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A Pilot Error has lead the Akagera Aviation Nyabihu crash

 

 

18/07/2015

 

The Aircraft Accident and Incident Investigation Office (AAIIO) blames a pilot error, for the Akagera Aviation crash. (LINK)

 

The pilot didn't apply all procedures during a low fly in, which the pilot has to deal with many factors such as, the Center Of Gravity, the wieght , the altitude and the RPM (Rotor Speed) .

 

Robisson has send several Safety bulletins to aware pilots, that in low fly conditions, the pilot can loose the control.

 

Furthermore, due the lack of a good covergare (both Air Radar and VHF) in Rwanda, the ATC didn't launch the 3 emergencies phases (INCERFA, ALERFA DETRESFA, despite there was no radio contact for more than two hours

 

History :

 

Zulu Time = GMT +2

 

On October 28, 2014, about 0845Z, a Robinson helicopter R44II, registration number 9XR-SJ, S/N 13437, operated by Akagera Aviation, on a charter flight to HRYG (Gisenyi) and back to HRYR (Kigali) with no planned landing, collided with ground during a precautionary landing in a valley in Kabuguzo Village, Kintarure Cell, Shyira Sector, Nyabihu District, Rwanda.

 

Pilot :

 

The pilot, aged 27 years, held valid Rwandan CPL (H) (Helicopter Commercial Pilot License) issued on November 29, 2012, English Proficiency level six (6), and a valid Medical Certificate class one (1) with no limitations. The pilot also held an FAA (Federal Aviation Authority) license issued on December 18, 2009. The pilot was type rated on the Robinson R44 II and AgustaWestland A109S.

 

According to pilot interview and Rwanda CAA records available, the pilot received PPL on April 24, 2012 and CPL on May 11, 2012 from the Los Angeles Helicopters of 3501, Lakewood Blvd, Long Beach, CA 90808, USA. He received mountain flying training from the same institution on May 22, 2012.

 

The pilot’s logbook showed he had flown 977.7 hours total flight time, including 600 hours in the Robinson R44 II. He had flown 1.7, 2.2 and 18.8 hours in the previous 24 hours, 7 days and 30 days, respectively before the accident. His most recent OPC (Operator Proficiency Checks ) and ground training was conducted on May 12, 2014.

 

The aircraft :

 

The R44II (9XR-SJ) was delivered in February 2013 and has logged 375.03 hours, since its delivery. Its last mandatory periodic inspection was made on 22 september 2014. It received its certificate of Registration on 21 March 2013.

 

The helicopter was equipped with one Lycoming engine model number IO-540-AE1A5 six cylinder, horizontally opposed overhead-valve, air-cooled, fuel injected, wet-sump engine S/N L-35183-48E, normally aspirated.

 

Probable Cause :

 

The pilot failed to properly flare the nose-heavy helicopter during a precautionary landing causing the nose section and skid strut end colliding with the ground and rolled over to the right. The pilot decision to fly the helicopter low in high terrain & close to its certificated performance, LRR (Low Rotor RPM), downdraft, tailwind & a left crosswind component and uneven landing area were contributing factors.

 

Findings :

 

The pilot was licensed, medically fit, qualified for the flight and was familiar with the route. He had done CRM (Crew Ressources Management) but not SRM training.

 

The maintenance records indicated that the aircraft was equipped and maintained in accordance with existing regulations and approved procedures.

 

The helicopter had a valid Certificate of Airworthiness and was recorded as being serviceable at the time of the flight.

 

There is no adequate communication coverage or aircraft surveillance when flying in the Northern / Northwestern regions of Rwanda.

 

ATC (Air trafic Control )emergency phases were not initiated as per the ATC procedures despite there was no radio contact for more than two hours.

 

The helicopter was operated close to its maximum certificated gross weight at the time of the accident.

 

RFM loading instructions do not clearly guide on the use of the dotted line (MOST FWD (Foward) CG WITH FULL FUEL TO KEEP CG (Center of Gravity) WITHIN LIMITS AT ZERO FUEL). The flight was initiated and commenced with the zero fuel CG forward of the dotted line.

 

High density altitude, downdraft and aircraft weight overloaded the MR (Main Rotor) blades causing the LRR and loss of lift that could have helped the helicopter to clear the rising terrain.

 

The helicopter did not have enough altitude or escape route to allow pilot to correct LRR or recover from the downdraft.

 

The helicopter had tail wind and crosswind component from the left just prior to impact.

 

Recomendations :

 

CAA issues a safety recommendation to pilots to minimize the unnecessary exposure of aircraft and crews to low-level hazards.

 

CAA issues requirements to all Operators involved in single crew operation to provide initial and recurrence SRM training.

 

Air Navigation Services provider to review communication systems and increase aircraft communication and surveillance coverage in Rwanda.

 

The Design Organization should review RFM and provide unambiguous loading instructions on the use of the dotted line (MOST FWD CG WITH FULL FUEL TO KEEP CG WITHIN LIMITS AT ZERO FUEL);-i.e. Specify action to be taken when zero fuel or as loaded CG is located forward of the dotted line.

 

 


 

 

Akagera Aviation Robinson R44 crashed Nyabihu

 

 

CIMG6112.JPG

 

 

02/11/2014

 

JEAN D'AMOUR MBONYINSHUTI

 

A small commercial helicopter belonging to Akagera Aviation crash-landed in Nyabihu District yesterday (28 October 2014).

 

All four passengers survived with  minor injuries, according to Police.

 

Superintendent Emmanuel Hitayezu, the Western Province regional Police spokesperson, said the accident happened at around10:30a.m in Kintarume Cell, Shyira Sector.

The helicopter was flying from Kigali to Rubavu.

 

“It was due to a technical problem, the pilot tried to control the plane but ended up crash-landing,” Hitayezu said.

 

The chopper was carrying three tourists. The three tourists and the pilot flew back to Kigali on another Akagera Aviation tourist helicopter.

 

FULL ARTICLE : HERE



02/11/2014
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