What happened
On July 17, 2019, a Cirrus SR2/22 (registration N830CD) was conducting an informal IFR training flight from Hilversum to Kolding/Vamdrup (EKVD). The flight was operated by a pilot with limited instrument experience, accompanied by an instructor and a passenger. Simultaneously, a Piper PA38 (registration OY-BRP) was performing a solo VFR instructional flight, conducting touch-and-go landings at the same aerodrome.
As the Cirrus SR22 descended through a broken cloud layer into visual meteorological conditions on the final approach to runway 01, the pilot and instructor established visual contact with the aerodrome. However, they failed to observe the Piper PA38, which was flying an extended right downwind leg.
Believing other traffic was present in the circuit based on incorrect assumptions, the crew of the Cirrus SR22 decided to deviate to the right of the extended centerline to fly a parallel track east of the aerodrome. They did not communicate this change in intention to the Vamdrup Aerodrome Flight Information Service (AFIS). Consequently, the two aircraft flew on conflicting opposite tracks, passing each other with a horizontal separation of only approximately 0.1 nautical miles and a vertical separation of less than 150 feet. Neither crew was able to perform an avoiding action in time.
The investigation
The investigation examined the radio communications, flight paths, and the mental models of both crews. Investigators analyzed the roles and responsibilities of the occupants in the Cirrus SR22, noting that the flight was an informal training session with an undefined command structure.
Technical analysis of the radar data confirmed the extremely close proximity of the two aircraft. The investigation also reviewed the weather conditions, which were within visual meteorological conditions (VMC) at the time of the encounter, and the communication logs between the aircraft and Vamdrug AFIS. The investigation established that the student pilot in the Piper PA38 had been instructed by AFIS to extend their downwind leg to maintain separation, but because the Cirrus SR22 crew had not declared their deviation, the AFIS and the student pilot maintained an incorrect mental picture of the traffic situation.
Findings
- The primary cause of the incident was a loss of situational awareness by the pilot and instructor of the Cirrus SR22.
- The crew of the Cirrus SR22 failed to correctly process and transfer traffic information regarding VFR aircraft on the right downwind leg.
- The decision to deviate from the approach track was made without notifying Vamdrup AFIS.
- Several contributing factors influenced the loss of situational awareness, including:
- The informal nature of the flight and the undefined split of flight duties between the pilot and instructor.
- High workload during an unstabilized approach.
- Unfamiliarity with the specific traffic procedures at EKVD.
- The relationship between the pilot and the instructor, which may have influenced decision-making through peer pressure or professional courtesy.