Lack of de-icing led to Fond-du-Lac, Sask. plane crash: TSB report

The Transportation Safety Board of Canada (TSB) decided an absence of enough de-icing tools and the follow of taking off with out de-icing led to the 2017 plane crash in Fond-du-Lac, Sask.

There have been 22 passengers and three crew members on board the West Wind Aviation ATR-42 plane. All have been injured within the crash, ten significantly. One passenger died days later.

The findings have been launched on Thursday in an investigation report by TSB.

On Dec. 13, 2017, the plane departed Fond-du-Lac Airport for Stony Rapids, Sask.

The plane collided with timber and terrain about 450 metres west of the departure finish of Runway 28.

“Early within the investigation, it was decided that the plane took off from Fond-du-Lac Airport with ice contamination on the plane’s essential surfaces,” TSB stated in a launch.

The operator had “some de-icing tools” within the terminal constructing, however TSB says it was “not enough” for de-icing an ATR-42 plane.

In 2018 the TSB beneficial ensuring there was enough de-icing and anti-icing tools out there for operators who want it. TSB additionally beneficial Transport Canada “take motion to enhance compliance with the laws to scale back the probability that crews take off with snow or ice contamination.”

The investigation additionally discovered that “nicely earlier than the accident” the plane encountered icing circumstances throughout the descent towards Fond-du-Lac.

“The flight crew activated each the anti-icing and de-icing programs, however some ice remained on the plane. Nevertheless, the crew didn’t discover any dealing with abnormalities and landed with out incident.”

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TSB stated 45 minutes earlier than the flight took off, icing circumstances have been nonetheless current and extra ice had fashioned on the plane.

“After finishing up a pre-flight inspection, the primary officer notified the captain of the presence of some ice on essential surfaces, however there was no additional dialogue or motion taken.”

“As a result of the out there inspection tools was insufficient, the primary officer’s ice inspection consisted of strolling across the plane, at night time, on a dimly lit apron, with no flashlight, and searching on the left wing from the highest of the steps on the left rear entry door. In consequence, the complete extent of the residual ice and ongoing accretion was unknown to the flight crew.”

TSB stated departing from distant airports like Fond-du-Lac with “some quantity of floor contamination” on the aircraft’s essential surfaces had turn into a standard follow.

This was partially because of the “inadequacy of de-icing tools or companies at these places.”

“The previous success of those variations resulted within the unsafe follow changing into normalized and this normalization influenced the flight crew’s choice to depart,” TSB stated.

“Throughout takeoff, the plane initially climbed; nevertheless, instantly after liftoff, the plane started to roll to the left with none pilot enter. This roll was on account of uneven carry distribution because of uneven ice contamination on the plane.”

“This lack of management within the roll axis, which corresponds with the recognized dangers related to taking off with ice contamination, finally led to the plane colliding with terrain.”

TSB added following the aircraft hitting the bottom, “the survivable house between the ground above the principle touchdown gear and the collapsed higher fuselage and the construction was diminished.”

TSB stated this led to extreme accidents suffered by passengers seated on this space, included the following demise of 1 passenger.

“The design requirements in impact on the time the ATR 42 was licensed didn’t specify minimal hundreds the construction should be capable of tolerate to permit a survivable house or minimal hundreds for fuselage influence vitality absorption. In consequence, the ATR 42 was not designed with these crashworthiness ideas in thoughts.”

TSB stated following the incident, West Wind, now often called Rise Air Aviation, has taken steps to enhance inside danger assessments and now supplies extra coaching, steering, and higher de-icing tools to crews.

The complete 240-page investigation report could be discovered on TSB’s website.