Aviation Investigation Report A14o0217
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AVIATION INVESTIGATION REPORT A14O0217 COLLISION WITH TERRAIN FLYBLOCKTIME INCORPORATED CESSNA 150M, C-GJAO WHITNEY, ONTARIO, 8 NM S 11 NOVEMBER 2014 Transportation Safety Board of Canada Place du Centre 200 Promenade du Portage, 4th floor Gatineau QC K1A 1K8 819-994-3741 1-800-387-3557 www.tsb.gc.ca [email protected] © Her Majesty the Queen in Right of Canada, as represented by the Transportation Safety Board of Canada, 2016 Aviation Investigation Report A14O0217 Cat. No. TU3-5/14-0217E-PDF ISBN 978-0-660-04808-6 This document is available on the website of the Transportation Safety Board of Canada at www.tsb.gc.ca The Transportation Safety Board of Canada (TSB) investigated this occurrence for the purpose of advancing transportation safety. It is not the function of the Board to assign fault or determine civil or criminal liability. Aviation Investigation Report A14O0217 Collision with terrain Flyblocktime Incorporated Cessna 150M, C-GJAO Whitney, Ontario, 8 nm S 11 November 2014 Summary A Flyblocktime Incorporated Cessna 150M (registration C-GJAO, serial number 15077889) with 2 people on board departed from the Ottawa/Rockcliffe Airport, Ontario, at 1803 Eastern Standard Time under night visual flight rules for a flight to the Toronto/Buttonville Municipal Airport. At 2025, the pilot transmitted a mayday on the emergency frequency 121.5 MHz, indicating that he was lost and that the aircraft was low on fuel. This and subsequent transmissions were relayed to air traffic control by high-flying commercial aircraft. C-GJAO was below radar coverage, and air traffic control made numerous attempts to assist the aircraft in locating a suitable aerodrome. At 2127, the pilot made a final radio transmission, and the aircraft crashed shortly thereafter. The emergency locator transmitter activated on impact. Search-and-rescue personnel located the accident site in the south end of Algonquin Provincial Park at approximately 2340 but were unable to access the scene of the accident until 0300 because of inclement weather. Both of the aircraft’s occupants were found fatally injured. Le présent rapport est également disponible en français. Aviation Investigation Report A14O0217 | 1 Factual information History of the flight On the day of the accident (11 November 2014), the pilot had planned a round-robin flight from Toronto/Buttonville Municipal Airport (CYKZ) to Trois-Rivières Airport (CYRQ) and return, with enroute stops at Peterborough Airport (CYPQ) and Ottawa/Rockcliffe Airport (CYRO). No flight plan or flight itinerary was filed, although one of these was required by regulation.1 The Cessna 150M (C-GJAO) departed from CYKZ at around 09072 with the pilot and 1 passenger on board. On the leg inbound to CYRO from CYPQ, the pilot flew through restricted airspace (CYR538) surrounding Rideau Hall in downtown Ottawa. The airspace violation occurred at 1144 during Remembrance Day ceremonies. Following an uneventful flight from CYRO to CYRQ and return, C-GJAO again landed at CYRO at 1726, and the fuel tanks were filled in preparation for departure. At 1727, civil twilight ended and night began. C-GJAO departed CYRO at 1803 for the final leg of the round-robin trip under night visual flight rules (VFR) toward CYKZ, the original departure point. On departure, the pilot did not contact air traffic control (ATC), nor was the aircraft in airspace where such contact was required. At 2025, the pilot made a mayday call on an emergency frequency (121.5 MHz), stating that he was lost and that the aircraft was low on fuel. The call was received and acknowledged by the flight crew of a high-flying commercial aircraft, who relayed the information to ATC at the Toronto Area Control Centre (CZYZ). Shortly after the mayday call, the pilot of C-GJAO reported that the aircraft was on the 170º radial of the VOR (very high frequency omnidirectional range) from Coehill (VIE) at 3600 feet.3 Over the next several minutes, ATC attempted, working with a few different commercial aircraft via transmission relay, to establish direct controller–pilot communication (DCPC) with C-GJAO by having the occurrence pilot switch frequencies to frequencies with receivers and antennas located closer to C-GJAO’s reported location. Although DCPC was occasionally established, it was transient. As a result, ATC continued to communicate with the occurrence pilot mainly by relay through several different commercial aircraft for the remainder of the occurrence flight. 1 Canadian Aviation Regulations (CARs) 602.73(2). 2 All times are Eastern Standard Time (Coordinated Universal Time minus 5 hours) unless otherwise noted. 3 All altitudes are in feet above sea level (asl), unless otherwise noted. 2 | Transportation Safety Board of Canada Between 2032 and 2043, the pilot reported the aircraft as being on various radials from VIE, including 170°, 217°, 180°, and 320°. The aircraft heading was reported by the pilot as varying from 180° to 240° magnetic (M). At 2041, ATC instructed the aircraft to climb in order to enter radar coverage, which would have made it possible for ATC to determine the aircraft’s exact position. The pilot climbed as high as possible while remaining in visual meteorological conditions. At 2048, the aircraft reached a reported altitude of 5200 feet, but ATC was still unable to acquire the aircraft on radar. At 2044, ATC asked the pilot how much fuel remained. The pilot reported that a quarter of the fuel in the aircraft’s tanks was left. At 2051, with some assistance from ATC, the pilot reported that the aircraft was on the intersection of the 330° radial from VIE and the 220° radial from the Killaloe VOR (YXI). ATC asked the pilot how many minutes’ fuel remained. The pilot responded that the aircraft’s tanks were almost empty. ATC determined from the pilot’s reported position that the nearest airport equipped with runway lights was the Haliburton/Stanhope Municipal Airport (CND4), approximately 22 nautical miles (nm) to the northwest. Although CYPQ was in a better-lit urban area than CND4, it was 40 nm away from the pilot’s reported position at that time then. At 2059, to help the pilot navigate to CND4, ATC instructed the pilot to fly a heading of 350°M to intercept the 320º radial from VIE. The pilot acknowledged and informed ATC that a descent would be initiated in order to maintain VFR. During the following 9 minutes, ATC requested several updates from C-GJAO as to the aircraft’s position with reference to the VIE and YXI VORs. The positions reported by the pilot suggested that the aircraft was not making progress toward the 320° radial, but rather was moving further away from it, to the east. At 2108, following a position report that established C-GJAO as being approximately 27 nm to the east of CND4, ATC instructed the pilot to fly a heading of 250°M. At 2114, ATC asked the pilot whether his directional gyro4 matched the standalone compass5 heading. The pilot confirmed that it did, and that the aircraft was now level at 2500 feet. At 2116, the pilot reported that the VOR receiver was indicating that the aircraft was on the 360° radial from VIE, although the indicator flag was fluctuating between “FROM” and “OFF”. At 2124, the pilot reported on the 320° radial from VIE. As CND4 is located very close to this radial, ATC informed the pilot that the airport should be located nearby and suggested that the pilot circle around to look for it. 4 The directional gyro is the aircraft’s vacuum-driven heading indicator, which operates independently from the magnetic compass. 5 The standalone compass is a liquid-filled magnetic compass, which operates independently from all other aircraft systems and is periodically calibrated to ensure accuracy. Aviation Investigation Report A14O0217 | 3 At 2127, the pilot reported that the aircraft was descending out of 2000 feet. When the commercial aircraft that was in direct contact with C-GJAO asked whether that was because the aircraft was out of fuel, the pilot responded in the affirmative. Although several attempts were made to contact C-GJAO following this transmission, there was no response. Radio navigation and radar track Pilots flying VFR at night between CYRO and CYKZ normally either fly directly, with the assistance of radio- or satellite-based navigation aids, or, more commonly, follow the well-lit major highways. The direct route is more expeditious; however, most of the route is over terrain that is sparsely settled and may be very dark at night. Although in-flight visibility may exceed the 3 nm minimum required by regulation,6 the lack of ground lighting in this area means that there are few visual cues to identify landmarks, making visual navigation difficult. To assist with this navigation, pilots often use radio-based navigation equipment and fly the V300 very high frequency (VHF) airway, which begins as the 256° radial outbound from the Ottawa VOR. The recorded radar track of the occurrence aircraft for the first 96 minutes following departure (Figure 1) indicates that, once clear of the lights of the Ottawa–Gatineau area, the pilot chose to follow the V300 airway. However, the track varied significantly in an area between the 256º and the 281° radials outbound from Ottawa/Macdonald-Cartier International Airport (YOW). The recorded radar track ended at approximately 1939, when the aircraft moved out of range of the Ottawa-based radar. On the recording, the aircraft’s cruise altitude varied between 2500 feet and 3900 feet. The final 98 minutes of the flight were not recorded on radar and, as a result, the aircraft’s flight path during this period is uncertain. 6 Canadian Aviation Regulations (CARs) 602.115 (b)(ii).