A jury at the Rescue 116 helicopter crash inquest has returned verdicts of accidental death for all four air crew – Capt Dara Fitzpatrick, Capt Mark Duffy and winch crew Paul Ormsby and Ciarán Smith.
As RTÉ news reports, the jury at the coroner’s court in Belmullet, Co Mayo, delivered verdicts on Thursday morning after considering evidence for over an hour and a half.
Evidence from a number of witnesses had been heard by coroner Dr Eleanor Fitzgerald at a resumed hearing on Wednesday, June 1st.
The inquest had opened in April 2018, a year after the crash in which all four air crew lost their lives when their Sikorsky S-92 crashed at Blackrock island, west of the Blacksod lighthouse refuelling point in north Mayo. It was adjourned pending completion of investigations by the Garda and Air Accident Investigation Unit (AAIU).
The bodies of the two winch crew have not been found.
The initial hearing had also heard that Capt Fitzpatrick died as a result of drowning, and Capt Duffy sustained fatal injuries as a result of the crash.
The decision by a Malin Coast Guard radio officer to task the Sligo based Rescue 118 helicopter, to evacuate an injured fisherman from the Scottish vessel Kings Cross 140 km west of Eagle Island, Co Mayo.
Crewman John James Strachan had severed his thumb when hauling nets on the night of March 13th 2017.
Mr Scott outlined how he had tried to secure top cover by the Air Corps and that he also "tried to get a Nimrod from the UK" but this was not available.
Rescue 116 was then asked to provide top cover and flew from Dublin. It was approaching Blacksod to refuel when it crashed at Blackrock island, west of Blacksod.
Mr Scott told the inquest that a doctor he had consulted did not object to his decision to take the injured crewman ashore.
He said he used his judgement, accrued over 42 years, and said “in my opinion the man needed off the vessel".
Mr Scott told the inquest he would make the same decision today.
Garda Supt Gary Walsh read a deposition from the captain of the Kings Cross fishing vessel, William Buchan, describing how crewman John James Strachan sustained a severed thumb when he was hauling in nets on the night of March 13th, 2017 when the vessel was 140 nautical miles west of Eagle Island.
Mr Buchan recalled hauling at about 9.15pm on March 13th, 2017 after five or six hours on blue whiting. Mr Strachan’s hand got caught, and he managed to get his hand ot of his glove but half of his thumb had been crushed and was inside the glove. He said they put the thumb top in the ship’s freezer.
Cork University emergency registrar Dr Mai Nguyen, who was consulted about the injury on the night of the call-out, told the inquest she felt the decision to task had been made before she was called. She described the injury as “minor”, and said she would not have sent the Irish Cost Guard as there was no hope of re-attaching the severed thumb and they were far from the coast.
A recording of calls between the Kings Cross vessel, Malin Coast Guard and Dr Nguyen confirmed this at the inquest.
After Dr Nguyen advised skipper, William Buchan on how to handle the casualty, she asked the radio officer if a “medevac” was being carried out and he said it was.
The inquest also heard that in the minutes before the Rescue 116 helicopter was due to land at Blacksod lighthouse helipad to refuel, visibility "dropped fast".
Lightkeeper Vincent Sweeney described how in the minutes before Rescue 116 was due to land to refuel, visibility "dropped fast", to the point that "you'd hardly see your arm in front of you".
There were 42 recommendations in the 350-page final AAIU report published last November - 19 applying to the air crew’s employer, CHC Ireland, which holds the Irish Coast Guard contract for four helicopter search and rescue bases.
The AAIU report found the “probable” cause of the crash was a combination of poor weather, the helicopter’s altitude and the crew being unaware of a 282 ft obstacle – as in Blackrock island – on a pre-programmed route guide to Blacksod.
Series of recommendations
The jury made a series of recommendations at the resumed inquest.
The jury foreman called for “definitive medical criteria informing any decision to dispatch an emergency helicopter.”
“There should be no ambiguity as to who the decision-maker is.
“There should be reliable top cover available at all times ideally not using another SARs aircraft. Based on clear evidence, errors in mapping and navigation aids contributed significantly to this accident,”he said.
“There needs to be cohesive oversight in relation to the various bodies and agencies who bear collective responsibility for the provision of these services,” he said.
“In making this statement, we wish to acknowledge the painstaking work undertaken by An Garda Síochána, the Air Accident Investigation Unit, the judicial and the many other agencies,”he said.
“We further wish to acknowledge the strength of those individuals who gave evidence and to the families and friends of the victims who have, for these past five years, been forced to relieve these harrowing experiences for the purposes of seeking the truth of these events,”he said.
“The burden of responsibility we collectively feel as a jury towards those who continue to operate on the front line of the rescue services, their families and to those lost in service cannot be overstated,” he said.
“We wish to take this opportunity to acknowledge the heroic efforts of the rescue services in the protection of the public on a daily basis,”he said.
“We offer our sincere sympathies to the family and loved ones of Dara Fitzpatrick, Mark Duffy, Paul Ormsby and Ciaran Smith,” he said.
“Ar dheis Dé go raibh a h-anam dilís.”
Coroner Dr Eleanor Fitzgerald thanked the jury for their service and diligence and said “this tragic accident and the loss of four people occurred from a multiplicity of factors and in normal conditions, this accident would not have happened”.
“But in their line of duty, is there such a thing as normal? In undertaking search-and-rescue missions there is always some risk involved,”she said.
“However, in this particular tragedy there were a few contributing factors,” Dr Fitzgerald.
Dr Fitzgerald described the conditions that night as “treacherous”.
Barrister Derek Ryan, representing Ciaran Smith’s widow Martina, their children Caitlin, Shannon and Finlay, his parents Michael and Teresa and his brother and sister,thanked the coroner, the jury and the Garda for their work.
“A very difficult matter has been dealt with efficiently and very sensitively by everyone involved and for that, thank you,” Mr Ryan said.
He paid tribute to the witnesses who gave “sometimes very difficult statements to this coroners court”.
“Ciaran’s family wish to thank all those involved in the original searches back in 2017, An Garda Síochána, the RNLI, the Coast Guard, Ciaran’s friends and colleagues, the military services, local boat owners and local fisherman.”
Mr Ryan also extended the Smith family’s thanks to the local people of the Belmullet area “who extended such kindness to Ciaran’s family at a very difficult time”.
Capt Dara Fitzpatrick’s father, John Fitzpatrick, concurred with the comments of the Smith family.
Read the RTÉ News report here