In its final report released late last month, the NTSB concluded that a combination of flight crew and ATC deficiencies led to a controlled flight into terrain (CFIT) accident involving an air ambulance Learjet 35A near San Diego on Oct. 24, 2004. The captain, copilot and three medical crewmembers were killed in the 12:30 a.m. crash. The Board determined that the probable cause of the accident was the flight crew’s failure to follow recommended procedures for departing at night in VMC and ATC’s failure to “provide terrain clearance instructions to the flight crew and failure to advise the flight crew of minimum safe altitude warning alerts.” Contributing to the accident was the pilots’ fatigue. “At the time of the accident, the captain had been awake about 17.5 hours, and the copilot had been awake about 16 hours, and both pilots had accumulated about 11 hours duty time.”