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Last updated: 19 October 2021
Status:Schlussbericht
Datum:Donnerstag 15 Mai 2003
Zeit:08:33
Flugzeugtyp:Silhouette image of generic BE20 model; specific model in this crash may look slightly different
Beechcraft 200C Super King Air
Fluggesellschaft:Royal Flying Doctor Service
Kennzeichen: VH-AMR
Werknummer: BL-126
Baujahr: 1985
Besatzung:Todesopfer: 0 / Insassen: 3
Fluggäste:Todesopfer: 0 / Insassen: 1
Gesamt:Todesopfer: 0 / Insassen: 4
Sachschaden: Zerstört
Konsequenzen: Written off (damaged beyond repair)
Unfallort:6 km (3.8 Meilen) NE of Coffs Harbour Airport, NSW (CFS) (   Australien)
Flugphase: Landung (LDG)
Betriebsart:Ambulanz
Flug von:Sydney-Kingsford Smith International Airport, NSW (SYD/YSSY), Australien
Flug nach:Coffs Harbour Airport, NSW (CFS/YSCH), Australien
Unfallbericht:
A Beechcraft 200C Super King Air, VH-AMR, impacted the sea or a reef about 6 km north-east of Coffs Harbour Airport, NSW (CFS). The impact occurred immediately after the pilot initiated a go-around during an instrument approach to runway 21 in Instrument Meteorological Conditions (IMC) that included heavy rain and restricted visibility. Although the aircraft sustained structural damage and the left main gear detached, the aircraft remained airborne.
During the initial go-around climb, the aircraft narrowly missed a breakwater and adjacent restaurant at the Coffs Harbour boat harbour. Shortly after, the pilot noticed that the primary attitude indicator had failed, requiring him to refer to the standby instrument to recover from an inadvertent turn. The pilot positioned the aircraft over the sea and held for about 30 minutes before returning to Coffs Harbour and landing the damaged aircraft on runway 21.

Probable Cause:

This occurrence is a CFIT accident resulting from inadvertent descent below the MDA on the final segment of a non-precision approach, fortunately without the catastrophic consequences normally associated with such events. The investigation was unable to conclusively determine why the aircraft descended below the MDA while in IMC, or why the descent continued until CFIT could no longer be avoided.

Accident investigation:
cover
Investigating agency: ATSB
Status: Investigation completed
Accident number: 200302172
Download report: Final report


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Map
This map shows the airport of departure and the intended destination of the flight. The line between the airports does not display the exact flight path.
Distance from Sydney-Kingsford Smith International Airport, NSW to Coffs Harbour Airport, NSW as the crow flies is 441 km (276 miles).

This information is not presented as the Flight Safety Foundation or the Aviation Safety Network’s opinion as to the cause of the accident. It is preliminary and is based on the facts as they are known at this time.
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