On August 27 last year a Cessna 421C on a medevac flight crashed on initial climb out of Las Cruces, N.M., killing the pilot, two medical workers and the patient. Less than six months later, that sequence was repeated when a Piper PA-46 Malibu went down just after takeoff from Felts Field Airport in Spokane, Wash., killing the lone occupant. In both accidents, piston-powered aircraft had been mistakenly fueled with jet-A instead of avgas before departure, according to the NTSB, which has not yet issued its final report on either crash.
Misfueling is the delivery of the wrong type, grade or quantity of fuel, or distributing it in the aircraft in a way the pilot is not expecting, and in its Safety 1st Professional Line Service Training program, the National Air Transportation Association (NATA) says it repeatedly highlights the dangers of misfueling aircraft. The online course emphasizes the need for line technicians to continually verify the correct fuel before beginning to pump it, yet the 421 and Malibu accidents have prompted the association to spotlight what remains a persistent danger. “How many misfuelings were caught by the line tech, or by the line supervisor or by the guy who was running up his engine and it started to run rough?” asked Michael France, NATA’s director of safety and training, adding that only the most disastrous cases are reported. “It happens more frequently than we know, and that’s the message that we have to get across to business owners, to understand there’s a lot of risk here.”
Check and Check Again
As it prepares a new misfueling awareness campaign, NATA is urging the industry to adopt EI 1597, a set of recommended overwing fueling protocols established by the London-based Energy Institute. As described at NATA’s recent Advanced Line Service Regional Workshop at Teterboro Airport, the current guidance centers around three areas: fuel orders, selective nozzles and procedures.
To be considered valid, fuel orders–whether taken over the radio by a CSR or delivered by the pilot–must include, each and every time, the fuel type, grade, quantity, how it is to be distributed and the N-number of the aircraft. According to NATA, gone are the days when a pilot’s casual “Give me 25 a side” would be considered adequate. While seasoned line service workers can identify most types of aircraft by sight, NATA is calling for an end to such guesswork and asking refuelers instead to rely on registration number rather than aircraft model, especially in cases where similar looking airframes have different fuel needs.
Once a complete fuel order is received, the line technician will verify it is correct by matching the wing fueling decal with the fuel decal on the truck before refueling. Absence of a wing fuel decal will demand a pause in the procedure. “If the refueler goes to verify and there’s no wing decal, this is now a nonstandard situation and it’s going to require a written and signed form from the pilot,” said France, who noted that many FBOs have adopted similar policies. “[The pilot] is going to have to go into the lobby or the fuel desk and put in their tail number and the type of fuel they want: then [the line service technician] has to get a copy of it, otherwise fueling doesn’t happen.”
While the nozzles that dispense different types of fuel are shaped specifically to prevent insertion into the wrong filler apertures (in most cases, aside from some engine conversions), there are situations where a “duckbill” jet-A spout must be swapped for a “round” one to accommodate a specific aircraft. Under the guidelines, if the nozzle for what is believed to be the correct fuel doesn’t fit the aircraft, it will also trigger a nonstandard fueling situation and require a pilot-signed form before the line technician can swap the nozzle and proceed. Once the fueling operation is completed, the nozzle will immediately be switched back to the original (a process that takes less than a minute). It will remain in place at all other times.
While these policies might lengthen the fueling process in some instances, the risk reduction is worth it, according to France. “Refueling is a process that involves a lot of different people,” he said. “It involves the line service professional, customer service and the pilot. The solution to this problem goes beyond just making sure the line techs verify and don’t assume.”