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Safety Recommendation Details
On April 21, 2013, about 0735 eastern daylight time, a Cameron Balloons US Z-225 balloon, N65625, operated by US Hot Air Balloon Team, collided with trees during an attempted landing in windy conditions and landed hard near a residence in Chester Springs, Pennsylvania. Of the 10 passengers on board, 3 were seriously injured; 6 passengers and the commercial pilot sustained minor injuries, and 1 passenger was not injured. The balloon sustained minor damage. The pilot stated that he obtained a weather briefing before departure and that the wind was 4to5knots when he launched on the accident flight; he stated that he normally would not launch if the wind was 10 knots or greater. The wind speed increased as the pilot was preparing to land. During the hard landing, one of the passengers or the pilot likely inadvertently contacted the burner switch, which caused a propane flash and burned three of the passengers, resulting in serious injuries. When asked why the pilot flames on the burners were still on during the landing, the pilot replied that larger balloons, such as the accident balloon, have three burners and it takes some time to extinguish the pilot flames. The NTSB determined the probable cause of the accident was “the pilot’s failure to extinguish the burner pilot lights prior to a hard landing in windy conditions.”
TO THE FEDERAL AVIATION ADMINISTRATION: Through appropriate revisions to FAA Order 1800.56J, “National Flight Standards Work Program Guidelines,” encourage principal operations inspectors to include in their general surveillance activities commercial balloon operators that hold letters of authorization(LOA), especially upon initial issuance of the LOA and then as necessary, particularly if the operator is involved in an accident. (Safety Recommendations A-14-011 and A-14-012 were superseded by A-17-045)
Original recommendation transmittal letter:
Closed - Unacceptable Action/Superseded
Chester Springs, PA, United States
Addressee(s) and Addressee Status:
FAA (Closed - Unacceptable Action/Superseded)
Safety Recommendation History
-From the NTSB Report AAR-17-03: Impact with Power Lines, Heart of Texas Hot Air Balloon Rides, Balóny Kubícek BB85Z, N2469L, Lockhart, Texas, July 30, 2016: On April 7, 2014, the NTSB issued Safety Recommendations A-14-11 and A-14-12, which asked the FAA to do the following: Amend 14 Code of Federal Regulations Section 91.147 to require commercial balloon operators to obtain and maintain a letter of authorization to conduct air tour flights. (A-14-11) Through appropriate revisions to FAA Order 1800.56J, “National Flight Standards Work Program Guidelines,” encourage principal operations inspectors to include in their general surveillance activities commercial balloon operators that hold letters of authorization (LOA), especially upon initial issuance of the LOA and then as necessary, particularly if the operator is involved in an accident. (A-14-12) These recommendations were issued as part of the NTSB’s investigation of a series of commercial hot air balloon accidents. The NTSB determined that greater regulatory oversight of balloon tour operators would help ensure compliance with procedures and regulations, reducing the likelihood of similar future accidents. For more information, see the correspondence history for A-14-11 and -12. On November 6, 2015, the FAA responded that requiring commercial balloon operators to obtain LOAs under 14 CFR 91.147 would not result in a higher level of safety because the primary purpose of 14 CFR 91.147 is to require pilots to be covered by a drug testing program. The FAA stated that there is no compelling evidence to show that drugs or medications not approved by the FAA have led to balloon accidents. (The NTSB notes that this accident is now evidence that drugs and medications not approved by the FAA have led to balloon accidents. However, as stated earlier, we believe that a second-class medical certificate would address this issue.) The FAA also stated that, because the level of balloon activity is so low, its nontraditional surveillance activities centered around major ballooning events effectively address oversight of commercial balloon operations. On March 4, 2016, the NTSB replied that the intent of the recommendations was not to require drug testing programs but to ensure that commercial balloon tour operators are included in principal operations inspectors’ general surveillance activities. The NTSB stated that the requirement to maintain an LOA with the flight standards district office would motivate operators to comply with regulations and the operating agreements in their LOAs to avoid enforcement actions that might result in a loss of business. The NTSB urged the FAA to reconsider its position on the recommendations and classified them “Open—Unacceptable Response.” Because of the FAA’s inaction on Safety Recommendations A-14-11 and -12 and the new recommendation discussed above for a more risk-based approach to identifying balloon operators for oversight, Safety Recommendations A-14-11 and -12 are reclassified CLOSED--UNACCEPTABLE ACTION/ SUPERSEDED.
We point out that the intent of these recommendations is to ensure that (1) the FAA’s flight standards district offices (FSDO) maintain a record of all commercial air tour balloon operators and (2) these operators are included in principal operations inspectors’ general surveillance activities. Although drug testing programs constitute one aspect of Title 14 Code of Federal Regulations (CFR) Part 91 section 147, we did not issue these recommendations for the purpose of requiring such programs. Rather, we issued them as a result of our concern about the operational deficiencies identified in our investigations of accidents involving commercial air tour balloon operations. Our concern is that such operations do not receive oversight equal to that of similar airplane and helicopter air tour operations. To conduct commercial operations, airplane and helicopter operators are required by 14 CFR 91.147 to receive and maintain an LOA that outlines operational limitations and provisions from the local FSDO. This imposes some level of FAA oversight by creating a record of operators with FSDOs for periodic surveillance checks to verify that flights are being conducted in accordance with the LOAs. You indicated in your letter that airmen operating under 14 CFR 91.147 do not undergo additional FAA surveillance that is common to air carrier operations. However, we believe that if these operators were required to obtain and maintain an LOA, they would be subject to such surveillance activities as (1) checks to verify that appropriately certificated pilots are employed and that they undergo required competency evaluations, (2) properly certificated and maintained equipment and safety checklists are used, (3) appropriate passenger safety briefings and flight planning are conducted, and (4) Part 91 flight operations procedures are followed. We also believe that commercial balloon operations would be motivated to comply with the provisions in their LOAs, knowing that an enforcement action, including suspending or revoking an LOA, could result in a loss of business. We continue to believe that if operators were required to obtain and maintain an LOA, FSDOs would have a record of all such operations, and principle inspectors could include these operators in their general surveillance activities. We are concerned that, if no action is taken to address this safety issue, we will continue to see such accidents in the future. Since these recommendations were issued in April 2014, an additional 25 balloon accidents have occurred, resulting in 4 fatalities and 25 serious injuries. We encourage you to reconsider your position. In the meantime, pending our receipt and review of a plan that is responsive to these recommendations, Safety Recommendations A-14-11 and -12 are classified OPEN—UNACCEPTABLE RESPONSE.
-From Michael P. Huerta, Administrator: The Federal Aviation Administration (FAA) has determined that a letter of authorization issued under Title 14, Code of Federal Regulations§ 91.147, Passenger Carrying Flights for Compensation or Hire, would not result in a significantly higher level of operational safety. The primary purpose of§ 91.147 is to require that someone who wishes to conduct passenger-carrying flights in an airplane or helicopter for compensation or hire must be covered under a drug testing program. Airmen operating under this part do not undergo additional FAA check rides/surveillance common to air carrier operations. There are several major ballooning events conducted throughout the country on an annual basis. Most notable is the October Annual Albuquerque, New Mexico, International Balloon Fiesta. Often, these events require initial FAA involvement prior to the event, such as issuing a certificate of waiver or authorization for the various ballooning activities. Since the amount of ballooning is so low, the FAA believes the risk posed to all pilots and participants is also low given that ballooners understand the risks and general hazards associated with this activity. Therefore, although surveillance for ballooning activity is not carried out in the traditional sense per FAA Order 1800.56 (as amended), the FAA regularly attends sanctioned ballooning events and performs certain oversight activities, such as checking pilot credentials and reviewing the airworthiness condition of the balloon. Additionally, the FAA lacks compelling evidence to believe that medications not approved by the FAA have Jed to balloon accidents. Furthermore, there are no known links that suggest the use of medications or drugs not approved by the FAA are a contributor to balloon accidents. I believe the FAA has effectively addressed these recommendations and consider our actions complete.
We look forward to receiving the results of your review and your plan for satisfying these recommendations. Pending our receipt and review of this detailed information, Safety Recommendations A-14-11 and -12 are classified OPEN—ACCEPTABLE RESPONSE.
-From Michael P. Huerta, Administrator: The Federal Aviation Administration (FAA) is reviewing these recommendations to determine the feasibility of their implementation. I will keep the Board informed of the FAA's progress on these safety recommendations and update the Board by March 2015.
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