What happened
On 16 November 2007, a Cessna 172M aircraft, registered 9M-BDI, was performing a ferry flight from Batam, Indonesia, to Pangkal Pinang. The flight, operated by Admal Sdn. Bhd., included a pilot and one passenger. Approximately one hour after departing Hang Nadim Airport, the pilot notified air traffic control of a climb and subsequently issued a MAYDAY call, stating a need to find a landing site while passing through 7,500 feet.
While the pilot initially made a vague reference to a fuel leak, the engine eventually stopped due to fuel exhaustion. The pilot attempted to restart the engine four times without success. Seeking a landing area, the pilot opted for a beach located 42 NM northwest of Pangkal Pin and performed a forced landing. During the landing roll, the nose wheel sank into soft sand and collapsed, causing the aircraft to overturn. The two occupants were able to evacuate the aircraft without assistance, though the pilot sustained minor injuries and the aircraft suffered substantial damage.
The investigation
The investigation focused on the aircraft's fuel state and the pilot's operational procedures. Investigators examined the engine performance and found no mechanical defects or malfunctions in the engine or the aircraft's systems. The aircraft was found to be airworthy and properly maintained.
Analysis of the flight revealed that the pilot had not utilized engine leaning procedures during the climb or the cruise at 9,000 feet. By maintaining a full rich mixture, the fuel consumption rate was higher than anticipated. Furthermore, the investigation noted that the pilot's intention to refuel from jerry cans of avgas carried in the cabin and take off from the beach confirmed the engine had failed specifically due to running out of fuel.
Findings
- The engine failed because of fuel exhaustion.
- The aircraft departed Batam with insufficient usable fuel to complete the planned flight leg.
- The pilot failed to follow prescribed engine leaning procedures, which led to increased fuel consumption.
- The pilot did not clearly communicate the specific nature of the emergency or the engine failure to air traffic control during the initial MAYDAY broadcast.
- The aircraft was carrying avgas in jerry cans within the passenger cabin.
Safety action
The NTSC issued recommendations to the operator and the Malaysian Department of Civil Aviation to improve oversight and training. Key areas for improvement include engine handling and fuel management procedures, the safe carriage of dangerous goods (such as avgas) in the passenger cabin, and stricter adherence to flight plan and documentation filing requirements.