CREW DISORIENTATION following artificial-horizon failure in turbulent cloud caused the 24 May, 1995, crash of a Knight Air Embraer Bandeirante shortly after take-off from Leeds Bradford Airport in the UK, says the Air Accident Investigation Branch (AAIB) report.
There was no other fault, says the report. The aircraft entered a steep spiral dive, the excessive speed leading to partial break-up before impact. All three crew and nine passengers were killed.
An unacceptable degradation of artificial-horizon reliability throughout the instrument's life was blamed on there being no published overhaul schedule for the Bandeirante's Aircraft Instrument Manufacturing 500 Series artificial horizon. The aircraft's instruments needed frequent repair, therefore.
A contributory factor cited is "the crewing combination of the newly promoted commander [with a] newly qualified first-officer", which regulations recommend "-should be avoided wherever possible". Finally, because of its pre-1990 date of registration, the aircraft was not required to be fitted with a cockpit-voice recorder or flight-data recorder.
The AAIB recommends that the European Joint Aviation Authorities consider that all civil multi-engined aircraft approved to carry more than nine passengers should be equipped with a CVR.
Source: Flight International
