Ambulance

The twin engine aircraft was performing an ambulance flight from Puntas Arenas to Santiago with two pilots on board, one patient, three doctors and two relatives. Following an uneventful flight at FL280, the crew was cleared to descend when the aircraft entered an uncontrolled descent while the crew was in contact with Puerto Montt ATC. The aircraft dove into the ground and crashed on the north slope of the Macá volcano, some 10 km northeast of Puerto Aguirre. The wreckage was found in the morning of March 24 at an altitude of 2,347 metres. The aircraft disintegrated and all 8 occupants were killed.

The airplane was dispatched on an emergency medical services flight. While being vectored for an instrument approach, the pilot declared an emergency and reported that the airplane was out of fuel. He said the airplane lost engine power and that he was heading toward the destination airport. The airplane descended through clouds and impacted trees and terrain short of its destination. No preimpact anomalies were found during a postaccident examination. The postaccident examination revealed about 1.5 ounces of a liquid consistent with avgas within the airplane fuel system. Based on the three previous flight legs and refueling receipts, postaccident calculations indicated that the airplane was consuming fuel at a higher rate than referenced in the airplane flight manual. Based on this consumption rate, the airplane did not have enough fuel to reach the destination airport; however, a 20-knot tailwind was predicted, so it is likely that the pilot was relying on this to help the airplane reach the airport. Regardless, he would have been flying with less than the 45-minute fuel reserve that is required for an instrument flight rules flight. The pilot failed to recognize and compensate for the airplane’s high fuel consumption rate during the accident flight. It is likely that had the pilot monitored the gauges and the consumption rate for the flight he would have determined that he did not have adequate fuel to complete the flight. Toxicology tests showed the pilot had tetrahydrocannabinol and tetrahydrocannabinol carboxylic acid (marijuana) in his system; however, the level of impairment could not be determined based on the information available. However, marijuana use can impair the ability to concentrate and maintain vigilance and can distort the perception of time and distance. As a professional pilot, the use of marijuana prior to the flight raises questions about the pilot’s decision-making. The investigation also identified several issues that were not causal to the accident but nevertheless raised concerns about the company’s operational control of the flight. The operator had instituted a fuel log, but it was not regularly monitored. The recovered load manifest showed the pilot had been on duty for more than 15 hours, which exceeded the maximum of 14 hours for a regularly assigned duty period per 14 Code of Federal Regulations Part 135. The operator stated that it was aware of the pilot’s two driving while under the influence of alcohol convictions, but the operator did not request a background report on the pilot before he was hired. Further, the operator did not list the pilot-rated passenger as a member of the flight crew, yet he had flown previous positioning legs on the dispatched EMS mission as the pilot-in-command.

The single engine aircraft was performing an ambulance flight from Nepalgunj to the capital city Kathmandu with a patient, one accompanist, two doctors, a nurse and a pilot on board. It crashed in unknown circumstances in a hilly and wooded terrain near Dhorpatan, killing all six occupants.

M/s Air Charter Services Pvt Ltd. offered their aircraft VT-ACF for operating medical evacuation flight to pick one critically ill patient from Patna on 25/05/2011. The Aircraft took off from Delhi to Patna with two crew members, two doctors and one male nurse. The Flight to Patna was uneventful. The Air Ambulance along with patient and one attendant took off from Patna at 20:31:58 IST, the aircraft during arrival to land at Delhi crashed near Faridabad on a Radial of 145 degree and distance of 15.2 nm at 22:42:32 IST. Aircraft reached Patna at 18:31 IST. Flight Plan for the flight from Patna to Delhi was filed with the ATC at Patna via W45-LLK-R594 at FL260, planned ETD being 22:00 hours IST and EET of 2hours for a planned ETA at VIDP being 24:00 hours IST. The crew took self-briefing of the weather and same “Self Briefing” was recorded on the flight plan submitted at ATC Patna. The passenger manifest submitted at Patna indicated a total of 2 crew and 5 passengers inclusive of the patient. Weather at Patna at the time of departure was 3000m visibility with Haze. Total fuel on board for departure at Delhi was 1516 lts. The preflight/transit inspection of the aircraft at Patna was carried out by the crew as per laid down guidelines. The crew requested for startup at 20:21 IST from Patna ATC and reported airborne at 20:33:43 IST. The aircraft climbed and maintained FL 260 for cruise. On handover from Varanasi Area Control (Radar), the aircraft came in contact with Delhi Area Control (East) Radar at 21:53:40 IST at 120.9 MHz. At 21:53:40 IST aircraft was identified on Radar by squawking code 3313. At 22:02:05 IST the crew requested for left deviation of 10° due to weather, the same was approved by the RSR controller. At 22:05:04 IST the crew informed that they have a critical patient on board and requested for priority landing and ambulance on arrival. The same was approved by the RSR controller. The aircraft was handed over to Approach Control on 126.35 MHz at 22:28:03 IST. At 22:28:18 IST VT-ACF contacted TAR (Terminal Approach Radar) on 126.35 MHz and it was maintaining FL160. At 22:32:22 IST, VT-ACF was asked to continue heading to DPN (VOR) and was cleared to descend to FL110. At 22:36:34 IST, the TAR controller informed VT-ACF about weather on HDG 330°, the crew replied in “Affirmative” and requested for left heading. At 22:38:12 IST, TAR controller gave aircraft left heading 285° which was copied by the aircraft. The aircraft started turning left, passing heading 289, it climbed from FL125 to FL141. At 22:40:32 IST the TAR controller gave 3 calls to VT-ACF. At 22:40:43 IST aircraft transmitted a feeble call “Into bad weather”, at that instance the aircraft had climbed FL 146.Thereafter the aircraft was seen turning right in a very tight turn at a low radar ground speed and loosing height rapidly from FL146 to FL 016. Again at 22:41:32 IST TAR controller gave call to VT-ACF, aircraft transmitted a feeble call “Into bad weather. Thereafter the controller gave repeated calls on both 126.35 MHz and also 121.5 MHz, before the blip on radar became static on a radial of 145 degree at 15.2 nm from DPN VOR at 22:42:32 IST. All attempts to raise contact with the aircraft failed. The TAR controller then informed the duty WSO and also the ATC Tower. At 22:50:00 IST, the tower informed the WSO that they have got a call from the City Fire Brigade confirming that an aircraft has crashed near Faridabad in a congested residential area known as Parvatia Colony. After the accident, local residents of the area and police tried to put off the fire and extricate the bodies from the wreckage of the aircraft.

The pilot had worked a 10-hour shift the day of the accident and had been off duty about 2 hours when the chief pilot called him around midnight to transport a patient. The pilot accepted the flight and, about 2 hours later, was on an instrument approach to the airport to pick up the patient. While on the instrument approach, all of the anti-ice and deice systems were turned on. The pilot said that the deice boots seemed to be shedding the ice almost completely. He extended the flaps and lowered the landing gear to descend; he then added power, but the airspeed continued to decrease. The airplane continued to descend, and he raised the flaps and landing gear and applied full climb power. The airplane shuddered as it climbed, and the airspeed continued to decrease. The stall warning horn came on, and the pilot lowered the nose to increase the airspeed. The airplane descended until it impacted level, snow-covered terrain. The airplane was equipped with satellite tracking and engine and flight control monitoring. The minimum safe operating speed for the airplane in continuous icing conditions is 140 knots indicated airspeed. The airplane's IAS dropped below 140 knots 4 minutes prior to impact. During the last 1 minute of flight, the indicated airspeed varied from a high of 124.5 knots to a low of 64.6 knots, and the vertical speed varied from 1,965 feet per minute to -2,464 feet per minute. The last data recorded prior to the impact showed that the airplane was at an indicated airspeed of 68 knots, descending at 1,651 feet per minute, and the nose was pitched up at 20 degrees. The pilot did not indicate that there were any mechanical issues with the airplane. The chief pilot reported that pilots are on call for 14 consecutive 24-hour periods before receiving two weeks off. He said that the accident pilot had worked the previous day but that the pilot stated that he was rested enough to accept the mission. The chief pilot indicated he was aware that sleep cycles and circadian rhythms are disturbed by varied and prolonged activity. An NTSB study found that pilots with more than 12 hours of time since waking made significantly more procedural and tactical decision errors than pilots with less than 12 hours of time since waking. A 2000 FAA study found accidents to be more prevalent among pilots who had been on duty for more than 10 hours, and a study by the U.S. Naval Safety Center found that pilots who were on duty for more than 10 of the last 24 hours were more likely to be involved in pilot-at-fault accidents than pilots who had less duty time. The operator’s management stated that they do not prioritize patient transportation with regard to their medical condition but base their decision to transport on a request from medical staff and availability of a pilot and aircraft, and suitable weather. The morning of the accident, the patient subsequently took a commercial flight to another hospital to receive medical treatment for his non-critical injury/illness. Given the long duty day and the early morning departure time of the flight, it is likely the pilot experienced significant levels of fatigue that substantially degraded his ability to monitor the airplane during a dark night instrument flight in icing conditions. The NTSB has issued numerous recommendations to improve emergency medical services aviation operations. One safety recommendation (A-06-13) addresses the importance of conducting a thorough risk assessment before accepting a flight. The safety recommendation asked the Federal Aviation Administration to "require all emergency medical services (EMS) operators to develop and implement flight risk evaluation programs that include training all employees involved in the operation, procedures that support the systematic evaluation of flight risks, and consultation with others trained in EMS flight operations if the risks reach a predefined level." Had such a thorough risk assessment been performed, the decision to launch a fatigued pilot into icing conditions late at night may have been different or additional precautions may have been taken to alleviate the risk. The NTSB is also concerned that the pressure to conduct EMS operations safely and quickly in various environmental conditions (for example, in inclement weather and at night) increases the risk of accidents when compared to other types of patient transport methods, including ground ambulances or commercial flights. However, guidelines vary greatly for determining the mode of and need for transportation. Thus, the NTSB recommended, in safety recommendation A-09-103, that the Federal Interagency Committee on Emergency Medical Services (FICEMS) "develop national guidelines for the selection of appropriate emergency transportation modes for urgent care." The most recent correspondence from FICEMS indicated that the guidelines are close to being finalized and distributed to members. Such guidance will help hospitals and physicians assess the appropriate mode of transport for patients.

The flight crew reported for duty at Liverpool Airport at 0845 hrs. Their original task was to fly to Belfast City Airport, collect a transplant organ, and take it to Cambridge Airport. However, on their arrival at Belfast the transfer was no longer required, so they were given a new task to fly to Belfast Aldergrove Airport and collect an organ to carry to Birmingham Airport. The aircraft departed Belfast Aldergrove at 1450 hrs with the co-pilot as pilot flying. The flight was uneventful and the aircraft was given a radar vector to intercept the ILS for a straight-in approach to Runway 15 at Birmingham. The Runway 15 ILS course is 149°M. The autopilot was engaged and the aircraft was flying on a track of 135°M, 13 nm from the touchdown zone and at a groundspeed of 254 kt, when it crossed the localiser centreline. The aircraft then turned right onto a corrective track but once again passed through the localiser course. Further corrections were made and the aircraft passed through the localiser once more before becoming established at 5 nm. The co-pilot later reported that, because the autopilot was not capturing the localiser, he had disconnected it and flown the approach manually. When the aircraft was at 10 nm, the radar controller broadcast a message advising of the presence of a fog bank on final approach and giving RVRs of 1,400 m at touchdown and in excess of 1,500 m at both the mid-point and stop end. The airfield was sighted by the commander during the approach but not by the co-pilot. A handover to the tower frequency was made at around 8 nm. When the aircraft was at 6 nm, landing clearance was given and acknowledged. The tower controller then advised the aircraft that there was a fog bank over the airfield boundary, together with the information that the touchdown RVR was 1,400 m. The commander responded, saying: “WE’VE GOT ONE END OF THE RUNWAY”. The aircraft was correctly on the localiser and the glideslope at 4 nm. The Decision Altitude (DA) of 503 feet amsl (200 feet aal) for the approach was written on a bug card mounted centrally above the glare shield. Both pilots recollected that the Standard Operating Procedure (SOP) calls of “500 above” and “100 above” DA were made by the commander. However, neither pilot could recall a call of ‘decision’ or ‘go-around’ being made. At between 1.1 nm and 0.9 nm, and 400 feet to 300 feet aal, the aircraft turned slightly to the right, onto a track of 152°M. This track was maintained until the aircraft struck the glideslope antenna to the right of the runway some 30 seconds later (see Figure 3, page 11). The aircraft came to rest in an upright position on the grass with a fire on the left side. The co-pilot evacuated through the main cabin door, which is located on the left side of the fuselage, and suffered flash burns as he passed through the fire. The commander was trapped in the cockpit for a time.

The pilot was performing an ambulance flight from Kingstown-E. T. Joshua Airport to Canouan. En route, while cruising off Bequia Island, the twin engine aircraft entered an uncontrolled descent and crashed in the sea. Some debris were found the following day but no trace of the pilot.

The airplane impacted terrain shortly after takeoff. The wreckage distribution was consistent with a high airspeed, low angle-of-attack impact. Examination of the ground scars and wreckage indicated that the landing gear was down, the flaps were down, and the engines were operating at a high power setting at the time of impact. An examination of the airframe, engines, and related systems revealed no mechanical malfunctions or failures. According to the owner’s manual for the airplane, the flaps should have been retracted and the landing gear should have been brought up as soon as a climb profile was established. Based upon the location of the wreckage, the direction of the impact, and the location of the airport, it is likely that the airplane crashed within one or two minutes after takeoff. The extended landing gear and flaps degraded the climb performance of the airplane. The pilot held an airline transport pilot certificate and had recent night flight experience. Toxicological results were positive for azacyclonol and ibuprofen but were not at levels that would have affected his performance. According to family members, the pilot normally slept from 2230 or 2300 to 0700; the accident occurred at 0015. Although the investigation was unable to determine how long the pilot had been awake before the accident or his sleep schedule in the three days prior to the accident, it is possible that the pilot was fatigued, as the accident occurred at a time when the pilot was normally asleep. The company did not have, and was not required to have guidance or a policy addressing fatigue management.

The twin engine aircraft, with a pilot and a flight nurse on board, was being operated by Skymaster Air Services under the instrument flight rules (IFR) on a flight from Bankstown Airport, New South Wales (NSW) to Archerfield Airport, Queensland. The aircraft was being positioned to Archerfield for a medical patient transfer flight from Archerfield to Albury, NSW. The aircraft departed Bankstown at 0740 Eastern Standard Time. At 0752, the pilot reported to air traffic control (ATC) that he was turning the aircraft around as he was having ‘a few problems. At about 0806, the aircraft collided with a powerline support pole located on the eastern side of the intersection of Sackville Street and Canley Vale Road, Canley Vale, NSW. The pilot and flight nurse sustained fatal injuries and the aircraft was destroyed by impact damage and a post-impact fire.

The aircraft was completing an ambulance flight from Palm Beach to Rio de Janeiro with intermediate stops in Aguadilla and Manaus, carrying one patient, a medical team and two pilots. During the takeoff roll from 10 at Manaus-Eduardo Gomes Airport, just before V1 speed, the crew heard a loud noise coming from the right side of the airplane. In the mean time, the aircraft started to deviate to the right. The captain decided to abandon the takeoff procedure and initiated a braking maneuver. Unable to stop within the remaining distance, the aircraft overran and came to rest 400 metres past the runway end. All six occupants escaped uninjured while the aircraft was damage beyond repair.