CEN09LA525

NTSB accident investigation · Cessna 182 · Caddo Mills, TX · August 15, 2009

Accident · Serious injuriesLimited investigationFinal report
Date
August 15, 2009, 11:38 local (16:38 UTC)
Place
Caddo Mills, TX
Injuries
1 serious, 4 uninjured
Damage
Minor damage
Phase of flight
Standing
Aircraft
N2364GCessna 182
Defining event
Standing-engine(s) operating: AC/prop/rotor contact w person
Weather
Visual (VMC) · Day
Status
Completed · report April 28, 2011
Report
Approved by Office Director
NTSB office
Central Region
Parties
United States Parachute Association, FAA Dallas FSDO
FAA report
20090815017759A
Case key
74531

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

On this page

Probable cause

The failure of the operator to ensure that the airplane engine was shutdown during passenger unloading and the lack of adequate supervision of the passenger by the pilot and ground crewmember.

Findings · 4

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Culture: standard operating practicesOrganizational issues › Management · OperatorCessna 182B: 1 caseAll aircraft: 10 casesProbable cause
Action: lack of actionPersonnel issues › Action/decision · PilotCessna 182B: 2 casesAll aircraft: 792 casesProbable cause
Action: lack of actionPersonnel issues › Action/decision · Ground crewCessna 182B: 2 casesAll aircraft: 792 casesProbable cause
Environmental issuesEnvironmental issues › Operating environment · Effect on operationCessna 182B: 1 caseAll aircraft: 14 cases

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

The airplane landed from a skydiving flight with a remaining passenger after three parachutists had jumped from the airplane. The engine was not shut down and the airplane was pointed toward the vehicle waiting for the passenger to deplane. When the passenger exited the airplane, a ground crewmember leaned toward the airplane to talk to the pilot while the passenger went around the right side of the airplane. The passenger walked forward into the rotating propeller. Federal Aviation Administration guidance information states that stopping the engine is the most effective way to ensure passengers arrive and depart the vicinity of an airplane safely. When necessary to discharge a passenger from an aircraft on which an engine is running, it advises that the pilot should never stop the aircraft with the propeller in the path of the passenger’s route from the aircraft.

Factual narrative

On August 15, 2009, about 11380 central daylight time, the rotating propeller of a Cessna 182B, N2364G, struck a deplaning passenger at the Caddo Mills Municipal Airport (7F3), Caddo Mills, Texas. The airplane was registered to an individual and was operated by North Texas Skydiving Center LLC under the provisions of Title 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed and no flight plan had been filed. The passenger was seriously injured and the pilot, who was the only other person remaining on board, was not injured. The flight had originated from 7F3 and had been conducting multiple flights to drop sport parachutists. According to the pilot, he had just landed after three parachutists had jumped from the airplane with one passenger remaining aboard. He stopped the airplane with its nose pointed toward a parked vehicle where the next group of parachutists was waiting to board. A ground crewmember arrived at the right cabin door and assisted the exit of the passenger while the engine and propeller were still operating. As the ground crewmember leaned in to speak to the pilot, the passenger went around the outboard side of the right wing strut and walked toward the group of persons waiting to board for the next flight. The passenger provided a written statement that she was on-board this flight to observe a group of parachutists and that she intended to later that day go up with an instructor for her first tandem jump. After the three parachutists had jumped, the airplane landed on the runway and taxied back toward the place where the next group of parachutists was waiting. The passenger was sitting aft-facing on the forward right side cabin floor when the airplane came to a stop. A ground crewmember came to the open right cabin door, tapped the passenger’s foot, and told her she was “good to go.” As she was exiting the airplane, the ground crewmember leaned in to talk to the pilot. The passenger then exited the right door of the airplane and walked forward toward the waiting vehicle when she was struck by the operating propeller. Several witnesses said the passenger did not appear to see the propeller as she slowly walked toward the parked vehicle. Inspectors from the Federal Aviation Administration (FAA) examined the airplane and found damage to two of the propeller blades and damage to the parachute worn by the passenger at the time of the accident. According to FAA Advisory Circular 91-42D "Hazards of Rotating Propeller and Helicopter Rotor Blade” A review of propeller accidents indicates that most were preventable. A propeller under power, even at slow idling speed, has sufficient force to inflict fatal injuries. On page 4 it cautions that the engine “should be shut down before boarding or deplaning passengers”...”when it is necessary to discharge a passenger from an aircraft on which an engine is running, never stop the aircraft with the propeller in the path of the passenger’s route from the aircraft.”

Aircraft

Registration
N2364G
Reported as
Cessna 182 (B)
Category
Airplane
Serial number
51664
Airframe hours
9,031
Engine
Continental O470, 235 horsepower, reciprocating
Damage
Minor damage
Flight
Skydiving · Part 91
Operator
North Texas Skydiving Center, LLC
Registered owner
Larry Portman DBA First Flight
Airworthiness certificate
Standard, Normal
Last inspection
Annual · August 3, 2000 · 1,799 hours before
Departed
7F3 · Caddo Mills, TX
Destination
7F3 · Caddo Mills, TX
Airport
7F3 · Caddo Mills Municipal Airport, runway 17R, 4,000 × 75 ft, concrete

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
83
Injuries
None
Certificate
Commercial
Airplane ratings
Multi-engine land, Single-engine sea
Medical
Class 2, With waivers/limitations
Last flight review
September 28, 2002
Seat
Left
Flight hours
6,000 total · 4,000 in this make and model · 30 in the last 90 days · 10 in the last 30 days · 30 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
180° at 9 knots, gusting 18
Visibility
10 statute miles
Lowest ceiling
None
Temperature
88 °F, dew point 70 °F
Altimeter
29.96 inHg
Observed at
KTKI, 19 nm away

Docket · 10

The files NTSB released with the investigation on February 9, 2011, on NTSB’s docket system: statements, records, photos and specialists’ reports. 5.6 MB in all.

FAA reports on this event · 1

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