JIM DAVIS – ACCIDENT REPORT
- This discussion is to promote safety and not to establish liability.
- The CAA’s report contains padding and repetition, so in the interest of clarity, I have paraphrased extensively.
Aircraft registration: ZS-FMV
Date and time of accident: 9 Aug 2011, 1530Z
Type of aircraft: Piper PA28-180
Type of operation: Private
PIC license type: PPL
License valid: Yes
PIC age: 18
PIC total hours: 88.8
PIC hours on type: 88.8
Last point of departure: Potchefstroom (FAPS)
Next point of intended landing: Wonderboom (FAWB)
Location of accident site: Near Groblersdal
Meteorological information: 270/05, viz <5km, +18C no cloud
People injured: 0
People killed: 0
At 4.40 pm local, the aircraft took off from Potchefstroom on a VFR flight to Wonderboom. The pilot stated that the evening before the flight, he completed his navigation planning (on a computer-based planning program) for a flight from FAWB to FAPS and back to FAWB. He planned to navigate with the aid of a map and to complete a navigation log as he progressed.
On the morning of the accident flight, the pilot decided to programme his planned route in the aircraft-equipped global positioning system (GPS) and to fly the route entered into the GPS.
The pilot stated he decided to change his return route to FAWB as the visibility was deteriorating as a result of smoke (veld fires) on route to FAPS. The new route entered into the GPS was FAPS-FAAP-HBV-FAWB.
After take-off from Potchefstroom, the pilot followed the GPS route. At the point where he was supposed to be overhead Aviators Paradise (FAAP), he realised the distance and direction to his next turning point (HBV) was incorrect. The pilot then decided to switch the GPS off and on and reprogrammed the route. He did this three times but the direction and distance stayed the same.
The pilot then set the VOR to HBV frequency 112.1 MHz but to no avail. As visibility deteriorated, the pilot decided to fly in an easterly direction towards where he believed the HBV beacon should have been. The pilot made radio contact with Johannesburg Information on frequency 119,5 MHz and asked them for assistance. As Johannesburg Information could not identify him on radar, they could not assist him. He decided to use his map to position himself, however he could not position himself on the map.
The pilot then decided he had no option but to land soon. He then selected a suitable open area to conduct a precautionary landing.
The landing was made on an open grass-covered area. During the landing, the right main wheel collided with an ant hill that was not visible due to the long grass. The wheel assembly broke off and the aircraft came to rest approximately 42 m further on.
The aircraft sustained substantial damage. Neither the pilot nor his passenger was injured during the sequence of the accident.
The aircraft was equipped with standard navigational equipment as per the Minimum Equipment List approved by the Regulator. There were no recorded defects to navigational equipment prior to the flight.
During the investigation, it was found that the co-ordinates that were programmed into the aircraft’s GPS for the designator FAAP (Aviators Paradise) were incorrect. The co-ordinates displayed the position for Arnot Power Station which used to have the designator FAAP. Arnot Power Station is located approximately 110 nm to the south-east of Aviators Paradise.
Earlier on the day of the accident, the pilot was flying from FAWB to FAPS. During the flight, the pilot never reverted back to his original flight plan, and relied only on the GPS for navigation.
After the accident, the VOR navigation equipment, transponder and GPS were tested and all the units were found serviceable.
Proper navigational planning for the flight was done by the pilot the day before the accident flight. However, on the morning of the flight, the pilot opted to use the GPS installed in the aircraft.
‘the programmed co-ordinates were wrong”
When programming his route into the GPS, the pilot did not verify the designators programmed into the GPS by checking the correct co-ordinates for Aviators Paradise, nor was the pilot flying with a back-up unit. Once he became uncertain of his position and reverted to a map, he was unable to determine his position with reference to the ground due to impaired visibility.
The pilot displayed poor situational awareness as he became lost, by deviating from the flight plan. It is unknown to the investigator as to how the pilot passed the Pretoria/Johannesburg area without making any positive reference to the ground.
With fuel quantity becoming low and the sun setting, the pilot opted to do a precautionary landing, which resulted in a collision with an ant hill.
The pilot depended entirely on the GPS for the flight, and only reverted to a map when he was already uncertain of his position.
So we have a very young, brand new pilot, possibly taking his first passenger on a cross-country, over a large area of urban sprawl, in poorish viz.
Would I like to have a GPS on such a flight? Definitely. Would I use it as my only means of navigation? Not a chance.
Would I use it as my primary means of navigation? Also, not a chance. I would have spread maps out on the floor the night before and drawn some good bold lines and measured some angles and distances. Then I would have looked carefully at how these lines lay in relation to big landmarks like ridges of hills, major highways, dams, lakes, rivers, railway lines, towns and cities.
And, at 18 years old, with a brand new PPL, if my mates had asked me to join them for a couple of ales the night before, I would have turned them down. I would want a clear head in the morning, and all my flight planning done properly.
Of course, it would have been a whole lot easier, to do the instant gratification thing. I could have gone on the razz with my buddies and then in the morning just pressed a couple of buttons on my phone and followed the magenta line.
No, I have no idea what this guy was doing the night before. He says he completed his navigation planning on a computer-based planning program, and that he planned to navigate with the aid of a map and to complete a navigation log as he progressed.
But that’s simply not true – he did NOT do that – he blindly following a line on the glass screen of an incorrectly programmed electronic gizmo.
If he had navigated with the aid of a map and a flight log as he said, then it’s simply not possible to fly 45º off track, on the wrong side of Johannesburg, for twice the distance to his waypoint at Aviator’s Paradise, while doing even elementary map reading.
It’s only possible if he had such confidence in his magenta line that all else was meaningless.
His no-map policy caused him to become lost, endanger two lives and write off a valuable aircraft.
However I must compliment him for making a timely decision to do a precautionary landing in daylight, instead of running out of fuel in the dark.
I believe that for light aircraft flying VFR, paper maps should be the primary planning and navigation tool and electronic equipment should be used as a backup.
If my life depends on it – and that can easily be the case – I want a primary navigation system that cannot fail. I like to put my trust in solid physical tools like a paper map and a Douglas protractor.
When I set off across desolate country on the way to Windhoek or the Okavango Delta I will remain within gliding distance of major roads, regardless of what magenta lines want me to do. Of course, I could enter way-points near the roads to do the same thing, but why go through a fallible electronic loop to tell me where to fly when I can see that by looking outside?
Naturally I am aware of the concept of having two electronic nav systems. But they will both be wrong if I put the decimal point in the wrong place, or an incorrect coordinate, like this guy.
Actually, I don’t blame the pilot for pointing in the wrong direction initially. If a computer based nav system somehow allows FAAP to be both
Aviators’ Paradise and Arnot Power Station, I would be the first to fall into the trap. But if I had a map in the cockpit, I would spot the problem within a couple of minutes of takeoff.
And with current world tensions and veiled threats of nuclear nasties, is it really unthinkable that General Cash-My-Cheque, or Ivan Astykov decides to switch off satellites? Unlikely, but not impossible. But they can’t confiscate my map and protractor.
I don’t mistrust the magenta line, but I am very concerned about what it does to pilots’ heads. It seems to give them the feeling they don’t need to do proper fight planning. Worse still, they don’t really need to navigate.
Take home stuff:
- Takeoff relaxed, knowing you have planned properly – on paper.
- Do not relax in the belief that the magenta line is infallible.
- Get the big picture right even if the small picture is iffy.
- Kick off in the right direction.
- Don’t alter heading without a very good reason.
- Earn the right to use the magenta line by first navigating properly.