R116 TRAGEDY: PILOT WARNED OF DANGERS YEARS BEFORE CRASH
Rescue helicopter crew had no data on island in their flight path
THE Rescue 116 disaster that claimed the lives of four people could have been averted if warnings about Coast Guard flight data had been heeded, it was reported last night.
A Coast Guard pilot had flagged the absence of Black Rock island from the on-board warning system four years ago – but the issue was not addressed, according to an RTÉ Prime Time investigation.
All four crew members of the Sikorsky 3-92 helicopter died after it crashed into the remote island during a rescue mission off the coast of Mayo in March.
The bodies of pilot Captain Dara Fitzpatrick and co-pilot Mark Duffy were later recovered, but winchman Ciarán Smith and winch operator Paul Ormsby are still missing.
A preliminary investigation found that
Captain Fitzpatrick pitched the helicopter ‘nose up’ to try to avoid smashing into the island 12 miles off the Co. Mayo coast. It later emerged that the on-board warning system did not have any data locating Black Rock.
Now, in what will come as harrowing news for the loved ones of the rescuers who died, it has emerged that the island may not have been on the data because it was 4.1 meters too short.
Prime Time reported that the Coast Guard pilot told database managers that the island – which reaches a height of 85.9 metres above sea level – was absent from the search-and-rescue service’s vital flight data which pilots use to navigate around the coast.
Reporter Katie Hannon said the pilot flagged the absence four years ago – but the error was not corrected.
However, explaining why Black Rock was not considered an ‘obstacle’ by the Aviation Authority, Hannon said: ‘The International Civil Aviation organisation has rules about what constitutes an obstacle and in general terrain, away from airports and aerodromes – anything that is under 90 metres high in Ireland doesn’t constitute an obstacle.
‘Now, Black Rock Island was just four metres under that threshold. So under those methods, it wouldn’t be an obstacle.
‘But there are much more stringent rules about what is an obstacle around an airport, and given that Black Rock was on an approach path for search and rescue landing to Blacksod refuelling base, there are serious questions why that was not considered an obstacle on that basis.’
The programme also revealed that nine days after the Rescue 116 tragedy, it was discovered that the aeronautical data relating to UNESCO heritage site Skellig Michael was also dangerously inaccurate.
The Coast Guard’s search-andrescue operation is run by a private operator, CHC Ireland, which is a subsidiary of a global helicopter services provider based in Canada.
It won a ten-year contract, worth €500million, to provide the service in 2012.
All of the Coast Guard’s searchand-rescue helicopters have been equipped with an Enhanced Ground Proximity Warning System since 2013. The EGPWS is designed to warn pilots to take action to avoid a collision if they get too close to terrain.
But the system can only work if its database has a complete picture of the obstacles on a flight path. And as Black Rock island was not in the system, the pilots flying Rescue 116 did not receive a warning and did not see the island until it was too late.
Prime Time revealed there was a chain of emails between Sligobased Coast Guard pilots and a senior CHC manager referring to Black Rock island and/or other omissions in the EGPWS in 2013.
A source told the programme the emails were sent after a pilot spotted the omission while carrying out test flights.
This was a particular safety concern as the island was on the route approved by the company for approaching the refuelling base at Blacksod Bay from the south.
According to a source quoted by Prime Time, Coast Guard personnel were told at a meeting in April, six weeks after the Rescue 116 crash, that management was trying to establish if this information had been passed on to the company that supplied the database for their system.
That company, Honeywell, told Prime Time it could not comment on an ongoing investigation. ‘Until that investigation is complete, any inferences or conclusions drawn at this time would be speculation,’ a spokesman said.
Prime Time also revealed that search and rescue pilots based in Dublin had been complaining that the EGPWS was alerting them to obstacle that didn’t exist.
A CHC spokesperson told the programme that the company was precluded from responding to questions under international protocols governing air accident investigations. The spokesperson said the company ‘has multiple systems and programmes that encourage employees to report any safety concerns... Our focus remains on supporting the families and friends of all of those affected by this accident.’
The Irish Aviation Authority’s State Safety Plan says that it provides terrain and obstacle data for use by database suppliers. A spokesman said: ‘Black Rock island was not shown as it does not constitute an obstacle under ICAO (International Civil Aviation Organisation) Standards.’
The lighthouse was shown but there was no indication that it was located on an island with a highest point of 282 feet.
The authority added that it has no record that it was advised that Black Rock island was not in the Coast Guard’s EGPWS system.
It also confirmed to RTÉ that it only learned that Skellig Michael was inaccurately depicted on their official maps nine days after the Rescue 116 crash.
The Irish Air Line Pilots’ Association said it would be inappropriate to comment while the accident investigation into the Rescue 116 tragedy was still on going.
But it said that separately from the Rescue 116 accident it had raised concerns with successive ministers for transport ‘on the effectiveness of the Irish Aviation Authority in fulfilling its Safety Regulatory and Oversight obligations’.
It said the concerns raised by IALPA were relevant to the revelations in Prime time.
However, the Aviation Authority rejected this claim, saying that the IALPA’s view ‘was not shared by anybody in the industry, specifically the international organisations that continuously audit Ireland’s safety oversight regime’.
It was four metres under threshold