Buffalo DC3 near Hay River on May 3rd 2019, forced landing after engine failure
Last Update: December 23, 2019 / 16:12:17 GMT/Zulu time
The Canadian TSB is looking into the occurrence to decide whether to deploy investigators on site.
The airline reported the cause was a mechanical fault, both crew are safe.
On May 7th 2019 the Canadian TSB reported they opened a Class 4 investigation (Limited Scope, medium level of efforts and investment, simple investigation process, short report maximum 2000 words without findings or recommendations estimated to be released in about 200 days). During the climb out of Hay River the #1 engine (PW R1830, left hand) lost power completely. The crew elected to return to Hay River, however, could not maintain altitude and increased power on the #2 engine, which began to run rough as result. The crew had initially declared PAN PAN, upgraded to MAYDAY and performed a forced landing about 3.5nm southeast of Hay River Airport. None of the two crew were injured, the aircraft sustained substantial damage although no fire broke out.
On Dec 21st 2019 the TSB released their final report without a formal conclusion but following safety message:
In this occurrence, the aircraft’s airspeed and altitude could not be maintained, primarily because of the increased drag when the landing gear was extended early in the approach. This highlights the need to follow SOPs and use standard phraseology, as well as the importance of checklist discipline, during an emergency.
The TSB described the sequence of events:
The captain was the pilot flying (PF) and the first officer (FO) was the pilot not flying (PNF).
Visibility at the time of departure was 4 statute miles (SM) in light snow. A few minutes later, the visibility decreased to 1½ SM in light snow, with a ceiling of 3500 feet above ground level.2
After departure, while the aircraft was climbing through 1200 feet above sea level (ASL)3 on the way to a cruising altitude of 5000 feet ASL, the flight crew completed the after-takeoff checklist and applied carburetor heat to 20 °C.
While the FO was applying the carburetor heat, oil pressure was observed decreasing on the left engine (Pratt & Whitney R-1830-92). Moments later, rising cylinder head temperature and oil temperature indications were also observed on the left engine. The captain directed the FO to contact the area control centre to declare a PAN PAN emergency4 and request a return to CYHY, which the FO then did. The aircraft flight manual (AFM) does not contain any procedures for abnormal engine indications.
As the aircraft reached an altitude of 1969 feet ASL (Figure 1, point 3), the captain set the left engine to a reduced power setting and increased the power on the right engine to maximum except takeoff (METO)5 power. The flight crew began to set up for an instrument landing system approach to CYHY via TANPO.
At 0747 (Figure 1, point 4), while the aircraft was in a right turn proceeding towards TANPO, smoke and oil were observed, and abnormal sounds were heard coming from the left engine. Using the engine failure checklist, the flight crew then shut down the left engine and feathered the propeller.
At 0748, because the situation had escalated, a MAYDAY emergency
7 was declared. Moments later, the flight crew completed the descent checklist and initiated the approach checklist. However, due to the escalating emergency, the flight crew was not able to complete the approach checklist, which included the landing briefing.
At 0753 (Figure 1, point 7), the aircraft levelled off at 1214 feet ASL. The FO observed zero hydraulic pressure on the landing gear DOWN gauge.8 Thinking this zero pressure was an issue, he mentioned it to the captain, who then directed the FO to “prep the gear.” The FO extended the landing gear, which the captain did not expect because the aircraft had not started its final approach and the airport had not been visually acquired.
At 0755 (Figure 1, point 8), as the aircraft continued towards TANPO, the altitude was between 1200 and 1300 feet ASL, and the airspeed was maintained at approximately 100 knots indicated airspeed (KIAS). When the aircraft was abeam TANPO, the captain began a right turn to intercept the localizer for the final approach. The aircraft’s airspeed decreased from 100 KIAS to 80 KIAS, while its altitude decreased to 1100 feet ASL. With the reduced airspeed, the aircraft’s flight control response became sluggish and the captain directed the landing gear to be raised (Figure 1, point 9).
After the landing gear was raised, at 0759, the flight crew heard abnormal sounds and felt vibrations from the right engine. The aircraft’s airspeed was 80 KIAS, and its altitude began to decrease to below 800 feet ASL.
In an attempt to maintain altitude, the right engine was increased to maximum takeoff power, but this had no effect. The flight crew then prepared for an emergency gear-up landing, and the aircraft’s flaps were lowered on short final to reduce speed for touchdown.
At 0801, the aircraft landed in muskeg on K’atl’Odeeche First Nation land, approximately 3.5 nautical miles southeast of CYHY. After the aircraft came to a stop, the FO exited the aircraft through the right-hand crew window, while the captain remained in the cockpit to secure the right engine and aircraft systems before evacuating via the forward door. The FO contacted the flight information centre to notify them of the crew’s status and aircraft location. The emergency locator transmitter had not activated during the forced landing, so the FO activated it manually to assist search and rescue in locating the aircraft. The flight crew was uninjured. The aircraft received substantial damage. There was no post-impact fire. First responders arrived at the accident site at 1114.
The TSB reported the captain (ATPL, 9,400 hours total, 300 hours on type) was assisted by a first officer (CPL, 900 hours total, 400 hours on type). The TSB annotated: "Based on a review of the captain and the FO’s work-rest schedules, fatigue was not considered a factor in the occurrence." Both crew had completed the CRM training, including effective communication, the captain on May 1st 2019, the first officer on Dec 28th 2018.
The TSB reported with respect to effective communication:
In Chapter 10, the SOPs indicate that “[e]mergency operating procedures are designed to follow, as close as possible, to [sic] normal operating procedures so as to reduce any confusion brought on by an abnormal occurrence.” The SOPs go on to say that “during an emergency situation, the PF will continue flying the aircraft and call for the appropriate actions and checklist. Which [sic] will be called or read out by the PNF.”
With regard to standard phraseology, Chapter 10 of the SOPs states the following:
During abnormal/emergency situations it is imperative that the flight crew not only understand and complete the applicable procedures, but also ensure that effective communication is maintained. The standardization of calls and actions removes the unexpected and enhances communication.
Aircraft Registration Data
Aircraft registration data reproduced and distributed with the permission of the Government of Canada.
This article is published under license from Avherald.com. © of text by Avherald.com.
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