Aviation Accident Summaries

Aviation Accident Summary MIA06LA044

Ponce, PR, USA

Aircraft #1

N495LF

MBB BO-105S

Analysis

After the patient was placed aboard the helicopter, the pilot started the engines and performed a hover check. He then moved the helicopter forward to gain airspeed and initiated a climb to cruise altitude. After reaching an altitude of about 100 feet, the main rotor rpm light and audio warning system activated, and the number 2 engine N1 rpm and torque began to decay. The pilot attempted to regain normal engine parameters, but was unable to regain engine rpm. The pilot maneuvered to avoid several light poles as he attempted to land in a parking lot. By this time, main rotor rpm had bled off sufficiently to prevent the hydraulic pumps from pressurizing the hydraulic system, and all flight controls locked is a slight right banked attitude. This prevented the helicopter from reaching the parking lot. The helicopter impacted a construction area in a right bank, nose down attitude. An on-site and later follow-up investigation by FAA and Rolls-Royce investigators revealed a B-nut on the Pc line connecting the power turbine governor (PTGOV) to the fuel control unit (FCU) had become loose at the T-fitting end. It was partially torqued and could be moved with the fingers. The female end was threaded onto the male end three-quarters of a turn. There was no cross-threading. The torque stripe was broken. According to Rolls-Royce Allison, "This line serves a critical function to the engine control system and when leakage occurs will cause the engine to roll back to an idle or near idle condition."

Factual Information

On January 12, 2006, at 0343 Atlantic standard time, a Eurocopter Messerschmitt-Boelkow-Blohm BO-105S, N495LF, registered to and operated by MSE Air Group, Inc., as Aviane Air Ambulance, and piloted by a commercial-certificated pilot, was substantially damaged when it collided with terrain during an attempted forced landing following a loss of power in one of its engines during takeoff from San Cristobal Hospital, Ponce, Puerto Rico. Night visual meteorological conditions prevailed at the time of the accident. The air ambulance flight was being conducted under the provisions of Title 14 CFR Part 135, and a company visual flight rules (VFR) flight plan had been filed. The pilot sustained minor injuries, and two medical flight crew members and one passenger were not injured. The flight had originated in San Juan, Puerto Rico, at 0141. The pilot stated that the flight from San Juan to Ponce had been uneventful, and landed at 0205. After the patient was placed aboard the helicopter, the pilot started the engines and performed a hover check. He then moved the helicopter forward to gain airspeed and initiated a climb to cruise altitude. After reaching an altitude of about 100 feet, the main rotor rpm light and audio warning system activated, and the number 2 engine N1 rpm and torque began to decay. The pilot attempted to regain normal engine parameters, but was unable to regain engine rpm. The pilot maneuvered to avoid several light poles as he attempted to land in a parking lot. By this time, main rotor rpm had bled off sufficiently to prevent the hydraulic pumps from pressurizing the hydraulic system, and all flight controls locked is a slight right banked attitude. This prevented the helicopter from reaching the parking lot. The helicopter impacted a construction area in a right bank, nose down attitude. An on-site and a later follow-up investigation by FAA and Rolls-Royce investigators revealed a B-nut on the Pc line connecting the power turbine governor (PTGOV) to the fuel control unit (FCU) had become loose at the T-fitting end. It was partially torqued and could be moved with the fingers. The female end was threaded onto the male end three-quarters of a turn. There was no cross-threading. The torque stripe was broken. According to Rolls-Royce Allison, "This line serves a critical function to the engine control system and when leakage occurs will cause the engine to roll back to an idle or near idle condition."

Probable Cause and Findings

A loose B-nut on the PC line connecting the power turbine governor (PTGOV) to the fuel control unit (FCU) that created a leak and caused the engine to roll back to an idle condition, causing a low hydraulic system pressure and subsequent control lock. A contributing factor was the unsuitable terrain (construction area) on which to make a forced landing.

 

Source: NTSB Aviation Accident Database

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