What happened
On January 18, 2020, an AS 350 B2 helicopter, registration PR-CJD, was involved in a vehicle and aircraft collision on a public road in the municipality of Santa Inês, Rio Branco, Brazil. The aircraft, operated by the Public Security Department (SESP), had landed on the BR-314 highway to conduct a police operation.
While the crew was performing pre-takeoff checks and starting the engine to return to Plácido de Castro Aerodrome, a truck traveling along the highway entered the return lane. The truck's trajectory brought it into direct contact with the helicopter's main rotor blades. The impact caused substantial damage to the aircraft's main rotor, transmission, tail cone, and right-side door. The collision resulted in minor injuries for two crewmembers and the truck driver, while the remaining three crewmembers and two occupants of the truck were unharmed.
The investigation
CENIPA's investigation revealed several systemic failures regarding both operational safety and maintenance oversight. Investigators found that the pilots lacked specific experience and formal training for landing and taking off on public roadways. Furthermore, the aircraft's maintenance records were found to be irregular; specifically, the aircraft had flown with expired airframe and engine inspections. The investigation also noted discrepancies in the engine and airframe logbooks, including the use of pencil for entries, erasures, and missing official signatures or identification codes.
Operational communication was also compromised. The aircraft's primary radio communicator was inoperative at the time of the accident, forcing the crew to rely on a portable radio. However, the crewmember assigned to coordinate with the ground police checkpoint failed to make the necessary calls to alert ground teams of the impending takeoff.
Findings
- Inadequate risk assessment: The crew failed to ensure the area was isolated, allowing vehicles and pedestrians to move freely around the helicopter during engine start-up.
- Lack of specialized training: There was no formal training program or documented instruction for conducting operations on public roads.
- Communication breakdown: The failure to establish contact with the ground checkpoint prevented the coordination of traffic control.
- Maintenance oversight: The aircraft had operated with overdue inspections, and logbook documentation was non-compliant with regulatory standards.
- Organizational deficiencies: Inadequate management planning led to a failure in providing and controlling necessary personal protective equipment (EPI), which contributed to crewmembers being thrown from the aircraft during the impact.