Rescue 116 Crash at Blackrock, Co Mayo(Mod note in post 1)

Storm 10

smurfjed wrote: »

I disagree, this was a 4 person crew, not two.

I read on pprune this morning that in a Civil SAR helicopter the two at the front are in charge unlike in a military helicopter where the 4 crew operate together and are trained to do so, the two crew in the rear of 116 were ex Air Corp so would have been well trained also.

Negative_G

Storm 10 wrote: »

I read on pprune this morning that in a Civil SAR helicopter the two at the front are in charge unlike in a military helicopter where the 4 crew operate together and are trained to do so, the two crew in the rear of 116 were ex Air Corp so would have been well trained also.

All air crew will participate and have input into the mission they are carrying out.

Military helicopter crews carrying out functions such as SAR will often choose to avoid the use of formalities such as "Sir" or "Ma'am" as required by the military rank structure. The reason for this is that if you have a very junior person crew member or co-pilot they may well be unwilling to highlight what they perceive as a danger to the pilot. This is known as a cockpit gradient and can be attributed to many civil and military accidents.

I think that nowadays the emphasis on safety and the cultural buy in toward CRM culture means this is on the way out. Thankfully.

Regardless of whether civil or military, you will have one person who is the captain and aircraft commander. They are ultimately responsible for the safety of the aircraft. It is there job to "filter" all information and decide whether it is pertinent and respond accordingly

In my opinion, a cockpit gradient is far less likely to be found in a civilian operation than a military one by virtue of the fact that they do not have a stringent rank structure and the formalities associated with it.

Green Peter

If the island was on their map they would have done the approach differently, can't believe there could be such an omission when it's even on my smart phone maps. Looks like they hadn't the help they should have had available to them and it's lack resulted in positioning they would never have placed themselves in. They were badly failed by equipment and a lack of resources that put them there in the first place. What a waste of life. R.I.P

TheChizler

It was definitely on maps available to them. What we don't know is which view map they had open at the time.

duskyjoe

These low level down to the deck company approaches ....., who approves them? A regulatory body or is it in house with the respective helicopter companies?

TomOnBoard

TomOnBoard wrote: »

2 questions arise for me on this. a) In your opinion would the use of NVG have shown the rock earlier than it was visible on the EO/IR display? I'm asking from a technology standpoint. b) Was the rock avoidable to an experienced pilot if s/he were heading for it at 75kts and at 200' and saw it for the first time, not expecting to be there, 13 seconds out?

In the midst of all the posting activity yesterday, I don't recall getting answers to these questions. They speak to the question of procedural and/or technology improvements that ought to be considered.

Gaoth Laidir

One thing I note is the rear crewmember's use of the phrase "Come right". I know this is probably the terminology used in a winch hover situation when small adjustments arr required but standard RT in the wider aviation world would use the command "turn" instead of "come". Splitting hairs I know but I wonder if it would have caused a quicker reaction by the pilot.

TomOnBoard

TomOnBoard wrote: »

I hope this issue of communication between R116 and R118 gets a good deal more attention immediately and doesn't have to await a final report.

R116 was tasked to provide Top Cover. However, by the time it was up and away, R118 was en route to Blacksod for a refuelling before heading out to the FV location. The report says that 116-118 direct comms was achieved only once, on secure VHF while 118 was at/near Blacksod. According to the report this was around 23:10-23:20, around 15 minutes after 116 left Dublin.

By the time 116 would have safely arrived at Blacksod and refuelled, it would have been 01:00 ish allowing for a best case scenario, before it left Blacksod to perform its mission of Top Cover provision. At that stage, 118 was more or less on the way back from the operation, based on its arrival at Blackrock to start searching, with the casualty still on board, at 02:13.

118 was lost to all comms for some time as evidenced by Shannon's efforts to make contact via a Translantic Aircraft (which also failed) together with 116's many attempts as described in the report. Being out of contact for so long seems to need explanation, as does a HEMS mission heading out so far ahead of its Top Cover accompaniment as to make that Top Cover largely redundant, at least from a comms perspective and possibly also from a SaR perspective if 118 itself had gone down.

The report stressed this matter of communications being on the mind of the 116 crew, and may have been why they were so far out, attempting to make contact before deciding to refuel.

At least 2 issues arise: a) if Top Cover is needed why would there be such a gap between the HEMS and Top Cover aircraft leaving Black Sod, and b) can satellite comms that deal with the deficiencies of radio be put in place to help plug that particular issue immediately.

I got some clarification on the satellite comms question from this post. However, I don't recall seeing anything relating to the question of why R118 was so far ahead of R116 when they were both part of the same mission.

Is this normal practice when one helicopter is flying Top Cover for another one?

Means Of Escape

smurfjed wrote: »

The approach was slow an cautious, but questions will be asked about whey they continued straight and level for 6 seconds after the initial back seat call for a turn.

Given that the back seat call obviously had information / view that was not known/ seen by the pilots
It's easy to say that one would then automatically bank to the left after this heads up but given that there has to be protocol to confirm the information and was probably the correct one made by the captain . She flew by the book which in this case was a mistake but she could not have known the impending collision was imminent
Others who were skilled pilots before her have made the same error in a very difficult situation and more often than not these situations and how to best deal with them are not found in the manual

What both pilots could not have known was the urgency for a turn until it was too late when the second call to turn was heard

I have yet to comprehend the logic or necessity to make an approach so low off the surface of the water at nighttime where one is at an even more disadvantage
Training routine does not wash and if it is what is set down in the recommended approach altitude then surely that has to be reviewed .
200 feet from the ground is too low day or night .
The altitude warning on a number of occasions certainly bears this true when flying over unknown terrain/ water with islands known to be present in the area

TomOnBoard

Coil Kilcrea wrote: »

It's distressing to read through the transcript and the sequence of events. It's difficult to comprehend for many reasons. And frankly, I don't have the words. But I'm struck by the fact that hover capability has to be an advantage in transitioning from IFR to VFR and wonder why not descend over the Blacksod landing pad?

Possibly a stupid question but it's puzzling me .....R111 also springs to mind where they tried to within a few hundred feet.

I was asking myself this question also.

There was an answer yesterday that explained flying in through a gradually descending approach such as App1 is preferable to a vertical landing, as it allows the crew to break cloud and puts less stress on the airframe. However, surely there are circumstances where the vertical landing capability of a helicopter is more important than using the less stressful approach, such as in conditions of low cloud cover.

Jacovs

Jacovs wrote: »

Looking at appendix B, page 37, what is the significance of the vertical red line on time stamp 7072 and then the vertical yellow line just after time stamp 7076?
Appendix B is referred to on page 27.

Is the red line the moment the helicopter physically responded to evasive manuevers and the yellow is when it entered the ocean?

Irish Steve

The issue of the landing is that in order to land at Blacksod, or other places without a precision approach guidance system, the aircraft must have visual contact with the landing point, and a vertical hover descent without visual contact is an absolute no go situation, as there is no way to ensure that there will not be contact by the rotor blades with an object that cannot be seen. So, the plan is always to break cloud, ideally over water, as there is unlikely to be any obstacle there, and then continue visually to land. Yes, the best way to do that is by descending close to the landing point, but other terrain in the area may make that more difficult.

In some respect, the technology on the S92 should make it possible to descend with a position accuracy of less than 10 metres, but I am not aware of that concept being used, the suggested profile I have seen discussed elsewhere is to descend over water, while remaining at least 2 miles clear of land, which would have been possible during the early stages of the approach profile that was in use, then, having made visual contact with the surface, the route goes to a point North East of Blacksod, where a turn on to a South West direction (into prevailing wind) brings them on final approach track to the landing pad.

faoiarvok

TomOnBoard wrote: »

I was asking myself this question also.

There was an answer yesterday that explained flying in through a gradually descending approach such as App1 is preferable to a vertical landing, as it allows the crew to break cloud and puts less stress on the airframe. However, surely there are circumstances where the vertical landing capability of a helicopter is more important than using the less stressful approach, such as in conditions of low cloud cover.

Less to do with stress on the airframe, more to do with keeping your options open in the event of a sudden technical problem (e.g. single engine failure) I think

Stopping a descent and climbing again uses a lot more energy when stationary than when moving forward, as the rotors will generate more lift for less engine power while the aircraft is moving forwards.

kerry cow

13 seconds is along time and allows plenty of time to proceed with caution .If it was a motor bike travelling at speed 13 second is a good warning .

Gaoth Laidir

kerry cow wrote: »

13 seconds is along time and allows plenty of time to proceed with caution .If it was a motor bike travelling at speed 13 second is a good warning .

But now imagine riding a motorbike at 90 mph down an unlit road in mist/fog and have a dark parked truck up ahead of you.

TomOnBoard

This article ( https://flyinginireland.com/2015/03/irish-coast-guard-enhancing-capabilities/ ) was referenced in an earlier post, and I find a number of things within it relating to mapping/ charting to be 'interesting' in the light of questions raised on reading the AAIU report:

"The crewmen’s Toughbook Ordnance Survey and Admiralty Chart based moving map is slaved to the radar and the FLIR. " I'm reading this to mean that, in the case of the Sligo-based S-92 being written about, the winch crew had access to a Moving map display based on OS and Admiralty Charts. I didn't see that mentioned in the AAIU report. Is such a capability standard across the fleet?

"Interestingly, when flying in the S-92, I noticed that despite all the high technology aides available at the touch of a button, the non-handling pilot always had a folded map resting on his knee. Ciaran and the co-pilot, Chief Pilot, Paraic Slattery said that this was done to make sure that basic map reading skills were retained and that crews did not get too reliant on automation." Again, was this SOP, and if so what paper map is used?

Finally, in relation to the cockpit displays, the article says: "The five panel, flatscreen, multifunction display gives the two pilots a huge amount of integrated information which serves to increase vastly their situational awareness." I found a cruel irony in that.

godskitchen

TheChizler wrote: »

It was definitely on maps available to them. What we don't know is which view map they had open at the time.

The report doesn't mention it being available on other maps, only that Honeywell said it is on other maps.

Or have I missed something?,

Stovepipe

We don't know if the crewman at the console was using his FLIR camera or was he using a feed from the radar? The radalt could have picked up a hit from a small rock in front of the cliff face but anything 13 seconds out is awash on a normal day.Was the viz so bad that they couldn't see the lighthouse beam? Were they exactly in line with the two lighthouses and confused the near one for the far one?

jonski

Gaoth Laidir wrote: »

But now imagine riding a motorbike at 90 mph down an unlit road in mist/fog and have a dark parked truck up ahead of you.

Bad analogy since in that case you would be watching out for the unknown, these people fully expected the way ahead to be clear . It's not like they were flying over land, they were of the opinion that they were flying over open sea .

Gaoth Laidir

jonski wrote: »

Bad analogy since in that case you would be watching out for the unknown, these people fully expected the way ahead to be clear . It's not like they were flying over land, they were of the opinion that they were flying over open sea .

And you on your bike are not expecting a parked truck on an otherwise empty laneway

Gaoth Laidir

There still must be more than a remote chance of finding the remaining two crewmen seeing as they are probably strapped to their seats. I'd imagine in that case they would be more likely to sink than float so they could still be in waters somewhere right in at Blackrock's rocky shoreline. If only conditions were not so hazardous there...

TomOnBoard

Negative_G wrote: »

All air crew will participate and have input into the mission they are carrying out.

Military helicopter crews carrying out functions such as SAR will often choose to avoid the use of formalities such as "Sir" or "Ma'am" as required by the military rank structure. The reason for this is that if you have a very junior person crew member or co-pilot they may well be unwilling to highlight what they perceive as a danger to the pilot. This is known as a cockpit gradient and can be attributed to many civil and military accidents.

I think that nowadays the emphasis on safety and the cultural buy in toward CRM culture means this is on the way out. Thankfully.

Regardless of whether civil or military, you will have one person who is the captain and aircraft commander. They are ultimately responsible for the safety of the aircraft. It is there job to "filter" all information and decide whether it is pertinent and respond accordingly

In my opinion, a cockpit gradient is far less likely to be found in a civilian operation than a military one by virtue of the fact that they do not have a stringent rank structure and the formalities associated with it.

Authority gradients are found in civilian life every day. The Theatre Surgeon who is known to throw the instruments on the floor in a strop prevents junior assistants from saying "watch that bleeder".

Proper procedures, good allocation of roles, regular training, team building and bonding all play a role in limiting the reality of authority gradients, and ensuring that individual members are heard and their commands (as distinct from their advices) acted upon without question when required. As in all things human however, individual personalities and their inter- personal interactions come into play also.

smurfjed

@TomonBoard,
From Pprune, I believe that the answers are YES and YES. Although the IR is apparently better than the NVG.
With the capabilities of the S92, there is no reason why the APP1 profile cannot be used to a 1 nm approach to landing over a defined route, it certainly doesn't appear that it needed the 10 nm route.

kerry cow

Just shows we are all human .there's no one special out there .We all have made 1 mistake .

ProfessorPlum

godskitchen wrote: »

The report doesn't mention it being available on other maps, only that Honeywell said it is on other maps.

Or have I missed something?,

3.5.7 Moving Map Display

"The helicopter was equipped with a EuroAvionics EuroNav 5 moving map display which had a number of maps/charts available for selection. The exact information in relation to Black Rock and Lighthouse varied from none, to detailed, depending on the selected map/chart."

TomOnBoard

Gaoth Laidir wrote: »

There still must be more than a remote chance of finding the remaining two crewmen seeing as they are probably strapped to their seats. I'd imagine in that case they would be more likely to sink than float so they could still be in waters somewhere right in at Blackrock's rocky shoreline. If only conditions were not so hazardous there...

Yes and yes. The hazardous nature of the conditions there have turned this piece of Irish waters into 'terra incognita' in respect of recovery, as those conditions preclude divers. The Holland I also exhausted its capabilities during those efforts on Granuaile. So I suppose the question is this. Is there any technology or approach that could reasonably be brought to bear on this?

IMHO, if a 100 carat flawless diamond was thought to have been lost there, someone would come up with a means of searching for it. And, before ye start, this is not about having a 'pop' at rescue efforts to date. It's about thinking along the lines that informed the decision to bring in Ocean Challenger when the airbag lift wasn't producing required results.

TomOnBoard

smurfjed wrote: »

@TomonBoard,
From Pprune, I believe that the answers are YES and YES. Although the IR is apparently better than the NVG.
With the capabilities of the S92, there is no reason why the APP1 profile cannot be used to a 1 nm approach to landing over a defined route, it certainly doesn't appear that it needed the 10 nm route.

It's a bit spooky that you had used "Yes and YES" in a reply to a post of mine while I was in the middle of writing a post and used the same term and I hadn't seen your reply.....

Telepathy through Boards? :eek::eek::eek:

TomOnBoard

smurfjed wrote: »

@TomonBoard,
From Pprune, I believe that the answers are YES and YES. Although the IR is apparently better than the NVG.
With the capabilities of the S92, there is no reason why the APP1 profile cannot be used to a 1 nm approach to landing over a defined route, it certainly doesn't appear that it needed the 10 nm route.

So basically if the EO/IR feed was being monitored on one of the cockpit displays, it would have shown the same image as was available to the winch operator and could have given the pilots at least 13 seconds to act which would have been enough time to deal with the obstacle. If NVGs were being used, a bit more time would have been available for action.

Coil Kilcrea

Gaoth Laidir wrote: »

There still must be more than a remote chance of finding the remaining two crewmen seeing as they are probably strapped to their seats. I'd imagine in that case they would be more likely to sink than float so they could still be in waters somewhere right in at Blackrock's rocky shoreline. If only conditions were not so hazardous there...

And I would think that's why they searched so extensively. The difficult conditions lost valuable time in the immediate aftermath which didn't help matters. It's very hard on the families, unspeakably cruel, but we have to hope they will be found.

I'm not sure if they've located all of the major pieces of wreckage underwater in the search off Blackrock. The waters are extensively fished and if other sunken wreckage is pulled out in fishing nets, that location might be worthy of further ROV investigation.

I know it's grasping at straws but who knows.

TomOnBoard

Coil Kilcrea wrote: »

And I would think that's why they searched so extensively. The difficult conditions lost valuable time in the immediate aftermath which didn't help matters. It's very hard on the families, unspeakably cruel, but we have to hope they will be found.

I'm not sure if they've located all of the major pieces of wreckage underwater in the search off Blackrock. The waters are extensively fished and if other sunken wreckage is pulled out in fishing nets, that location might be worthy of further ROV investigation.

I know it's grasping at straws but who knows.

I'm thinking of the area, under water but close to the island and inaccessible to divers and Holland I, that I think GaothLaidir is thinking as well, rather than areas well outside the island where netting would take place.

If, however someone could say that such seats are relatively light-weight and capable of being carried for distances by the current, then I might think very differently as other factors as to buoyancy etc would come into play.