What happened
On August 10, 2002, an Aero Commander 500S, registration PT-KBF, operated by Tropical Táxi-Aéreo Ltda., was conducting a passenger transport flight between Cacoal and Porto Velho, with a scheduled stop at the Fazenda Nova Vida airfield (SWNI) in Ariquemes, Brazil.
After landing at the unpaved airfield, the pilot positioned the aircraft at the runway threshold and shut down the engines to allow a passenger to board. Once the passenger had entered through the rear left door, the pilot performed the required engine start procedures. During the post-start checks, while the pilot was monitoring engine instruments, a loud noise and a sudden vibration were felt from the left side of the aircraft. Upon looking out the left window, the pilot observed a person falling to the ground after being struck by the left propeller. The pilot immediately shut down the engines and rushed to assist the victim. The individual was transported to a hospital in Porto Velle, but later succumbed to their injuries.
The investigation
CENIPA's investigation established that the pilot was fully qualified, with a valid commercial pilot license and sufficient experience for the operation. The aircraft was within weight and balance limits, and all maintenance documentation and airworthiness certificates were up to date.
The investigation found that the pilot had followed the aircraft's flight manual procedures, which include verifying that the area around the propellers is clear before and during engine start. The pilot had checked the area before starting the right engine and performed a similar check for the left engine. However, the victim approached the aircraft from behind the left side after the engines were already running. It is believed the individual, who was accompanying the passenger, approached the aircraft to wave goodbye to the pilot, inadvertently entering the propeller's rotation arc.
Findings
- The lack of airport infrastructure procedures to prevent unauthorized persons from remaining near the movement area during arrivals and departures contributed to the accident.
- The absence of a ramp marshal or ground controller at the airfield meant there was no personnel to supervise aircraft movements and prevent the person from approaching the propeller.
- The victim approached the left propeller arc after the engines were already operational, likely due to a desire to wave to the crew.