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WPR17LA159 · Robinson Helicopter Company R44 II

21 Jul 2017 · Van Nuys, CA, United States

National Helicopter Service & Engineerin Robinson Helicopter Company R44 II · Accident: system/component malfunction/failure (non-power) en route

From Van Nuys Airport (VNY) to Van Nuys Airport (VNY)

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Event

NTSB case
WPR17LA159
Event typeAccident: someone killed or seriously injured, or the aircraft substantially damaged (NTSB definition). Incident: an occurrence that affected or could have affected safety, short of that. Glossary
Accident
InvestigationHow far the investigation had got when the record was published: preliminary, ongoing, final or completed. Unknown where the source does not say. Glossary
Completed
API-reported fatalities
0 · all aircraft and ground
Ground fatalities
Unknown
OperationWhat kind of flying it was, grouped by the rules it flew under: airline (US Part 121), air taxi and commuter (Part 135), general aviation (Part 91 and similar), military or government. Glossary
General aviation
WeatherVisual meteorological conditions (VMC): good enough to fly by looking outside. Instrument conditions (IMC): cloud or low visibility, flying by instruments. Glossary
Visual Meteorological Cond

Robinson Helicopter Company R44 II

Aircraft type
Robinson R44
Category
Helicopter
RegistrationThe aircraft's tail number, such as N12345 or G-ABCD. Registrations are reissued, so the same one years apart can be a different aircraft. Glossary
N3254E
Onboard fatalities
Unknown
Route
From Van Nuys Airport (VNY), Van Nuys, CATo Van Nuys Airport (VNY), Van Nuys, CA
Aircraft age
About 10 years (built 2007)
Flight rulesThe regulations the flight operated under: in the US, Part 91 (general aviation), Part 121 (airlines), Part 135 (air taxi and commuter) and others; for flights abroad, the NTSB's coarser commercial or non-commercial code. Glossary
Part 91: General Aviation
Phase of flightThe stage of the flight when things started to go wrong: standing, taxi, takeoff, initial climb, en route, maneuvering, approach or landing. Glossary
En route · cruise
Defining eventThe single coded event the NTSB judges best describes what happened (records from 2008 on). Older records name the first occurrence in the sequence instead. Glossary
System/component malfunction/failure (non-power)
DamageDestroyed: beyond practical repair. Substantial: damage that affects the structure, performance or handling and normally needs major repair. Minor: less than that. Glossary
Substantial

Cause areas

  • Aircraft › Aircraft systems

Approximate · Coordinates from the NTSB case API, not marked as estimated; no uncertainty radius is established.

NTSB narrative

**This report was modified on July 26, 2022. Please see the public docket for this accident to view the original report.** The commercial pilot reported that, during a local sightseeing flight over a densely populated area, he heard an unusual sound and saw that the engine tachometer was indicating a higher-than-normal engine rpm. He reduced engine power and attempted to manipulate the helicopter controls to align the engine and rotor speeds to no avail. Subsequently, the rotor rpm began decaying, and the pilot assumed the helicopter had experienced a catastrophic drive failure and chose to conduct an autorotation, during which the helicopter landed hard. The airframe sustained substantial damage.

Postaccident examination of the helicopter and engine did not reveal evidence of any mechanical malfunctions or failures that would have precluded normal operation, and witness signatures indicated that the engine was producing power at the time of ground impact. However, a wire within the right magneto, which provided a signal to both the engine governor and engine tachometer on the instrument panel, was found detached at a solder joint where it had been soldered to the connector rather than crimped. Further, neither the wire nor its connector was aviation-grade. The investigation could not determine when the modification to the wire was made.

Review of onboard video and a spectrographic analysis of the recorded audio revealed that the engine rpm initially decreased but then appeared to be restored a few seconds later while the helicopter slowed. For about the next 40 seconds, the engine continued to operate at the same rpm and the helicopter continued to slow and gradually descend. The engine rpm then quickly decreased, and the helicopter rapidly descended in a manner consistent with the pilot initiating an autorotation. The detached wire would have resulted in both the tachometer and governor not receiving a correct engine rpm signal. As a result, the engine governor would not have been able to make appropriate adjustments to engine power as demand changed, and the pilot would not have had a way to gauge engine power and make corrective manual throttle inputs. The pilot's statement that the tachometer rpm increased does not match a scenario where the wire completely detached. However, it is possible that the event was initiated when the wire remained partially connected and thus created a spurious increase in signal frequency to the tachometer and governor due to vibrations. Thus, in this scenario, the tachometer would read higher than normal and the engine rpm would decrease as the governor tried to compensate for the high engine rpm signal.

The Helicopter's Operating Handbook provided separate procedures for the failure of the engine governor and tachometer but not for the failure of both. Because the engine governor control system and engine tachometer both share a common speed signal source and thereby a common failure point, this signal wire failure left the pilot with a confusing set of cues and no definitive procedures for corrective action. In addition, the helicopter's low rotor rpm warning horn was not working, but the low rotor lamp was working. This failure would have resulted in another set of contradictory cues for the pilot to process, further compounding the confusion he was likely experiencing during the high-stress event.

Probable cause

An improper repair of the right magneto's tachometer and governor signal wire, which failed during cruise flight and initiated a simultaneous malfunction of both the engine tachometer and governor control system, which resulted in erroneous and contradictory information between the engine tachometer and main rotor tachometer that led the pilot to perform a forced landing. Contributing to the accident was the lack of guidance on how to address the simultaneous failure or malfunction of both the engine tachometer and governor control system.

Verbatim NTSB analysis and probable cause from the NTSB dataset

Sources

NTSB record WPR17LA159
Event ID
20170721X55655
Case number
WPR17LA159
Dataset
full-current
Source SHA-256
5cf380f0061817c0331a6b2d8cc7e0ee3a79bea469a1001dc5c10e56f35f5ab3
Source notes (4)
  • Unreviewed is an editorial label, not an investigation status. API-sourced is not report-checked or human-reviewed. Explicit event totals are used without summing aircraft injury tables; onboard allocation is withheld. Unknown values remain unknown. The operation category is mapped from the NTSB-reported FAR part and has not been reviewed.
  • Filled from the NTSB case API where the bulk record had no value: investigation status, coordinates. Values present in the bulk record are kept.
  • The date is the local date, which is the same as the UTC date the NTSB stores.
  • API snapshot SHA-256: ba16d83eaa6308541a3bf08ecda32f6298656de36560ed0d3b878a76eb78f42a; retrieved 2026-09-16T05:34:32.523Z.