# NTSB MIA05TA124: Bell OH-58A, N244RP, St. Augustine, FL, June 29, 2005 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Final report - Date: June 29, 2005, 12:42 local (16:42 UTC) - Place: St. Augustine, FL - Coordinates: 29.939722, -81.338607 - Nearby events: https://openairdocs.org/map.md?lat=29.9397&lon=-81.3386&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Highest injury: Minor injuries - Injuries: 1 minor, 1 uninjured - Status: Completed, report December 28, 2006 - Report: Approved by Office Director - Parties: FAA Flight Standards District Office, Rolls-Royce Corporation - NTSB case key (mKey): 61845 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=MIA05TA124 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/61845/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=61845 - Page: https://openairdocs.org/ntsb/MIA05TA124 ## Probable cause The failure of the compressor section of the engine for undetermined reasons resulting in the total loss of engine power during the initial climb. A factor in the accident was the operator's use of a confined area for takeoff during non-emergency or routine situations. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of engine power(total) - mech failure/malf, takeoff - initial climb - compressor assembly,blade - failure,total - Forced landing, descent - emergency - Hard landing, emergency landing - facility inadequate, company/operator management (contributing factor) - unsuitable terrain or takeoff/landing/taxi area - encountered, pilot in command ## Analysis The purpose of the flight was to reposition the helicopter to a high school for a static display. After takeoff from a confined area consisting of an immediately adjacent building, antenna, and a parking lot with numerous cars, the pilot executed a pedal turn to depart over the parking lot. During climb out while flying between 35 to 40 feet agl, and between 30 to 35 knots, he heard a "bang" and the helicopter yawed to the right. He later stated the right yaw may have been due to his over correction. He lowered the collective and turned left in an attempt to land on grass at the edge of the parking lot. He pulled collective to clear vehicles below and as a result, the helicopter impacted the ground hard; the main rotor blades collided with several vehicles. Examination of the helicopter revealed no discrepancies with the tail rotor drive system. The main drive shaft was fractured at both ends; no evidence of preexisting cracks were noted. Examination of the engine revealed leading and trailing edge damage to the first and second stage compressor blades, while the 3rd, 4th, and 5th stage compressor blades were fractured near the blade root. No evidence of preexisting cracking was noted on any of the fractured compressor blades. ## Factual narrative On June 29, 2005, about 1242 eastern daylight time, a Bell OH-58A, N244RP, registered to and operated by St. Johns County Sheriff's Office, made a hard landing following a loss of engine power shortly after takeoff from the St. Johns County Emergency Operations Center (St. Johns EOC), St. Augustine, Florida. Visual meteorological conditions prevailed at the time and no flight plan was filed for the public-use, local flight from the St. Johns EOC. The helicopter was substantially damaged and the commercial-rated pilot sustained minor injury and one observer was not injured. The flight was originating at the time of the accident. The purpose of the flight was to reposition the helicopter to a nearby high school for a static display. The pilot stated that after starting the engine, he contacted the St. Augustine Airport Air Traffic Control Tower for departure, and after lifting off the ground into a hover, he made a left pedal turn to depart across the southwest parking lot. During climb out while flying between 35 to 40 feet above ground level (agl), and between 30 to 35 knots, he heard a loud "bang" and the helicopter yawed to the right. He later reported that the right yaw could have been him overcorrecting. He lowered the collective and started a left pedal turn in an attempt to land on the grass at the edge of the parking lot. In an effort to clear vehicles below, he pulled collective and continued the turn. He heard the low rotor warning, and observed the low rotor warning and engine out lights were illuminated. He then pulled the rest of the collective to clear the vehicles, and as the helicopter cleared them, it, "...settled rapidly to the ground and impacted the ground behind the cars. The rotor blades struck a car and the top of a truck. One half of a blade departed the aircraft and struck a van in the east parking lot." He performed an emergency shutdown of the engine and he and the passenger were assisted out of the helicopter. Examination of photographs provided by the St. Johns County Sheriff's Office revealed the helicopter departed from grass located between the front of the St. Johns EOC with a nearby antenna, and a parking lot with numerous vehicles. The helicopter came to rest upright in a northerly direction immediately adjacent to vehicles parked in a parking lot, or an estimated 100 feet from the initial departure point. A car located adjacent to where the helicopter came to rest exhibited extensive damage to the roof and rear portion of the vehicle; a crease was noted on the body of the car. Damage to the top covering the bed of a truck also located adjacent to where the helicopter came to rest was noted. A window of a St. Johns County van parked in the parking lot near where the helicopter came to rest was damaged. Examination of the helicopter revealed the left skid tube was separated but located in close proximity to the helicopter, while the right skid tube was separated only at the aft crosstube. Both main rotor blades were fractured along their length. The helicopter was removed from the scene and the engine was examined by a representative of the engine manufacturer with FAA oversight. The examination revealed that the drive shaft from the engine to the main transmission was separated at both ends of the KAflex driveshaft. Rotational scoring was noted on the drive shaft, and "oscillatory damage" was noted to the fireshield tunnel between the engine and main transmission. A section of aluminum tubing with attached fittings was noted in the compressor inlet area, and the compressor bell housing was damaged and exhibited "circumferential scoring." A cursory examination of the helicopter by the FAA and engine manufacturer representative revealed no obvious damage to the tail rotor drive system, or tail rotor assembly. The engine compartment did not exhibit evidence of previous oil leaks, and no apparent bending of the engine mounts; the engine appeared aligned with the forward fireshield. The engine was removed from the helicopter and sent to the manufacturers facility for disassembly inspection. Examination of the engine at the manufacturer's facility with FAA oversight revealed the compressor inlet bellmouth forward of the engine compartment forward fireshield exhibited an inward puncture and rotational scoring. All of the compressor inlet guide vanes were damaged, and the upper and lower compressor case halves had "exit holes with metal bending from outside to inside." All first and second stage compressor blades exhibited leading and trailing edge damage, and all compressor blades of the third, fourth, and fifth stages were fractured near the blade root, while the sixth stage compressor blades were fractured near the tips. The remaining section of blades of the sixth stage compressor were bent opposite the direction of rotation. The compressor impeller exhibited "heavy rub" on all blades, and all vanes of the vane diffuser were damaged. The compressor shroud was noted to be "...heavily damaged from rotational scoring into the base metal" and the compressor air discharge tubes were dented from the inside to the outside. Examination of the accessory gearbox revealed it contained oil and was noted to rotate freely. The oil was golden in color and did not have a burned aroma. Examination of the combustion section revealed the outer combustion case and combustion liner contained compressor blade and vane material. Examination of the turbine section revealed metal splatter was noted on the first stage nozzle shield and first stage nozzle. All blades of the first stage turbine wheel (gas producer) were damaged near the tips. The second, third, and fourth stage turbine nozzles showed, "moderate deposits of unidentified material on their outer rings." The second stage turbine wheel (gas producer) exhibited metallic deposits and impact marks on all blades. The third and fourth stage turbine wheels (power turbine), exhibited, "...centrifuging of what appeared to be metallic debris to the outer ring." All internal engine shafts were noted to be "intact and unremarkable." All engine bearings were "...intact, oil wetted and rotated free and smooth." Leak check of the pneumatic system revealed no leaks. Failure analysis personnel of the engine manufacturer examined damaged and fractured hardware to include the fractured compressor blades and vanes, as well as the vanes and blade of the first stage turbine nozzle and first stage turbine wheel, respectively. The damaged compressor blades and vanes all exhibited evidence of overload failure, while the vanes and blade of the first stage turbine nozzle and first stage turbine wheel exhibited impact and temperature damage. The damaged main drive shaft was retained for further examination by the NTSB Materials Laboratory (NTSB Met Lab) located in Washington, D.C. Metallurgical examination of the main drive shaft by the NTSB Met Lab revealed the forward flexible coupling fractured into a number of pieces, while the aft flexible coupling fractured in 5 locations which allowed separation of the fitting from the shaft. One "frame" and a section of one of the "...shorter legs of one frame..." of the forward flexible coupling was not located nor submitted for examination while all pieces of the aft flexible coupling were located/submitted. Examination of all fracture surfaces revealed all exhibited features consistent with overstress, with no evidence of preexisting failure or malfunction. All the bolted connections for the forward and aft flexible couplings were "intact." Rotational scoring was noted on the forward and aft halves of the main drive shaft, the forward flexible coupling, and on the fractured pieces of the forward coupling, while negligible rotational scoring was noted on the aft fitting. A review of the provided maintenance records revealed that from September 17, 1987, to October 3, 2000, the engine was installed i ## Aircraft - Registration: [N244RP](https://openairdocs.org/deregistered/N244RP-2007-03-19), registration cancelled 2007-03-19, S/N 71-20533 (OpenAirDocs) - Reported make and model: Bell OH-58A - Registry model: [Bell OH-58A](https://openairdocs.org/model/bell-oh-58a) (registry code 1181579) (OpenAirDocs) - Category: Helicopter - Serial number: 71-20533 - Airframe hours: 4175.5 - Engines: Allison T63-A-720 317 horsepower turbo shaft - Damage: Substantial damage - Flight: Public aircraft - local, Public use - Operator: St. Johns County Sheriff's Office - Registered owner: Florida St. Johns County Sheriff's Office - Last inspection: 100 hour, May 1, 2005, 30.9 hours before - Departed: St. Augustine, FL ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 38; injuries: none; commercial, private; airplane ratings: single-engine land; medical: class 2, without waivers/limitations; last flight review November 1, 2004; seat: right; flight hours: 1,868 total, 1,474 in this make and model, 1,578 as pilot in command, 96 in the last 90 days, 24 in the last 30 days, 3 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 150° at 5 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 82 °F, dew point 75 °F - Altimeter: 30.04 inHg - Observed at: KSGJ ## 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 20050629014949A](https://openairdocs.org/incident/20050629014949A), Jun 29, 2005: Bell OH58A, St Augustine, FL, Destroyed. (-23) Accident happened at the st johns emergency operations center located about 1 mile south of the St Augustine FL airport. On takeoff at about 50 ft pilot… ## Docket (12 files) The files NTSB released with the investigation on October 10, 2006, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=61845. 16.2 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 213 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267046&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Materials Laboratory Factual Report 06-014, KAFLEX main drive shaft (item 2, .PDF, 290 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40256333&FileExtension=.PDF&FileName=Materials%20Laboratory%20Factual%20Report%2006-014,%20KAFLEX%20main%20drive%20shaft-Master.PDF - FAA Inspector Statement (item 3, .PDF, 11 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267047&FileExtension=.PDF&FileName=FAA%20Inspector%20Statement-Master.PDF - Report From Local Agency-St. Johns County Sheriff's Office (item 4, .PDF, 2.7 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40389882&FileExtension=.PDF&FileName=Report%20From%20Local%20Agency-St.%20Johns%20County%20Sheriff%27s%20Office-Redacted.PDF - Reports from Parties to the Investigation-Rolls-Royce (item 5, .PDF, 3.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40389883&FileExtension=.PDF&FileName=Reports%20from%20Parties%20to%20the%20Investigation-Rolls-Royce-Redacted.PDF - Documents received from St. Johns County Sheriff's Office (item 6, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267052&FileExtension=.PDF&FileName=Documents%20received%20from%20St.%20Johns%20County%20Sheriff%27s%20Office-Redacted.PDF - Record of NTSB Conversation (item 7, .PDF, 56 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267053&FileExtension=.PDF&FileName=Record%20of%20NTSB%20Conversation-Master.PDF - Statement of Party Representatives to NTSB Investigation (item 8, .PDF, 1.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267054&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - Release of Aircraft Wreckage, NTSB Form 6120.15 (item 9, .PDF, 66 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267055&FileExtension=.PDF&FileName=Release%20of%20Aircraft%20Wreckage,%20NTSB%20Form%206120.15-Redacted.PDF - Photo 1: Digital photograph provided by St. Johns County Sheriff's Office. View of the accident site. (item 10, .PDF, 2.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267228&FileExtension=.PDF&FileName=Photo%201%3A%20%20Digital%20photograph%20provided%20by%20St.%20Johns%20County%20Sheriff%27s%20Office.%20%20View%20of%20the%20accident%20site.-Master.PDF - Photo 2: Digital photograph provided by St. Johns County Sheriff's Office. View of the accident site. (item 11, .PDF, 2.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267232&FileExtension=.PDF&FileName=Photo%202%3A%20%20Digital%20photograph%20provided%20by%20St.%20Johns%20County%20Sheriff%27s%20Office.%20%20View%20of%20the%20accident%20site.-Master.PDF - Photo 3: Digital photograph provided by St. Johns County Sheriff's Office. View of the accident site. (item 12, .PDF, 2.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40267230&FileExtension=.PDF&FileName=Photo%203%3A%20%20Digital%20photograph%20provided%20by%20St.%20Johns%20County%20Sheriff%27s%20Office.%20%20View%20of%20the%20accident%20site.-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.