These are NTSB accident identification
numbers. A new one is generated roughly 1,500 times a year, about four times a day. In the vast
majority the consequences are relatively mild and aircraft is damaged there maybe
injuries the situation is regrettable but people
get on with their lives sometimes the price is much higher. We
hear about such accidents from time to time but unless there's a personal
connection they tend to be just another data point in our daily lives, just part
of the news for the people directly involved though that one terrible day echoes down through the years and
represents a profound break in their lives in January 2011 Rust Jeter join their ranks he agreed to speak with the Air Safety
Institute about his experience and provided funding for this project in
hopes of both helping pilots avoid the error he made and reminding them how
much is really at stake when they get behind the controls of an aircraft this
is his story Russ and his family live here in the
Pacific Northwest about 70 miles north of Seattle, This is seaplane country and
recreational opportunities abound for those who enjoy the great outdoors. My name is Russ Jeter and I'm my real
estate developer investor at this point in my life I was a building contractor
for many years and that's when I took up flying and so slightly over 25 years of
flying and somewhere in the low 4,000 hours of anything from the Cherokee 182
a floatplane to a jet. Russ is the father of two grown children and he and his
wife Kimberly also a pilot have two younger boys Jacob and Jonah. Jacob who
was with the during the accident will be eight next week, and Jonah turn six in
January. When Jacob was born he was 21 days old when he first went flying with Kimberly and I and he and his younger brother Jonah didn't know anything else flying was as part of what the family
did. By the age of six Jacob had begun to
show a strong interest in outdoor activities including aviation. From an
early age he was just a robust healthy smiling happy little guy in 2010, July of 2010, Jacob and I flew a 206 that had the g1000 panel headed over to
Idaho. And it was just him and I, nicely he was setting in the copilot's seat and on the
g1000 you could see the icon for the plane and in our path and so I said you
want to fly for a little bit you just keep the airplane icon on the path and I
thought five or ten minutes will be bored with this and and want me to
switch on the autopilot but i just thought to myself mark to myself that it
was an hour before he was ready to relinquish the control so he had started
to develop an interest and that was the reason that the morning of the accident
you went flying with me January 22, 2011 dawned
clear and calm over northwestern Washington State Russ and two fellow
seaplane pilots, Adam Jones and Steve Rebarnsey had agreed to go flying is a
group that morning. Russ would be in his 1999 Cessna 206 which had been fitted
with amphibious floats and converted to turban power. We didn't get moving as
quickly as i would have liked to I was a little groggy it didn't seem like I was
waking up as quick as I usually do and I think my my fellow pilots were removing
equally slow squeak we lollygag before taking off. One of my friends had his
airplane park near mine and so we went off flying
and splashed a few places and then we met the third pilot with his plane
over Arlington that was three pilots and a daughter and a wife and my son
that were accompanying us and we had lunch to discuss what was going on the
pilots agreed to do one more landing together on nearby Lake Goodwin. After
that Russ and Jacob would split off from the group and head home. We took off from Arlington and no
particular sequence I just ended up taxiing out last behind the other two
guys. Jacob was sitting in the copilot's seat
and so right after we departed he said can I fly in / let him fly a little bit
we got closer to Lake Goodwin he said can I land and said well no you can't
land but you can watch what I do and just follow along and then just pay
attention. The lake was not quite glassy but fairly
close to being glasses so I set up and stabilized approach with a very low
descent rate and as I got close to the water which is not completely obvious in
the almost glassy water. Situation I felt a little teeny bump, almost like I was
landing a little nose down instead of nose up. In a retrospect, I think that was
the rear main gear contact in the water and causing a little resistance so it
may be kind of dip a little forward and just about the time I was going to
advance the throttle, the front gear settled down enough to catch the water
and then that sucked the front end down. And before I even had a nanosecond to
think about it the front-end sunk in the plane flipped and Jacob... the only thing that I recall and it's
one of those things that did I recall it, or was in my head. Scream DAD! The next thing i know is
the plane flipped over and I can remember seeing the windshield implode
the pilots of the two other aircraft had already taken off and we're departing
the area when they saw something disturbing on the lake below I remember looking down and that's hard
for me to talk about so I decide and I look down saw a float plane that was upside down saw the wheel sticking out the bottom of the float I knew instantly and so I told my,
told, l told my little girl that that's Russ. And so my head is underwater
and I gasping and I don't know why but I'm it's the gasping reflex when you hit
with cold water. So, I'm sucking in cold water instead of holding my breath. I couldn't see and so I kind of calmly thought to myself well this is how it ends I'm trapped upside-down inverted I'm drowning I'm sucking water in and in
one more breath of water I'll pass out and then I thought oh my god, Kimberly
losing both of those and at that point is clear as everything is to that point
nothing I don't know what happened The next thing I know I feel my legs the
shins which were scraped exiting the window on the 206 which levers up so
somehow or another from inverted and seat-belted in drowning I've got 225 or 30 pounds of me and a
wall shirt and a safety vest. Upside down and through the window, which the
hinge broke, skin my legs and its first thing I recall is this grating of my
legs when I'm on the surface By this time several fishermen had made their
way to the submerged aircraft followed close behind by Russ' fellow pilots.
Russ was ah, had water coming out of my mouth, was a coughing gagging,
he was in tough shape basically. The fishermen hollered at me, and they were going what? I said there's a little boy in the plane you have a little boy. So at some point the fishermen were able
to drag me over the side of the boat because at that point I was so
hypothermic I I couldn't do much of anything I'd tried to take my jacket off
because i couldn't dive down because I've blown up like the the Goodyear
blimp because i was going to try to dive back down but I couldn't even get my
jacket off. It was just me and another guy that were
able to to dive down it seemed like some of the other guys are trying. They were
working up on top with a coldness of the water that's what people don't
understand. Which is semi like in a state of shock you're not you know
you're not firing on all eight-cylinders yet great visibility great light going
down but when you you went through that window started looking through the
window and went through the window it was absolutely pitch black in the cabin. From the moment I hit the water I could feel it just basically debilitating me. First attempt was unable to get the door open enough or the window open enough to get in. Second time I was able to get in but I wasn't able to get the seat belt off. A simple chore that anybody would think would be very easy. All of us were in fairly good shape, if not good shape. We could not get the job
done. Their rescue efforts having failed. The men tried towing the aircraft ashore, but the submerge tail and propeller hung up on the bottom of the lake holding the cabin underwater By this time, I think I was panicking somebody at some point
said the sheriff divers getting in the water. He appeared very shortly and had
my son under his arm told him to shore. Jacob had been in the 38 degree water
for more than half an hour Russ watched in shock as paramedics
began resuscitation efforts praying that the coldness of the water might allow his son to be revived even after the prolonged immersion. He rode along in the ambulance as Jacob was rushed to the hospital So one of the other pilots had
gotten home and got to her house and told her there's been an accident
that we were both at the hospital and so she was en-route with the lady driving
her to the hospital when she got through to me in the emergency room. And I told her to pray. That Jacob had
twelve people working on him and all we can do is pray. Some point before she got to the hospital the senior ER doc came over to me and he said why one more call
to make and we have a couple of
the things we want to try but there's not been any response Eventually the doctors had exhausted
their options shortly thereafter Russ' wife
Kimberly arrived at the hospital. And to this day, I don't know how? The first thing she said was I'm glad you are alive. With superhuman grace and understanding my wife gave me, with our son lying there dead. I still don't know to this day how, how she did that. Alongside his crippling grief over the loss of his son in the days and weeks following the
accident Russ was haunted by the question of how
he could have made such a simple yet consequential mistake. Since I was flying straight leg in 182, and flying retractable amphibious float plane, and flying a retractable jet. I had made it a practice, regardless of how maybe seemingly embarrassing it was that i did a gear undercarriage
mixture propped check on everything. The 182 that never had a gear
retraction in its life, I always did that check. There was no question what had happened. What Russ wanted to know was why, on that day, he became so distracted that he failed to perform what had become a
nearly automatic task. His search for answers let him to elite spectrum consulting which focuses on human factors and challenging high-risk
environments Human factors refers to those physical and psychological factors that can impact worker performance. He was in a state of distress and trying
to better understand what had happened to him. He was given an opportunity to
take our human readiness audit. It identifies these areas that may be
unknown to the individual that could impact their performance. Russ took the assessment responding to the questions as he would have prior to the accident. In doing so, one specific event stood out In March of 2010 just about the time of my mom's 83rd birthday. She was diagnosed with ovarian cancer. In December of 2010, Russ and his family spent Christmas with his mother and it became apparent that our struggle was nearing an end. In early January with her condition worsening rapidly, Russ plan to visit her one last time, but events conspired to prevent the trip. And unfortunately the trip I didn't make
resulted in me watching my mom died on the web cams on the afternoon of January 9th. He had lost his mother, I think it was 12 days prior to the event, and of course when one is dealing with life stressors they impact a number of things We become preoccupied. Our sleep becomes fitful and disturbed and it's well known in the literature that it even when one has restricted sleep, that
it impacts their ability to attend and focus and to be able to perform
optimally So between the ninth and about the 20th the January it's pretty hazy. A lot of sleep deprivation, a lot of agony over losing my mom, a lot of grief. Looking back, Russ came to believe that the emotional turmoil and lack of sleep in the days prior to his accident had become a significant impairment Not to his physical flying of the aircraft, but to his ability to maintain focus while interacting with his son If the annunciator went on that said gear down for runway landing, I either didn't hear it was oblivious to
it. The truth of the matter is I didn't look at my flywire. I didn't notice my
lights and I didn't maintain a sterile cockpit I was chatting with my son I hadn't really thought about the death of my my mother less than two weeks before
impairing me, but once I started talking to psychologists, once I started
realizing that I'd sent out my mother's obituary the morning of the accident, once i started thinking about the sleepless nights I realized that I was
unaware that of my impairment. When people are asked to engage in routine events they typically can do that without much decremented their performance. However, it's when events go awry and something novel occurs or
something out of the ordinary that's when the system tends to break
down The distinction between routine and non-routine flight environments was
emphasized by the fact that Russ had gone flying by himself in the 206 the day before the accident. It was the first time he'd flown the aircraft in several weeks It's time to have the accident would have been the day before by myself and hadn't flown and hadn't, you know, felt confident or whatever I mean I just had
I hadn't flown in a while. Instead doesn't give me a higher sense of
confidence that hey, I'm back in the groove things you're good the weather is nice, let's go fly Of course, as the thousands of pilots who
made inadvertent gear-up landing is can attest one need not be significantly
impaired to make the simple mistake of forgetting to flip a switch. All the same
circumstantial evidence and common sense suggests that factors like those that
affected Russ Jeter play a significant and often unacknowledged
role in many aircraft accidents. Educating people about the importance of
their physical health, their psychological health, their nutrition
status, their sleep status these are all critical. I think for the most part people have not recognized that or ignore those factors and it's
only when you've been faced with a disaster circumstance or crisis moment
that you appreciate how important those things can be. It almost mandates a
heightened sense of awareness in our training as pilots that we need to have
a more sensitive and introspective look at our psychological makeup before
flying Have I been sleeping well, am I thinking clearly. and I don't think a lot of people, maybe men are as sensitive to that self analysis. Of course it's one thing to note that increased self-awareness could help make pilot
safer but quite another to devise a workable means toward that end. Was I feeling a little bit less with it, but you know when in the aftermath of the
death of your mother, you expect to feel a little shitty anyway.
So, where do you where to you draw the line. It's very difficult for a person to
objectively assess their own ability. We can ask someone who's let's say of an
individual who typically will sleep seven to eight hours and for whatever
reason they have four hours of sleep and if we were to ask that individual how do you feel cognitively? Do you think you're operating at your best? They may and very likely would say I
think I'm doing fine, but in fact when we run people through any sort of laboratory study we find that that's not in fact the case.
In fact there's a considerable literature that says that if you restrict someone to 4 hours of sleep and give them a series of cognitive tests to take they perform as does an individual that
has had five beers. To help provide a reference point for self-assessment, the FAA and others have relied on devices like the I.M.S.A.F.E. model which asks
pilots to take inventory of their physical and psychological states prior
to flying In general, pneumonic such as I.M.S.A.F.E. are very valuable and they're important components of creating a culture of safety. Having said that there are also
limitations. The limitation of concern is that whenever one uses a self appraisal
tool we tend to ignore some of those areas that may be problematic. I think pilots tend to be more confident than the average person. I'd like to reach those people that have
confidence and it's never going to happen to me and have them say well just
make sure it doesn't because it's no where, no where you want to go Yeah I sought counseling immediately
after the accident because I had never faced anything like this in my, my, you
know, my life. It was very hard for me not to dwell on particulars of the accident
or what if this or what if that the fact that I made a mistake you know resulted in a situation of not only having the sadness and grief of losing my son, but
the guilt. One of the things Russ found most troubling was his escape from the submerged cockpit and the fear that the memory loss surrounding the event was somehow tied to a conscious decision to abandon his son. The initial response to cold water immersion results in an inspiratory gasp hyperventilation, there is tachycardia or racing heart and there's vasoconstriction particularly in the peripheral limbs and that of course would immobilize one's ability to
manipulate very readily. I was losing control my arms and remember that I remember getting caught steps and banging up to the steps and actually end up through a step and was trying to get, you know, back outside the float but I
could no longer even get my arms above my shoulders anymore i mean it was just
banging around that your arms, your arms just weren't working The body is trying to regulate as quickly as possible and blood is drawn away from the brain
during this period of vasoconstriction and of course that will impact one's
ability to think clearly and think in the most attentive way. I've ridden in 206 several times, I could remember for the life of me how the seatbelt latched up and, and what the, what the door handle configuration was and I remember everyone's eyes just glossing over and like saying you know anyone have any
ideas and in looking at everybody everyone's just shutting down. And so that help piece together some of the things that really were making me feel guilty about me surviving and Jacob dying. A lot of people have reached out and there's various things they say that really kind of mean the same thing. It's God's will, it's an accident. No one blames you. It's, it's the state of the humaness, of us And I'm trying to wrap my arms around
that. But it's not an easy thing to do and i'm seeking my own forgiveness. Of course Jacobs death had repercussions that went far beyond his father's personal grief. It's been extraordinarily tough on my wife
She doted on him and conversely he doted on her. They had a a beautiful relationship. He was swimming on the local swim team of which my wife is is a big-time athlete and swimmer and so he was becoming her mini-me in the swimming pool. Part of the thing the aftermath of the tragedy is people want to do something and so a lot of people donated to Jacobs' school and so that money is gone to library books and then in our local community here there's several thousand acres of community
forest lands and not all of that is preserved and the single largest chunk
of land that was left with 75 acres and so friends and family and even some
relative strangers have chipped in and preserve that 75 acres in perpetuity and Jacobs honor. And so up on the highest mountain overlooking the forest lands in
our community, we've put a bench and a plaque that acknowledges that
contribution and Jacob's name. We recently got a letter from the organ
transplant people informing us that a girl with bone cancer had part of
Jacob's femur. It's the best of news and it is the worst news It's really good news is that we can help somebody, but you think of what's involved in being able to be in the position to help her is a very high price to pay. Following an event like this, many pilots would be reluctant to ever fly again. Russ was apprehensive about returning to
the cockpit, but ultimately for him, the decision hinged on what good would
come of such a sacrifice and what would best honor his son's memory. I've always loved flying. It's been a passion, I go to the conventions, I read the magazines I mean, I love flying and I chose not to fly for five months after the accident. And I was just may be terrified of what I might see, what I might imagine, but a funny after five months, I needed to take some recurrency to take an FAA check ride or give my
pilot's license up. and I'd spent too many hours and too much work to get my instrument rating, to get my commercial rating, to get my twin engine rating, to
get my ATP rating to just give that up and so I had to go and I went and took
some training, did some flying, and I left the airport and I thought my son would be proud of me I didn't give up our honor his memory I did something that he and I love doing
together and I could feel the sense that my son would have been proud of me for
getting back in the airplane. More than a hundred years ago, Wilbur Wright the second person ever to fly a powered aircraft said that someone seeking perfect safety and flying would be best off to sit on the fence and watch the birds Generations of pilots have understood his meaning while also doing everything possible to make it safe to
get off the fence and into the air. The ability and freedom to fly is a
great gift but one that sometimes comes at great cost. As pilots, we want to share
our passion and focus on the positive which is as it should be but we also do
ourselves no favors if we deceive ourselves about what's ultimately at stake and the burden that falls on our shoulders when we take others into the air. By no stretch of the imagination are we healed and we may never we never may
never be healed. When we're in a good place we seek to honor his memory so what I like to do and the reason I'm doing this safety video is what would Jacob want and he would want for us to try to prevent this sort of accident for us to help others and learn something from the terribly high price that he had to pay yeah
He got back up. His son WOULD be proud of him. Also I'm so glad they included that and the Wilbur Wright phrase.
Anything on this site that can bring more attention to safety and checklists and reducing/eliminating the room for error/failure is a good thing.
As a father of 5 young kids - you can probably imagine how many times I get people telling me "please be careful", and "don't you worry?".
But I tell them that while I am careful and I do worry - I am in the business of creating adventure and memories for my family, and there will always be some risk in getting off the couch and having an adventure.
That was heart wrenching to watch, but contained a fantastic human factors study.
Almost all of the big mistakes I've made flying can be traced back to fatigue. I'm convinced that IMSAFE is the single most important part of preflight. Most aircraft systems are redundant in some way. There's no backup for me in the single pilot world.
I cried. Also, time to make my own checklist. Realised I've been missing explicitly going through IMSAFE last few flights, which is rash.
He goes to various airports and gives a presentation on crash survival (and of course on his own crash). Highly recommended, definitely go see him if he's at your area. Really powerful, even better than the video.
This one broke my heart.
This is extremely timely for me. Will watch it tonight, thanks