CEN14LA419

NTSB accident investigation · Evolution Trikes Revo · South Haven, MI · August 11, 2014

Accident · FatalLimited investigationFinal report
Date
August 11, 2014, 12:16 local (16:16 UTC)
Place
South Haven, MI
Injuries
1 fatal
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N214EVEvolution Trikes Revo
Defining event
Enroute: Loss of control in flight
Weather
Instrument (IMC) · Day
Status
Completed · report June 16, 2016
Report
Approved by Office Director
NTSB office
Central Region
Parties
Evolution Aircraft, Inc., Federal Aviation Administration
FAA report
20140811013169A
Case key
89850

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 noninstrument-rated pilot’s decision to continue visual flight into instrument meteorological conditions, which resulted in his loss of aircraft control and the resultant overstress and in-flight breakup of the weight-shift-control aircraft.

Findings · 5

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.

Use of equip/info: aircraft controlPersonnel issues › Task performance · PilotAll aircraft: 9,295 casesProbable cause
Wing structure: main frame (on wing)Aircraft › Aircraft structures · Capability exceededAll aircraft: 8 casesProbable cause
Info processing/decision: decision making/judgmentPersonnel issues › Action/decision · PilotAll aircraft: 3,098 casesProbable cause
Ceiling/visibility/precip: below VFR minimaEnvironmental issues › Conditions/weather/phenomena · Response/compensationAll aircraft: 184 casesProbable cause
Performance/control parametersAircraft › Aircraft oper/perf/capability · Not attained/maintainedAll aircraft: 1,269 casesProbable cause

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 noninstrument-rated sport pilot was returning to his home airport on a personal cross-country flight in a recently manufactured weight-shift-control aircraft. A witness located near the accident site reported hearing an "engine revving up," followed by a "loud bang." She subsequently noticed the aircraft's wing descending out of the clouds "like a maple leaf." The aircraft's wing impacted a cornfield, and the fuselage was found about 600 yards east of the wing. Examination of the wreckage revealed that the hang block and three attachment bolts, both ends of the control bar, the bolt holding the safety cable to the mast, and the left wing leading edge tube were fractured. All of the fracture surfaces were consistent with overstress. The fracture of the left wing leading edge tube toward the aft direction was consistent with a negative g event. The wreckage signatures of a negative g event and overstress were consistent with a loss of aircraft control and the subsequent in-flight breakup of the aircraft. The pilot had a demonstrated history of noncompliance with Federal Aviation Administration (FAA) regulations. He was counseled by FAA personnel for flying in less than visual flight rules conditions about 1 month before the accident. Instrument meteorological conditions (IMC), including ceilings at 500 ft above ground level, existed along the route of flight at the time of the accident. It is likely that the pilot improperly decided to continue visual flight into IMC and that he subsequently lost control of the aircraft, which resulted in the overstress and in-flight breakup of the aircraft.

Factual narrative

The Evolution Trikes Revo weight-shift-control aircraft was issued a special airworthiness certificate on July 26, 2014. The aircraft was equipped with a Rotax 912 4-cylinder powerplant and an MGL Avionics Explorer electronic flight instrumentation system (EFIS). The EFIS unit did not contain any non-volatile memory for the accident flight. On August 11, 2014, at 1216 eastern daylight time, an Evolution Trikes Revo weight-shift-control aircraft, N214EV, impacted terrain following an in-flight breakup near South Haven, Michigan. The pilot was fatally injured and the aircraft sustained substantial damage. The aircraft was registered to Evolution Aircraft Inc. and was operated by a private individual under the provisions of 14 Code of Federal Regulations Part 91 as a personal flight. Instrument meteorological conditions were expected along the route of flight and were reported immediately prior to the accident. The flight originated from Lansing Municipal Airport (IGQ), Chicago, Illinois, about 1115, and was en route to Hastings Airport (9D9), Hastings, Michigan. A witness stated she "heard an engine revving up", followed by a "loud bang". She then walked outside her house and saw a wing descending out of the clouds "like a maple leaf". No radar data was available for the accident sequence. On August 12, 2014, an autopsy was performed on the pilot by the Department of Laboratories in Lansing, Michigan. The cause of death was blunt force injuries. The FAA's Civil Aeromedical Institute in Oklahoma City, Oklahoma performed toxicology tests on the pilot. Toxicology detected the presence of the medications paroxetine (Paxil®) and methylphenidate (Ritalin® and Concerta®). Paroxetine is a prescription serotonin reuptake inhibitor (SSRI) medication used to treat depression. Methylphenidate is a prescription stimulant medication used in the treatment of attention deficit disorders and narcolepsy. The other substances detected were caffeine and acetaminophen (Tylenol). Medical records were obtained from the pilot's personal physician. Although limited, these records reflected visits for medication refills of methylphenidate and paroxetine. The pilot carried diagnoses of attention deficit disorder and depression. No mental status exams and no descriptions of the pilot's mood or behavior were recorded. At 1156, the weather observation station at South Haven Regional Airport (LWA), South Haven, Michigan, located about 3 miles south of the accident site, reported wind from 060 degrees at 3 knots, visibility 5 miles in light rain, ceiling broken at 500 ft agl, overcast clouds at 2,300 ft agl, temperature and dew point 21 degrees C, altimeter setting 29.88 inches of mercury. At 1216, the LWA weather observation station reported wind from 020 degrees at 3 knots, visibility 5 miles in moderate drizzle, scattered clouds at 500 ft agl, scattered clouds at 2,300 ft agl, ceiling broken at 8,000 ft agl, temperature and dew point 21 degrees C, and altimeter setting 29.89inches of mercury. At the time of the accident, the National Weather Service had an Airmen's Meteorological Advisory (AIRMET) current over the area for instrument meteorological conditions due to ceilings below 1,000 ft agl and visibility below 3 miles in precipitation and mist. The pilot, age 45, held a sport pilot certificate with light-sport aircraft, powered parachute, and flight instructor ratings. The pilot did not hold a medical certificate; a medical certificate is not required to exercise sport pilot privileges. On July 23, 2012, the pilot reported having 377 hours of total flight experience, 133 hours of weight-shift-aircraft, and 244 hours of powered parachute on his FAA application for a flight instructor rating. Recent pilot logbooks were not available for the investigation. The pilot had a history of noncompliance with FAA regulations. On October 13, 2011, the pilot was counseled for a low flying complaint. On May 5, 2012, the pilot was given an FAA reexamination following an accident. On June 8, 2013, the FAA gave the pilot a formal warning notice. On July 1, 2014, the pilot was counseled by the FAA for flying in less than visual flight rules (VFR) conditions. The issue of aerodynamic tumble was discussed with weight-shift-control aircraft subject matter experts. The tumble mode, a peculiarity of weight-shift-control aircraft, is a departure from controlled flight leading to a nose-down pitch autorotation, with known rotation rates up to 400 degrees per second. Following a series of fatal weight-shift control aircraft accidents, the United Kingdom's Air Accidents Investigations Branch (AAIB) commissioned a safety study of the tumble mode. This safety study, as well as a description of the tumble mode, is included in the docket for this investigation. The aircraft's wing impacted a cornfield and the fuselage was located about 600 yards to the east of the fuselage. Examination revealed the aluminum hang block and three attach bolts had fractured. Also fractured were both ends of the control bar, as well as the bolt holding the safety cable to the mast. The entire wing envelope was present, with the exception of the outboard 54 inches of the left wing leading edge (aluminum tube), which was located near the fuselage. The left wing leading edge was bent 90 degrees aft at the location of fracture. The fracture of the left wing leading edge tube toward the aft direction was consistent with a negative G event. The mast of the carriage was twisted left, consistent with a left yaw force on the wing. The left wing strut was fractured in two locations. All fracture surfaces were consistent with overstress. The engine and propeller exhibited damage consistent with operation at impact. No evidence of bird remains (snarge) was found on any of the wreckage. Additional wreckage information is located in the docket for this investigation. Examination of the airframe and engine revealed no evidence of mechanical malfunctions or failures that wouldhave precluded normal operation.

Aircraft

Registration
N214EV
Reported as
Evolution Trikes Revo (NO SERIES)
Category
Weight-shift
Serial number
000604
Built
2014
Airframe hours
25
Engine
Rotax 912ULS, 100 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Evolution Aircraft Inc
Registered owner
Evolution Aircraft Inc
Airworthiness certificate
Special, Special light-sport (Special)
Departed
KIGQ · Lansing, IL
Destination
9D9 · Hastings, MI
Equipment
Electronic primary flight display

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
45
Injuries
Fatal
Certificate
Sport Pilot
Seat
Front
Restraint
None
Toxicology
Performed
Flight hours
377 total · 133 in this make and model

Weather

Conditions
Instrument (IMC) · Day
Wind
60° at 3 knots
Visibility
5 statute miles
Lowest ceiling
500 ft broken
Temperature
70 °F, dew point 70 °F
Altimeter
29.87 inHg
Observed at
KLWA, 3 nm away

Docket · 9

The files NTSB released with the investigation on May 2, 2016, on NTSB’s docket system: statements, records, photos and specialists’ reports. 19.7 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.