# NTSB CEN22LA328: Eurocopter Deutschland EC 135, N228MT, Mount Vernon, IL, July 20, 2022 - Type: NTSB accident investigation - Classification: Accident · No injuries · Class 4 · Limited · Final report - Date: July 19, 2022, 20:41 local (Jul 20, 2022, 01:41 UTC) - Place: Mount Vernon, IL · On helipad. - Coordinates: 38.317926, -88.86306 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=38.3179&lon=-88.8631&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing: Airport occurrence](https://openairdocs.org/ntsb-events/070) - Highest injury: No injuries - Injuries: 3 uninjured - Status: Completed - Report: Approved by Office Director - Investigation class: Class 4 - Basic report with no Prelim publish - NTSB office: Central Region - Parties: FAA Springfield FSDO - NTSB case key (mKey): 105540 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN22LA328 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/105540/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=105540 - Page: https://openairdocs.org/ntsb/CEN22LA328 ## Probable cause The inadequate securement of the cloth fire extinguisher cover, which resulted in it being blown off the fire extinguisher and ingested into the helicopter’s fenestron during the landing. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Object/animal/substance: debris/dirt/foreign object](https://openairdocs.org/ntsb-findings/03022055): Environmental issues › Physical environment · Effect on equipment (probable cause); cases with it: [Eurocopter Deutschland EC 135 P2+, 2 cases](https://openairdocs.org/ntsb-findings/03022055/cases.md?model=5620030), [All aircraft, 101 cases](https://openairdocs.org/ntsb-findings/03022055/cases.md) - [Tail rotor](https://openairdocs.org/ntsb-findings/01046400): Aircraft › Aircraft propeller/rotor · Failure (probable cause); cases with it: [Eurocopter Deutschland EC 135 P2+, 3 cases](https://openairdocs.org/ntsb-findings/01046400/cases.md?model=5620030), [All aircraft, 23 cases](https://openairdocs.org/ntsb-findings/01046400/cases.md) - [Tail rotor](https://openairdocs.org/ntsb-findings/01046400): Aircraft › Aircraft propeller/rotor · Damaged/degraded (probable cause); cases with it: [Eurocopter Deutschland EC 135 P2+, 3 cases](https://openairdocs.org/ntsb-findings/01046400/cases.md?model=5620030), [All aircraft, 23 cases](https://openairdocs.org/ntsb-findings/01046400/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing: Airport occurrence](https://openairdocs.org/ntsb-events/070) (defining event); cases with it: [Eurocopter Deutschland EC 135 P2+, 2 cases](https://openairdocs.org/ntsb-events/070/sequence.md?model=5620030), [All aircraft, 56 cases](https://openairdocs.org/ntsb-events/070/sequence.md) - [Landing: Prop/jet/rotor blast/suction](https://openairdocs.org/ntsb-events/082); cases with it: [Eurocopter Deutschland EC 135 P2+, 2 cases](https://openairdocs.org/ntsb-events/082/sequence.md?model=5620030), [All aircraft, 44 cases](https://openairdocs.org/ntsb-events/082/sequence.md) - [Landing: Sys/Comp malf/fail (non-power)](https://openairdocs.org/ntsb-events/330); cases with it: [Eurocopter Deutschland EC 135 P2+, 2 cases](https://openairdocs.org/ntsb-events/330/sequence.md?model=5620030), [All aircraft, 994 cases](https://openairdocs.org/ntsb-events/330/sequence.md) - [Landing: Part(s) separation from AC](https://openairdocs.org/ntsb-events/338); cases with it: [Eurocopter Deutschland EC 135 P2+, 3 cases](https://openairdocs.org/ntsb-events/338/sequence.md?model=5620030), [All aircraft, 563 cases](https://openairdocs.org/ntsb-events/338/sequence.md) ## Analysis During the landing, the pilot lowered the helicopter air ambulance down to the concrete pad. Shortly before touchdown, a cloth fire extinguisher cover from a nearby mobile fueling unit was blown airborne from the main rotor system wash. The cloth fire extinguisher cover was ingested into the tail rotor (the fenestron). During the cloth fire extinguisher cover ingestion sequence, the fenestron hub flexed, the metal fenestron hub cover detached, and it was also ingested. The pilot was able to land the helicopter without further incident. The helicopter sustained substantial damage to the fenestron. The evidence indicated that the ingestion of the metal fenestron hub cover contributed to the severity of the damage sustained. The operator reported there were no preimpact mechanical malfunctions or failures with the airframe and the engines that would have precluded normal operation. The investigation revealed that the cloth fire extinguisher cover, which did not have a lanyard installed, was not secured with the retention bracket for the fire extinguisher on the mobile fueling unit. The operator additionally reported that foreign object debris checks are conducted by crew members anytime they are on the pad and that the mobile fueling unit is inspected during the daily fuel quality check. The Accident Investigation Board Norway along with the European Aviation Safety Agency, previously issued a formal safety recommendation to Eurocopter (Airbus) regarding the securement of the metal fenestron hub cover. ## Aircraft - Registration: [N228MT](https://openairdocs.org/aircraft/N228MT), registered now, S/N 0908, built 2010 (OpenAirDocs) - Reported make and model: EUROCOPTER DEUTSCHLAND GMBH EC 135 (P2+) - Registry model: [Eurocopter Deutschland EC 135 P2+](https://openairdocs.org/model/eurocopter-deutschland-ec-135-p2-plus) (registry code 5620030) (OpenAirDocs) - Registry engine: [Pratt & Whitney Canada PW206B2](https://openairdocs.org/engine/pratt-whitney-canada-pw206b2) (registry code 52288, turbo-shaft) (OpenAirDocs) - Category: Helicopter - Serial number: 0908 - Year built: 2010 - Airframe hours: 1271.2 - Engines: Pratt & Whitney Canada PW206B2 447 horsepower turbo shaft; Pratt & Whitney Canada PW206B2 447 horsepower turbo shaft - Damage: Substantial damage - Flight: Part 135 - Operator: Air Evac Lifeteam, doing business as Air Evac Lifeteam - Registered owner: Air Evac Lifeteam - Airworthiness certificate: Standard, Normal - Last inspection: 100 hour, July 12, 2022 - Departed: CPS, Cahokia, IL - Destination: Same as departure - Flight plan: Company VFR - Airport: MVN, Mount Vernon - Equipment: Electronic multifunction display, Onboard weather, Satellite tracking device, ADS-B, Auto-pilot, Electronic flight bag or handheld device ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 50; injuries: none; airline transport; airplane ratings: single-engine land; instrument ratings: helicopter; medical: class 2, with waivers/limitations; last flight review April 2, 2022; seat: right; restraint: 4-point; flight hours: 3,210.5 total, 2,671.3 as pilot in command ## Weather - Conditions: Visual (VMC), Dusk - Wind: 170° at 4 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 84 °F, dew point 73 °F - Altimeter: 29.82 inHg - Observed at: KMVN - METAR: KMVN 200056Z AUTO 17004KT 10SM CLR 29/23 A2982 RMK AO2 SLP095 T02890228 ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20220719007199A](https://openairdocs.org/incident/20220719007199A), Jul 19, 2022: Eurocopter Deutschland Gmbh EC 135 P2+, Mount Vernon, IL, Substantial damage. On July 19, 2022 at approximately 1941 CDT N228MT, an EC-135 P2+, sustained substantial damage during landing at Mount Vernon Airport (mvn) in Mount Vernon,… ## Docket (4 files) The files NTSB released with the investigation on August 22, 2022, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=105540. 15.4 MB in all. - Pilot/operator aircraft accident report, NTSB form 6120.1 (item 1, PDF, 9 pages, 1.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14250842&FileExtension=pdf&FileName=NTSB%20Form%206120_1%20Redacted-Rel.pdf - Accident photographs (item 2, PDF, 6 pages, 2.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14250194&FileExtension=pdf&FileName=Accident%20Photographs-Rel.pdf - Accident sequence video footage (courtesy of the operator) (item 3, MP4, 9.7 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14250583&FileExtension=mp4&FileName=N228MT%20-%20Accident%20Sequence%20Video%20Footage-Rel.mp4 - Additional documents (item 4, PDF, 11 pages, 2.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14250204&FileExtension=pdf&FileName=Additional%20Documents%20Redacted-Rel.pdf From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.