ASN Wikibase Occurrence # 232215
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| Date: | Saturday 18 January 2020 |
| Time: | 15:15 UTC |
| Type: |  Helibras HB 350B2 Esquilo (AS 350B2) |
| Owner/operator: | SESP - Secretaria da Segurança Pública |
| Registration: | PR-CJD |
| MSN: | 4727 |
| Year of manufacture: | 2009 |
| Fatalities: | Fatalities: 0 / Occupants: 5 |
| Aircraft damage: | Substantial |
| Category: | Accident |
| Location: | Rio Branco, AC -
 Brazil
|
| Phase: | Standing |
| Nature: | Military |
| Departure airport: | Rio Branco, AC |
| Rio Branco-Plácido de Castro International Airport, AC (RBR/SBRB) | |
| Investigating agency: | CENIPA |
| Confidence Rating: |  Accident investigation report completed and information captured |
A helicopter belonging to the Acre Public Security Secretariat and providing support to Operation Close Frontier, which was taking place in the Belo Jardim neighborhood, was standing on a link between two roadways. The helicopter was about to take off when a Volkswagen 8-150 Delivery truck carrying a load of drums turned left into the link and collided with the main rotor of the helicopter. Both the helicopter and the truck were badly damaged. The two helicopter crew suffered minor injuries and were sent to the emergency room for treatment.
Contributing factors.
- Attitude – a contributor.
There was an inadequate assessment of the risks associated with the activation of the engine while vehicles and people could move freely around the helicopter, contrary to what was established in item 8 of the POP for take-off in a restricted area, which revealed a complacent attitude towards important procedures for the safety.
- Training – a contributor.
The lack of a formally implemented training program resulted in organizational failures that led to the non-performance of actions that could prevent the operation on a public road, without the proper isolation of the area.
- Communication – a contributor.
During take-off procedures on public roads, communication between the crewmembers and the crew on the ground (police checkpoint) did not involve the dissemination of relevant information about the operation.
- Crew Resource Management – a contributor.
There was inefficiency in the use of human resources available for the operation of the aircraft, due to inadequate management of the tasks assigned to each crewmember, which resulted in non-compliance with operational standards.
- Organizational culture – a contributor.
The weakness of the organization's safety culture was found, which affected the collective perception of its members in relation to the risks inherent to police operations in urban areas.
- Team dynamics – a contributor.
The inadequate evaluation of all parameters related to that operation, possibly resulting from deficiencies in the training process and in the systematic disclosure of applicable manuals, contributed to an inefficient performance by the team.
- Instruction – undetermined.
It was inferred that the training process previously received by those involved in the occurrence did not give them the fullness of knowledge and technical conditions necessary for the performance of that specific activity, a condition that affected their performance in that complex scenario.
- Flight planning – a contributor.
The need to interrupt the traffic of vehicles, of people, and the convenience of carrying out a detailed briefing involving the crew and ground crew (police checkpoint) were not adequately considered.
- Management planning – a contributor.
The fact that both crewmembers positioned on the sides of the aircraft were thrown out of the helicopter, due to the non-use of EPI, revealed the inadequacy in the planning carried out by the organization, at its management level, with regard to the provision and control of the use of equipment.
- Organizational processes – a contributor.
The inefficiency in the management of people and processes, including managerial planning, documentation of standards and procedures, risk management and operational safety management led to failures in supervision, in monitoring the performance of crewmembers and in the design of important organizational procedures for the maintenance of safety.
- Support systems – undetermined.
The inadequacies of the rules and manuals may have contributed to the procedures not having been effectively implemented in the UAP.
- Managerial oversight – a contributor.
The non-conformities pointed out in relation to the manuals and procedures that should guide air operations, the finding that the helicopter had flown with overdue inspections, as well as the lack of records on the completion of the planned training, affected the performance of the crew and compromised the operations safety.
Accident investigation:
 |
|
Sources:
https://g1.globo.com/ac/acre/noticia/2020/01/18/helice-de-helicoptero-do-ciopaer-bate-em-caminhao-ao-iniciar-decolagem-em-rio-branco.ghtml
https://www.resgateaeromedico.com.br/helicoptero-do-ciopaer-e-atingido-por-caminhao-no-momento-da-decolagem-em-rio-branco-ac/
https://www.aeroflap.com.br/helicoptero-colide-com-um-caminhao-durante-a-decolagem/
http://aerossurance.com/helicopters/collision-truck-police-as350/
Location
Media:
We look at the investigation into how a police helicopter came to be rotors running on an open public road and be struck by a truck carrying biological waste (with impact VIDEO). https://t.co/Q50zEiAuSd #police #helicopter #accident #flightsafety #aviationsafety pic.twitter.com/tayOsGg1Sn
— Aerossurance (@Aerossurance) April 2, 2022
Revision history:
| Date/time | Contributor | Updates |
|---|---|---|
| 19-Jan-2020 07:43 | VM | Added |
| 19-Jan-2020 07:45 | harro | Updated [Aircraft type, Cn, Operator, Total fatalities, Other fatalities, Country] |
| 19-Jan-2020 07:49 | harro | Updated [Location, Source, Embed code] |
| 19-Jan-2020 08:30 | RobertMB | Updated [Aircraft type, Total occupants, Nature, Source, Narrative] |
| 19-Jan-2020 15:36 | harro | Updated [Nature, Narrative] |
| 19-Jan-2020 18:12 | Anon. | Updated [Nature] |
| 19-Jan-2020 20:56 | Iceman 29 | Updated [Embed code] |
| 26-Mar-2022 14:21 | harro | Updated [Time, Destination airport, Narrative, Category, Accident report] |
| 02-Apr-2022 11:05 | Aerossurance | Updated [Aircraft type, Departure airport, Source, Embed code] |
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