Probe of fatal helicopter incident calls for more vigilance around ‘danger areas’
Transportation Safety Board releases report on rotor strike that killed passenger on James Bay island
The Transportation Safety Board of Canada is calling for more vigilance around helicopter “danger areas” after a passenger was struck and killed by a tail rotor in April 2024. (Screenshot courtesy of Transport Safety Board of Canada)
A report into the death of a passenger struck and killed by a helicopter’s tail rotor in Nunavut last year calls for more vigilance around helicopter “danger areas.”
The Transportation Safety Board of Canada — the federal agency that investigates aviation, marine and rail accidents — released its report on an incident on Akimiski Island, one of Nunavut’s southernmost points in James Bay.
On April 21, 2024, a pilot with Heli Explore Inc. was operating an Aerospatiale AS350 BA helicopter, flying a series of flights from Attiwapiskat, Ont., to hunting camps around the northern Ontario community and on Akimiski Island, the report said.
Akimiski Island is one of Nunavut’s southernmost points, located in James Bay. (Image created by Jeff Pelletier via Datawrapper)
The pilot had his commercial helicopter licence, a valid medical clearance and more than 2,000 hours of experience.
Around 5:05 p.m., the pilot departed the Attiwapiskat airport with a passenger and gear for a flight to a camp on Akimiski Island. After a 15-minute flight, they landed outside of the camp and were greeted by a snowmobiler.
With the helicopter still on, the pilot eventually signalled to the snowmobiler that he could approach the helicopter, and to the passenger that he could disembark. The snowmobiler and passenger began unloading gear from the helicopter’s storage compartments.
The passenger was moving toward the back and under the boom of the helicopter when he was struck and killed by the spinning tail rotor. The snowmobiler had tried to warn him not to move that way. The impact dislodged the tail’s gearbox and the pilot turned off the engine.
The passenger did not receive a safety briefing on the day of the flight, the safety board said. However, the passenger had flown aboard helicopters “numerous” times and should have known to stay away from the rear.
It also wasn’t clear if the passenger had reviewed a safety card, which highlights some of the helicopter’s danger areas. However, the word “danger” was marked in the area of the tail rotor.
After the incident, Heli Explore Inc. began providing passengers with more helicopter safety information, the report said. As well, its pilots now shut down the engines for the loading and unloading of passengers and gear.
“Pilots are reminded to ensure that all passengers and ground personnel are briefed on and understand the hazards of helicopter danger areas, especially the tail rotor, when moving about a helicopter with its engines running and rotors turning,” the transportation safety board report said.
Heli Explore Inc. did not respond to a request for comment for this story.
System safety science has indisputably proven that the most effective and most efficient means of addressing hazards is to remove them from the system.
This inexcusably deficient report lazily notes “Pilots are reminded to ensure that all passengers and ground personnel are briefed on and understand the hazards of helicopter danger areas, especially the tail rotor”.
Relying on safety policies to shield people from poorly designed systems is an example of outdated and ineffective thinking. Eliminating hazards has been scientifically proven to be the most effective and most efficient means of preventing accidents. Relying on safety briefings and training to respond to dangerous designs has been proven to be the least effective means of hazard response.
Those who are truly dedicated to mitigating risk in helicopter operations have eliminated tail rotors from their helicopters.
The fatally flawed aircraft design involved in this entirely preventable accident belongs to AS-350 C-GWMO S/N 1879, built in 1985. In 1999 Airbus eliminated the tail rotor from the AS-350 to produce the infinitely safer updated design of the H130, which is equipped with an anti-torque fenestron. The fenestron differs from a conventional open tail rotor, by being integrally housed within the tail boom, which thus shields those on the ground from the rotating blades. This technology has been fitted to helicopters since the 1960s.
The Safety Management Systems for the world’s safest helicopter operators dictate that they will not a fly a helicopter equipped with a tail rotor. The world’s safest helicopter operators have never had, and will never have a tail rotor strike accident, because they have eliminated the hazard presented by tail rotors.
A 40 year old helicopter such as AS-350 C-GWMO S/N 1879 reflects the safety standards of a previous century.
Those of us who are truly dedicated to aviation safety will ignore the outdated and ill-advised unscientific nonsense suggested by the TSB. We have already rendered tail rotor strikes to be impossible.
Well that’s a sanctimonious rant that ignores the realities of life. So if you get your big wish and all the rotor having heli’s are taken out service, who is paying to replace them? How will people access remote areas, and FYI 99% of Nunavut is a remote area, if companies can’t get those machines, or have to jack up the price ridiculously? Bc news flash, the north is already incredibly and prohibitively expensive to operate in.
This isn’t some thought exercise, this is actual people and businesses in the north. And it’s perfectly reasonable that pilots be responsible for delivering a safety briefing and check regularly even when they have experienced passengers.
Also, it’s good to remember that these aren’t busses or cars in cities that everyone will be riding, these are working machines that access remote areas. I have spent A LOT of time on helicopters, small planes, large planes, gliders and getting to/from and working in some of the most remote places in Canada. Catering to the lowest common denominator safety wise isn’t actually a good choice and in my experience makes people feel LESS responsible for their own personal safety. That’s anecdotal but I’ve seen it happen over the years working for large miners, the less responsible people feel for their own wellbeing, the more entitled and more careless they act.
The TSB seems to have really missed the opportunity to be more proactive in its findings and recommendations. The hierarchy of hazard controls from most effective to least effective is:
1) Elimination.
2) Substitution.
3) Engineering Controls.
4) Administrative Controls.
5) Personal Protective Equipment (PPE)
Making the least effective recommendation is both disappointing and a distraction from the real safety response which is required. I hope this report is reconsidered and rewritten.