Pilot Debrief

CESSNA 150L near Union, IL — 2018-05-27

Final reportCEN18LA205
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Date
2018-05-27
Location
Union, IL, USA
Airport
55LL
Aircraft
CESSNA 150L
Registration
N19366
Category
Airplane
Highest injury
Serious
Fatalities
0
Phase of flight
Approach

Probable cause

The pilot’s medical impairment at the time of the accident, which resulted in a collision with power lines off the end of the runway.

NTSB narrative

The airline transport pilot reported that he was returning from a routine glider tow flight when he thought "something was wrong." He noted that it seemed to "get dark" although there was plenty of daylight. The airplane was high on the approach. The pilot continued the flight inbound but was unsure of the airplane's exact altitude or airspeed as it crossed the runway threshold, and he did not recall verifying that the engine power was at idle. The airplane "bounced down the field" and he flew toward an opening in the trees off the end of the runway. The pilot did not see the power lines until the airplane struck them and then came to rest in a field. The pilot recalled not having an "aviation related thought" during the landing. A postaccident examination of the airframe and engine did not reveal any evidence of preimpact mechanical malfunctions or failures that would have precluded normal operation. The pilot had completed the Federal Aviation Administration BasicMed medical certification, which was valid at the time of the accident. The pilot described symptoms consistent with fainting or nearly fainting, which commonly occur when blood pressure is low and would have led to an inability to safely fly the airplane. The pilot thought that dehydration or heat exhaustion might have caused his symptoms. However, given his long-standing paroxysmal atrial fibrillation, his difficulty effectively controlling it after the accident, his documented low blood pressure during those episodes, and his lack of symptoms during the episodes of atrial fibrillation other than "feeling bad," it is likely that his symptoms during the flight were related to an episode of atrial fibrillation associated with a rapid heart rate and low blood pressure. Therefore, symptomatic near fainting as a result of uncontrolled paroxysmal atrial fibrillation likely caused the accident.

Analysis

Primary failure mode
Human factors
First missed decision gate
Pilot could have verified throttle position before landing approach.

NTSB coding

Evidence available

  • 9 docket documents
View NTSB final reportView NTSB docket

Docket documents9

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