2 fatalities

5 Sep 2014: SOCATA TBM 700 (N900KN) — Caribbean Sea, Unknown

Caribbean Sea, Unknown

On 5 Sep 2014, a SOCATA TBM 700 (registration N900KN) was involved in an aviation accident near Caribbean Sea, Unknown. 2 people were killed. Investigators recorded the probable cause as: The design of the cabin pressurization system, which made it prone to unnecessary shutdown, combined with a checklist design that prioritized troubleshooting over ensuring that the pilot was sufficiently protected from hypoxia. This summary draws on records from NTSB; 12 related events involving the same aircraft type or operator are linked below.

SourcesNTSBPrimary reportUpdated 1778583330Data APIEditorial standards

On September 5, 2014, a Daher-Socata TBM700 (TBM900 model), N900KN, crashed into the Caribbean Sea near Jamaica. The pilot and passenger were fatally injured. The flight from Rochester, NY to Naples, FL experienced a pressurization issue and loss of communications before radar contact was lost.

History of Flight

On September 5, 2014, about 1410 eastern daylight time, a Daher-Socata TBM700 (marketed as a TBM900 model), N900KN, was destroyed when it impacted open water in the Caribbean Sea near the northeast coast of Jamaica. The commercial pilot and the passenger were fatally injured. The flight originated from Greater Rochester International Airport (ROC), Rochester, New York, at 0826 and was destined for Naples Municipal Airport (APF), Naples, Florida. The personal flight was conducted under 14 CFR Part 91.

Preflight and Departure

The pilot arrived at ROC and spoke with FBO employees, who described his demeanor as relaxed. After his wife (the passenger) arrived, they loaded bags and boarded. The airplane departed at 0826. Air traffic control instructed the pilot to climb to 9,000 ft and then to Flight Level 280. The flight proceeded without incident for about 45 minutes.

Loss of Communications and Pressurization Issue

About 0912, ATC lost communications with the airplane for a few minutes. The pilot eventually re-established contact, stating "ah something happened I don't know what happened to you but we're back." At 1003, the pilot reported "we need to descend ... we have an indication that's not correct in the plane." The controller cleared the flight to FL250, and the pilot acknowledged. When asked if he was declaring an emergency, the pilot replied "ah not yet." The airplane began descending from FL280.

Subsequent communications were intermittent. The pilot acknowledged clearance to FL200 but radar data showed the airplane remained at FL250. The pilot also acknowledged a clearance direct to the Taylor VOR but did not alter course. The pilot's voice became faint in one transmission. After 1008:40, no further radio transmissions (verbal or carrier signal) were received from the flight.

Intercept and Observations

About 1039, two Air National Guard F-16s intercepted N900KN about 40 miles southeast of McEntire Joint National Guard Base, South Carolina. The airplane was at FL250 and 175 knots indicated airspeed. One ANG pilot observed two occupants in the cockpit: the left seat occupant sat with back straight; the right seat occupant's torso and head were slouched against the fuselage. Headsets were observed, and neither occupant was wearing an oxygen mask. The pilot's left seat occupant's boom mic was pointed upward. About 1 hour 20 minutes after intercept, the left seat occupant's head slumped forward, but chest movement indicated breathing.

Two F-15s from Homestead Air Reserve Base relieved the F-16s about 70 miles east of Daytona Beach. One F-15 pilot noted the airplane maintained heading, airspeed, and altitude. No signs of smoke or fluid from the engine were observed. Exterior lights and instrument panel were illuminated. Photographs confirmed neither occupant wore an oxygen mask. The bottom corners of the emergency exit door on the right side appeared recessed into the fuselage frame; a postaccident demonstration by the manufacturer revealed that the door protruded when the airplane was pressurized.

Descent and Crash

About 1409, the airplane entered a high rate of descent from FL250. The last radar target was recorded over open water about 10,000 ft msl, about 20 nautical miles north of Port Antonio, Jamaica. Search efforts located an oil slick and small debris. The airplane was recovered about 4 months later by autonomous underwater vehicle and salvage.

Personnel Information

The pilot, age 68, held a commercial pilot certificate with single-engine land and instrument ratings. His most recent FAA third-class medical was issued August 6, 2013, with the limitation "must wear glasses for distant vision, have glasses for near vision." He reported 7,100 flight hours, with 240 hours in the preceding 12 months. He had owned two previous TBM700 aircraft. He completed a 5-day TBM900 training course at SIMCOM Aviation Training one week before the accident, which included pressurization system training and oxygen mask procedures.

The pilot-rated passenger, age 68, held a private pilot certificate with single-engine land rating. She reported 410 flight hours on her latest medical application in 1992.

Aircraft Information

The Daher-Socata TBM900, serial number 1003, was manufactured in 2014 and powered by a single Pratt & Whitney PT6A-66D turboprop engine. It was delivered factory-new in March 2014 and registered to the pilot on April 8, 2014. At the time of the accident, the aircraft had accumulated about 102 hours since the pilot acquired it.

The bleed air and cabin pressurization system includes a global air system controller (GASC) that manages the environment. The pilot's operating handbook describes normal procedures for setting the BLEED switch to AUTO after engine start. The system can detect overheat via an overheat thermal switch (OTSW). If the OTSW opens, the GASC records fault codes and may close the flow control shutoff valve, stopping bleed air into the cabin. Loss of bleed air causes cabin depressurization.

Fuel Performance

The airplane was last serviced with 177 gallons of fuel on August 29, 2014. Based on manufacturer performance calculations, the airplane consumed about 23 gallons in climb to FL280, then flew for about 5 hours 25 minutes with a mean fuel flow of about 49 gallons per hour, consistent with normal cruise.

Contributing factors

Causes

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Other contributing factors

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