Casualties unknown

2023-07-13: (YS-289-P) — SV

SV

On July 13, 2023, an aircraft (registration YS-289-P) was involved in an aviation accident near SV. Investigators recorded the probable cause as: The engine failure was driven by inadequate maintenance and a failure to adhere to manufacturer-recommended compression standards and service bulletins, compounded by insufficient maintenance documentation. This summary draws on records from the Autoridad de Aviacion Civil de El Salvador (AAC).

Sourcesthe Autoridad de Aviacion Civil de El Salvador (AAC)Primary reportUpdated 1785088295Data APIEditorial standards

A Piper Cherokee experienced engine failure during a sightseeing flight near Santa Ana, resulting in an emergency landing and an overturned aircraft.

What happened

On July 13, 2023, at approximately 11:30 A.M. local time, a Piper Cherokee PA-140, registration YS-289-P, was conducting a sightseeing flight from Ilopango International Airport toward Santa Ana. While flying approximately one mile from the city, the aircraft experienced an engine failure. Unable to maintain flight, the pilot executed an emergency landing in a sugarcane field at Hacienda La Reforma, Santa Ana.

Upon impact, the aircraft's nose gear collapsed as it dug into the ground, causing the plane to flip over and come to rest in an inverted position. The pilot escaped without injury, though a passenger sustained minor facial lacerations and was treated at Hospital Rosales.

The investigation

The Salvadoran Civil Aviation Authority (AAC) conducted an investigation into the crash, focusing on the mechanical failure and maintenance history of the Lycoming O-320-E2A engine. The investigation utilized a "Bowtie" analysis to evaluate risks and contributing factors. Investigators examined the aircraft's structural damage, which included a broken windshield, propeller damage, and internal engine damage, as well as the maintenance logs provided by the operator.

Findings

  • Engine Maintenance Deficiencies: The investigation identified a lack of adequate maintenance and failure to follow service bulletins. Specifically, evidence showed that certain cylinders were operating with compression pressures below 65 psi, indicating that the engine was not being maintained according to manufacturer recommendations.
  • Inadequate Documentation: There was a significant lack of complete and accurate maintenance records, which prevented a proper assessment of the aircraft's airworthiness.
  • Operational Risks: The investigation noted that improper preservation procedures and a lack of continuous operations may have contributed to undetected engine deterioration.
  • Maintenance Oversight: The investigation highlighted that the operator failed to ensure all maintenance corrections and inspections were documented and performed in compliance with regulatory standards.

Probable cause

The engine failure was driven by inadequate maintenance and a failure to adhere to manufacturer-recommended compression standards and service bulletins, compounded by insufficient maintenance documentation.