NTSB CAROL · Event
Event MIA04LA113
Aircraft involved
Probable cause & findings
The failure of the pilot-in-command to maintain recommended main rotor RPM following a reported total loss of engine power due to undetermined reasons, during a practice autorotation resulting in a hard landing and subsequent roll over.
Factual narrative
On July 28, 2004, about 1610 eastern daylight time, a Robinson R22 Mariner, N516PB, registered to Sky Aviation LLC, operated by Palm Beach Helicopters, experienced a hard landing at the Palm Beach County Park, Lantana, Florida. Visual meteorological conditions prevailed at the time and no flight plan was filed for the 14 CFR Part 91 instructional, local, flight. The helicopter was substantially damaged and the certified flight instructor (CFI) was not injured while the pilot-rated student (student) sustained minor injuries. The flight originated about 36 minutes earlier from the Palm Beach County Park. The CFI stated that the student had completed six power-off autorotative landings; three without assistance in preparation for a CFI checkride that was planned. The CFI took control of the helicopter to demonstrate an autorotative descent and entered the maneuver while flying at 700 feet and an indicated airspeed of 85 knots. Upon entry, the CFI set the attitude of the helicopter to maintain 60-65 knots and turned 180 degrees from the entry heading without losing altitude. During the turn he cross checked the main rotor rpm and airspeed, both remained stable and the descent rate was 1,800 to 2,000 feet-per-minute (FPM). During the final 90 degrees of the turn, the descent angle appeared steep and it was apparent to him that the actual touchdown point would be short of the intended point of landing. The CFI verbally stated that he would recover at another location and when the flight was 75-100 feet, he leveled the helicopter by rolling out of the turn and lowered the collective to maintain main rotor rpm. At that point the indicated airspeed was 65 knots, and the main rotor rpm was 98-100 percent. The flight continued and 50 feet, he increased throttle with the intention of leveling off with power applied, and verified both needles were "joined." He raised the collective control to recover and the helicopter yawed sharply to the left with an immediate loss of main rotor rpm (approximately 93 percent). He immediately applied right anti-torque pedal input and lowered the collective control. At approximately 5 feet while in a 3-5 degree nose-up attitude he applied full up collective but the helicopter contacted the ground at an estimated indicated airspeed of approximately 45 knots slightly left skid low. The helicopter rolled onto the left side pinning the student's left arm; the helicopter was lifted and the student was freed. He further reported that the engine was not operating when the helicopter came to rest. NTSB review of the Robinson R22 Beta Flight Training Guide revealed that with respect to practice forced landings, prior to passing through 100 feet, the helicopter should be aligned with the touchdown area, at 60 to 70 knots, rotor in the green range (97% to 104%), and in trim. As previously reported by the CFI, at 40 feet the rotor rpm decreased to 93% following throttle application and resulting right yaw. Postaccident examination of the helicopter the day after the accident by an inspector from the Federal Aviation Administration revealed that the carburetor heat was full on, there was evidence of an exhaust leak at the carburetor heat intake, the bracket for the carburetor heat scoop was broken and "...appeared to have been that way for some time", and the engine air filter was burnt in one area. Following recovery of the helicopter, the engine was started and operated in the airframe with no discrepancies noted. The engine was then removed from the helicopter, placed in a test cell and operated with a test club installed. The engine was started and only operated to approximately 2,550 rpm instead of 2,700 rpm. Low differential compression (5 psi) of the No. 3 cylinder was noted when testing using 80 psi. Examination of the No. 3 cylinder, piston, and piston pin, was performed by personnel from Engine Components, Inc., with FAA oversight, which revealed discolorations which are typical of high temperature operations. Wear on the exhaust valve seating face and exhaust valve guide was noted. NTSB review of the maintenance records revealed all new cylinders were installed at the time the engine was overhauled on February 15, 2004; the engine had accumulated 186.6 hours at the time of the accident. The helicopter minus the retained No. 3 cylinder with piston and piston pin was released to Christopher Dannecker, of CTC Services Aviation (LAD, Inc.), on March 2, 2005. The retained components were released to Debra Sparks, of Palm Beach Helicopters, on March 11, 2005. The helicopter landed hard and rolled over after the certified flight instructor (CFI) attempted to recover from a simulated autorotative descent. According to the CFI, as he attempted to level off at 75 to 100 feet above the ground, the helicopter yawed sharply to the left along with a loss of main rotor rpm, and despite his efforts to recover, the helicopter touched down left skid low. The engine was later placed in a test cell and when started operated to approximately 2,550 rpm instead of 2,700 rpm. The No. 3 cylinder was noted to only have 5 psi during the differential compression test. Further examination of the No. 3 cylinder by the cylinder manufacturer revealed discolorations which are typical of high temperature operations; wear on the exhaust valve seating face and exhaust valve guide was noted. Source: NTSB Aviation Accident Database (Pre-2008 Archive) Retrieved: 2026-02-12
Verbatim from NTSB's published report. Source file
NTSB_2004_MIA04LA113.txt.
Findings + structured fields enriched from FAA avall.mdb.
Full investigation docket on
data.ntsb.gov ↗.
Beyond the agency record
Search this event elsewhere.
Pre-filled searches into the sources where news + community discussion of aviation events lives. External sources are reported, not agency. Treat them as signal that something happened, not as fact about what happened.
Entity-clustered aviation events in the press — last 24 hr + 30-day archive.
Official agency record + docket.
Investigative docket: factual reports, photos, transcripts.
Long-running aviation incident database (Flight Safety Foundation).
Community NTSB synthesis blog — often has photos and witness reports.
Gold-standard aviation incident blog.
Aviation industry news search.
GA pilot forum — informed but rumor-prone.
GA pilot subreddit search.
Tail-number page — flight history (free tier limited).
AOPA Air Safety Institute search.
Mainstream press coverage. Recent events only.
Privacy-preserving news search.
External links open in a new tab. We don't ingest their content; we deep-link search queries.
Related research
What the literature says.
Academic papers and agency reports matching this event's aircraft type or causal vocabulary (stall, maintenance). Sourced from NASA NTRS, NTSB Safety Studies, FAA CAMI, AOPA Air Safety Institute, Embry-Riddle Scholarly Commons, arXiv, and the Semantic Scholar academic graph.
- Embry-Riddle Scholarly Commons 2023 · Conference paper
The Value of Strong Partnerships to Build a Successful Aviation Maintenance Career Pathway Program for Transitioning Military Service Members
The aerospace industry is competing with other industries for a qualified workforce, and many of those competing industries are investing heavily in creating workforce development pipelines.
- Embry-Riddle Scholarly Commons 2026 · Journal article (IJAAA)
From Reactive to Predictive: A hybrid Trust-Mediated Adoption Framework for Data-Driven Maintenance in Distributed-Authority Aviation Environments
Modern aviation maintenance operates within increasingly data-intensive technological environments, yet the operational integration of predictive maintenance into routine decision-making remains incon…
- NASA NTRS 2026 · Conference Paper
Computational Analysis of Steady State Aerodynamics of Transonic Truss-Braced Wing Configuration in Deep Stall
This study presents a computational investigation of steady state aerodynamics of the Subsonic Ultra-Green Aircraft Research (SUGAR) Transonic Truss-Braced Wing (TTBW) configuration over a wide range …
- Semantic Scholar 2025 · Article (Applied Sciences)
Decision-Making Framework for Aviation Safety in Predictive Maintenance Strategies
The implementation of predictive maintenance (PM) in aviation presents unique challenges due to strict safety requirements, complex operational environments, and regulatory constraints.
- Embry-Riddle Scholarly Commons 2024 · Journal article (JAAER)
Low-Resource Automatic Speech Recognition Domain Adaptation – A Case-Study in Aviation Maintenance
With timeliness and efficiency being critical in the aviation maintenance industry, the need has been growing for smart technological solutions that optimize and streamline the different underlying ta…
- Embry-Riddle Scholarly Commons 2024 · Journal article (JAAER)
A New Trajectory in UAV Safety: Leveraging Reinforcement Learning for Distance Maintenance Under Wind Variations
In the field of aviation, safety is a critical cornerstone, and the operation of Unmanned Aerial Vehicle (UAV) systems is deeply connected with this principle.
Browse the full corpus — academia portal ↗