# NTSB ERA17LA018: Cessna 208, N208KM, Dunnellon, FL, October 14, 2016 - Type: NTSB accident investigation - Classification: Accident · Fatal · Limited investigation · Final report - Date: October 14, 2016, 17:35 local (21:35 UTC) - Place: Dunnellon, FL - Coordinates: 29.061666, -82.376663 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=29.0617&lon=-82.3767&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-cruise: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) - Highest injury: Fatal - Injuries: 1 fatal, 10 uninjured - Status: Completed, report July 16, 2018 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: FAA/FSDO - NTSB case key (mKey): 94227 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA17LA018 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/94227/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=94227 - Page: https://openairdocs.org/ntsb/ERA17LA018 ## Probable cause The jumpmaster's failure to guard the reserve parachute ripcord, which caused an inadvertent deployment of his reserve parachute. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Passenger (probable cause); cases with it: [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) (defining event); cases with it: [All aircraft, 1,556 cases](https://openairdocs.org/ntsb-events/900/sequence.md) ## Analysis The airplane was at 1,250 ft above ground level carrying a load of skydivers. According to a skydiving instructor onboard the airplane, the jumpmaster leaned forward to assist a skydiver in exiting the airplane when the jumpmaster's reserve parachute inadvertently deployed and entered the airplane's slipstream. The jumpmaster attempted to pull the parachute back into the airplane but was pulled into the door frame and dragged out of the airplane. The jumpmaster, who appeared to be unconscious, descended to the ground beneath his streaming (unopened) reserve parachute without deploying his main parachute. The pilot maintained control of the airplane and landed safely. Examination of the jumpmaster's reserve parachute revealed that it was damaged by impact with the door frame, thus it did not deploy properly. It is likely that the jumpmaster failed to guard his reserve parachute ripcord, which was exposed on the front of his parachute, and the ripcord snagged on something as he attempted to assist the exiting skydiver, which caused the reserve parachute to deploy prematurely. ## Factual narrative On October 14, 2016, about 1735 eastern daylight time, a Cessna 208, N208KM, was substantially damaged during a skydiving event over Marion County Airport (X35), Dunnellon, Florida. One of the 10 skydivers on board was fatally injured, and the commercial pilot and the other 9 skydivers were not injured. The airplane was registered to a private individual and operated by the National Parachute Test Center, Inc., (NPTC) under the provisions of Title 14 Code of Federal Regulations Part 91 as a commercial skydiving flight. Visual meteorological conditions prevailed, and no flight plan was filed for the local flight, which departed X35 about 1700.According to a report prepared by NPTC, in addition to the pilot, there were 8 jumpers, a jumpmaster, and a training advisor assigned to the flight. Before boarding the airplane, the training advisor, who was a skydiving instructor familiar with the airplane, instructed the jumpmaster on the procedure used to make static line jumps from the Cessna 208. Upon boarding the airplane, the jumpmaster elected not to hook up the static line of his main parachute. When questioned by the training advisor, the jumpmaster replied, "I am not going to jump, so I do not have to." The flight departed and climbed to an altitude of 1,250 ft above ground level. According to the NPTC report, the first three skydivers exited the airplane uneventfully, and the fourth moved into position. The training advisor observed that the fourth skydiver seemed to hesitate, and the jumpmaster leaned forward toward him. As the fourth jumper exited the airplane, the training advisor noticed a flash of white and watched as the jumpmaster's reserve parachute deployed and entered the airplane's slipstream. The jumpmaster attempted to pull the parachute back into the airplane and was pulled into the door frame before being dragged out of the airplane. Observers on the ground watched as the jumpmaster descended beneath his streaming (unopened) reserve parachute to the ground. The ground observers reported that the jumpmaster made no movements, appeared to be unconscious, and did not deploy his main parachute. The pilot reported that he was able to maintain control of the airplane and land without further incident. Examination of the airplane by a Federal Aviation Administration (FAA) inspector revealed that the cargo door frame and fuselage were buckled. Inspection of the jumpmaster's main parachute by an FAA-certificated senior parachute rigger revealed that it was intact and remained in the deployment bag. Examination of the reserve parachute revealed that the injector spring was wrapped around the suspension lines. The deployment ring, connector snap, and part of the spreader bar were located midway up the suspension lines. The jump inspection booklet located on the parachute indicated that the reserve parachute was inspected 3 days before the accident. NPTC attributed the damage to the reserve parachute to impact with the door frame as thejumpmaster was pulled from the airplane. The FAA inspector who examined the airplane reported that the jumpmaster was using a military-style parachute with the reserve parachute positioned below the chest. According to the FAA inspector, "the reason the reserve parachute deployed is unclear at this time but since the D ring [ripcord handle] is exposed on the front of the parachute speculation is that the D ring may have accidently caught or snagged on another jumper or something in the aircraft." According to NPTC, the accident resulted from the jumpmaster's "failure to guard his Reserve Ripcord Handle" and "was compounded by [his] failure to exit the aircraft immediately" when his reserve parachute deployed. ## Aircraft - Registration: N208KM (not matched to a registry record) - Reported make and model: CESSNA 208 (A) - Category: Airplane - Serial number: 20800150 - Year built: 1989 - Airframe hours: 11336.1 - Engines: P&W CANADA PT6A-114 600 horsepower turbo prop - Damage: Substantial damage - Flight: Skydiving, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: 100 hour, August 26, 2016, 42 hours before - Departed: X35, Dunnellon, FL - Destination: X35, Dunnellon, FL - Airport: X35, Marion County Airport - Equipment: Auto-pilot ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 67; injuries: none; commercial; airplane ratings: single-engine land; medical: class 2, with waivers/limitations; seat: left; restraint: 5-point; flight hours: 6,761 total, 2,065 in this make and model, 6,615 as pilot in command, 39 in the last 90 days, 25 in the last 30 days, 3 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 50° at 6 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 82 °F, dew point 63 °F - Altimeter: 30.12 inHg - Observed at: OCF, 10 nm away ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Incident 20161014021769I](https://openairdocs.org/incident/20161014021769I), Oct 14, 2016: Cessna 208, Dunnellon, FL, Substantial damage, 1 fatal. The decedent was acting as jumpmaster for a group of static line jumpers with military type parachutes. He did not intend to jump and did not have his static… ## Docket (5 files) The files NTSB released with the investigation on June 4, 2018, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=94227. 7.9 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 7.0 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40463665&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Memorandum of Record - FAA Statement (item 2, .PDF, 104 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40463666&FileExtension=.PDF&FileName=Memorandum%20of%20Record%20-%20FAA%20Statement-Master.PDF - Operator Report (item 3, .PDF, 145 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40463667&FileExtension=.PDF&FileName=Operator%20Report-Master.PDF - Photo Array (item 4, .PDF, 3 photos, 295 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40463668&FileExtension=.PDF&FileName=Photo%20Array-Master.PDF - MILP T-10 Parachute Diagram (item 5, .PDF, 1 photo, 385 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40463669&FileExtension=.PDF&FileName=MILP%20T-10%20Parachute%20Diagram-Master.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.