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September 28, 2008 · Aerospatiale SA365N-1 D N1 · N92MD

District Heights, MD

Overview

Report Status
Final with probable cause
Event Type
Accident
Date
September 28, 2008
Injury Outcomes
5 injuries (4 fatalities, 1 serious injury)
Location
District Heights, MD
Aircraft
Aerospatiale SA365N-1 D N1
Tail Number
N92MD
Operator
Maryland State Police
Injuries
Fatal
Aircraft Damage
Substantial
NTSB Number
MIA08MA203

The Safety Board's full report is available at http://www.ntsb.gov/Publictn/2009/AAR0907.pdf. The Aircraft Accident Report number is NTSB/AAR-09/07 On September 27, 2008, about 2358 eastern daylight time, an Aerospatiale (Eurocopter) SA365N1, N92MD, call sign Trooper 2, registered to and operated by the Maryland State Police (MSP) as a public medical evacuation flight, impacted terrain about 3.2 miles north of the runway 19R threshold at Andrews Air Force Base (ADW), Camp Springs, Maryland, during an instrument landing system approach. The commercial pilot, one flight paramedic, one field provider, and one of two automobile accident patients being transported were killed. The other patient being transported survived with serious injuries from the helicopter accident and was taken to a local hospital. The helicopter was substantially damaged when it collided with trees and terrain in Walker Mill Regional Park, District Heights, Maryland. The flight originated from a landing zone at Wade Elementary School, Waldorf, Maryland, about 2337, destined for Prince George's Hospital Center, Cheverly, Maryland. Night visual meteorological conditions prevailed for the departure; however, Trooper 2 encountered instrument meteorological conditions en route to the hospital and diverted to ADW. No flight plan was filed with the Federal Aviation Administration (FAA), and none was required. The MSP System Communications Center (SYSCOM) was tracking the flight using global positioning system data transmitted with an experimental Automatic Dependent Surveillance-Broadcast communications link.

NTSB Probable Cause

The pilot's attempt to regain visual conditions by performing a rapid descent and his failure to arrest the descent at the minimum descent altitude during a nonprecision approach. Contributing to the accident were (1) the pilot’s limited recent instrument flight experience, (2) the lack of adherence to effective risk management procedures by the Maryland State Police, (3) the pilot’s inadequate assessment of the weather, which led to his decision to accept the flight,, (4) the failure of the Potomac Consolidated Terminal Radar Approach Control (PCT) controller to provide the current Andrews Air Force Base weather observation to the pilot, and (5) the increased workload on the pilot due to inadequate Federal Aviation Administration air traffic control handling by the Ronald Reagan National Airport Tower and PCT controllers.

Full Narrative

The Safety Board's full report is available at http://www.ntsb.gov/Publictn/2009/AAR0907.pdf. The Aircraft Accident Report number is NTSB/AAR-09/07 On September 27, 2008, about 2358 eastern daylight time, an Aerospatiale (Eurocopter) SA365N1, N92MD, call sign Trooper 2, registered to and operated by the Maryland State Police (MSP) as a public medical evacuation flight, impacted terrain about 3.2 miles north of the runway 19R threshold at Andrews Air Force Base (ADW), Camp Springs, Maryland, during an instrument landing system approach. The commercial pilot, one flight paramedic, one field provider, and one of two automobile accident patients being transported were killed. The other patient being transported survived with serious injuries from the helicopter accident and was taken to a local hospital. The helicopter was substantially damaged when it collided with trees and terrain in Walker Mill Regional Park, District Heights, Maryland. The flight originated from a landing zone at Wade Elementary School, Waldorf, Maryland, about 2337, destined for Prince George's Hospital Center, Cheverly, Maryland. Night visual meteorological conditions prevailed for the departure; however, Trooper 2 encountered instrument meteorological conditions en route to the hospital and diverted to ADW. No flight plan was filed with the Federal Aviation Administration (FAA), and none was required. The MSP System Communications Center (SYSCOM) was tracking the flight using global positioning system data transmitted with an experimental Automatic Dependent Surveillance-Broadcast communications link.

Flight

Event TypeAccident
Event Time23:58 EDT
Nearest AirportAndrews A.F.B. (3nm)
Runway19R
Runway Length9003 ft
Runway Width200 ft
Flight Plan FiledNone
Flight Plan ActivatedNo
Aircraft FireNo
Aircraft ExplosionNo

Aircraft

AircraftAerospatiale SA365N-1 D N1
Tail NumberN92MD
Aircraft CategoryHeli
DamageSubstantial
OperatorMaryland State Police
Engines2
Engine TypeTurboshaft
Engine DetailsArriel · 1C1 · Turboshaft · 586 | Arriel · 1C1 · Turboshaft · 586
Seats6

People & Injuries

Injury Summary5 injuries (4 fatalities, 1 serious injury)
Fatal4
Serious1
Minor0
Uninjured0
Total5
Crew 1Age 59 · Second Class · Fatal

Conditions

ConditionsIMC
LightDark Night
Wind90° @ 3 kt
Visibility4 sm
CeilingBroken clouds 500 ft
Temperature / Dew Point68 F / 68 F
Altimeter29.90 inHg
Observation Time04:11
Weather SourcePILO

Appendix: Source Data