What happened
On October 26, 2014, a Cessna U206G, registration PP-FFR, was conducting a medical transport flight for the Government of the State of Roraima. The mission involved transporting a patient from Santa Maria do Boiaçu to Boa Vista, Brazil. The flight departed from an unregistered and uncertified airstrip in Santa Maria do Boiaçu.
Approximately one hour and twenty minutes into the flight, the pilot reported an engine failure. The pilot attempted to restart the engine in flight but was unsuccessful. The crew subsequently performed an emergency landing in a clearing within the Cherueni Indigenous Reserve. The aircraft sustained light damage, and the pilot and four passengers sustained light injuries. Following the landing, the occupants abandoned the aircraft to seek help, which delayed their rescue by one day.
The investigation
CENIPA investigators examined the aircraft's engine, battery, generator, and Emergency Locator Transmitter (ELT). Laboratory tests conducted by the Department of Aerospace Science and Technology (DCTA) and CINDACTA IV confirmed that the engine, battery, and ELT were all in perfect working order and capable of performing as required. The engine was even successfully tested for in-flight restart capabilities.
Upon inspecting the aircraft, investigators found that the fuel tanks, fuel selector valve, and the entire fuel system were empty. While a fuel delivery receipt showed the aircraft had been loaded with 200 liters of AVGAS, there was no logbook entry to verify the exact fuel quantity at takeoff. The investigation noted that the total flight time, including deviations for weather and ground idling, exceeded the aircraft's maximum endurance.
Findings
- Fuel exhaustion was the primary cause of the engine failure.
- Inadequate flight planning, specifically regarding weather analysis and route deviations.
- Inadequate managerial planning by the coordinating government authority, which authorized an operation to an unregistered airstrip without a planned intermediate refueling stop.
- Poor pilot judgment regarding the decision to continue the flight despite weather-induced deviations.
- Lack of survival equipment and signaling devices (such as flares or smoke) on board.