What happened
On December 10, 2009, a Cirrus SR20 crashed into trees approximately 5.5 km east of the Strausberg airfield, resulting in the fatal injury of the pilot. The aircraft was performing a return flight from Warsaw-Babice, Poland, to Strausberg, Germany, under Visual Flight Rules (VFR).
At approximately 17:28 local time, the aircraft struck trees at a shallow angle while flying through a forested area. The impact caused the separation of the engine, propeller, and tail surfaces from the fuselage. The pilot had previously contacted the Strausberg airfield controller at 17:23, stating they were approaching for landing, but noted they could not yet see the airfield. At the time of the crash, the aircraft was flying at night in weather conditions characterized by rain and low visibility.
The investigation
The BFU investigation examined the flight's progression, the aircraft's technical state, and the meteorological conditions. Investigators recovered a handheld GPS device that recorded the flight path and confirmed the aircraft's position up to the moment of impact.
Technical analysis of the wreckage revealed that the altimeter was set to 1021 hPa, while the actual local pressure (QNH) was 1015 hPa, meaning the pilot was flying approximately 180 feet lower than indicated. The investigation also found that the Horizontal Situation Indicator (HSI) had been removed due to a defect, and the Cirrus Airframe Parachute System (CAPS) safety pin had not been removed, preventing manual deployment of the parachute.
Medical examinations of the pilot revealed the presence of antidepressants in the bloodstream at concentrations significantly higher than typical therapeutic levels. Furthermore, the investigation found that the aircraft operator's flight manual prohibited night operations for this specific single-engine aircraft type, yet the flight was planned and executed during nighttime hours.
Findings
- The pilot flew into a wooded area at a shallow angle during nighttime VFR operations under critical weather conditions.
- The aircraft was flying below the minimum safety altitude.
- An incorrect altimeter setting contributed to an error in perceived altitude.
- The pilot misjudged the deteriorating weather conditions, which included rain and low cloud ceilings.
- The aircraft operator's safety culture was insufficient, as the flight was planned in violation of company procedures regarding night flying.
- The pilot's use of medication may have significantly impaired flight capability.