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NTSB Report

September 8, 2002 · Adler SA-1 · N551SA

Mead, CO

Overview

Report Status
Final with probable cause
Event Type
Accident
Date
September 8, 2002
Injury Outcomes
1 injury (1 fatality)
Location
Mead, CO
Aircraft
Adler SA-1
Tail Number
N551SA
Injuries
Fatal
Aircraft Damage
Destroyed
NTSB Number
DEN02LA103

Witnesses observed "a rotor or a wing" separate from the gyroplane, and the gyroplane then descended and impacted terrain. According to the deputy's report, a rotor blade was found about 150 feet north of the point of impact, and other debris was strewn to the southwest. The co-builder of the accident gyroplane, who was also a close friend of the pilot, contacted three gyroplane experts: the designer of the SA-1 Dominator and President of Rotor Flight Dynamics; a gyroplane aerodynamist; and the designer of another gyroplane. They examined the wreckage and compiled both a factual and analytical report. The following is based on the factual portion of the report. The separated rotor blade was bowed upward and had fractured about 2 feet from the tip. The fracture was consistent with positive overload. There was orange paint and primer transfer marks on the top and upper leading edge (the tail cone was painted orange). The attached rotor blade was also bent upward. The propeller blades exhibited no strike marks. The rotor head and hub bar were intact. The hub bar, normally bent 2.5 degrees upward, was bent approximately 10 degrees upward. The roll pillow blocks bore evidence of hammering and were mushroomed. The pitch stops were similarly damaged. In the analytical portion of the report, the necessity of maintaining blade loading at all times in order to maintain main rotor blade rotation was noted. The fracture on the separated main rotor blade was in "a purely upward bending moment which could only have occurred if the blade rpm had dramatically slowed...If totally unloaded, the blade rpm can deteriorate as fast as 120 rpm/sec." Normal rotor blade rpm is 320 to 400 rpm. If rotor blade rpm were allowed to drop, increasing the velocity of air moving through the rotor system, severe blade "flapping" would result as evidenced by the pounding and mushrooming of the roll pillow blocks and bending of the hub bar on the rotor head. A toxicological test revealed 2.024 (ug/mL, ug/g) paroxetine in the blood and liver. The drug is an antidepressant and contraindicated for flight. The pilot's personal physician prescribed the drug for the treatment of fibromyalgia, a condition manifested by muscle soreness. Adverse effects of the drug include drowsiness, muscle weakness, agitation, and tremors.

NTSB Probable Cause

the pilot's failure to maintain main rotor rpm, resulting in blade flapping, subsequent blade contact with the airframe, and loss of control.

Full Narrative

On September 8, 2002, approximately 0930 mountain daylight time, an Adler SA-1 gyroplane, N551SA, registered to and operated by the pilot, was destroyed when it impacted terrain and burned near Mead, Colorado. The private pilot was fatally injured. Day visual meteorological conditions prevailed, and no flight plan had been filed for the personal flight being conducted under Title 14 CFR Part 91. The local flight originated approximately 0900 from the Jefferson County (Jeffco) Airport, Broomfield, Colorado. Two witnesses told a sheriff's deputy that the gyroplane sounded as if it was "struggling." Two other witnesses submitted written statements. One witness said that he "could tell the aircraft was having mechanical problems." The gyroplane dropped about 1,000 feet, "lost a wing" and began to "spin and tumble out of control." Another witness said he heard the engine either "miss or stall slightly," and also saw "a rotor or a wing" come off in flight. All four witnesses saw smoke as the gyroplane impacted terrain and immediately caught fire. According to the deputy's report, a rotor blade was found about 150 feet north of the point of impact, and other debris was strewn to the southwest. The impact site was circular in shape, approximately 5 to 6 meters (16 to 20 feet) in diameter. The accident occurred 0.25-mile south of (Weld) county road 32 and 0.25-mile west of county road 13, at a location of 40 degrees, 12'48.30" north latitude, and 104 degrees, 57'02.80" west longitude. The co-builder of the accident gyroplane --- a physician and a close friend of the pilot --- contacted three gyroplane experts: the designer of the SA-1 Dominator and President of Rotor Flight Dynamics; a gyroplane aerodynamist; and the designer of another gyroplane. They examined the wreckage and compiled both a factual and analytical report. The following is based on the factual portion of the report. The separated rotor blade was bowed upward and had fractured about 2 feet from the tip. The fracture was consistent with positive overload. There was orange paint and primer transfer marks on the top and upper leading edge (the tail and nose cones were painted orange). The attached rotor blade was also bent upward. The propeller blades exhibited no strike marks. The rotor head and hub bar were intact. The hub bar, normally bent 2.5 degrees upward, was found bent approximately 10 degrees upward. The roll pillow blocks bore evidence of hammering and were mushroomed. The pitch stops were similarly damaged. The analytical portion of the report noted the necessity of maintaining blade loading at all times in order to maintain main rotor blade rotation. The fractured main rotor blade was "a purely upward bending moment which could only have occurred if the blade rpm had dramatically slowed…If totally unloaded, the blade rpm can deteriorate as fast as 120 rpm/sec." Normal rotor blade rpm is 320 to 400 rpm. If rotor blade rpm were allowed to drop and the velocity of air moving through the rotor system were to increase, severe blade "flapping" would result. The rotor head had been subjected to severe blade flapping as evidenced by the pounding and mushrooming of the roll pillow blocks and the bent hub bar. The authors said there is no in-flight maneuver that can lead to blade flapping at normal rotor rpms. Only the unloading of the rotor blades will do this. FAA's Civil Aeromedical Institute (CAMI) conducted a toxicological screen on specimens taken from the pilot and found 2.024 (ug/mL, ug/g) paroxetine in the blood. According to a CAMI toxicologist, paroxetine is an antidepressant and contraindicated. Some of the adverse effects include drowsiness, muscle weakness, agitation, and tremors." When advised of these results, the physician/co-builder of N551SA contacted the pilot's personal physician and learned that he had prescribed the drug for the treatment of fibromyalgia, a condition manifested by muscle soreness.

Flight

Event TypeAccident
Event Time09:30 MDT
Nearest Airport0nm
Flight Plan FiledNone
Flight Plan ActivatedNo
Aircraft FireGrd
Aircraft ExplosionNo

Aircraft

AircraftAdler SA-1
Tail NumberN551SA
Aircraft CategoryGyro
DamageDestroyed
Operating RulePart 91
Engines1
Engine TypeReciprocating
Engine DetailsRotax · 912WLS · Reciprocating · 100
Seats1

People & Injuries

Injury Summary1 injury (1 fatality)
Fatal1
Serious0
Minor0
Uninjured0
Total1
Crew 1Age 51 · Third Class · Fatal

Conditions

ConditionsVMC
LightDaylight
Wind140° @ 4 kt
Visibility10 sm
CeilingNone
Temperature / Dew Point46
Altimeter30.12 inHg
Observation Time15:53
Weather SourceWFAC

Appendix: Source Data