R44 Raven II ZK-IPY. Courtesy of Over The Top.
Mast bump and in-flight break-up, Robinson R44, ZK-IPY, Lochy River, near Queenstown, 19 February 2015
Status
Closed
Occurrence Date
Report Publication Date
Jurisdiction
NZ
On 19 February 2015 a Robinson Helicopter Company R44 helicopter registered ZK-IPY (the helicopter) was returning to Queenstown from a training flight when it suffered a mast bump and crashed in bush near the Lochy River. The instructor and student on board were killed.
The Transport Accident Investigation Commission (Commission) investigated the accident, but the cause of the mast bump and resulting in-flight break-up could not be conclusively determined. The Commission’s final report was published on 25 August 2016.
On 31 August 2016 the Commission was advised of new evidence concerning the mental health of the instructor prior to the crash, in 2014. On 28 September 2016 the Commission resumed the inquiry to evaluate the new evidence, conduct further enquiries and identify any relevant safety issues.
The Commission concluded that it is very unlikely that any medical factor contributed to the accident. As a result, no changes were made to the original findings in the published report. The Commission made a further finding: that it is very likely that the instructor was medically fit to fly when his most recent medical certificate was issued.
The Commission also found that: there are currently too many ways for a holder of an aviation document to circumvent the civil aviation process designed to prevent pilots flying if they are not medically fit to do so; and that there is currently a low awareness amongst medical practitioners of their duty to report to the Civil Aviation Authority if they become aware that a pilot has developed a medical condition that would otherwise render them unfit to fly.
The Commission made recommendations to the Director of Civil Aviation: that he improve the mechanisms for informing medical practitioners of the requirement to report to the Civil Aviation Authority; and that he review the medical application process to ensure that it is more robust in identifying potentially serious health issues with pilots and other aviation document holders.
The Commission also made a recommendation to the Chief Executive of the Ministry of Health that they consider adding the following functions to the national electronic health record database being developed:
- that a person's occupation be added to the record to allow monitoring of individuals in safety-critical occupations who have potentially adverse health conditions or medications, so that the appropriate authority can be alerted to possible public safety risks
- a mechanism to draw the attention of all health practitioners to their obligation to notify the appropriate authority when a person or patient has a health condition or need for medication that could pose a threat to public safety in that individual's occupation.
The Transport Accident Investigation Commission (Commission) investigated the accident, but the cause of the mast bump and resulting in-flight break-up could not be conclusively determined. The Commission’s final report was published on 25 August 2016.
On 31 August 2016 the Commission was advised of new evidence concerning the mental health of the instructor prior to the crash, in 2014. On 28 September 2016 the Commission resumed the inquiry to evaluate the new evidence, conduct further enquiries and identify any relevant safety issues.
The Commission concluded that it is very unlikely that any medical factor contributed to the accident. As a result, no changes were made to the original findings in the published report. The Commission made a further finding: that it is very likely that the instructor was medically fit to fly when his most recent medical certificate was issued.
The Commission also found that: there are currently too many ways for a holder of an aviation document to circumvent the civil aviation process designed to prevent pilots flying if they are not medically fit to do so; and that there is currently a low awareness amongst medical practitioners of their duty to report to the Civil Aviation Authority if they become aware that a pilot has developed a medical condition that would otherwise render them unfit to fly.
The Commission made recommendations to the Director of Civil Aviation: that he improve the mechanisms for informing medical practitioners of the requirement to report to the Civil Aviation Authority; and that he review the medical application process to ensure that it is more robust in identifying potentially serious health issues with pilots and other aviation document holders.
The Commission also made a recommendation to the Chief Executive of the Ministry of Health that they consider adding the following functions to the national electronic health record database being developed:
- that a person's occupation be added to the record to allow monitoring of individuals in safety-critical occupations who have potentially adverse health conditions or medications, so that the appropriate authority can be alerted to possible public safety risks
- a mechanism to draw the attention of all health practitioners to their obligation to notify the appropriate authority when a person or patient has a health condition or need for medication that could pose a threat to public safety in that individual's occupation.
Location
Queenstown (-45.185800,168.595000) [may be approximate]