Report released on crash of firefighting helicopter in Queensland

The Bell 214B crashed while on a water-dropping mission Nov. 13, 2019

B214 helicopter crash Queensland November 13 2019
Bell 214, Queensland, Australia, November 13, 2020. Photo by operator.

The Australian Transport Safety Bureau has released an Occurrence Brief regarding the Bell 214B that crashed while it was on a water dropping mission near Pechey, Queensland, Australia November 13, 2019.

The pilot suffered minor injuries and was flown to a hospital by another helicopter.

Below is the complete text of the Brief. (We added the photo taken by 9News):


Occurrence Briefs are concise reports that detail the facts surrounding a transport safety occurrence, as received in the initial notification and any follow-up enquiries. They provide an opportunity to share safety messages in the absence of an investigation.

What happened
On 13 November 2019, a Bell 214B helicopter was water bombing during fire control operations near Pechey, Queensland. At 1344 Eastern Standard Time, the helicopter approached the bushfire downwind and down hill from the north-west at about 60 knots, and made a descending right-hand turn back into wind over the fire.

The descent was continued towards the drop zone. The airspeed was further slowed and the height was reduced to about 150 feet above ground level (50 feet above treetop level). The pilot then released the load of water before departing the drop area into rising terrain. The pilot heard the low rotor RPM warning and had insufficient altitude and clearance from obstacles to recover the rotor RPM and continue flying. He was concerned that further actions required to recover the rotor RPM would result in the helicopter possibly striking trees or ending up in the actively burning fire.

Helicopter Down crash Queensland Australia
Bell 412B crashed while working on a fire near Pechey, Queensland, Australia November 13, 2019. Photo by 9News

In maintaining the climb to avoid rising ground, trees and fire, the rotor RPM appeared to decay further. As the helicopter cleared the trees, it began to descend, yawed to the right and the left-hand skid collided with the ground. The helicopter rolled onto its left side resulting in substantial damage. The pilot was able to turn off the fuel to stop the engine and exited the helicopter via the overhead window with minor injuries. Neither the g-force activated ELT beacon or flight tracking alarm were triggered.

The distance from the last water drop to the impact point was less than 100 metres and the recovered aircraft showed little evidence of damage from forward moment.

B214 helicopter crash Queensland November 13 2019
Bell 214, Queensland, Australia, November 13, 2020. Photo by operator.

Operator’s investigation and comments
Based on the pilot’s account of the accident and assessment of the recovered aircraft, mechanical malfunctions were ruled out as a contributing factor. The operator determined that the accident was most likely the result of a loss of rotor RPM that the pilot was unable to recover, due to a downwind descending turn, low altitude for the water drop, and a departure into rising terrain. The pilot had to make a decision between putting the helicopter into tall trees and active bushfire or climbing over the trees to clear ground. In choosing the latter, the rotor RPM decayed further and the helicopter contacted the ground.

The operator stated that the helicopter type is renowned for its ‘hot and high’ performance making it a very effective firefighting platform. Firefighting combines a number of factors which result in flying that is close to the performance limits of the aircraft – high gross weights, low airspeeds, low altitude, close quarters manoeuvring, high work rate environment and adverse weather conditions. In this case the combination of factors immediately leading up to the accident resulted in the helicopter operating outside its performance envelope without having enough space and height to recover.

Safety action
As a result of this occurrence, the aircraft operator has advised the ATSB that they are taking the following safety actions:

The operator has provided a briefing to all of their pilots on the circumstances and the outcome of this accident. The pilot involved in this accident will be involved in future training and checking to enable the recognition and avoidance of the circumstances that saw the limitations and flight envelope exceeded. This training will become part of the operator’s annual training for all pilots conducting fire control operations.

Safety message
Fire control flying operations can involve challenges and complexities that require crews to maintain a heightened awareness of their aircraft’s operating limits and the environmental conditions. Flying within operating limits can ensure pilots have a performance margin to react to unforeseen circumstances.

About this report
Decisions regarding whether to conduct an investigation, and the scope of an investigation, are based on many factors, including the level of safety benefit likely to be obtained from an investigation. For this occurrence, no investigation has been conducted and the ATSB did not verify the accuracy of the information. A brief description has been written using information supplied in the notification and any follow-up information in order to produce a short summary report, and allow for greater industry awareness of potential safety issues and possible safety actions.

Preliminary report released about crash of Air Tanker 134

The accident occurred January 23, 2020 in Australia

ATSB preliminary report crash Air Tanker 134 Australia
Figure 1: Flight path of N134CG (white). Source: Google Earth, Aireon and RFS tracking data, annotated by the ATSB.

Today the Australian Transport Safety Bureau released a preliminary report about the crash of Air Tanker 134, an EC-130Q, that occurred January 23, 2020 while fighting a bushfire in New South Wales. The location was 50 km north-east of Cooma-Snowy Mountains Airport (near Peak View). All three members of the crew perished, First Officer Paul Clyde Hudson, Captain Ian H. McBeth, and Flight Engineer Rick A. DeMorgan Jr.

Below is the complete text of the report.


Preliminary report published 28 February 2020

Sequence of events
On 23 January 2020, at about 1205 Eastern Daylight-saving Time,[1] a Lockheed EC130Q (C‑130) aircraft, registered N134CG and contracted to the New South Wales (NSW) Rural Fire Service, departed Richmond RAAF Base, NSW. The crew had been tasked with a fire retardant drop over the ‘Adaminaby Complex’ bush fire.

After approaching the Adaminaby complex fire, the drop was unable to be completed and the aircraft was diverted to a secondary tasking, to drop retardant on the ‘Good Good’ fire (Figure 1). Witnesses reported seeing the aircraft complete a number of circuits, prior to completing the retardant drop. The drop was conducted on a heading of about 190°, at about 200 ft above ground level, with a drop time of approximately 2 seconds. The crew released about 1,200 US gallons (4,500 L) of fire retardant during the drop.

Witness videos taken of the aircraft leading up to the accident showed a number of passes conducted at varying heights prior to the retardant drop. Following the retardant drop (Figure 2), the aircraft was observed to bank left, before becoming obscured by smoke[2] after about 5 seconds. A further 15 seconds after this, the aircraft was seen flying at a very low height above the ground, in a left wing down attitude. Shortly after, at about 1316, the aircraft collided with terrain and a post-impact fuel-fed fire ensued. The three crew were fatally injured and the aircraft was destroyed.

ATSB preliminary report crash Air Tanker 134 Australia
Figure 2: Overview of the drop zone (red fire retardant) and accident location. Source: ATSB

A review of the Airservices Australia audio recording of the applicable air traffic control frequency found no distress calls were made by the crew prior to the impact.

Wreckage and impact information
The accident site was located on slightly sloping, partially wooded terrain, about 50 km north-east of the Cooma-Snowy Mountains Airport. The wreckage trail (Figure 3) was approximately on a heading of 100°, with the initial impact at an elevation of about 3,440 ft above mean sea level.

The ATSB’s on-site examination of the wreckage, damage to the surrounding vegetation, and ground markings indicated that the aircraft initially impacted a tree in a left wing down attitude, before colliding with the ground. The post-impact fuel-fed fire destroyed the aircraft. The examination also found that an emergency dump of the fire retardant had not been activated.

The engines, propellers, and several other components have been retained by the ATSB for further examination.

ATSB preliminary report crash Air Tanker 134 Australia
Figure 3: Aircraft impact and wreckage. Source: ATSB

Aircraft information
The Lockheed C-130 is predominantly an all-metal, high-wing aircraft, largely designed for military operations. The aircraft was manufactured in 1981 and was powered by four Allison T56-A-15 turboprop engines, fitted with Hamilton Sundstrand 54-H60-91 four blade propellers. Previously owned by the United States Navy, the aircraft was re-purposed for firefighting activities and registered as N134CG in 2018 (Figure 4). The modifications included the installation of an avionics package and firefighting tank system known as Retardant Aerial Delivery System XXL (RADS).

The RADS included a 4,000 US gallons (15,000 L) tank system located within the aircraft’s fuselage. The system was capable of delivering discrete quantities of retardant, dependent on the duration that the doors remained open. It was controlled from the cockpit, with drop controls located on both the pilot and copilot yokes. The system also included an emergency dump switch, which, when activated, fully opened the doors and jettisoned the load. The doors remained open until the RADS was reset by the crew.

N134CG arrived in Australia in November 2019, but had previously operated in the country during the 2018‑2019 fire season. The aircraft was designated as a ‘large air tanker’.

ATSB preliminary report crash Air Tanker 134 Australia
Figure 4: N134CG. Source: Coulson Aviation

Meteorological information
A Bureau of Meteorology graphical area forecast, issued at 0924 and valid for the time of the flight, forecast moderate mountain wave activity above 3,000 ft (above mean sea level) in the area of operation from Richmond to Cooma, and included the Adaminaby and Good Good fire grounds. A SIGMET[3] issued at 0947 forecast severe turbulence below 10,000 ft.

The aerodrome forecast for the Cooma-Snowy Mountains Airport[4] was amended at 0948, and indicated wind speeds of 30 kt, gusting to 48 kt, with a mean wind direction of 320°. It also included blowing dust and visibility of 2,000 m, with severe turbulence below 5,000 ft above ground level.

The weather observations recorded at the airport about 11 minutes prior to the accident, indicated a wind speed of 25 kt, gusting to 39 kt, from a direction of 320°, with visibility reduced to 6,000 m.

Cockpit voice recorder
Cockpit voice recorders (CVR) are designed on an endless loop principle, where the oldest audio is continuously overwritten by the most recent audio. The CVR fitted to the aircraft was a Universal model CVR-30B, part number 1603-02-03, serial number 1541. This model of recorder used solid-state memory to record cockpit audio and had a recording duration of 30 minutes.

The CVR was recovered from the aircraft and transported to the ATSB’s technical facility in Canberra, Australian Capital Territory, on 25 January 2020 for examination and download. The CVR was successfully downloaded, however, no audio from the accident flight had been recorded. All recovered audio was from a previous flight when the aircraft was operating in the United States.

Further investigation
The investigation is continuing and will include consideration of the following:

  • Engine, gearbox and propeller component examinations
  • Aircraft maintenance history
  • Aircraft performance and handling characteristics
  • Impact sequence
  • Analysis of numerous witness reports
  • Review and analysis of the available recorded data, including witness videos, aircraft tracking data, audio recordings and any onboard systems
  • Review and analysis of environmental influences
  • The crew’s qualifications, experience and medical information
  • The nature of aerial fire-fighting operations
  • Operating policies and procedures
  • Exploring the possible reasons why the CVR did not record the accident flight
  • Similar occurrences

The ATSB will continue to consult with the engine and airframe type certificate holders. Accredited representatives from the United States National Transportation Safety Board (NTSB) have been appointed to participate in the investigation.

Acknowledgments
The ATSB acknowledges the support of the NSW Police Force, NSW Rural Fire Service, NSW Fire and Rescue, the Australian Defence Force, and those involved with facilitating safe access to an active fire ground and supporting the ATSB’s on-site investigation team.

_________

The information contained in this preliminary report is released in accordance with section 25 of the Transport Safety Investigation Act 2003 and is derived from the initial investigation of the occurrence. Readers are cautioned that new evidence will become available as the investigation progresses that will enhance the ATSB’s understanding of the accident as outlined in this preliminary report. As such, no analysis or findings are included.

_________

  1. Eastern Daylight-saving Time (EDT): Coordinated Universal Time (UTC) + 11 hours.
  2. From the video, it was unclear if the aircraft flew behind the smoke or entered the smoke.
  3. Significant meteorological information (SIGMET): a weather advisory service that provides the location, extent, expected movement and change in intensity of potentially hazardous (significant) or extreme meteorological conditions that are dangerous to most aircraft, such as thunderstorms or severe turbulence.
  4. The Cooma-Snowy Mountains Airport has an elevation of 3,106 ft.

Report released for multiple smokejumper injuries on wildfire in Utah

Three of the seven jumpers were injured and evacuated by two helicopters

Injuries smokejumpers Miner Camp Peak Fire
Map from the FLA.

The Wildland Fire Lessons Learned Center has released a Facilitated Learning Analysis for an incident within an incident. Three of the seven smokejumpers that parachuted into the Miner Camp Peak Fire on July 29 east of Meadow, Utah were injured when landing. (Map) Two injuries were to the hand or wrist and the other was diagnosed at the scene as a broken collar bone or at least the potential for one.

The jumpers were evacuated by two helicopters, an air ambulance and a helicopter with hoist capabilities.

The jumpers received the resource order for the fire at 8:30 a.m. on July 29 while they were engaged in physical training. Since some of them “like to run trails in the surrounding area”, they did not get off the ground until 10:30. Due to the delayed departure, the distance they had to fly, and multiple issues related to fuel, the seven jumpers did not arrive on the ground at the fire until 5 p.m.

You can read the FLA here. (2.1 MB .pdf file)

Helitack crew is extracted as fire approaches, leaving water bucket attached to the helicopter

report crew extracted fire water bucket attached helicopter
Photo of the heel of the fire as seen from the helispot. Photo from the preliminary report.

(Originally published at 9:28 a.m. MDT August 20, 2018)

While researching another topic I ran across a preliminary report about a helitack crew that on July 1, 2018 was extracted by their helicopter after the wind changed on the fire, driving it toward their helispot. This occurred on the Spring Creek Fire in Colorado. Because of the timing of the events and since they had to quickly move 150 yards to another location as dense smoke made it unsafe for the helicopter to land at the helispot, it might be described as a close call. But it appears that the reason the report was written was that the crew decided to leave the water bucket and long line attached as they evacuated in the aircraft. Having passengers in a helicopter with a bucket attached is not consistent with policy.

Below are excerpts from the preliminary report. The photos are also from that document. Our opinion is at the end, following the excerpt.


NARRATIVE

…The HMGB [Helicopter Manager, Single Resource] called pilot and requested him to land and pick up the crew, thinking there was still plenty of time to load bucket, gear and crew members. At the time of radio call the pilot had just dropped water in view of the crew, and was less than thirty seconds from the helispot. Winds continued to increase from 10 to at least 30-35 mph. At this time fire behavior increased dramatically, causing all the vehicles parked near helispot (approximately six or eight) to mobilize as quickly as possible and drive down the road below.

The IC asked the crew face to face if we were all good before he left. The HMGB considered jumping in the vehicles for a ride but quickly decided not to. The Decision was based on the time it would take to physically get into vehicles, the time it was taking for the vehicles to actually get headed down the road, the location of the fire at the time, and not being familiar with the fire experience of the vehicles occupants. HMGB deemed it best for the helitack crew to stick together.

As aircraft approached helispot, the pilot informed crew that there was too much smoke to land, but had another landing zone in sight downslope. The crew grabbed gear and began hiking towards the aircraft’s hovering location approximately one hundred and fifty yards down down slope. Helitack crew arrived at the new landing zone as the helicopter was landing. HMGB and crew began loading gear on the pilots side, and had full intentions of loading bucket and longline, but HMGB noticed pilot signaling to plug in flight helmet. Crew members continued to load gear and HMGB went around nose of aircraft, opened managers door, stood on skid and plugged in flight helmet. Pilot advised that he recommended loading crew and picking up with the longline and bucket attached to get to a safe location. Pilot made decision based on the fires rapid progression from time crew left helispot and hiked down to the second LZ. HMGB took a quick scan of fire and agreed with pilot that we needed to lift ASAP.

report crew extracted fire water bucket attached helicopter
Two days later looking NNE. Red H is helispot. White circle is second LZ. Green arrow shows wind direction all afternoon. Yellow arrows show wind switch and fire spread direction.

HMGB went back to cargo area and told the two crew members to forget the bucket and load up we would lift with the bucket attached and relocate to a safe location. The crew members understood and agreed and loaded up. The HMGB made sure aircraft doors were secure, confirmed everyone was buckled and told pilot we were ready to lift. As aircraft lifted, the longline and bucket were on the managers side of aircraft. The HMGB relayed the status of longline to pilot until it was out of view and in view of the pilot out the bubble window.

As aircraft flew away, the pilot informed air attack exactly what we had done. The air attack understood and relayed that the fire experienced a microburst, and one hundred percent of the fire perimeter had active fire spread.The aircraft flew about one quarter of a mile well below the fires heel, over sage brush and grass fuel model, and found a safe place to land. Once on the ground the pilot informed crew we had plenty of fuel, and to take our time loading bucket. The aircraft departed landing zone and flew back to airport in Alamosa, CO to RON. The manager met with the rest of the crew and notified the crews superintendent. HMGB conducted an AAR, and notification was made up the chain of command in the region and the home base region.

report crew extracted fire water bucket attached helicopter
The photo shows the fuel at the helibase, vehicles, and the area where the helicopter was working.

CORRECTIVE ACTION

During the AAR, HMGB commended crew members for their vigilance on the scene of fire. Crew was constantly watching the fires behavior and spread, discussing the wind direction and different options to escape if needed. The black identified as a safety zone had a road going from the helispot up past it and was viable until the wind switched and increased pushing the fire up towards the road edge. The crew identified the helispot’s lack of burnable fuel and deemed it a safe spot. A later flight showed that the helispot did not burn, but when the IC decided to leave the spot, the crew did too. Plus one will never know how much heat was actually funneled over it. There was another open ridge downslope about 500-600 yards with a road leading to it that a helicopter could most likely land. The crew could have gotten a ride down to scout it out before the fire blew up, but that location didn’t have a vantage of the fire.

The crew actively talks with pilot about what to do in emergency situations. The crew had even talked earlier in the week about flying with a longline attached. It was comforting to know that those discussions took place and what to expect and the risk involved. The crew also practices proficiency bucket deployment, and packaging drills almost weekly. (Not with rotors turning) This gives managers and crew members a rough idea of how long it takes to perform these functions in the field. The HMGB on board has worked with the pilot for over eight seasons. The relationship, discussions, and trust built over the years was extremely valuable in the decision made that day.

Colorado DFPC Aviation Unit Chief comments:

Appropriate action taken during the extreme fire conditions and glad there was a positive outcome. Suggest a review of the additional risk decision to fly with the longline and bucket with personnel on board. The cost of a longline and bucket burning up is not worth the additional risk and exposure to employees. This is similar to teaching firefighters to drop their packs prior to deployment of a fire shelter from my perspective.

(end of excerpt from the preliminary report)


Our opinion

The report clearly outlines the fact that the crew felt they did not have time to package and load the bucket and long line, but there is no mention that they considered disconnecting it and taking off without it, leaving it on the helispot. Surely they did think about it, but the replacement cost if it was destroyed in the fire may have been a concern.

I support breaking the rules if there is an urgent, critical need to do so, and if all of the alternatives and possible outcomes are considered. Especially if a person’s life is threatened.

In 2012 a firefighter on the Pole Fire in Oregon was rescued from an advancing wildfire by climbing into a water bucket below a helicopter. The firefighter very reluctantly got into the bucket only after repeated warnings from the pilot that the fire was approaching and he was in immediate danger.

In 2014 on the King Fire east of Placerville, California when a hand crew was in danger of being overrun by flames a helicopter pilot considered using his bucket to extract the personnel. However, he continued to communicate with the crew and escorted them to safety as they walked and ran a considerable distance, orbiting over them and providing constant updates. The whole time he had water in his bucket saving it in case there was a need to protect the crew.

Report released on landing gear failure on CL-415 in France

There was a mechanical failure while taxiing.

CL-415 landing gear failure Ajaccio France

Above: photo of the incident scene, from the report.

(Originally published at 6:55 p.m. MST November 22, 2017)

The French government has released a report about an incident that occurred August 1, 2016 at Ajaccio. As best we can tell from the document, which is in French of course, is that a CL-415 experienced a mechanical failure in the right side landing gear while taxiing and turning left onto a runway before takeoff on a fire mission.  When one of the components broke, the gear partially collapsed, causing the aircraft to tip to the right, coming to rest on the float under the wing tip.

Thankfully the crew was not injured.

The report appears to indicate that the problem was related to a maintenance issue due to a translation error in a technical document.

In the photo above, some of the foam and liquid is probably from a fire engine that can be seen in the photo at the top of this article.

Report: MV-22 Osprey crash caused by dust from rotor wash

The Marine Corps investigation into the crash of an MV-22 Osprey tilt-rotor aircraft May 17 in Hawaii determined that it was caused by dust stirred up by the rotor wash.

Osprey_dust_USAF_photo
File photo of MV-22 Osprey. USAF photo..

After making multiple attempts to land in brown-out conditions, the buildup of debris on the turbine blades and vanes led to a compressor stall in the left engine, which decreased lift and resulted in the hard landing and fire.

The report found that pilot performance and an improper site survey of the landing zone led to the accident, resulting in the deaths of two and injuries to 20 on board.

The potential for the Osprey to deliver water or personnel to fight wildfires was evaluated by the Marine Corps in tests with a 900-gallon water bucket. They recommended that the aircraft not exceed 90 knots with a bucket and 50 knots when dropping water.

MV-22 Osprey with bucket
MV-22 Osprey with bucket. DOD photo.

The Osprey is a tilt-rotor aircraft capable of vertical or short takeoff and landing. When airborne, it can cruise at over 300 mph, can carry 24 to 32 troops, or 15,000 pounds of external cargo.

However, there are some issues that would stand in the way of the Osprey fighting fires, such as the very powerful rotor wash that has injured people nearby, the extreme heat that comes out of the engine exhaust which has started wildland fires and damaged flight decks on ships, and the high cost of $83,256 dollars an hour.

We have written a number of articles at Fire Aviation and at Wildfire Today about the MV-22 Osprey and its suitability for fighting fires.

NIFC: air tanker unable to fill rate decreases in 2013

Air tanker unable to fill requests (UTF)

The National Interagency Fire Center has released their annual summary of wildfire activity in 2013. In the aviation section one of the stats we always find interesting is the number of requests for large air tankers that are unable to be filled (UTF). That is, when firefighters officially submit a request for an air tanker but there are none available because all of them are committed to fires, they are on their day off, or they have a mechanical problem.

An air tanker having a day off is ridiculous, especially when the fleet size has atrophied from 44 at the beginning of 2002 down to nine when the 2013 fire season began. But that is the way the U.S. Forest Service writes their contracts for large air tankers.

During the 2002 fire season the wings literally fell off two air tankers, killing five aviators, causing the USFS to begin grounding the older museum pieces that summer, continuing the process into 2004. Since then the UTF rate has been climbing. Much of the time when firefighters need air tankers there are none available, reaching a high of 48 percent in 2012.

After 2004 when the groundings settled down and the fleet size ranged from 9 to 21, the average UTF rate was 26 percent. In 2013 it was 21 percent. Before the two wing failures, with 40 air tankers on contract the average UTF rate was 7 percent for 2000 through 2001.

In articles like this pointing out how the air tanker fleet has decreased by 75% over the last 11 years, we usually mention that air tankers don’t put out fires. Under ideal conditions of moderate burning conditions without a strong wind, they can sometimes slow down a fire making it easier for firefighters on the ground to make better progress and actually stop the fire. It is one tool in the toolbox. But an *aggressive, prompt, initial attack with overwhelming force both on the ground and from the air is more likely to keep a new fire small than what we have seen in recent years with reductions in the number of firefighters and aircraft. An aggressive attack can prevent a small fire from becoming a megafire that can cost over $100 million.

In 2013 there were nine fires with suppression costs exceeding $10 million. The Rim Fire in and near Yosemite National Park ran up bills amounting to $127 million.. And those dollar figures do not include the damage to privately owned property or the lives lost. Information provided by the USFS shows that 11,625 homes burned in wildfires over the last three years; and they don’t have records for ALL structures that burn in wildfires across the nation. If those houses had an average value of $100,000, we are looking at a monetary value of $1.1 trillion. During that three year period 60 people were killed in wildfires, including firefighters and local residents.

While the number of acres burned in wildfires in the United States in 2013 (minus Alaska) was lower than the recent trend, the number of air tanker requests that were filled (1,017) was four times higher than the average between 2002 and 2012, which was 252 per year. The year with the second highest number of filled requests since 2002 was 2011 when large air tankers were requested 407 times.

Acres burned lower 49 1990 - 2013

We are at a loss to come up with a reason for the unprecedented increase in the number of filled requests, in a year that had the fourth lowest number of acres burned in the lower 49 states in the last 10 years. The number of requests for large air tankers was 1,343, compared to an average of 434 per year.

The information in this report might be 100 percent right and truthful. But, sadly, we are now forced to look at these and other statistics coming out of Boise and the Interagency Fire Center and consider that they may or may not be accurate. We learned a lesson after the U.S. Forest Service issued their “FY 2013 Aviation Safety Summary” last month which claimed there were no USFS aircraft accidents in the last three years. At least four accidents since 2008 with a total of nine fatalities, including the 2012 crash of the MAFFS air tanker on a USFS fire which killed four aviators, do not show up in their stats. Nor are they even mentioned anywhere in the report. Their use of imaginative criteria for leaving out certain accidents made it appear that they had a pretty good accident record, when the opposite is true.

That lesson learned means we now have to look at these Boise reports and question their accuracy. This is really unfortunate. It casts doubt on reports and statistics that might have the potential for us to learn other lessons that could enhance the safety of firefighters at the point of the spear — busting their asses out on hot, steep, dusty, smoky, rocky slopes in the middle of nowhere for weeks at a time.

*Prescription for keeping new fires from becoming megafires.

USFS report: no aviation accidents in last three years

The U.S. Forest Service has released an aviation safety report titled “FY 2013 Aviation Safety Summary” which theoretically analyses, or at least lists, accident trends. Their presumed safety goal, although we could not find in the report any goals or objectives, is to reduce accidents. We were astounded to read on page 4 a statement that was repeated in various ways on pages 8, 18, and 33:

The Forest Service did not have any accountable accidents again in FY 2013; this was the third year in a row without an accident.

That statement was backed up by these two charts, and others in the report:

USFS Aircraft accident statistical summary USFS air tanker accidents 10-yr stats

At least four accidents since 2008 with a total of nine fatalities do not show up in these stats:

  • 2008, September 1: crash of a Neptune air tanker at Reno with three fatalities;
  • 2012, June 3: crash of a Neptune air tanker in Utah with two fatalities;
  • 2012, June 3, crash of a Minden air tanker at Minden, Nevada (one landing gear did not lower), irreparable damage, no fatalites;
  • 2012, July 1, crash of a MAFFS air tanker in South Dakota, four fatalities.

There may have been other accidents between 2004 and 2007 that also were not listed.

We checked with the USFS about the discrepancy and spokesperson Jennifer Jones told us that the accidents “were not included in the document because it was a U.S. Forest Service aviation safety report and the airtankers were under the operational control of other agencies when the accidents occurred, so they are not considered reportable accidents for the U.S. Forest Service.”

It turns out that if an air tanker under contract to the USFS is flying on a fire for another agency and crashes, the USFS will not include that accident in the report. However, the MAFFS air tanker crashed while making a drop on the White Draw fire on the Black Hills National Forest.

C-130 MAFFS crash, July 1, 2012
C-130 MAFFS air tanker crash, July 1, 2012. US Air Force photo

A statement in the report absolves the USFS from responsibility for accidents involving military aircraft:

Military aircraft remain under the operational control of the military even while supporting USFS operations.

But the military does not totally agree. In the Air Force report on the MAFFS crash it says on page 5:

Fire suppression management is under civilian control.

And later on page 29:

Second, due to the need for swift reaction to live fires, the practical supervision of executing a MAFFS mission, by default, is under civilian control.

We could not find the word “MAFFS” anywhere in the 33-page FY 2013 Aviation Safety Summary document, or any reference to the nine fatalities we listed above.

In 2012 MAFFS air tankers dropped 2.45 million gallons of retardant on fires, frequently under USFS operational control.

The 2012 landing gear failure on the Minden air tanker was not listed, the USFS said, because “the National Transportation Safety Board determined that it did not meet the definition of an accident”. But part of the definition of an “accident” in this summary report (page 3) is one “in which the aircraft receives substantial damage.”

A reasonable person would think that an aviation summary document that compiled accident statistics would at least mention that aircraft on long term exclusive use contracts to the USFS crashed and killed nine crewmembers, even if they were on temporary loan to another organization for an hour or a few days. The agency selected these aircraft and the contractors, and the fact that there were four major accidents involving their chosen aircraft and contractors deserves mention, at least to honor their service. The nine fatalities and four crashes in a five-year period is a very disturbing trend that should not be ignored. And even more so when you also consider the 2010 accident that does show up in the stats. That one may be the June 26, 2010 accident in which Neptune’s T-44 went off the end of the runway at Rocky Mountain Regional Airport (Jeffco) near Denver due to a hydraulic system failure.

If the USFS analyzed the crash trends involving their contractors, including those occurring on non-USFS fires, they might find, for example, they should reconsider the specs in the contracts, the crash history of  contractors, the suitability of aircraft designed for maritime patrol in the 1950s that are then used for flying in and out of canyons under air frame stresses the engineers did not consider, and the age of the aircraft. If what you are doing is not working, and these crashes and fatalities indicate it is not, then you need to do something different. The next-generation air tanker concept is a step in the right direction, but using jet airliners to fly into canyons is a concept that needs to be proven.

At a minimum, future reports should have a separate section to list the mishaps and accidents that involve their contracted aircraft even if they are on a non-USFS fire. And, accidents that involve MAFFS air tankers working under an agreement with the USFS, and accidents that result in major damage, should be listed as reportable accidents, regardless of specific jargon used by the NTSB.

It should not make any difference, for statistical, reporting, and accident prevention purposes, if the cause of an accident is mechanical, weather, or pilot error — they all should be recorded and reported. If the objective is learning lessons and preventing future accidents. they must be tracked and remembered. Splitting hairs and using imaginative criteria for leaving out certain accidents can turn the entire accident reporting program into a farce.