Pilot Debrief

ENGINEERING & RESEARCH ERCOUPE 415-C near Elkhart, IL — 2024-08-07

Final reportCEN24FA312
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Date
2024-08-07
Location
Elkhart, IL, USA
Aircraft
ENGINEERING & RESEARCH ERCOUPE 415-C
Registration
N3093H
Category
Airplane
Highest injury
Fatal
Fatalities
1

Probable cause

An off-airport landing in a soybean field for reasons that could not be determined. Contributing to the severity of the pilot’s injuries and airplane damage was a fire that occurred at an unknown time.

Contributing factors

Contributing to the severity of the pilot’s injuries and airplane damage was a fire that occurred at an unknown time.

NTSB narrative

The pilot was on a multi-leg cross country flight after purchasing the airplane. A friend of the pilot stated that the pilot landed the airplane at an airport on the first evening of the flight and was planning to continue west the next morning. A fuel receipt confirmed that the pilot purchased 16.34 gallons of fuel at that airport. Two days after the flight was supposed to arrive at the final destination, the friend reported the pilot missing. The airplane was not equipped with ADS-B, and it did not have a transponder, so flight track data was not available for the investigation. On the evening that the pilot was reported missing, the airplane wreckage was found in a soybean field about 87 nm west of the last known fuel stop. The main wreckage exhibited heavy thermal damage to the engine compartment, cockpit, and fuselage. The investigation was unable to determine if the fire started before or after impact. Examination of the airframe indicated that there were no preimpact mechanical malfunctions or failures that would have precluded normal operation. The signatures on the propeller blades indicated that the propeller was likely not rotating at the time of impact and the engine was likely not producing power. Due to thermal damage, rust, and corrosion, the engine and magnetos could not be functionally tested. The investigation was unable to determine whether the engine lost power or if the pilot shut down the engine before impact with the ground. The header tank and left and right fuel tanks were burned and compromised, during the accident sequence, so the fuel amount at the time of the accident could not be verified. However, based upon the fuel receipts, the pilot likely filled the airplane to its full 24-gallon capacity before departing. The airplane’s emergency locator transmitter (ELT) was not transmitting on emergency frequency 121.5 MHz at the time the airplane was located, nor was there evidence of an ELT transmitting in the area in the days before the airplane was located. The airplane was found about an hour after search and rescue was deployed and three days after the accident likely occurred. The pilot was found 18 ft away from the main wreckage and there was a 2 ft wide by 18 ft long trail of vegetation displacement between the main wreckage and his location. The vegetation displacement indicated the pilot was likely alive after the accident and either walked or crawled away from the wreckage and was not ejected upon impact. According to the pilot’s autopsy report, his cause of death was thermal burns. His autopsy identified thermal burns over 80% of his body surface, without evidence of smoke inhalation or airway thermal injury. The autopsy report noted there was no fatal traumatic injury or lethal natural disease found. Based on available evidence, the possibility cannot be excluded that the pilot might have survived long enough after the crash to be transported to a burn center had rescue not been delayed. Regardless, his burns were very likely to be fatal even with specialized care. A widely used clinical burn mortality prediction tool predicts little to no hope of survival for a 77-year-old patient with 80% body surface area burns. The pilot’s autopsy identified cardiovascular disease, including coronary artery disease and an old area of stroke. This cardiovascular disease was associated with increased risk of an impairing or incapacitating cardiovascular event. There was no autopsy evidence that such an event occurred, but such an event does not leave reliable autopsy evidence if it occurs immediately before death. The old stroke affecting a small area of the brain may or may not have had significant symptoms. The pilot had spine disease and a history of left leg weakness that had affected his ability to operate rudder pedals and foot brakes. His leg weakness would not be expected to directly affect control of an airplane without foot-operated controls, such as the accident airplane. However, chronic pain may have performance-impairing effects. Postmortem toxicology results indicated that the pilot had used the medication gabapentin, which the pilot’s daughter indicated the pilot was taking for back and leg pain. The pilot might have been experiencing associated impairing medication effects such as psychomotor or cognitive slowing at the time of the accident, but the magnitude of any such effects could not reliably be determined from the measured gabapentin level alone. Based upon ground scars and damage to the airplane, it is likely that the pilot attempted a forced landing to the field. The investigation was unable to determine why the pilot performed an off-airport landing in the soybean field. The airplane’s lack of ADS-B and transponder, and the failure of the ELT to activate as designed, delayed the rescue response. However, it is unlikely that the timing of the rescue response affected the survivability of the accident.

NTSB coding

Evidence available

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  • 17 docket documents
View NTSB final reportView NTSB docket

Docket documents17

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