Video: NTSB Issues Chilling Report on 2019 Collings Foundation B-17 Crash.

The docket for this major investigation, which we are still in the process of reviewing, includes thousands of pages and hundreds of photographs, videos and charts and graphs, among other materials. Sections of the docket that cover what the NTSB refers to as "survivability factors," and the report from the powerplant group, contained some alarming details.

The flight was being conducted under an exemption to the regulations as a Living History Flight Experience (LHFE), which allowed the Collings Foundation to fly paying passengers without meeting all of the requirements that govern revenue-generating flights. Such exemptions are quite common, and allow passengers to experience flight in aircraft, like the B-17, that were never intended for paying passengers.

The B-17 had taxied to Runway 6 at KBDL for the sightseeing flight with 10 passengers and 3 crewmembers aboard. After completing a run-up, it departed normally. Shortly thereafter, however, a crewmember reported a problem with the number-four engine (the one farthest from the pilot on the right) and turned back to the field.

Engine Findings

Much speculation about the crash has focused on the plane's engines, Curtiss-Wright R-1820 nine-cylinder radials, and the NTSB has focused a great of attention to them---the powerplant team's report alone is 132 pages long. Investigators found that the number-three "!engine's pistons and spark plugs showed evidence of detonation that would have resulted in a significant loss of engine power." Engine numbers three and four are both on the right (starboard) side of the plane.

Investigators also found problems with the number-four engine, the one the pilot reported a problem with, and which necessitated to the return to the field. "The examination of the No. 4 engine," the section's author wrote, "showed the P-lead to the left and right magnetos was separated from the magnetos' housings." It goes on to say, "The leads to each of the magnetos were secured with a single strand of safety wire that was loose. The lead to the left magneto was completely out of the housing allowing the grounding tab to contact the housing shorting it out."

The investigators checked its functionality and discovered that the faulty ground was likely the cause of the loss of power, writing, "When a piece of cardboard was placed between the grounding tab and the magneto case wall, all nine ignition leads sparked. The lead to the right magneto was partially engaged, so the grounding tab was not contacting the case. But the gap between the points was less than the required minimum and when the magneto was tested, the No. 8 cylinder's ignition leads did not spark at all and the sparks for the other eight cylinders' ignition leads were weak and intermittent."

The condition of the respective propellers seems to support what investigators found when they tore down the engines and accessories. They found that the condition and configuration of the propeller of engine number four was consistent with it having been in the feathered position, while the "!damage to the No. 3 propeller was consistent with the propeller being in the normal operating position." Much speculation has centered on whether the accident came after the loss of power in one or multiple engines.

Crash And Aftermath

After the pilot reported the problem to the tower, the B-17 entered a downwind to Runway 6, the same runway from which it had departed, but landed short of the runway and veered off to the right before crossing the infield and the parallel taxiway before entering a non-movement zone and hitting a deicing facility a couple of hundred yards away from the initial ground contact.

The plane burst into flames.

Seven were killed, and six survived. One of the more disturbing findings presented in the factual report was that several seat belts failed. One survivor reported that his seat belt failed and that he was thrown forward.

The plane was not outfitted with seats but, rather, floor seating positions with seat belts. Some of the seat belts failed when the plane crashed, and one was reported to have been missing a part on its fastener that a surviving passenger reported prevented him from fastening it.

An excerpt from the report paints a picture of desperation before, during and after the crash.

"During impact passenger LS5 reported his seatbelt failing, being thrown forward, striking his head on something. He reported that passenger LS6 ’flew past me' toward the front of the airplane. After the airplane stopped the passenger across from him was lying on the floor (no longer in his seatbelt). He attempted to drag him out of the airplane but could not move him. He then ’saw fire toward the front, just beyond the turret' and evacuated the airplane behind passenger RS5 who had opened the aft, right door. Passenger LS6 reported that he briefly lost consciousness and ’found [himself] lying at the front' of the waist gunners' area. It was extremely hot and he saw light to the rear of the airplane from the open door. He crawled to the door and jumped out of the airplane into fire and aviation fuel."

Though it wasn't required, 9-0-9 had a load master ("LM" in the report), who helped paying passengers find their seats and fasten their belts and make crew briefings to them.

"Prior to impact at the front of the airplane, the LM stated that he ’sat down right on the turret and I just held on. I was blacked out. Whenever I guess I woke up! I was not sitting on the turret anymore.' His leg was stuck on something and passenger RS1 helped him free it. He realized he could not evacuate through the tail because of the fire so he ’pushed the plexiglass out and I jumped. I don't even remember looking.' Passenger LS1 followed the LM out the window behind the pilot and passenger RS1 followed her. They all reported exiting onto a storage tank for de-icing fluid. Passenger RS1!reported fracturing his left foot while transitioning from the tank to the ground."

The NTSB's factual report doesn't attempt to draw any conclusions, merely to present the evidence it has gathered in its investigation. It's the data that the Board will use in issuing its final report at some point in the future, at which time it will most likely present statements of probable cause.