Trim Runaways, CAPS Saves, and Why IFR Pilots Still Lose Control: Lessons from This Week’s NTSB Reports
NTSB News Talk – Aviation Accidents, Safety Investigations & Pilot LessonsShow Notes
Episode 17 of NTSB News Talk brings together an unusually rich set of accidents and safety insights, all centered on pilot decision-making, trim system failures, swept-wing stall risks, and the ongoing challenge of hand-flying in IMC when automation misbehaves. In this week’s discussion, hosts Max Trescott and Rob Mark use recent NTSB reports to highlight the mistakes, mechanical failures, and chain-of-events that continue to trap even experienced pilots. For listeners who fly IFR, rely on autopilots, or operate aircraft with electric pitch trim, this episode offers lessons that are immediately relevant. The episode opens on an encouraging note. Max reports that the United States saw three CAPS parachute deployments in three days—Tuesday, Wednesday, and Thursday. These weren’t all Cirrus aircraft, either; one was N163BR, a Lancair Turbine LX7, one of the fastest experimental turbine singles in the fleet. All three incidents involved engine failures on approach, and every person involved walked away uninjured. For Max and Rob, it’s another sign that whole-airframe parachutes continue to save lives and will become increasingly common as the general aviation fleet modernizes. But the tone shifts as the hosts examine the crash of N30HG, a King Air B100 on a humanitarian mission to Jamaica following Hurricane Melissa. Shortly after takeoff from Florida, the aircraft descended rapidly and struck palm trees before crashing into a pond, killing both on board. A similar King Air pilot’s Facebook account of a pitch trim runaway and violent pitch-down event becomes an important point of comparison. While the NTSB has not yet identified the cause, the parallels highlight how aggressive and unexpected trim-related events can be—and how essential it is for pilots to know exactly where the trim and autopilot disconnects are located, especially when operating older turbine aircraft. In the next case, XA-JMR, a Mexican registered Hawker 800XP fatal accident near Battle Creek, Michigan, post-maintenance work required a swept-wing stall test. The Hawker had been down for seven months while technicians inspected the wing’s leading edges for corrosion. Manufacturer guidance requires that a qualified test pilot perform the post-maintenance stall series. But when the crew was unable to schedule one, they elected to fly the test themselves. Moments after entering the test area at 15,000 feet, the crew transmitted in Spanish that they had stalled the aircraft and were attempting to recover—an attempt that ultimately failed. For Rob, a veteran swept-wing pilot, the lesson is clear: pilots must say “no” when a task exceeds their experience or training, especially in high-AOA testing where swept-wing handling characteristics are unforgiving. The episode then examines several loss-of-control accidents during IFR operations. N9627X, a Cessna 210 bound for Jonesboro, Arkansas deviated around convective weather, then began a series of inexplicable turns and large speed changes before crashing in heavy IMC. A separate Cirrus SR22 accident in Louisiana involved a pilot who reported autopilot issues during a go-around, then lost control while hand-flying. Both accidents reinforce how quickly pilots can become disoriented when hand-flying after automation confusion—especially in turbulence or low visibility. The hosts next highlight a N79338, a Mooney M20E, takeoff accident in New York involving a newly purchased aircraft with a history of contaminated fuel. Although the aircraft showed normal fuel samples before takeoff, the engine lost power at 200 feet. The CFI attempted a turn back but quickly realized the aircraft was too low, resulting in a crash into trees. Max emphasizes that turn-backs below a few hundred feet are rarely survivable, even for experienced pilots, and that extensive high-power runups should be mandatory when an aircraft has a known fuel-system issue. Another puzzling case involves C-FETM, a Canadian-registered Beech V35 Bonanza that depart
More from NTSB News Talk – Aviation Accidents, Safety Investigations & Pilot Lessons
A Boeing 767 lands more than 3,700 feet down a Miami runway and overruns the pavement, killing five people on the ground. A Cirrus SR22 crashes during a second go-around, killing all five aboard. And a Cessna 421 loses both engines after being fueled with Jet A instead of avgas. In Episode 41 of NTSB News Talk, aviation safety experts Max Trescott and Rob Mark examine the critical decisions behind these accidents and the lessons pilots can take away. The newly released Miami Boeing 767 preliminary report raises serious questions about tailwinds, unstable approaches, airspeed warnings, and a go-around attempted far too late. A new NTSB final report on a fatal Cirrus SR22 crash at Kill Devil Hills reveals striking flight-data evidence of excessive pitch and an aerodynamic stall. The hosts also discuss Diamond DA40 crashed in mountainous terrain near Eldorado Springs, Colorado, a deadly Piper JetProp icing encounter over Wisconsin, a Gulfstream air ambulance crash following reported electrical problems, a Beech Bonanza fuel-starvation accident involving a congressman, a fatal nighttime Piper crash, and a midair collision between gliders. From fuel management and emergency procedures to stall prevention and go-around proficiency, this episode highlights a fundamental truth: even experienced pilots cannot afford to skip the basics.
Episode 40 examines a wide range of recent accidents before focusing on a troubling pattern: pilots flying with impairing OTC medications or drugs in their systems. Max Trescott and Rob Mark begin with a fatal nighttime crash of C-GPTX, a Cessna 172 in Saskatchewan and the runway overrun of Eclipse 500 N816KD at Auburn, California. They also discuss Beech Travel Air N529RB, which was flown in repeated low-level circles about 100 feet above the Pacific before crashing into the ocean, raising the possibility of an intentional act. Preliminary reports include Piper Seneca N212ML, lost near the Bahamas in convective weather; C-IFBY, a Para-Ski VX powered parachute carrying three people even though its U.S. operation did not qualify under Part 103; and Lake Amphibian N6185V, which apparently ran out of fuel just miles from Ithaca. Final reports include a fatal VFR-into-IMC accident involving N9626K, a Piper PA-28 and the crash of Ameriflight Beech C99 N130GP after a partial engine-power loss. The episode closes with four fatal-accident reports involving the active ingredients in Benadryl and Zyrtec, or cyclobenzaprine, cannabis, or morphine. The takeaway is simple: “over the counter” does not mean “safe to fly,” and pilots need to understand the FAA’s medication waiting-period guidance. Max also explains why medication effects can undermine a pilot’s own self-assessment.
New information from the NTSB is filling in the final seconds of the Amazon Prime Air Boeing 767 crash in Miami. The agency’s summary of the cockpit voice recorder shows repeated concerns about excessive speed, followed by touchdown and then, 16 seconds later, a call for a go-around. The brakes were released at a ground speed of 120 knots and go-around thrust was applied before the attempt was abandoned. Recorded data showed no indication that the speed brakes or thrust reversers were deployed. Max Trescott also revisits his ADS-B analysis of Flight 7598 and explains why he believes an automation surprise involving the Boeing 767’s vertical modes may have contributed to the airplane becoming high and fast. Then Max and Rob Mark examine the fatal KNBC AS350B2 helicopter crash in Los Angeles, including ADS-B evidence and reports of a possible low-rotor-RPM warning. Other accidents include N734ZK, a Cessna 172N crash at Montgomery-Gibbs Executive Airport, N9485P, a fatal Piper Comanche accident at a short Alaska runway, N93R, a Lockheed 12A that took off with full flaps, a fuel-exhaustion accident involving N413AW, a Pipistrel Alpha, and N188PC, a Pilatus PC-12 loss of control in IMC. The episode closes with a story from the NASA ASRS Callback newsletter about a Cirrus pilot’s successful recovery from a dangerous distraction in instrument conditions.
An Amazon Prime Air Boeing 767 crashes after overrunning Runway 30 at Miami International Airport—and ADS-B data contains an important clue about how the approach became unstable. In this episode, we analyze the September 6 crash of Prime Air Flight 7598, operated by 21 Air with Boeing 767 N1997A. The flight from San Juan initially followed an almost perfect three-degree approach toward Miami. But approximately five miles from the runway, the aircraft unexpectedly leveled near 1,600 feet. The ADS-B data shows that 1,600 feet had been entered as the selected altitude much earlier in the descent. That raises the possibility of an automation surprise, although another possibility is that the crew leveled inadvertently after disconnecting the autopilot to hand-fly. The crew then attempted to recover using a descent approaching twice the normal glide angle. The 767 crossed the displaced threshold around 175 knots, apparently touched down near 160 knots, and was still traveling about 110 knots when it left the runway. We also examine a fatal PC-12 spatial-disorientation accident, new evidence of helicopter wake turbulence in a Cessna 150 collision, and a troubling student-pilot night CFIT accident involving a CFI cross-country endorsement. FAA No Go Over the Counter Medications List
In Episode 37 of NTSB News Talk, Max Trescott and Rob Mark examine new evidence from the fatal Learjet 55 air ambulance crash in Philadelphia and several other accidents with important lessons for pilots. Brought to you by AVEMCO aircraft insurance. Support Rob and Max by making a donation at Patreon.com The Learjet 55 departed Northeast Philadelphia Airport at night into a roughly 400-foot overcast. Newly released NTSB docket material shows the aircraft initially beginning its assigned right turn before slowly rolling left. The exceptionally gradual roll raises the possibility of somatogyral illusion—a form of spatial disorientation in which the inner ear may fail to detect slow rotational movement. Investigators also examined somatogravic illusion, cockpit workload, pitch trim, and the captain’s previous training history. Both engines appeared to be producing takeoff power, making an engine failure less likely. Max and Rob also discuss two wrong-runway landings near Chicago that illustrate continuation bias and task saturation. Other accidents include a Cirrus Vision Jet striking a pipe across a closed portion of a runway at Driggs, Idaho; a fatal Cessna 150 collision with a Pennsylvania State Police helicopter; N1850N a Beechcraft Duchess accident during simulated single-engine training; and a photographer fatally struck by the wing of glider N8217W. Also, two wrong-runway landings near Chicago, N772MR (Envoy 3936) and N1128M Learjet 60. Those final incidents highlight a recurring human-factors problem: once pilots commit mentally to a plan, contradictory evidence can become surprisingly difficult to recognize.