MEDWAY AIR AMBULANCE LLC

Operated by Medway Air Ambulance (per NTSB report)

The fueler’s inadvertent addition of diesel exhaust fluid (DEF) to the FSII reservoir on the fuel truck, and its subsequent mixture with the JET A that was used to fuel the airplane, resulting in a total loss of power to the right engine and a partial loss of power to the left engine.

Operated by MEDWAY AIR AMBULANCE LLC (per NTSB report)

The flight crew’s improper decision to continue the unstabilized approach, which resulted in an aerodynamic stall and impact with the runway during landing.

Operated by Medway Air Ambulance (per NTSB report)

The flight crew’s encounter with windshear during the landing flare, which resulted in a hard landing.

Sanction: $12,000 · case closed 2010-05-10

Part: STARTER GEN — FAILED (ZONE 400) · airframe 7,783 hrs · 5,773 cycles

RIGHT ENGINE STARTER/GENERATOR FAILED IN FLIGHT WITH NO INDICATION OF FAILURE. RESULTS OF THE INDICATION FAILURE RESULTED IN MAIN BATTERIES AND EMERGENCY BATTERY DISCHARGE, COUPLED WITH FAILURE TO PROPERLY LOAD SHED. THESE SEVERAL INSTANCES RESULTED IN LOSS OF INDICATIONS IN THE COCKPIT. CREW TOOK EMERGENCY MEASURES TO SAFELY LAND THE AIRCRAFT.

Part: ELECTRICAL SYS — FAULTED · airframe 9,064 hrs · 6,316 cycles

LOSS OF RIGHT SIDE OF AIRCRAFT ELECTRICAL SYSTEMS WHILE IN FLIGHT

Part: HYDRAULIC LINE — CHAFED (HYDRAULIC SYS) · airframe 15,758 hrs · 11,386 cycles

AIRCRAFT WAS IN ROUTE, DIVERTED. DUE TO HYDRAULIC FAILURE. AIRCRAFT DECLARED AN EMERGENCY LANDING. GEAR WAS BLOWN DOWN WITH EMERGENCY AIR BOTTLE. AIRCRAFT LANDED WITHOUT FURTHER INCIDENT.

Part: FIRE DETECTOR — FAILED (LT ENGINE) · airframe 15,201 hrs · 11,055 cycles

WE WERE CLIMBING SOMEWHERE IN THE LOW 20’S. WE THEN NOTICED THE MASTER CAUTION FLASHING. A QUICK SEARCH OF THE PANEL ALSO REVEALED THE LEFT ENGINE FIRE LIGHT TO BE FLASHING. WE THEN PULLED THE LEFT POWER LEVER TO IDLE FOR 15 SECONDS AS PER THE MEMORY ITEMS. THE LIGHT FAILED TO EXTINGUISH IN THE 15 SECONDS SO WE THEN PULLED THE LEFT T HANDLE AND WAITED A SECOND, WITH THE FIRE LIGHT STILL FLASHING WE FIRED ONE OF THE FIRE BOTTLES INTO THE LEFT ENGINE. AFTER A FEW SECONDS AND THE FIRE LIGHT STILL FLASHING, WE FIRED THE SECOND FIRE BOTTLE INTO THE LEFT ENGINE. I THEN CALLED OFF AND WE COMPLETED THE ENGINE FIRE-SHUTDOWN CHECKLIST. ATC WAS INFORMED EARLY IN THIS PROCESS AND WE WERE IN THE PROCESS OF DESCENDING AND DIVERTING TO KBHM. WE SHOT THE APPROACH AND LANDED IN KBHM WITHOUT INCIDENT. A POST FLIGHT INSPECTION BY THE FIRE DEPARTMENT AND THEN US PILOTS DID NOT REVEAL ANY SIGNS OF AN ACTUAL ENGINE FIRE, LEADING US TO BELIEVE THAT IT WAS AN ISSUE WITH A SENSOR.

Part: RELIEF VALVE — MALFUNCTIONED (CABIN PRESSURE) · airframe 10,416 hrs · 9,005 cycles

AIRCRAFT LOST PRESSURIZATION DURING DECENT. CREW PERFORMED EMERGENCY LANDING. NO FURTHER INCIDENT ON LANDING. PERFORMED GROUND CHECKS OF PRESSURIZATION SYSTEM. COULD NOT DUPLICATE PROBLEM. FURTHER TROUBLESHOOTING REVILED INTERMITTENT FAULT IN DIFFERENTIAL RELIEF VALVE OPENING EARLY. REMOVED AND REPLACED DIFFERENTIAL RELIEF VALVE. PERFORMED FUNCTIONAL CHECKS OF PRESSURIZATION SYSTEM. ALL CHECKS GOOD. AIRCRAFT RETURNED TO SERVICE.

Part: CIRCUIT BOARD — BURNED (CABIN) · airframe 13,311 hrs · 11,738 cycles

ACFT DEPARTED, VFR, RECEIVED IFR CLEARANCE FROM APPROACH CONTROL, BEGAN CLIMB TO 11,000 FT. PILOT DETECTED A STRONG ELECTRICAL ODOR AND CONFIRMED FROM PASSENGERS THAT VISIBLE SMOKE CAME FROM BEHIND SIDE WALL ON ACFT RT SIDE. ELECTRICAL LOADS WERE SHED, AND EMERGENCY DECLARED. EMERGENCY RETURN TO DEPARTURE. SMOKE AND FUMES ELIMINATED/SOURCE OF FIRE EXTINGUISHED THROUGH LOAD SHEDDING. NO INJURIES, DAMAGE TO ACFT, OR FURTHER INCIDENTS.

Part: WIRE — BURNED (COCKPIT) · airframe 11,093 hrs · 9,338 cycles

ON DESCENT INTO HLN, SMOKE WAS NOTICED IN THE COCKPIT. THIS WAS PRECEDED BY AN AUG/AIL ANNUNCIATOR LIGHT ON THE GLARESHIELD. AN EMERGENCY WAS DECLARED, THE EMERGENCY CHECKLIST WAS ACCOMPLISHED, AND AN EMERGENCY LANDING WAS MADE. TWO COCKPIT CREW AND TWO MEDICAL TECHNICIANS WERE ONBOARD. IT WAS FOUND THAT A BURNED OUT WIRE BEHIND THE CIRCUIT BREAKER PANEL ON THE F/O SIDE WAS RESPONSIBLE. REPAIRS WERE MADE IAW COMPANY PROCEDURES AND THE A/C RETURNED TO SERVICE.