit glass debris.

Ex PK-URR, ZK-IJV

---

LINKS:
ATSB: https://youtu.be/nSWILVsyrII
Flight Aware: https://www.youtube.com/watch?v=nSWILVsyrII&t=0s
Pprune thread: https://www.pprune.org/rotorheads/650560...st11363001

P2 comment: Note that the ATSB link provided (above) is for the ABC Youtube version of the Popinjay amateur hour press conference. A quick visit to the ATSB official Youtube channel and Facebook page shows that both the Appin and Gold Coast Popinjay press conferences were apparently not officially recorded by the ATSB??    

Compare that to this for the NTSB equivalent webpages - HERE & HERE.  

Next from 1NewsNz: https://www.1news.co.nz/2023/01/07/inqui...18-months/

..The Australian Transport Safety Bureau (ATSB) updated its website on Friday to state the anticipated date for completing its investigation was between July and September in 2024.

"A final report will be released at the conclusion of the investigation. Should a critical safety issue be identified during the investigation, the ATSB will immediately notify relevant parties, so that appropriate safety action can be taken," the bureau's website said.

The Australian National Audit Office 2019 report into the bureau's investigative efficiency found that it took an average of 19 months to produce a report on "complex" incidents.

ATSB Chief Commissioner Angus Mitchell has previously said that transport safety investigators with experience in helicopter operations, maintenance and survivability engineering had been deployed to the crash site from the bureau's Brisbane and Canberra offices...

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PS BOLO ALERT! - Popinjay MIA, last seen 1 week ago postulating in the vicinity of the Seaworld theme park:

     

[Peetwo]

AO-2023-001 update: Lawyer's Picnic??

Via the Oz:

Sea World helicopter crash a legal minefield for those involved



ATSB investigators examine the wreckage of one of the helicopters involved in a mid-air crash at Sea World on January 2. Picture: NewsWire / David Clark

By ROBYN IRONSIDE
AVIATION WRITER
@ironsider
9:31PM JANUARY 9, 2023
30 COMMENTS

The Sea World Helicopters crash could result in criminal charges against the company involved, and lead to changes in the way scenic joy flights are managed ­nationwide, aviation lawyers say.

Four people were killed in the horrific mid-air crash last Monday, including Sea World Helicopters chief pilot Ashley Jenkinson. British newlyweds Ron and Diane Hughes and Sydney mother Vanessa Tadros also died. Ms Tadros’s son Nicholas ­remains on life support in a critical condition at the Queensland Children’s Hospital.

The Australian Transport Safety Bureau is investigating the collision, which occurred as one Eurocopter took off from the Sea World helipad and another was descending to land. They were in “G” class airspace, which requires pilots to “see and be seen” and ­remain in regular radio contact.

Video taken by a passenger showed the incoming pilot apparently unaware of the proximity of the ascending helicopter ­moments before the crash.

Heavy demand for the five-minute joy flights in peak tourist season meant Sea World Helicopters was conducting as many as seven flights an hour.

AvLaw managing director and chairman Ron Bartsch said he expected flight and duty times would be examined closely by both the ATSB and Civil Aviation Safety Authority.

“Another aspect of the investigations will no doubt involve looking into the density and mix of traffic and a possible review of the classification of airspace to ­ensure it is appropriate,” Professor Bartsch said. “I expect they will examine the chief pilot responsibilities and workload as well.”

Any recommendations made by the ATSB would have industry-wide implications.

Aviation lawyers suggested a finding of “reckless navigation” under the Civil Aviation Act could result in criminal charges against Sea World Helicopters. Investigators could also find the company failed to follow its own safety management system in breach of regulations.

University of South Australia adjunct professor of law Rick Sarre said state workplace health and safety inspectors had the power to bring charges of criminal negligence, similar to what ­occurred at Dreamworld in 2016 after four people were killed on a ride. In that case, theme park owner Ardent Leisure was fined $3.6m after a coroner found “unjustifiable failings” in safety management at Dreamworld.

“If that occurs in the case of Sea World Helicopters, it will be the company rather than the (surviving) pilot who would be held ­liable,” Professor Sarre said.

Australian Helicopter Industry Association president Ray Cronin said the operators of ­scenic joy flights were already held to the same standards as airlines, and he did not expect any significant changes to regulation as a result of the Sea World crash.

Plus:

Lengthy legal battle awaits Sea World chopper crash survivors


Emily and Bobby Sheets, survivors of the fatal Whitsunday Air Services helicopter crash in 2018, are still fighting for compensation in court five years later.

    By ROBYN IRONSIDE
    8:32PM JANUARY 10, 2023

Survivors of the horrific Sea World Helicopters’ crash face a lengthy legal battle for compensation under what aviation lawyers say is flawed legislation.

The Civil Aviation (Carriers Liability) Act applies to the vast majority of aircraft crashes in Australia, and caps compensation at $925,000.

Although that figure might appear substantial, for people who suffer permanent injuries, ongoing psychological trauma and an inability to work, the money does not stretch far, particularly after legal fees are subtracted.

In the case of Sydney father Jay Stevens, the funds barely covered his medical expenses when he was left a paraplegic after a scenic helicopter flight over Uluru crashed in 2018.

Although he sought uncapped damages under common law for his injuries, the court found the Civil Aviation (Carriers Liability) Act applied, severely restricting any pay out.

Survivors of another helicopter crash at Hardy’s Reef in the Whitsundays, Emily and Bobby Sheets, were still fighting for any compensation five years after the incident.

Emily’s mother Susan Hansel died when the helicopter operated by Whitsunday Air Services missed a pontoon and plunged into the sea, along with Susan’s husband Peter Hansel.

Despite the Australian Transport Safety Bureau investigation finding pilot error was the main contributing factor to the crash, Whitsunday Air Services was vigorously defending the couple’s claim for compensation on the basis they were not seriously injured.

AvLaw Aviation Consulting founding director and chairman Ron Bartsch said there was strict liability or no fault liability under the Act, meaning that negligence did not have to be proven.

But insurance companies and operators still strenuously defended claims for damages, drawing out the process and making it very difficult for the victim.

“This means that a proportion of any damages is eaten up with legal costs,” said Professor Bartsch.

He said the Act was well overdue for amendment to address shortcomings such as the matter of psychological injury.

“If it’s too difficult to sue an aircraft operator and there are very limited rights of recovery then this is acts as an impediment to incentivising operators to maintain their safety standards in this context,” Prof Bartsch said.

Under the Act, psychological injuries such as post traumatic stress disorder (PTSD) were not recognised, unless it could be proven that mental trauma had resulted in physical injury.

Lawyer Ros Everett came close to having PTSD recognised as a physical injury when she was able to show neural pathways in the brain of nurse Karen Casey changed after a plane crash off Norfolk Island in 2009.

The NSW Supreme Court found in favour of Ms Casey but the ruling was appealed by operator Pel-Air and Ms Everett said they were left with no choice but to settle.

“This law is just so difficult to navigate,” said Ms Everett.

“I would’ve loved to have run the case all the way to get a definitive ruling that PTSD does constitute a physical injury but if we’d lost Karen would’ve been stuck with their legal bill.”

More than a week after the Sea World Helicopters’ crash, three of the ten people injured in mid-air collision remain in hospital.

Nicholas Tadros, 10, is listed as critical but stable in the Queensland Childrens’ Hospital. Nine-year-old Leon de Silva and his mother Winnie are both stable but face several more weeks of hospital treatment.

Four people were killed in the crash including chief pilot Ashley Jenkinson, British newlyweds Ron and Diane Hughes, and Nicholas’ mother Vanessa.

The Australian Transport Safety Bureau is investigating the crash which occurred in clear conditions about 150m above ground as one helicopter took off and the other was coming into land.

An update on the investigation is expected by the end of February, with a final report due late next year. 

Under the Act, psychological injuries such as post traumatic stress disorder (PTSD) were not recognised, unless it could be proven that mental trauma had resulted in physical injury.

Lawyer Ros Everett came close to having PTSD recognised as a physical injury when she was able to show neural pathways in the brain of nurse Karen Casey changed after a plane crash off Norfolk Island in 2009.

The NSW Supreme Court found in favour of Ms Casey but the ruling was appealed by operator Pel-Air and Ms Everett said they were left with no choice but to settle.

“I would’ve loved to have run the case all the way to get a definitive ruling that PTSD does constitute a physical injury but if we’d lost Karen would’ve been stuck with their legal bill.”

More than a week after the Sea World Helicopters’ crash, three of the ten people injured in mid-air collision remain in hospital.

Nicholas Tadros, 10, is listed as critical but stable in the Queensland Childrens’ Hospital. Nine-year-old Leon de Silva and his mother Winnie are both stable but face several more weeks of hospital treatment.

Four people were killed in the crash including chief pilot Ashley Jenkinson, British newlyweds Ron and Diane Hughes, and Nicholas’ mother Vanessa.

The Australian Transport Safety Bureau is investigating the crash which occurred in clear conditions about 150m above ground as one helicopter took off and the other was coming into land.

An update on the investigation is expected by the end of February, with a final report due late next year.

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