Inquiries & Recommendations

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On 26 February 2025, the Commission recommended that Kawasaki Heavy Industries revise the Kawasaki BK117 B-2 Flight Manual to include specific data for Vortex Ring State to assist pilots in avoiding this phenomenon.

Introduce a requirement for crew of passenger vessels equipped with Category II EPIRB’s to also carry a personal location beacon or similar device capable of transmitting a distress message, to increase the timeliness of notification of an emergency.

Work with lifejacket industry stakeholders to educate and raise awareness with users of inflatable lifejackets of the: • doffing and deflation procedures • potential hazard of inflating when obstructed overhead.

On 26 February 2025, the Commission recommended that the Director of Civil Aviation at the Civil Aviation Authority of New Zealand use the lessons from this report to raise awareness for helicopter pilots of the risks associated with inadvertently entering flight conditions that are conducive to Vortex Ring State.

On 26 February 2025, the Commission recommended that Kawasaki Heavy Industries revise the Kawasaki BK117 B-2 Flight Manual to include specific data for Vortex Ring State to assist pilots in avoiding this phenomenon.

Work with lifejacket industry stakeholders and commercial operators to identify and implement effective safety measures that mitigate the risks associated with incorrectly re-arming and re-packing inflatable life jackets.

On 26 February 2025, the Commission recommended to the Director of Civil Aviation at the Civil Aviation Authority of New Zealand that they promote, through the appropriate International Civil Aviation Organization (ICAO) forum, consideration for the requirement and implementation for Vortex Ring State alerting systems to be installed in new helicopters.

On 26 February 2025, the Commission recommended that the Chief Executive of the Ministry of Business, Innovation and Employment and Next Generation Critical Communications collaboratively conduct a review of the emergency 111 system with sector stakeholders, to remove unnecessary delays and improve New Zealand’s emergency response efficiency.

Work with lifejacket industry stakeholders to develop guidelines on the information that should be covered in safety briefings on lifejacket use, including doffing, deflation and hazards.

On 26 February 2025, the Commission recommended that the Director of Civil Aviation at the Civil Aviation Authority of New Zealand use the lessons from this report to raise awareness for helicopter pilots of the risks associated with inadvertently entering flight conditions that are conducive to Vortex Ring State.

On 26 February 2025, the Commission recommended to the Director of Civil Aviation at the Civil Aviation Authority of New Zealand that they promote, through the appropriate International Civil Aviation Organization (ICAO) forum, the need for additional information to be included in all rotorcraft flight manuals, to assist pilots in avoiding Vortex Ring State.

On 26 February 2025, the Commission recommended to the Director of Civil Aviation at the Civil Aviation Authority of New Zealand that they promote, through the appropriate International Civil Aviation Organization (ICAO) forum, the need for additional information to be included in all rotorcraft flight manuals, to assist pilots in avoiding Vortex Ring State.