The flight instructor, who was controlling the Cessna 172, and the student pilot were conducting an instructional flight. During the takeoff from the airport in Charleston, West Virginia, the airplane lifted off about 1,000′ down the runway, pitched nose up, and rolled left to an inverted attitude before it hit terrain next to the runway in a nose-down attitude.
The student pilot recalled that as the airplane rotated during the takeoff, he heard the flight instructor exclaim, but could not recall any subsequent events. The flight instructor died in the crash.
Post-accident examination of the flight controls revealed no evidence of any preimpact mechanical malfunctions or failures that would have precluded normal operation.
Examination of the wreckage revealed witness marks along the flight instructor’s seat tracks that corresponded with the seat in the nearly full-aft position. Given the flight instructor’s stature, it is unlikely that this position would allow her to fully actuate the flight controls, and it is therefore unlikely she purposefully initiated the takeoff with her seat in this position.
While one of the two locking pins that would have secured the seat from sliding fore and aft was found fractured, it is likely that the jockeying of the seat during the victim extraction process resulted in the fracture of the locking pin, and left the witness marks observed on the seat track.
Examination of the wreckage and maintenance documents also revealed that the airplane was not equipped with a manufacturer-recommended secondary seat stop mechanisms for either of the pilot seats.
Review of operational and maintenance documents published by the airframe manufacturer showed the critical importance of ensuring that the pilot seats were secured prior to initiating a flight, and that accelerations such as those encountered during a takeoff could dislodge an unsecured seat.
Had the flight instructor, who was performing the takeoff, not properly secured her seat prior to initiating the takeoff, it may have resulted in her seat sliding aft, and her inadvertent application of control inputs to the control yoke during the rotation and initial climb, consistent with steep climb, descent, and impact.
The aft seat position could have also likely resulted in her inability to apply complete or sufficient control inputs to the rudder pedals, consistent with the left yaw/roll observed during the takeoff.
Probable cause: The flight instructor’s failure to ensure that her seat was properly secured before initiating the takeoff, which resulted in a subsequent loss of control. Contributing was the lack of an installed secondary seat stop.
NTSB Identification: ERA16FA141
This March 2016 accident report is provided by the National Transportation Safety Board. Published as an educational tool, it is intended to help pilots learn from the misfortunes of others.
Instructors take note: This may be something you want to include in your EMERGENCY PROCEDURES training along with engine out, fire, electrical, etc etc etc.
Manny Puerta says
McFarlane seat roller kit, rails and an Aero Stop seat stop to the rescue for my 185. Never liked the Cessna stop, but it does the job. Why would someone do nothing for an existing problem that has such severe consequences?
Part of MY passenger briefing plus a mental note to ‘self’ … make sure both pins are latched in my C172 seats and stay off the yoke if the seat slides aft. Simple as that.
I’m not aware of any ‘free’ stuff from Textron … they make recommendations but … ??
While not having a lot of Cessna experience, it’s pretty common knowledge that this is an issue–the maintenance provider and owner/operator should be ashamed of this oversight. Of the times I have adjusted a Cessna seat, the majority involved taking several tries to get the damn thing to lock, and thinking it was locked only to be surprised. I feel that the assignment of blame on the CFI is the sort of lazy accident investigation techniques that AOPA has called out recently.
Ken Thompson says
I experienced a seat “slide back” very early in my flying career: First solo. We had flown about half an hour that morning. After a couple of landings the CFI climbed out and told me to do three full-stop landings.
I taxied the 150 out, powered up, and a split second after rotation my seat slid back in the track.
I could not reach the pedals but I was tall enough, or my arms are long enough, to get my finger tips on the yoke. I pushed forward enough to level out 100 feet or so AGL. Then I quickly pulled the seat forward and climbed on out. I completed my three landings and parked it for the day.
Had I not been tall enough to reach the yoke, or been a fairly agile 19 year old, things may have ended quite differently.
Oh, and counting the half hour Dual I had that morning, I was doing first solo with only 5.1 hours.
How long has Cessna offered that seat stop safety mod… FOR FREE??? Hint: over 10’years. This accident is so sad, and SO avoidable. Chock up another maintenance fail. Plus who knows how many AMTs who did annuals for otherwise clueless owners who then passed up FREE…(yes FREE!!) Cessna parts and labor upgrades to prevent exactly this accident.
Wylbur Wrong says
When I was first learning to fly, my CFI told me that if my seat started to slide away, to let go of the yoke immediately. If you don’t, your typical reaction is to pull on what you are holding to keep from “falling” or sliding away from the controls. So one pulls on the yoke and takes it with them to full back… Nose goes up, stall and spin.
This Cessna seat problem has at least 1 AD and is why the seat rails have to be inspected for cracks, etc. (for C150, 152, 172, not sure about the 182, 177, and 210).
Now if the AD were modified to make the secondary latch a required item…
BTW — if you have this happen to you once (the seat slides back) in training, you will be a believer. BTDT as a student pilot. The CFI immediately realized the problem — and I remembered what he had said, let go of that yoke if your seat starts sliding back….
Seat tracks and the pin holes for the seats wear oversize over the decades since being built. Some owners refuse to spend the $’s to correct the ware problem and even fight having to install secondary seat stops for normal operations. There are several manufacturers who make these secondary stops, but is to say that they get installed every time.