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PRESS RELEASE: 30 MAY 2024 – FINAL REPORT ON RMN HELICOPTER CRASH AT LUMUT BASE

The Royal Malaysian Navy (RMN) issues the following statement:

  1. A Board of Inquiry was established on the day of the incident, comprising nine RMN officers with aviation and aeronautical engineering expertise, and involved assistance from the Air Force Headquarters – Directorate General Technical Airworthiness (DGTA) and Malaysian Armed Forces medical doctors.
  2. This Final Report follows the Preliminary Report released on May 9. Based on the Preliminary Report, the following were identified:
    a. All aircrew involved were confirmed to be in good health and fit to fly. Their flight qualifications were valid and not expired.
    b. Both helicopters, the Maritime Operation Helicopter (MOH) AW139 and the AS 555 SN Fennec, were confirmed to be airworthy on the day of the incident.
    c. Maintenance of both helicopters was carried out according to procedures and routines set by the Original Equipment Manufacturer (OEM).
    d. Weather conditions on the day were favorable for flight.
    e. The AW139 was equipped with a black box, while the 21-year-old Fennec, built in 2003, was not. Data from the AW139’s black box was received from the OEM on May 3 for further evaluation.
    f. Expertise and views from OEMs, Leonardo Helicopter, and Airbus Helicopter were sought to complete the investigation, including a full analysis of the AW139’s black box recordings.
    g. The Board of Inquiry investigated the factors contributing to the incident, including:
    (1) Re-analysis of the flight profile on the incident day using flight simulators and actual aircraft.
    (2) Consultation with Airbus Helicopter for any available data from the Fennec to aid the investigation.
  3. After a comprehensive investigation, the Board of Inquiry found the following:
    a. Autopsy reports confirmed no issues of hypoglycemia or fatigue among the aircrew, no use of illegal substances, and no recorded or identified mental illnesses. All aircrew were medically certified as fit to fly.
    b. The deaths of the 10 victims were caused by multiple injuries due to the aviation crash.
    c. The AW139 did not experience any technical issues according to the Black Box Analysis Report. The Fennec was also confirmed free of technical problems based on visual and audio analysis and documentation. Maintenance was performed according to OEM procedures.
    d. Oil, lubricant, and fuel samples were tested and confirmed normal by the Defence Science and Technology Research Institute (STRIDE).
    e. Weather conditions were suitable for flight on the incident day.
    f. The Black Box Analysis Report for the AW139 was used to assist the investigation. For the Fennec, flight profile proof was obtained through flight simulation using actual aircraft.
    g. Expertise from Leonardo Helicopter and Airbus Helicopter was sought to assist the investigation. Airbus Helicopter confirmed that the Fennec lacked Non-Volatile Memory (NVM) equipment to aid the investigation.
  4. The Board of Inquiry concluded the following as causes of the accident:
    a. Primary Factor: The Fennec was not at the prescribed altitude and heading, entering the path of the AW139.
    b. Secondary Factor: The AW139 crew’s channelized attention on course change limited their evasive response.
  5. This Final Report aligns with the previously released Preliminary Report and will be sent to the State Airworthiness Authority (SAA) for record.
  6. The RMN also shared ongoing efforts to support the welfare of the crash victims’ families, receiving attention from the Malaysian Armed Forces (ATM).
  7. Religious ceremonies and psychological assistance through counselors have been provided, and compensation payments from the Group Takaful Scheme, contributions from the National Warrior Trust Fund, and other donations have been distributed to eligible heirs. Pension and monthly service benefits for eligible beneficiaries have also commenced. Additional donations will be distributed as processes are completed.
  8. The RMN welcomes contributions to the Lumut Tragedy Fund 24 established by the ATM. This fund remains open, and proceeds will be distributed to the victims’ families. These efforts aim to ease the burdens faced by the victims’ families.
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