A lack of communication between crews and leaders contributed to a boat crash that killed an Eglin airman during a training exercise in Pensacola Bay last fall, according to an accident report released March 19.
Maj. Garrett Knowlan with the 96th Test Wing was killed Oct. 11 after he was hit by a boat participating in the training.
"Evidence suggested a misunderstanding of command and control responsibilities," the report said.
Knowlan had been in Pensacola for a three-day parachute water survival training course.
The 32-year-old flight test engineer recently had moved to Eglin from Hurlburt Field and was transitioning to fly F-15s and F-16s, which is why he was required to take the training course. The jets are equipped with ejection seats and frequently fly over water.
The Air Force contracts with Naval Air Station Pensacola for the training. Contracted crews from Metson Marine Services had been hired to operate six boats for the exercise.
For the exercise on Oct. 11 students were to be dropped from a parasail into the bay and inflate a one-man life raft.
Knowlan was the first student to begin the exercise, according to the report from the Air Force's Ground Accident Investigation Board.
He was towed off a launch platform on a parasail. After given the signal, he detached from the tow rope and used the parasail to float down into the water.
He successfully inflated his life raft and was debriefed by an instructor on a nearby pick-up boat.
The boat left him in the water.
Meanwhile, another boat picked up a student who had a knee injury and wasn't able to perform the parasail practice. He was directly dropped off in the water for the life-raft exercise.
Although leaders of the exercise discussed that morning that they were going to allow the student to participate in the lifeboat portion, they did not communicate to everyone involved in the exercise exactly how it was going to be coordinated, including where and when the student would be put in the water, the report said.
They also did not use the radio to make it clear to all boats involved after the student had been put in the water.
A second student had been launched on a parasail, and then a third boat went to launch a third student.
That boat's captain reported that he was unaware that the injured student had been put in the water, the report said. The captain misidentified the injured student as Knowlan.
The safety officer onboard noticed two students in the water, but did not communicate that to the captain or continue to monitor the students, according to the report. Instead, he monitored the parasail, which he felt was fundamental to his safety duties.
"His decision to disregard students ahead and look around did not incorporate other facts he also knew: that tow boats routinely pass very near students, that tow boat path can be unpredictable ... and that everyone else (on the boat) was already looking backward at the parasail," the report states.
At 11 a.m., about one minute after starting their tow, the crew felt the boat hit something in the water. They noticed Knowlan's helmet floating near the boat and realized what had happened.
A rescue swimmer found Knowlan lodged under the boat and reported that he appeared to be dead, according to the report.
He had suffered extensive injuries and died instantly, the report stated.
Investigators found no medical or environmental conditions that contributed significantly to the incident, and everyone involved had required training. Knowlan did nothing to contribute to the accident.
The report states that procedures did not require specific calls about the number of students in the water, and that the job of the safety observer lacks a standardized qualification process.
It was unknown late Tuesday whether any changes have been are will be implemented in response to the report.