[Peetwo]

Final Report on fatal crash of Cessna VH-HWY.

Ref: https://www.atsb.gov.au/publications/inv...-2017-102/

What happened


On 23 October 2017, a charter flight operated by Air Frontier using a Cessna C210L aircraft, registered VH-HWY (HWY), was tasked to transport a coffin with a deceased person from Darwin Airport to Elcho Island, Northern Territory. There were two pilots on board – the supervising pilot in command in the right seat and the pilot in command under supervision on the left. After departing Darwin at 1307 CST, the left seat pilot requested air traffic control (ATC) for a 5 NM diversion left or right of track to avoid adverse weather. The aircraft was cleared to divert right of track, and to climb to 9,500 ft. After four minutes, ATC asked whether further track diversions were required; first 10 NM, then 20 NM, which were accepted.

At 1332, the aircraft entered an uncontrolled descent before it collided with terrain. The pilots were fatally injured and the aircraft destroyed.

What the ATSB found

Shortly after VH-HWY diverted to avoid adverse weather, the aircraft entered an area of strong convective activity and rapidly developing precipitating cells, which resulted in it experiencing severe turbulence and possibly reduced visibility for the pilots. While flying in these conditions, a combination of airspeed, turbulence and control inputs probably led to excessive loading on the aircraft’s wings, which separated from the fuselage in-flight before it collided with terrain.

The ATSB found that the pilots had no experience flying in the ‘build-up’ to the wet season in the Darwin area. Although pairing a supervisory pilot with a pilot new to the company was likely to reduce risk in other instances, in this case it did not adequately address the weather-related risks because neither pilot had experience flying in the region during the wet season.

Safety message

Recognising and avoiding tropical weather conditions that present significant hazards to flight can be particularly challenging for pilots without operational experience in the tropics. Knowing how to reduce the risk, including the appropriate distance to keep away from thunderstorms and cumulus clouds predominantly comes through exposure to those conditions. In many cases, deviations of 10 NM to avoid phenomena like towering cumulus clouds may not be sufficient.

Pilots are encouraged to use all available resources to avoid adverse weather, including forecasts and requesting ATC assistance. Awareness of the weather avoidance actions of other pilots in the area can also be useful. There is considerable value in ongoing education and guidance for pilots in recognising and responding to deteriorating weather conditions during flight. This can include additional (cue-based) training, guidance specific to the risks in the region, education initiatives from industry bodies, and learning from the knowledge and experience of peers.

Smaller operators employing pilots with limited exposure to local conditions, such as in the tropics, can better manage related risks by pairing new pilots with ones experienced in those conditions.

VH-HWY in Darwin VH-HWY in Darwin

Source: Air Frontier

And via the Oz today: 

Fatal crash pilots lacked Northern Territory wet season experience: ATSB

ROBYN IRONSIDE
AVIATION WRITER
@ironsider

6:52PM APRIL 9, 2019



The single engine Cessna 210 operated by Air Frontier disappeared from the radar twice before plunging at high speed from about 10,000 feet, 25-minutes into the flight.


An investigation into a light plane crash that killed both pilots on board has found neither had experience flying in the Northern Territory’s wet season.

Pilot in command under supervision Darcy McCarter, 23, and supervising pilot Daniel Burrill, 33, were transporting the body of an indigenous man from Darwin to Elcho Island for a traditional Aboriginal burial when they struck bad weather on October 23, 2017.

The single engine Cessna 210 operated by Air Frontier disappeared from the radar twice before plunging at high speed from about 10,000 feet, 25-minutes into the flight.

The Australian Transport Safety Bureau investigation found turbulence combined with the high airspeed ripped the wings from the plane as it nosedived to earth.

A final report on the crash released today, said 14 minutes after departure the pilot in command under supervision requested a diversion from the flight plan due to weather.

Further diversions were sought as the weather worsened, and eventually the aircraft was lost from Air Traffic Control radar twice within 15 seconds.

“Shortly after VH-HWY diverted to avoid adverse weather, the aircraft entered an area of strong convective activity and rapidly developing precipitating cells, which resulted in it experiencing severe turbulence and possibly reduced visibility for the pilots,” the report said.

The report went on to highlight the hazards of the Northern Territory wet season.

“Pilots in tropical areas need to recognise and respond to these conditions to avoid the hazards including turbulence, windshear and reduced visibility,” said the report.

“This is more challenging when a pilot has not experienced these conditions and therefore may not accurately assess the situation or perceive the risks.”

In the case of this flight, neither pilot had flown during a previous wet season in Darwin, the report noted.

“Although pairing a supervisory pilot with a pilot new to the company was likely to reduce risk in other instances, in this case it did not adequately address the weather-related risks because neither pilot had experience flying in the region during the wet season,” the ATSB report said.

A safety message was issued advising “smaller operators” to manage the risk of employing pilots with limited exposure to local conditions by pairing them with ones experienced in those conditions.

MTF...P2