On December 1, 2018, at approximately 0018 coordinated universal time, PSA Airlines flight 5541, a Bombardier CRJ200, N202PS, struck a tug during engine start at LaGuardia Airport (LGA), Queens, New York. There were no injuries to the 27 passengers and crew onboard. The airplane was substantially damaged. The flight was operating under 49 Code of Federal Regulations Part 121 as a regularly scheduled passenger flight from LGA to Akron-Canton Airport (CAK), North Canton, Ohio. According to the operator, the accident airplane had six deferred items on the dispatch release including auxiliary power unit (APU) crossflow, power crossflow shutoff valves (SOV), and the APU. These deferred items rendered the fuel tank transfer on the ground inoperative and required the right engine to be started via an air cart. The flight crew indicated that the tug driver had to use hand signals to communicate back to them because the transmit function on his headset was inoperative. The captain indicated that he had requested to start both engines at the gate to limit fuel imbalance while on the ground, but the ground crew had denied that request. The towing operation was initiated with only the right engine running. A cross-bleed start on the CRJ200 requires a significant increase in thrust in the operative engine to allow the appropriate amount of bleed pressure to power the air turbine starter and imparts a lateral thrust imbalance on the airplane. A checklist item on the CRJ200 Engine Start (Cross-Bleed) procedure is to set the parking brake prior to initiating a cross-bleed engine start. However, the captain initiated the cross-bleed start while still under tow after receiving clearance from the ground crew. According to the operator, the flight data indicated the start was initiated with the right engine N2 first increasing to approximately 82.5%, and then to maximum N2 about 12 seconds after start was initiated. About ten seconds later, a lateral acceleration of 0.20 g was recorded. The tug impacted the right side of the airplane underneath the right front galley door, after jack knifing while remaining attached to the nose gear. The airplane sustained a hole 14.5 inches by 7.5 inches and a fractured stringer.