Thu, Feb 24, 2005
Investigation Finds Seat Slides Back, Pilot Loses Control On
Go-Around
An Australian coroner Wedneday released findings that concur
with an Australian Transport Safety Bureau report blaming an
illegally-modified sliding seat for the death of a student pilot.
The pilot, 46-year old Ramasamy Ayathurai was killed September
28th, 2001 when he lost control of a Cessna 172 while attempting a
go-around at the Latrobe Valley Airport southeast of Melbourne,
Australia.
The pilot stated his intention to make a full stop landing on
runway 03. Witnesses heard the engine power increase and saw the
aircraft begin a go-around from about 100 ft on short final,
according to the ATSB report. The aircraft entered a steep left
climbing turn with flaps fully extended. At about 300 feet, the
wings were seen to roll level, and the aircraft "fishtailed". The
aircraft then pitched down and impacted the ground, destroying the
aircraft and killing the pilot. Weather at the time of the accident
was clear sky with unlimited visibility and a light breeze.
Examination of the wreckage found no evidence to suggest that
the aircraft was not capable of normal operation. However, the
investigation revealed that the pilot's seat stops did not match
factory specifications and allowed the pilot to adjust the seat
forward of the seat rail. In other words, he apparently ran the
seat off its tracks. The ATSB report found the rear seat latch was
engaged 410mm fwd of the door rear pillar.
Tests conducted on a
pilot of the same basic size revealed that the subject could not
properly manipulate the controls of the aircraft with the seat in
that position. The pilot could not apply much forward elevator
control and could only reach the throttle by pulling back on the
control wheel. Testing of a similar aircraft showed significant
forward pressure was required to control the aircraft in a full
throttle and full flap go-around.
The ATSB concluded that aircraft mishandling and loss of control
could not be ruled out, but the event as described was consistent
with the seat sliding back and denying the pilot adequate control
input to avoid the accident. As a result, the ATSB issued three
Safety Advisory Notices alerting pilots, aircraft owners, and
mechanics to use the proper parts, install them correctly, and to
insure the proper engagement of the seat locks before flight.
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