BACKGROUND: Accidents during start-up and shut-down procedures of aircraft can lead to fatalities or destroyed aircraft. Start-up procedures for propeller aircraft include the possibility of hand-propping, which may increase the occurrence of injuries from propeller strikes.METHODS: A set of 142 accidents from a 10-yr period were selected from the U.S. National Transportation Safety Board online database. Only fixed-wing aircraft in the "standing" phase of flight were included in the dataset. The significance of differences was determined using Pearson's Chi-squared analysis.RESULTS: The severity of the injuries sustained in the accidents were inversely related to the amount of damage to the aircraft. Hand-propping without properly securing the aircraft was more likely to result in substantial damage to the aircraft. Pilots with less than a thousand hours of flight experience were significantly more likely to use an incorrect hand-propping procedure.CONCLUSIONS: It is recommended to make the advisory on hand-propping a regulatory article of the Federal Aviation Administration so that pilots' knowledge of this procedure is mandatory and part of their initial training, especially securing the aircraft during hand-propping. Highlighting throttle positions in both regular and hand-propping procedures may optimize checklist design and further mitigate accidents during start-up procedures.de Voogt AJ, Kalagher H, Burns S. General aviation accidents involving fixed-wing aircraft on the ground. Aerosp Med Hum Perform. 2022; 93(7):597-600.