ERA13TA261

NTSB accident investigation · Bell 407 · Columbia, MD · May 31, 2013

Accident · No injuriesFinal report
Date
May 30, 2013, 23:07 local (May 31, 2013, 03:07 UTC)
Place
Columbia, MD
Injuries
4 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N407HCBell 407
Defining event
Enroute-cruise: Loss of engine power (total)
Weather
Visual (VMC) · Night/dark
Status
Completed · report June 2, 2014
Report
Approved by Office Director
NTSB office
Eastern Region Aviation
Parties
Bell Helicopter, HCPD, Rolls-Royce, FAA/FSDO
FAA report
20130530008569A
Case key
87050

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 short circuit failure of a tantalum capacitor, internal to the engine’s electronic control unit, resulting in an uncommanded shutdown of the engine in flight.

Findings · 1

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.

Engine fuel and control: fuel control electronicAircraft › Aircraft power plant · MalfunctionAll aircraft: 6 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

During a routine police patrol flight, while about 600 feet above the ground, the helicopter suddenly yawed to the left and the red "ENGINE OUT" warning light illuminated. The engine lost all power and the pilot performed an autorotation landing on a nearby football field. While avoiding obstacles, the helicopter landed hard, resulting in substantial damage to the airframe. A postaccident examination of the engine revealed no damage or obvious reason for the loss of power. The engine's electronic control unit (ECU) was removed and was shipped to the manufacturer's facility for evaluation and testing. The examination of the ECU revealed that the engine was operating normally until an unexpected activation of the full authority digital electronic control overspeed protection system fuel reduction solenoid, which is internal to the ECU, resulting in an uncommanded in-flight engine shutdown. A subsequent ECU functional review confirmed that a short circuit failure of a tantalum capacitor was the source of the ECU malfunction. After the accident, Bell Helicopter issued an Alert Service Bulletin and Rolls-Royce issued an accompanying Commercial Engine Bulletin that included the installation of an overspeed adapter to reduce the likelihood of a false overspeed activation.

Factual narrative

On May 30, 2013, about 2307 eastern daylight time, a Bell 407, N407HC, was substantially damaged during an autorotation following a total loss of engine power at Columbia, Maryland. The commercial pilot and three crewmembers were not injured. The helicopter was registered to the State of Maryland and was operated by the Howard County Police Department as a public use flight. Night, visual meteorological conditions prevailed and no flight plan was filed. The local flight originated at Tipton Airport (FME), Fort Meade, Maryland, about 2210.According to the operator, the helicopter was on a routine patrol flight on a heading of 130 degrees and at a speed of 120 knots. About 600 feet above the ground, the helicopter suddenly yawed to the left and the red "ENGINE OUT" warning light illuminated. The pilot commenced an autorotation for landing on a nearby high school football field. To avoid trees and a goal post, the pilot extended the glide path by raising the collective control. The helicopter landed hard on the football field and came to rest in an upright position. The pilot secured the rotor blades and engine and the crew exited the helicopter without injuries. The wreckage was recovered and secured in a local hangar. The wreckage was examined on June 4 and 5, 2013, by Federal Aviation Administration inspectors and investigators from the airframe and engine manufacturers. The damage was determined to be substantial, including a severed tail boom and damaged main rotor blades. Damage to the landing gear also resulted. The on-scene examination of the engine revealed no damage or anomalies. The engine's electronic control unit (ECU) was removed and was shipped to the manufacturer's facility at West Hartford, Connecticut for further evaluation and testing. The examination of the ECU revealed that the engine was operating normally until an unexpected activation of the Full Authority Digital Electronic Control (FADEC) Overspeed Protection System (OSPS) fuel reduction solenoid, internal to the ECU, occurred, resulting in an uncommanded in-flight shutdown of the engine. The unit's non-volatile memory revealed evidence of an OSPS power supply malfunction shortly after the solenoid activated. An ECU functional review confirmed that a short circuit failure of component C49, a 22 uF tantalum capacitor, part number M39003/09-0254, was the source of the ECU malfunction. The ECU, Rolls-Royce part number 23080490, was affected by Rolls-Royce Commercial Engine Bulletin (CEB) 73-6052, dated December 3, 2012, which, if complied with, replaced the old ECU with an improved design (part number 23088856). The design change incorporated improvements to the OSPS. The compliance date per Rolls-Royce was March 31, 2015. Compliance was not mandatory through an FAA Airworthiness Directive (AD). For additional information regarding the engine and ECU examinations, refer to the excerpts of the Rolls-Royce Engine Investigations Report and the Triumph Group Investigation Report,located in the public docket for this accident investigation. On January 23, 2014, Bell Helicopter Alert Service Bulletin (ASB) 407-14-102 and Rolls-Royce Commercial Engine Bulletin (CEB) A-73-6059 were issued to (1) install an overspeed adapter to reduce the likelihood of a false overspeed activation as well as to introduce a recurring functional check of the overspeed protection circuits within the ECU; (2) provide instructions to apply Stabilant 22 to the connector and adapters required in the bulletin, and (3) introduce a recurring 50-hour requirement to functionally check the overspeed protection system by performing overspeed test shutdowns.

Aircraft

Registration
N407HC
Reported as
Bell 407
Category
Helicopter
Serial number
53745
Built
2006
Airframe hours
1,930
Engine
Rolls-Royce 250 C47B, 650 horsepower, turbo shaft
Damage
Substantial damage
Flight
Public aircraft - local · Public use
Operator
Howard County Police Department
Registered owner
State Of Maryland
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 9, 2013 · 18 hours before
Departed
FME · Fort Meade, MD
Destination
FME · Fort Meade, MD

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
52
Injuries
None
Certificates
Commercial, Flight instructor
Airplane ratings
Single-engine land
Instrument ratings
Airplane, Helicopter
Medical
Class 2, With waivers/limitations
Last flight review
April 30, 2013
Seat
Right
Flight hours
4,360 total · 1,340 in this make and model · 4,288 as pilot in command · 78 in the last 90 days · 23 in the last 30 days

Weather

Conditions
Visual (VMC) · Night/dark
Wind
Calm
Visibility
10 statute miles
Lowest ceiling
None
Temperature
79 °F, dew point 66 °F
Altimeter
30.12 inHg
Observed at
BWI, 10 nm away

Docket · 9

The files NTSB released with the investigation on April 3, 2014, on NTSB’s docket system: statements, records, photos and specialists’ reports. 8.6 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.