ASN Wikibase Occurrence # 156879
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| Date: | Thursday 18 May 1978 |
| Time: | 23:45 |
| Type: |  Piper PA-39-160 Twin Comanche C/R |
| Owner/operator: | Navair |
| Registration: | VH-DXA |
| MSN: | 39-55 |
| Fatalities: | Fatalities: 2 / Occupants: 2 |
| Aircraft damage: | Destroyed |
| Category: | Accident |
| Location: | 11 km NNW of Dubbo, NSW -
 Australia
|
| Phase: | Approach |
| Nature: | Passenger - Non-Scheduled/charter/Air Taxi |
| Departure airport: | Sydney Airport, Sydney, NSW (SYD/YSSY) |
| Dubbo City Regional Airport, Dubbo, NSW (DBO/YSDU) | |
| Investigating agency: | ATSB |
| Confidence Rating: |  Accident investigation report completed and information captured |
Written off (damaged beyond repair) 18 May 1978 when crashed 11 Km North-North-West of Dubbo, New South Wales. Both persons on board (pilot and one passenger) were killed. It was suspected - but not conclusively proven - that the pilot had suffered a heart attack (cardiac arrest) whilst at the controls. According to the following excerpt from the official ATSB report dated 19 June 1980:
"[name redacted] attempted to obtain a seat on a scheduled evening flight to Dubbo but was unsuccessful, as the flight was fully booked. She was most anxious to get to Dubbo and she was given advice and assistance, which resulted in arrangements being made for this flight.
The pilot submitted a flight plan to the Sydney Air Traffic Control Centre for a flight to Dubbo and turn under the Instrument Flight Rules (IFR). The weather forecast for Dubbo was poor and the pilot nominated Sydney as an alternate aerodrome in the event that he was unable to land at Dubbo. The flight Endurance of the aircraft was given on the flight plan as 300 minutes and this was adequate for the proposed flight. The pilot was the holder of an instrument rating and licence endorsements which qualified him to undertake the planned flight.
During the flight to Dubbo, the aircraft cruised at an altitude of 8,500 feet. The pilot reported to Sydney by radio that the aircraft passed Sofala at 21:54 hours and that he was estimating Dubbo at 22:29 hours. At 22:11 hours, the pilot advised that he had commenced descent into Dubbo. He then contacted Dubbo Flight Service Unit (FSU) and was advised that the appropriate altimeter setting was 1009 (millibars).
Shortly before 22:27 hours, Dubbo FSU checked the cloud base in the area and then informed the aircraft that there wore eight oklas of cloud at 1200 feet, with lower patches. The pilot reported to Dubbo FSU at 22:41 hours that the aircraft was over Dubbo and would be "commencing an NDB descent into Dubbo". Apparently the pilot was unable to make visual contact with the ground at the completion of this procedure and he reported at 23:02 hours that he had "missed out" and would make one more attempt.
At 23:23 hours, in response to an inquiry by Dubbo FSU, the pilot advised that he was "running inbound again". He called again at 23:24 hours and advised that he would "go round and have one more go", adding "if I don't make it this time I'll give it away."
Dubbo FSU advised the aircraft at 23:29 hours that the main cloud base was now 600 feet with lower patches down to 400 feet. The pilot responded that he would come down to the minimum altitude once more and if the cloud did not break he would "give it away". At 23:42 hours he advised that he was outbound for another attempt and the FSU requested that he "call again by time on the hour". The pilot acknowledged this request this was the last communication from the aircraft.
The search and rescue procedures were implemented when the aircraft failed to respond to calls. The wreckage was found, on the following morning, in a position consistent with the aircraft having been inbound towards the NDB, near the alignment of, but approximately 1000 feet lower than, the specified descent procedure.
Initial impact had taken place with a tree, whilst the aircraft was in substantially level flight. The outer panel of the port wing was torn off as a result of this contact. The aircraft rolled to the left and struck the ground inverted, then skidded into an irrigation dam approximately 300 metres south of the tree.
Examination of the wreckage did not disclose any pre-existing defect or malfunction of the aircraft which could have contributed to the accident. The altimeter sub-scale was found set to 1009 millibars. Post-mortem examination of the pilot revealed extensive atheroma of the coronary arteries. There was also evidence that the pilot had had a cardiac infarct, at some time in the past. He had not reported any such event at any of the routine medical examinations which he had undergone for renewal of his pilot licence.
However, medical statistics suggest that about 15% of myocardial infarcts cause no symptoms and it is'possible that the pilot was unaware that it had occurred. The condition of the pilot's heart was consistent with the possibility of sudden incapacitation or sudden death. There was, nevertheless, no corroborating evidence, such as of a loss of control, to suggest that the pilot had become grossly incapacitated during flight.
There was, equally, no available evidence of a more subtle degree of incapacitation such as may possibly have led to errors in the operation of the aircraft in the relatively stressful circumstances of the pilot's attempts to approach Dubbo. Misreading of the altimeter for that or any other reason remains a possibility which cannot be eliminated on the basis of the available evidence.
The medical history of the pilot indicated that he had been mildly hypertensive about eight years previously. In 1976 his regular electrocardiogram was queried on the grounds of some non-specific changes.A specialist medical check made as a result led to the conclusion that [name redactd] did not have ischaemic heart disease. The cardiac infarct noted at the post-mortem examination was also not diagnosable during the 1976 examination. Subsequent routine medical examination of the pilot including an electrocardiogram did not indicate an inability on his part to meet the required standards.
From the available evidence it has not been possible to determine the cause of the accident"
Sources:
1. http://www.atsb.gov.au/publications/investigation_reports/1978/aair/197801157/
2. http://www.airliners.net/photo/Piper-PA-30-160-Twin/2512387/M/
Revision history:
| Date/time | Contributor | Updates |
|---|---|---|
| 21-Jun-2013 14:43 | Uli Elch | Added |
| 21-Jun-2013 14:55 | Uli Elch | Updated [Date, Registration, Cn, Location, Country, Source, Narrative] |
| 28-Jan-2015 02:41 | Dr. John Smith | Updated [Aircraft type, Operator, Total fatalities, Total occupants, Other fatalities, Location, Phase, Nature, Destination airport, Source, Embed code, Narrative] |
| 26-Mar-2017 18:05 | Dr.John Smith | Updated [Time, Total fatalities, Total occupants, Location, Nature, Departure airport, Source, Embed code, Narrative] |
| 26-Mar-2017 18:06 | Dr.John Smith | Updated [Destination airport] |
| 27-Mar-2017 20:48 | Dr.John Smith | Updated [Narrative] |
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