# NTSB WPR10LA300: Arbc Inc DBA Lindstrand 120A, N501LB, Grants Pass, OR, June 18, 2010 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: June 18, 2010, 08:20 local (15:20 UTC) - Place: Grants Pass, OR - Coordinates: 42.428054, -123.390274 - Nearby events: https://openairdocs.org/map.md?lat=42.4281&lon=-123.3903&mi=10 - Phase of flight: [Other](https://openairdocs.org/ntsb-phases/800) (OpenAirDocs' grouping) - Defining event: [Other: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) - Highest injury: Serious injuries - Injuries: 1 serious, 1 uninjured - Status: Completed, report January 7, 2011 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: Portland FSDO - NTSB case key (mKey): 76360 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR10LA300 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/76360/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=76360 - Page: https://openairdocs.org/ntsb/WPR10LA300 ## Probable cause The balloon ground crew member's decision to not release his hold on the basket of an ascending hot air balloon basket as it lifted off of the ground. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Action: incorrect action selection](https://openairdocs.org/ntsb-findings/02041010): Personnel issues › Action/decision · Ground crew (probable cause); cases with it: [Arbc Inc DBA Lindstrand 120A, 1 case](https://openairdocs.org/ntsb-findings/02041010/cases.md?model=5190008), [All aircraft, 397 cases](https://openairdocs.org/ntsb-findings/02041010/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Other: Miscellaneous/other](https://openairdocs.org/ntsb-events/900) (defining event); cases with it: [Arbc Inc DBA Lindstrand 120A, 2 cases](https://openairdocs.org/ntsb-events/900/sequence.md?model=5190008), [All aircraft, 1,556 cases](https://openairdocs.org/ntsb-events/900/sequence.md) ## Analysis During the post-landing, pre-deflation portion of a hot air balloon flight, the basket of the balloon began to lift off the ground when one of the individuals holding it released their grip on the top rim of the basket. At that point, the remaining three individuals holding the basket released their grip on the top rim of the basket and the balloon began to ascend. As the basket lifted higher into the air, one of the individuals who had released their grip on the basket top rim grabbed onto the rope handles near the base of the basket and was therefore lifted about 20 feet into the air. As soon as the pilot realized that someone was hanging from the bottom of the basket, he began venting air from the top of the balloon in order to get the basket back on the ground. But the individual hanging from the rope handles lost his grip and fell to grassy terrain below. The injured person had extensive experience acting as a balloon ground crew member and as a passenger in a balloon. He had no memory of the event, and it could not be determined why he grabbed onto the rope handles after releasing his grip from the basket rim. ## Factual narrative On June 18, 2010, about 0820 Pacific daylight time, an individual fell from the exterior of the basket of a Lindstrand 120A hot air balloon, N501LB. That individual received serious injuries when he impacted the grassy terrain of an elementary school playground in Grants Pass, Oregon. The pilot of the balloon, who was the sole interior occupant, was not injured. The balloon, which was owned and operated by the pilot, was not damaged. The 14 Code of Federal Regulations Part 91 flight departed a city park in Grants Pass about 90 minutes prior to the accident. Visual meteorological conditions prevailed at the time of the accident. No flight plan had been filed. According to the pilot, at the end of the flight he landed in a grassy area of an empty elementary school playground. After the landing, three of the four passengers were instructed to climb out of the basket, and to keep their weight on the top rim of the basket as the still inflated balloon was moved along the ground to the location where it was going to be deflated. After reaching the location where the balloon was to be deflated, the last passenger was instructed to exit the balloon, but to keep her weight on the top rim of the basket as the other passengers were doing. Soon after the last passenger exited the basket and applied her weight to the top rim of the basket, the basket shifted as one of the individuals holding it adjusted the position of their weight. As the balloon shifted, one of the individuals who was providing downward force on the basket released their hold on the basket because they interpreted the shift as the lift-off of the basket. This individual released their hold because all those participating had been briefed to let go of the basket if it began to lift off the ground. Once that person removed their weight from the basket, the balloon began to ascend, and the three remaining individuals holding onto the basket released their grip on the top rim. But then, as the balloon continued to ascend, one of the individuals who had released his grip on the basket rim grabbed onto the rope handles near the base of the basket, and was therefore lifted into the air as the balloon continued its ascent. The pilot did not initially realize that someone was hanging from the bottom of the basket, but when he heard others yelling for that individual to let go, he became aware of the situation. At that time the pilot immediately began venting air from the top of the balloon in order to get it rapidly back on the ground, but before the pilot was able to get the balloon's basket back on the ground, the individual holding onto the rope handles lost his grip and fell approximately 20 feet to the terrain below. The individual who fell from the balloon does not have memory of the event, but according to the pilot, this individual had worked as part of his ground crew, and taken occasional flights with him, for over 20 years. The pilot stated that this individual had a long termfamiliarity with the rule that you do not hold onto the basket of a balloon once it begins to ascend. It could not be determined why the individual grabbed onto the handles at the base of the basket after releasing his hold from the basket rim. ## Aircraft - Registration: [N501LB](https://openairdocs.org/aircraft/N501LB), registered now, S/N 5426, built 2009 (OpenAirDocs) - Reported make and model: ARBC INC DBA LINDSTRAND 120A - Registry model: [Arbc Inc DBA Lindstrand 120A](https://openairdocs.org/model/arbc-inc-dba-lindstrand-120a) (registry code 5190008) (OpenAirDocs) - Registry engine: [NONE](https://openairdocs.org/engine/none) (registry code 00000, none) (OpenAirDocs) - Category: Balloon - Serial number: 5426 - Airframe hours: 71 - Damage: No damage - Flight: Personal, Part 91 - Operator: His Sky Ministries - Registered owner: His Sky Ministries - Airworthiness certificate: Standard, Normal - Last inspection: Annual, April 6, 2010 - Departed: Grants Pass, OR - Destination: Grants Pass, OR ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 59; injuries: none; commercial; airplane ratings: single-engine land; medical: class 3, without waivers/limitations; last flight review May 20, 2010; flight hours: 3,245 total, 71 in this make and model, 3,245 as pilot in command, 14 in the last 90 days, 8 in the last 30 days, 2 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: calm - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 46 °F, dew point 39 °F ## 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 20100618035069A](https://openairdocs.org/incident/20100618035069A), Jun 18, 2010: Arbc Inc Db 120A, Grants Pass, OR, No damage. Passenger was instructed to step out of the balloon basket and keep her weight on the basket for ballast. The balloon shifted due to her weight change and she… ## Docket (1 files) The files NTSB released with the investigation on September 28, 2010, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=76360. 554 KB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 554 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40333546&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.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.