Deceased
Andrew Alan Thomas Wilson
Demographics
27y, male
Coroner
Decision ofDeputy State Coroner MacMahon
Date of death
2010-06-15
Finding date
2015-08-14
Cause of death
Effects of fire and inhalation of products of combustion sustained when the aircraft he was piloting suffered engine failure and impacted with the ground and became engulfed in flames
AI-generated summary
A 27-year-old pilot died when the aircraft he was piloting experienced engine failure during cruise, resulting in impact with the ground and fire. The death was caused by effects of fire and inhalation of combustion products. The coroner identified that guidance material for multi-engine aeroplane operations and engine failure procedures (CAAP 5.23) was incomplete at the time. Key clinical lesson: although this is an aviation case rather than a healthcare matter, the underlying principle mirrors clinical practice—clear, finalised guidance protocols for managing critical emergencies (engine failure equivalent to clinical decompensation) must be completed, accessible, and universally applied. System-level failures in regulatory guidance and inability to compel witness testimony hampered investigation.
AI-generated summary — refer to original finding for legal purposes. Report an inaccuracy.
Error types
CORONER’S COURT Andrew Alan Thomas WILSON Inquest: 14 August 2015 Hearing dates: 14 August 2015 Date of findings: Coroner’s Court, Glebe NSW 2037 Place of findings: Paul MacMahon Findings of: Deputy State Coroner CORONIAL LAW – Death following aircraft engine failure, Catchwords: Section 81(1) Findings, Engagement of families of deceased with Regulator, Recommendations made in accordance with Section 82.
2010/436074 File number: Mr J Gormley SC – Counsel Assisting Representation: Mr J Rule – Civil Aviation Safety Authority (CASA)
Non-publication order made pursuant to Section 74(1) (b) Coroners Act 2009: Nil Findings made in accordance with Section 81(1) Coroners Act 2009: Andrew Alan Thomas WILSON (Born 21 February 1983) died on 15 June 2010 on Canley Vale Road, Canley Vale in the State of New South Wales. The cause of his death was the effects of fire and inhalation of the products of combustion which he sustained when the aircraft that he was piloting suffered engine failure and as a result impacted with the ground and became engulfed in flames.
Recommendations made in accordance with Section 82 (1) Coroners Act 2009: To: The Chief Executive Officer – Civil Aviation Safety Authority (CASA)
That CASA finalise the guidance material for CAAP 5.23 such that the guidance material is completed and released as soon as possible noting that the guidance material in question provides for multi-engine aeroplane operations and training to support the flight standard in Appendix A of s.1.2 of the CAAP relating to engine failure in the cruise;
That CASA undertake public consultations in order to assist CASA in the development of a legislative proposal enabling CASA to compel the attendance of persons at compulsory sworn interviews to answer questions concerning specific aviation and safety measures where a reasonable suspicion exists that; a. a significant safety risk exists or existed in an aviation operation; and b. evidence of a witness or witnesses likely to have knowledge of an aviation safety risk cannot be obtained in any other way.
Paul MacMahon Deputy State Coroner 14 August 2015
Gregory Merriman, a 58-year-old Aboriginal man, died from acute myocardial infarction caused by advanced ischaemic heart disease while in custody at Metropolitan Reception and Remand Centre on 27 December 2022. He experi…
This inquest examined multiple deaths occurring during an active armed offender incident at Westfield Bondi Junction on 13 April 2024. The deceased perpetrator had a documented history of treatment-resistant schizophreni…
On 13 April 2024, a mass stabbing incident at Westfield Bondi Junction resulted in six deaths and multiple injuries. The coronial investigation examined security response, identifying critical systemic failures: the CCTV…
Source and disclaimer
This page reproduces or summarises information from publicly available findings published by Australian coroners' courts. Coronial is an independent educational resource and is not affiliated with, endorsed by, or acting on behalf of any coronial court or government body.
Content may be incomplete, reformatted, or summarised. Some material may have been redacted or restricted by court order or privacy requirements. Always refer to the original court publication for the authoritative record.
Copyright in original materials remains with the relevant government jurisdiction. AI-generated summaries are for educational purposes only and must not be treated as legal documents. Report an inaccuracy.