For Lori Chynn, the crash of Cougar Flight 491 is about the two small, titanium studs that sheared off as the helicopter flew to the Grand Banks oilfields on the morning of March 12, 2009.
Her husband, White Rose medic John Pelley, was among the 17 people who died when the helicopter crashed and sank into the North Atlantic.
Chynn describes the broken bolts as the root cause of the crash, and says inspecting and replacing them would have prevented the tragedy.
“That’s the part that’s so hard to hear — that this was preventable,” she said.
“I just feel that if the helicopter was not in the air this would not have happened.
“It shouldn’t have been in the air. The studs should have been replaced right away.”
Chynn has closely followed the Transportation Safety Board (TSB) investigation of the crash and took part in the helicopter safety inquiry led by commissioner Robert Wells.
“My husband was a very outspoken person and he stood up for what he believed in.
“So, I feel that each time something comes out he has to have a voice. That’s very important.”
More than a week ago, Chynn listened as TSB officials outlined their investigation report to the families of passengers killed in the crash.
They were briefed on its contents at a separate location before the report was released to the media. TSB officials stayed with the families for more than four hours, answering their questions.
Chynn said one thing missing from the briefing was an opportunity to hear the publicly released portion of communications between the Flight 491 pilots and Gander air traffic control.
“They provided a very good, safe place to come and go and ask questions. Why did they not provide the same opportunity with that?”
“Why weren’t we given the opportunity to hear this, if we wanted to?”
She would have preferred to hear what was released before it aired on television.
“I wasn’t expecting this to come on the news and when it did it really unnerved me,” she said. “It was an awful feeling to hear. It was very haunting.”
But it doesn’t change her mind about the cause of the crash.
“I believe the pilots did the best that they could. They wanted to come home to their families, too.”
The TSB said two of three titanium studs failed in flight, resulting in a complete loss of oil from the main gearbox that powers the helicopter.
Since the crash, Sikorsky S-92 helicopters use stronger steel studs, and six studs now secure the oil filter bowl to the main gearbox.
The TSB report outlined what it called a complex web of 16 factors that contributed to the crash. And agency officials said taking one or two of those factors out of the web might have prevented the crash.
Chynn sees it a little differently.
The detailed TSB report clarified many things, but she isn’t entirely satisfied with it. She doesn’t see all 16 contributing factors as equal.
“I just feel that there wasn’t enough emphasis put on the root cause … the studs,” she said. “That’s the cause of the accident.”
Chynn said the TSB report did help her understand the notion of a 30-minute run dry capability for helicopters — a test the Sikorsky S-92 failed during certification by the U.S. Federal Aviation Administration (FAA).
Dry run refers to how long a helicopter can continue to fly after losing all oil from its main gearbox.
U.S. regulations require 30 minutes of flying time unless failure of the oil lubricating system is shown to be “extremely remote” — as was the case with the S-92.
The TSB report recommended that aviation regulators — FAA, Transport Canada and the European Aviation Safety Agency — reconsider the way they certify helicopters.
It recommended the FAA remove the “extremely remote” provision from the 30-minute run dry rule.
The TSB also said 30 minutes may not be sufficient when flying long distances over water — recommending regulators review its adequacy.
Chynn believes the S-92 should be thoroughly evaluated to make sure it’s up to the job of safely transporting people to and from the province’s oilfields.
“Is this the right helicopter to be going over the North Atlantic?
“The bottom line here is, safety for offshore workers — the same as safety for any worker.
“We need to learn from this how to make our offshore workers safer — bottom line — at whatever cost.
“I don’t ever want any other family to have to go through this … the recommendations need to be followed through.
“Whatever has to be done has to be done.”