San Juan-Luis Muñoz Marín (Isla Verde)

About 3 months before the accident, the twin-engine airplane underwent an annual maintenance inspection during which the mechanic identified numerous discrepancies with both engines and the airframe. The airplane was not subsequently approved for flight and the owner was provided a list of the discrepancies. The purpose of the accident flight was to relocate the airplane to another airport where the pilot planned to have the discrepancies addressed. The mechanic reported that he had advised the pilot that he needed to apply for a ferry permit from the FAA in order to complete the accident flight, but there was no evidence that the pilot had obtained one. On the day of the accident flight, air traffic control data showed that the pilot departed and climbed the airplane to about 1,500 ft mean sea level (msl). About 2 miles from the departure airport the pilot advised air traffic control of his intent to return to the departure runway due to a vibration of the right engine. The controller immediately cleared the pilot to enter the left downwind for the departure runway. The airplane then turned to the left and began a descent toward the left downwind leg of the traffic pattern. When the airplane was about a mile from the airport, the pilot reported that the airplane had an “engine failure” and that he intended to land on the departure runway, but in the opposite direction. Recorded flight track data showed that the airplane then turned directly toward the approach end of that runway and that during the final 30 seconds of track data, the airplane’s altitude and groundspeed decreased rapidly. Surveillance video captured the final few seconds of flight, and showed the airplane in a steep vertical descent and a right roll. The airplane impacted a residential area into trees, powerlines, and propane fuel tanks. After the impact, the airplane sustained significant postimpact fire damage. The airplane was destroyed and the pilot was killed. One person on the ground was slightly injured.

The pilot departed San Juan-Luis Muñoz Marín Airport at 1049LT on a cargo flight to Basseterre-Robert L. Bradshaw International Airport, Saint Kitts & Nevis. The flight was performed by Mountain Air Cargo on behalf of FedEx. The pilot continued the flight at FL110 until 1139LT, reduced his altitude down to FL100 and maintained this level until 1153LT. At this moment, the aircraft was descending between 600 and 800 feet per minute and the pilot decided to divert to the Juancho E. Yrausquin Airport located on Saba Island, Dutch Antilles. While approaching to island from the south, the pilot realized he would not make it, so he attempted to ditch the aircraft some 900 metres off shore. The pilot evacuated the cabin and was quickly rescued while the aircraft sank by a depth of about 1,500 feet. According to the pilot, he decided to divert to the nearest airport due to a loss of engine power.

On October 29, 2014, at about 1840 Atlantic Standard Time, a Shorts SD3-60, United States registered N380MQ was destroyed when it crashed into the sea shortly after takeoff from Runway 28 at Princess Juliana International Airport, Sint Maarten, Dutch Antilles, Kingdom of the Netherlands. The two crewmembers on board sustained fatal injuries. The aircraft was operated by SkyWay Enterprises Inc. on a scheduled FedEx contract cargo flight to Luis Munoz Marin International Airport, San Juan, Puerto Rico. At 1839 local, Juliana Tower cleared the aircraft for takeoff Runway 28 - maintain heading 230 until passing 4000 feet. At 1840 local, Tower observed the aircraft descending visually and the radar target and data block disappeared. There were no distress calls. Night conditions and rain prevailed at the time of the accident. Coast Guard search crews discovered aircraft debris close to the shoreline about 1 ½ hours later. The Sint Maarten Civil Aviation Authority initiated an investigation in accordance with ICAO Annex 13. Local investigation authority personnel were joined by Accredited Representatives and advisors from the following states: the USA (NTSB/FAA), United Kingdom (AAIB and Shorts Brothers PLC), and Canada (TSB, TC, PWC). Organization of the investigation included the following groups: Operations, Accident Site and Wreckage, Powerplants, Aircraft Maintenance, Air Traffic Services, Meteorology, and GPS Study. The operator made available personnel for interviews but deferred to participate in the groups. Flight recorders were not installed nor required on this cargo configured aircraft. The original FDR and CVR were removed following conversion to cargo only operations. A handheld GPS recovered from submerged wreckage was successfully downloaded. Data revealed the aircraft past the departure runway threshold on takeoff and attained a maximum GPS recorded altitude of 433 feet at 119 knots groundspeed at 18:39:30. The two remaining data points were over the sea and recorded decreasing altitude and increasing airspeed. The wreckage was recovered from the sea and examined by technical experts. Assessment of the evidence concluded there were no airframe or engine malfunctions that would have affected the airworthiness of the aircraft. The experts concluded that the aircraft struck the sea while under normal engine operation. Operations and human performance investigators evaluated the evidence and analyzed extensive interviews. The investigation concluded that the aircraft departed from the expected flight path in an unusual attitude. The pilot flying most likely experienced a somatographic illusion as a result of a stressful takeoff and acceleration from flap retraction. The pilot’s reaction to pitch down while initiating a required heading change led to an extreme unusual attitude. Circumstances indicate the pilot monitoring did not perceive/respond/intervene to correct the flight path and recover from the unusual attitude. The aircraft exceeded the normal maneuvering parameters, the crew experienced a loss of control, and lacking adequate altitude for recovery, the aircraft crashed into the sea.

The twin engine aircraft departed San Juan-Luis Muñoz Marín (Isla Verde) Airport, Puerto Rico, on a charter flight to Punta Cana, carrying two pilots, one flight attendant and 10 crew members from Air Europa positioning to Punta Cana. Following an uneventful flight, the crew completed the approach and landing on runway 08. After a roll of about 1,500 feet, the aircraft deviated to the left, made a 45° turn, veered off runway and came to rest in a wooded area, bursting into flames. All 13 occupants evacuated safely, among them two passengers were slightly injured. The aircraft was destroyed.

The captain and first officer were conducting an international cargo flight in the twin-engine turboprop airplane. After about 40 minutes of flight during night visual meteorological conditions, an air traffic controller cleared the airplane for a descent to 7,000 ft and then another controller further cleared the airplane for a descent to 3,000 ft and told the flight crew to expect an ILS (instrument landing system) approach. During the descent, about 7,300 ft and about 290 kts, the airplane entered a shallow left turn, followed by a 45-degree right turn and a rapid, uncontrolled descent, during which the airplane broke up about 1,500 ft over uneven terrain. The moderately loaded cargo airplane was not equipped with a flight data recorder or cockpit voice recorder (CVR) (although it previously had a CVR in its passenger configuration) nor was it required by Federal Aviation Administration (FAA) regulations. There were also no avionics on board with downloadable or nonvolatile memory. As a result, there was limited information available to determine what led to the uncontrolled descent or what occurred as the flight crew attempted to regain control of the airplane. Also, although the first officer was identified in FAA-recorded radio transmissions several minutes before the loss of control and it was company policy that the pilot not flying make those transmissions, it could not be determined who was at the controls when either the loss of control occurred or when the airplane broke up. There was no evidence of any in-flight mechanical failures that would have resulted in the loss of control, and the airplane was loaded within limits. Evidence of all flight control surfaces was confirmed, and, to the extent possible, flight control continuity was also confirmed. Evidence also indicated that both engines were operating at the time of the accident, and, although one of the four propeller blades from the right propeller was not located after separating from the fractured hub, there was no evidence of any preexisting propeller anomalies. The electrically controlled pitch trim actuator did not exhibit any evidence of runaway pitch, and measurements of the actuator rods indicated that the airplane was trimmed slightly nose low, consistent for the phase of flight. Due to the separation of the wings and tail, the in-flight positions of the manually operated aileron and rudder trim wheels could not be determined. Other similarly documented accidents and incidents generally involved unequal fuel burns, which resulted in wing drops or airplane rolls. In one case, the flight crew intentionally induced an excessive slide slip to balance fuel between the wings, which resulted in an uncontrolled roll. However, in the current investigation, the fuel cross feed valve was found in the closed position, indicating that a fuel imbalance was likely not a concern of the flight crew. In at least two other events, unequal fuel loads also involved autopilots that reached their maximum hold limits, snapped off, and rolled the airplane. Although the airplane in this accident did not have an autopilot, historical examples indicate that a sudden yawing or rolling motion, regardless of the source, could result in a roll, nose tuck, and loss of control. The roll may have been recoverable, and in one documented case, a pilot was able to recover the airplane, but after it lost almost 11,000 ft of altitude. During this accident flight, it was likely that, during the descent, the flight crew did regain control of the airplane to the extent that the flight control surfaces were effective. With darkness and the rapid descent at a relatively low altitude, one or both crewmembers likely pulled hard on the yoke to arrest the downward trajectory, and, in doing so, placed the wings broadside against the force of the relative wind, which resulted in both wings failing upward. As the wings failed, the propellers simultaneously chopped through the fuselage behind the cockpit. At the same time, the horizontal stabilizers were also positioned broadside against the relative wind, and they also failed upward. Evidence also revealed that, at some point, the flight crew lowered the landing gear. Although it could not be determined when they lowered the gear, it could have been in an attempt to slow or regain control of the airplane during the descent. Although reasons for the loss of control could not be definitively determined, the lack of any preexisting mechanical anomalies indicates a likelihood of flight crew involvement. Then, during the recovery attempt, the flight crew's actions, while operating under the difficult circumstances of darkness and rapidly decreasing altitude, resulted in the overstress of the airplane.

Following an uneventful cargo flight from Christiansted-Henry E. Rohlsen Airport, the crew completed the landing normally at San Juan-Luis Muñoz Marin Airport. While taxiing to the ramp, the nose gear collapsed and the aircraft came to rest. Both pilots escaped uninjured and the aircraft was damaged beyond repair.

The airplane, operated by Fresh Air, Inc., crashed into a lagoon about 1 mile east of the departure end of runway 10 at Luis Muñoz Marín International Airport (SJU), San Juan, Puerto Rico. The two pilots died, and the airplane was destroyed by impact forces. The airplane was operated under the provisions of 14 Code of Federal Regulations (CFR) Part 1251 as a cargo flight. Visual meteorological conditions prevailed at the time of the accident, and a visual flight rules flight plan was filed. The flight had departed from runway 10 at SJU destined for Princess Juliana International Airport, St. Maarten. Shortly after takeoff, the first officer declared an emergency, and then the captain requested a left turn back to SJU and asked the local air traffic controllers if they could see smoke coming from the airplane (the two tower controllers noted in postaccident interviews that they did not see more smoke than usual coming from the airplane). The controllers cleared the flight to land on runway 28, but as the airplane began to align with the runway, it crashed into a nearby lagoon (Laguna La Torrecilla). Radar data shows that the airplane was heading south at an altitude of about 520 ft when it began a descending turn to the right to line up with runway 28. The airplane continued to bank to the right until radar contact was lost. The estimated airspeed at this point was only 88 knots, 9 knots below the published stall speed for level flight and close to the 87-knot air minimum control speed. However, minimum control speeds increase substantially for a turn into the inoperative engine as the accident crew did in the final seconds of the flight. As a result, the airplane was operating close to both stall and controllability limits when radar contact was lost. Pilots flying multiengine aircraft are generally trained to shut down the engine experiencing a problem and feather that propeller; thus, the flight crew likely intended to shut down the right engine by bringing the mixture control lever to the IDLE CUTOFF position and feathering the right propeller, as called out in the Engine Fire In Flight Checklist. This would have left the flight crew with the left engine operative to return to the airport. However, postaccident examinations revealed that the left propeller was found feathered at impact, with the left engine settings consistent with the engine at takeoff or climb setting. The right engine settings were generally consistent with the engine being shut down; however, the right propeller’s pitch was consistent with a high rotation/takeoff power setting. The accident airplane was not equipped with a flight data recorder or a cockpit voice recorder (nor was it required to be so equipped); hence, the investigation was unable to determine at what point in the accident sequence the flight crew shut down the right engine and at what point they feathered the left propeller, or why they would have done so. Post accident examination of the airplane revealed fire and thermal damage to the airframe on the airplane’s right wing rear spar, nacelle aft of the power section, and in the vicinity of the junction between the augmentor assemblies and the exhaust muffler assembly. While the investigation was unable to determine the exact location of the ignition source, it appears to have been aft of the engine in the vicinity of the junction between the augmentor assemblies and exhaust muffler assembly. The investigation identified no indication of a fire in the engine proper and no mechanical failures that would have prevented the normal operation of either engine.

Before departing on the flight that preceded the accident flight, the flight crew performed an engine-run, including a magneto check, during which they noted backfiring from the left engine. The captain first attributed the issue to water contamination of the fuel but then attributed it to fouled spark plugs. An additional engine run resulted in no further backfiring, and the captain decided to depart on the cargo flight; no maintenance was requested or performed on the left engine before departure. When the airplane was near the destination airport, the left engine backfired once again. The flight continued to the destination airport where the airplane landed uneventfully and the cargo was off loaded; again, no maintenance was performed or requested for the left engine. For the accident flight, the first officer was the pilot flying and the captain was the pilot monitoring. During the takeoff, the local controller noted black smoke trailing the left engine and advised the flight crew; however, the captain attributed the smoke to normal operation for the airplane type and decided to continue the flight. Meanwhile, air traffic control communications for the flight were transferred to San Juan Combined En Route Approach Control (San Juan CERAP). The local controller who noted the black smoke continued to watch the airplane’s departure. When the airplane was about 1 mile west of the runway, the controller observed bright orange then red flames from behind the left engine and immediately informed the San Juan CERAP controller, who in turn immediately notified the flight crew. The captain assumed control of the airplane and directed the first officer to go to the cabin to visually inspect the left engine. The first officer returned to the cockpit and informed the captain that he observed fire, and they immediately executed the fire checklist and shut down the left engine. However, the fire continued because it was located in an area where fire suppression bottles could not reach. The pilots returned to the airport; fire rescue vehicles were pre-positioned along various portions of the runway. The airplane touched down on the runway centerline. Because the fire had damaged the left brake line, braking was asymmetrical, and the airplane departed the right side of the runway and came to rest adjacent to the airport perimeter fence.

During taxi to a runway, the instrument panel and cockpit floor erupted in flames. Examination of the wreckage revealed that the majority of the wires contained inside the main junction box had very little damage except for two wires that had insulation missing. The damage appeared to be associated with the routing of the two wires. Both wires were connected to the battery relay and ran through wires in and around the exposed terminal studs. Heat damage was noted on the insulation of wires and other components that were in contact with the exposed wires. The wires ran from the battery relay to the forward section of the cockpit, where the fire started. Due to the fire damage that consumed the cockpit, the examination was unable to determine what system the wires were associated with. Further examination revealed that the fuel pressure was a direct indicating system. Fuel traveled directly to the instruments in the cockpit via rigid aluminum lines routed on the right lower side of the fuselage, where more severe fire damage was noted. Review of maintenance records did not reveal any evidence of the fuel pressure indicating system lines and hoses having ever been replaced; however, they were only required to be replaced on an as-needed basis. The electrical system, instrument lines, and hoses through the nose compartment were required to be inspected on a Phase D inspection; the airplane's last Phase D inspection was completed about 9 months prior to the accident and the airplane had accrued 313.1 hours of operation since that inspection.

The charter flight departed for the destination, where the passengers would connect with another airline flight. The instrument-rated pilot may have felt pressured as the flight departed late. The accident airplane approached the destination airport from the east, descending at 250 knots ground speed from 8,800 feet above mean sea level (msl), on a 270 degree assigned heading, and was instructed to enter the right downwind for runway 10. The airplane's altitude readout was then observed by the approach controller to change to "XXX." The pilot was queried regarding his altitude and he advised that he was descending to 3,200 feet msl. The pilot was asked to confirm that he was in visual flight rules (VFR) conditions and was advised that the minimum vectoring altitude (MVA) for the area was 5,500 feet msl. The pilot responded that “We just ahh,” at which time the controller advised that she missed his transmission and asked him to repeat it. The pilot stated “Ahh roger, could we stay right just a little, we are in and out of some clouds right now.” The controller advised the pilot to “Maintain VFR” and again of the MVA. The controller then made multiple attempts to contact the pilot without result. The wreckage was discovered on the side of a mountain, where the airplane impacted after entering instrument meteorological conditions. Because aircraft operating in VFR flight are not required to comply with minimum instrument altitudes, aircraft receiving VFR radar services are not automatically afforded Minimum Safe Altitude Warning services except by pilot request. The controller's query to the pilot about his altitude and flight conditions was based on her observation of the loss of altitude reporting information. The pilot had not indicated any difficulty in maintaining VFR flight or terrain clearance up to that point. His comment that the aircraft was "in and out of some clouds" was her first indication that the pilot was not operating in visual conditions, and came within seconds of impact with the terrain. The controller was engaged in trying to correct the situation, and despite having been advised of the minimum vectoring altitude, the pilot continued to descend. The airplane was equipped with a terrain avoidance warning system but it could not be determined if it was functional. The pilot owned the charter operation. Documents discovered in the wreckage identified the pilot and airplane as operating for a different company since the pilot did not have the permissions necessary to operate in the United Kingdom Overseas Territories.