N28MP

Substantial
Fatal

HUGHES 369S/N: 970191D

Accident Details

Date
Tuesday, November 27, 2012
NTSB Number
CEN13FA075
Location
Childress, TX
Event ID
20121128X12341
Coordinates
34.420276, -100.240997
Aircraft Damage
Substantial
Highest Injury
Fatal
Fatalities
1
Serious Injuries
1
Minor Injuries
0
Uninjured
0
Total Aboard
2

Probable Cause and Findings

The improper maintenance of the helicopter fuel system that resulted in erroneous fuel gauge indications and the pilot’s inadequate fuel management, both of which resulted in fuel exhaustion during a long-line hover. Also causal was the lack of company procedures to ensure adequate maintenance and fuel planning.

Aircraft Information

Registration
N28MP
Make
HUGHES
Serial Number
970191D
Model / ICAO
369

Registered Owner (Historical)

Name
BRIM EQUIPMENT LEASING INC
Address
PO BOX 3009
Status
Deregistered
City
ASHLAND
State / Zip Code
OR 97520-0301
Country
United States

Analysis

HISTORY OF FLIGHTOn November 27, 2012, about 1558 central standard time, a MD Helicopters, Inc. MD 500D (Hughes 369D), N28MP, experienced a loss of engine power during long-line power line construction. The helicopter subsequently impacted terrain during a forced landing near the transmission tower where the work was being performed. The helicopter received substantial damage. The commercial pilot sustained serious injuries, and the long-line worker was fatally injured. The helicopter was registered to and operated by Brim Equipment Leasing Inc. (D.B.A. Brim Aviation) under the provisions of 14 Code of Federal Regulations Part 133 as an external-load operation flight. Visual meteorological conditions prevailed for the flight that originated near the accident site, which was about two miles northeast of Childress, Texas.

The long-line operation consisted of a 50 foot long-line with a web seat attached to and suspended underneath the helicopter. The long-line worker was performing work on the power line while attached to the helicopter hovering overhead.

The pilot said that they had planned to hang travelers on a section of east/west power line towers on the day of the accident. He said that on the day of the accident, a 15-gallon fuel load was "working best." His rule for refueling was that he obtained fuel when the fuel gauge indication was close to 100 pounds, which he said would almost allow a ½-hour of flight time.

A company mechanic said that the first operation of the day was to unclip the lines. A full load of fuel was loaded onto the helicopter with only the main tank fueled. He said that he remembered filling the helicopter with fuel two times and each time 15 gallons of fuel was loaded, which was the amount specified by the pilot. The mechanic did not know how much fuel was added prior to the accident. The mechanic said that the helicopter was gone for about an hour since its last refueling prior to the accident. The fuel added was not recorded in a log.

About 1400, the pilot departed on a flight to repair a section of fiber optic line that fell down before work continued on the towers. He then flew back and landed at the landing zone where the helicopter was re-rigged for crew operations and refueled. He lifted off with the long-line worker, and they worked on several towers. A traveler was hung on the tower near the accident site, and the helicopter was positioned in a stable hover about 120-150 feet above the ground. The helicopter experienced a pronounced sharp left yaw, which the pilot thought was from a wind gust. The pilot said that it was "milliseconds" between the left yaw and the engine "winding down." The pilot did not hear any unusual noises or vibrations before the loss of engine power and the only annunciation he had time to see was the engine-out annunciation. He did not see any other red/yellow annunciators illuminate. The pilot applied right pedal input. The helicopter started to settle, and he then heard the engine out horn and saw the engine out light illuminate. The pilot's first thought was to get away from the tower because the helicopter would have hit the lower arm of the tower. As the helicopter moved away from the tower, he looked at the horizon and estimated that the helicopter was about 50 feet above the ground when he "bottomed out the collective." The helicopter settled faster and onto the ground in a right-side-low attitude.

A long-line worker on the ground said that he was about 200-300 feet away from the helicopter when he "heard all the sound go away" and "it just shut down," while the helicopter was on the north side of the tower. The helicopter then spun clockwise 180 degrees when it lost power. He said the helicopter "seemed" to spin and turn "pretty fast" and did not recall how fast it spun. He said that the long-line worker was hanging on the traveler when he was pulled off the traveler by the long-line.

The long-line worker that was on the ground and witnessed the accident stated there was no easy way for a long-line worker to release from a harness and it would take several seconds to do so. The pilot stated there was no company policy or procedure for the release of the long-line. The pilot said that he could not "specifically say" that he was trained to release the long-line. If a long-line worker wanted to get off of the long-line, he had to be "jettisoned." The pilot said that for the long-line worker to jettison themselves, they would have to use a knife to cut the long-line. PERSONNEL INFORMATIONThe pilot held a commercial pilot certificate with a rotorcraft-helicopter rating. He reported a total aircraft flight time of 2,700 hours, of which 800 hours were in the MD 500D (Hughes 369D) helicopters.

Since 1990, he was a helicopter pilot in law enforcement and search and rescue operations. Since 2009, he was a helicopter pilot in Part 91, 133, and 135 operations. Until September 2012, he was employed as a full-time pilot flying Eurocopter helicopters for power line and freight flights, after which he was employed on a part-time basis.

On September 16, 2012, he was hired by Brim Aviation as a helicopter pilot. On September 17 and September 18, 2012, he received pilot training at Brim Aviation that was comprised of ground and flight training. Company Pilot Training and Qualification Record showed that the pilot's ground training consisted of ground testing, and the flight training consisted of two flights. The record did not indicate total flight, ground, and testing hours received by the pilot nor flight maneuvers he performed and the results of those maneuvers. The record had only two entries by the company president, who was also the company's director of operations, which stated the pilot passed knowledge and skill requirements outlined in Part 133 and 137. There were no entries to identify who provided and the pilot's flight instruction. During the pilot's post-accident interview, he identified the company instructor/check airman as the person who provided his flight training and testing.

The pilot did not have a Federal Aviation Administration (FAA) record of any previous incidents, accidents, or enforcement actions.

The pilot had been off work for several weeks prior to beginning work on November 26, 2012. The pilot said that he left his home in Chico, California, on November 24, 2012, to travel to Texas to begin work on November 26, 2012. On November 26, 2012, he slept all night and woke up once to go to the bathroom and woke up again at 0730 to start his work day. He worked until 0830-0900, returned to the hangar at 1000 after further flying was cancelled due to wind conditions, and went to bed about 2230. On the day of the accident, he left the crew quarters located in Childress, Texas, about 0700 and drove about 20-30 minutes to the hangar where the helicopter was kept near Wellington, Texas.

Part 133 did not have any crew member duty time/rest requirements. The pilot said that his work duration was dependent on a combination of daylight, time, and number of towers. In the southern areas of the country, work duration was driven by daylight.

Post-accident examination of the helicopter revealed one bottle of 5-hour ENERGY drink in the glove box between the front seats of the helicopter. The pilot said that he did not take any prescription or over-the-counter medications before the accident flight. He said that he does not consume any alcoholic beverages while on work trips and did not consume 5-hour ENERGY drinks.

The pilot stated that he did not have any safety concerns pertaining to Brim Aviation. AIRCRAFT INFORMATIONThe aircraft was a MD Helicopters, Inc. MD 500D (Hughes 369D), serial number 970191D, helicopter certified under Civil Air Regulations (CAR) Part 6. The helicopter was purchased by and registered to Brim Equipment Leasing Inc. in 2005 and was used in long-line and law enforcement operations.

The helicopter was powered by a Rolls Royce, 250-C20B, serial number CAE-836143, engine.

The helicopter was equipped with an ARS-Air Rescue Systems (ARS) belly band, part number: "ARS-3RR 10a", date of manufacture: "22389-312A-10 of 10", date-in-service: "6-3-12".

The last maintenance inspection on the helicopter was a 100-hour inspection dated November 17, 2012, at an aircraft total time of 15,301.6 hours and a Hobbs time of 5,901.4 hours. The helicopter flew about 4 or 5 times since that inspection, which was performed in a hangar at Brim Aviation's Wellington, Texas, facility.

According to the MD 500D Rotorcraft Flight Manual, section 2-11, Fuel System Limitations, Table 2-1, lists the usable fuel for standard non self-sealing fuel tanks as 1.9 gallons. Section 3-13, Fuel System Malfunctions, states that "FUEL LEVEL LOW" indicator would be "ON" when approximately 35 lbs of fuel (22.5 lbs usable) remain in the fuel tank.

Investigators examined the helicopter for the presence of a maintenance discrepancy log. The only log found aboard the helicopter that contained a section for discrepancies, titled "PILOTS REMARKS OR DISCREPENCIES," was contained in a "Brim Aviation Engineering Log Book Report." The Brim Aviation Engineering Log Book Report began with its first entry on page 2401, dated November 11, 2011, and ended with its last entry on page 2446, which was not dated. Page 2445 was dated November 16, 2012.

Only two pages within The Brim Aviation Engineering Log Book Report contained airworthiness entries within the discrepancies section, which were on pages 2409, undated, and 2410, dated February 18, 2012. The discrepancy entry on page 2409 was: "Throttle friction sticky" and "Pilot's door exterior handle non operational." The discrepancy entry on page 2410 was: "Pilot's exterior door handle – inop," "Gov. control linkage – Bolt spins – Retighten & Re cotter," "Reinstall Skid Mirror," Reinstall Steps."

There were no entries within the "POWER CHECKS" section for any of the pages from 2401 to 2445. The pilot stated that engine ...

Data Source

Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# CEN13FA075