L2013-03 Ultralight airplane accident in Sysmä 3.5.2013

The accident occurred on Friday, 3 May 2013, at Lake Ylä-Vehkajärvi near Sysmä. Both the pilot and the passenger perished. They had taken off in a float-equipped ultralight aircraft from their own lakefront, likely intending to fly a short local flight. Immediately after the takeoff the ultralight was seen climbing at a steep angle, rocking from side to side before nose-diving into a wooded area close to the shore. The pilot and the passenger died in the high-speed collision with the ground. As a result of the collision the aircraft caught fire and the wreckage was badly burned. There were three eyewitnesses to the occurrence.

The probable causes of the accident were an excessively steep climb angle, failing to recognise the indications of partial stall and the consequent abrupt stall at a low altitude. The pilot’s degraded capacity played a crucial role in the events that led to the accident. Despite suffering from diagnosed illnesses that would normally preclude medical certification, the pilot possessed a valid medical certificate. The pilot had repeatedly omitted illness and medication-related information from the medical certificate application form.

Contributing factors included significant overload of the plane, the pilot’s insufficient experience on slow flight and stalls, and the Cora 200 Arius F ultralight’s abrupt stall characteristics. The pilot’s limited recent flying experience and scant experience on seaplanes constituted further contributing factors.

The investigation found safety-related shortcomings and inconsistencies in the pilot’s handbooks of the Cora 200 Arius F ultralight type and in the aircraft weight and balance reports. Pursuant to Section 25 of the Safety Investigation Act (525/2011) these observations were reported to the Finnish Transport Safety Agency, including a recommendation to notify the operators of the aircraft type of these shortcomings.

The following four Safety Recommendations were issued on the basis of the investigation:

1. Finnish Transport Safety Agency: prepare the framework for requesting additional tests during the medical examination process, and the minimum requirements for the content of comments for such tests.

2. Finnish Transport Safety Agency: during the additional training of, especially, psychiatrists, neurologists and cardiologist, make certain that the option of consulting the pilot’s medical examiner, or the Finnish Transport Safety Agency, is pointed out, along with the currently available practice of reporting illnesses and medication which may impact their patients’ flying performance.

3. Finnish Transport Safety Agency: ensure that ultralight aircraft pilot’s handbooks describe the slow flying and stall characteristics or any other essential, flight safety-related peculiarities in sufficient detail. These characteristics must be given for wheel and float configurations as well as for all permissible weights and power settings.

4. Finnish Aeronautical Association: ensure that the training syllabi for ultralight pilots and flight instructors include sufficient familiarisation with slow flying and stall characteristics as well as emergency training so that pilots are able to recognise an oncoming stall and take the correct action.

L2013-03 Report (pdf, 0.54 Mt)