ANC98LA112

NTSB accident investigation · de Havilland DHC-2 · Nondalton, AK · July 30, 1998

Accident · FatalLimited investigationFinal report
Date
July 30, 1998, 08:00 local (16:00 UTC)
Place
Nondalton, AK
Injuries
1 fatal, 6 uninjured
Damage
No damage
Phase of flight
Taxi
Aircraft
N123EFde Havilland DHC-2
Weather
Visual (VMC) · Day
Status
Completed · report May 19, 1999
Report
Approved by Office Director
NTSB office
Alaska Regional Office
FAA report
19980730023569A
Case key
43543

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilot's inadequate procedures/directives when he allowed a passenger to exit the cabin area while the propeller was still turning, and the passenger's failure to follow the pilot's instructions to stay away from the propeller. A factor associated with the accident is the passenger's unfamiliarity with aircraft.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Propeller/rotor contact to personTaxi - from landing
Procedures/directives - inadequatePilot in commandCause
Procedures/directives - not followedPassengerCause
Lack of familiarity with aircraftPassengerFactor

Analysis

The pilot of the float equipped fishing lodge airplane instructed his passenger, a guide employed by the lodge, to exit the airplane's cabin and stand on a float in preparation for docking at a remote site. The pilot reminded the guide, a new lodge employee unfamiliar with aircraft, to stay behind the door until he shut the engine off, and the propeller had stopped. The guide did not stay behind the door, but walked forward on the float prior to engine/propeller stoppage. The guide was fatally injured when he was struck by the propeller.

Factual narrative

On July 30, 1998, about 0800 Alaska daylight time, the propeller of a float equipped Dehavilland DHC-2 airplane, N123EF, struck and fatally injured a deplaning passenger near Six Mile Lake, Alaska, located about 2 miles south of Nondalton, Alaska. The airplane was not damaged, and none of the remaining five passengers, or the commercial certificated pilot, were injured. The 14 CFR business flight operated in visual meteorological conditions. No flight plan was filed. The flight departed the Rainbow River Lodge, Iliamna, Alaska, about 0733.

The lodge owner, the pilot, and a fishing guide employed by the lodge, were all interviewed via telephone by the NTSB investigator-in-charge on the day of the accident. All the interviewees related essentially the same information. The purpose of the flight was for the pilot to transport three fishing guides, and three lodge guests, to a remote fishing site near the outflow of Lake Clark and Six Mile Lake. After the airplane landed, it water taxied towards the shore. As it approached the shore, the pilot instructed the fishing guide seated in the right front (copilot) seat to leave the cabin, and stand on the float behind the right side cabin door, until the propeller stopped turning. After the propeller stopped, the guide was to go to the front of the float, grab a docking rope, and dock the airplane.

Simultaneously, or nearly simultaneous with these instructions, the pilot said he pulled the mixture to idle cutoff, and turned the magnetos to the "OFF" position. The pilot then reached down to retract the water rudders, and heard a noise like the airplane's float had hit a rock. He looked up, and did not see the fishing guide who had just left the cabin. The pilot opened the right cabin door, and saw the guide lying on the float.

The guide had been struck by the propeller, and received injuries to his head and neck. Seats were removed from the airplane to allow the injured guide to lie down, and he was then flown to Iliamna for medical treatment, but died en route.

The pilot related the guide had only been working for the lodge for a few days. He said he gave the guide a briefing when he first arrived about the hazards associated with docking, and that he must remain behind the cabin door until the propeller stopped. He also related that he routinely warns whomever is assigned the docking duty on each flight to stay behind the door until the propeller stops. He says he gives this warning each time, just before the guide leaves the cabin to step onto the float. He said he gave this warning to the deceased guide just before he left the cabin. This information was corroborated by another fishing guide who was seated in the cabin and was wearing an intercom head set. The pilot, the deceased guide, and the aforementioned guide, were the only ones wearing intercom headsets.

A Federal Aviation Administration (FAA)Inspector from the Anchorage Flight standards District Office (FSDO), and an Alaska State Trooper, interviewed the pilot and various lodge employees and passengers on the accident flight. Copies of their reports/interview excerpts, are appended.

The Anchorage FSDO inspector timed how long it took the propeller on the accident airplane, and the propeller on another, similar DHC-2 airplane, to stop moving from idle power when the mixture was pulled to idle and the ignition turned off. The inspector did this three times. The average time to stoppage was nine seconds.

Aircraft

Registration
N123EF
Reported as
de Havilland DHC-2
Category
Airplane
Serial number
735
Engine
P&W R-985, 450 horsepower, reciprocating
Damage
No damage
Flight
Business · Part 91
Registered owner
Chris F. Goll
Airworthiness certificate
Standard, Normal

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
55
Certificate
Commercial
Airplane ratings
Single-engine land, Single-engine sea, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--w/ waivers/lim
Seat
Left
Flight hours
13,540 total · 1,166 in this make and model · 11,740 as pilot in command · 120 in the last 90 days · 45 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
315° at 5 knots
Visibility
30 statute miles
Lowest ceiling
None
Temperature
50 °F

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.