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A near-collision last year at the Ottawa airport between a landing Federal Express plane and a departing helicopter is part of a dangerous and persistent problem with runway incursions, the Transportation Safety Board says.
In its report on the June 2014 incident, released Wednesday, the Transportation Safety Board of Canada (TSB) said the number of runway incursions has remained “too high” in the five years since it first warned that the problem posed a major risk.
The federal agency said there were 346 runway incursion incidents in 2010, 454 in 2011, 429 in 2012, and 381 in 2013.
“They continue to occur more than once a day,” the investigation report said. “The board remains concerned that the incursions and the risk of collisions will continue until better defences are put in place.”
More than five million takeoffs and landings occur each year at Canadian airports, which means that runway incursions are relatively rare. But as the TSB report notes, “their consequences can be catastrophic.”
The deadliest aviation accident in history was the product of just such a mistake: 583 people died at a Canary Islands airport in March 1977 when a departing Boeing 747 hit a passenger plane still on the fogbound runway.
The TSB report released Wednesday presents the findings of the agency’s investigation into an incident that occurred on June 5, 2014, at Ottawa International Airport.
At 8:45 a.m., an Ornge air ambulance, with the call sign C-GYNM, was told by the airport control tower that it could taxi from its hangar toward Runway 25 on an adjoining strip of pavement, known as Taxiway Echo. The medevac helicopter, with two flight crew and two paramedics aboard, was headed to Pembroke for a patient transfer.
Three minutes later, the helicopter arrived at the taxiway’s “hold short line,” a safe distance back from the runway, where aircraft are supposed to stop and wait for further instructions.
The helicopter’s co-pilot contacted the control tower when the aircraft reached the line. The controller then told the helicopter crew to amend its assigned departure heading “while we wait.”
The pilot thought he had been told to “line up and wait,” which is the standard instruction given by controllers when they want an aircraft to enter the runway and prepare for takeoff. The co-pilot asked the air traffic controller to repeat the message as the pilot taxied toward the runway.
Fortunately, the controller saw what was happening and ordered the air ambulance to stop in its tracks just as a Federal Express Airbus was on its final approach to Runway 25. The helicopter halted just short of the runway, allowing the plane to land safely.
The helicopter was so close to the runway, however, that the Federal Express pilot was unsure if he had the space to squeeze by it and onto a taxiway. The airport controller asked the helicopter to back up and make room for the plane.
The air ambulance later took off for Pembroke.
The Transportation Safety Board investigated the unusual incident because of its ongoing concern about runway incursions.
Safety board investigators analyzed the cockpit voice recorder and conducted interviews with those involved. Their final report suggests that both the controller and the pilot made mistakes.
The air traffic controller, the board said, used an unusual phrase, “while we wait,” to instruct the helicopter crew to hold short of the runway. “If air traffic control uses non-standard phraseology, there is a risk of inconsistencies and miscommunication between air traffic control and the pilot,” the report concluded.
What’s more, the safety board said, the pilot likely became distracted after receiving a new heading for his flight, which meant that he didn’t check to see if the runway was clear before moving toward it. Instead of looking down the runway in both directions — as company policy demands — the pilot was making changes to his flight instruments.
“If flight crews do not follow company standard operating procedures before taxiing onto a runway, there is an increased risk of collision between aircraft,” the board concluded.
After the incident, Ornge issued bulletins to its flight crews, reminding them to ask for clarification if they have any doubt about the instructions received from a controller. It also reminded pilots that both crew members must understand a traffic control message before acting on it.
For its part, Nav Canada, the company that controls Canada’s civilian airspace, reviewed the event with its staff in November, and emphasized to controllers the importance of using standard phrases to communicate with aircrews.
Nav Canada spokesman Ron Singer said the company has been investing in technology to reduce the number of runway incursions as part of a concerted effort to address the problem.
At the Ottawa airport, he said, Nav Canada has installed a ground radar surveillance system that allows controllers to better monitor ground movements, and an alert system that sounds an alarm to warn of an impending runway incursion.
aduffy@ottawacitizen.com
查看原文...
In its report on the June 2014 incident, released Wednesday, the Transportation Safety Board of Canada (TSB) said the number of runway incursions has remained “too high” in the five years since it first warned that the problem posed a major risk.
The federal agency said there were 346 runway incursion incidents in 2010, 454 in 2011, 429 in 2012, and 381 in 2013.
“They continue to occur more than once a day,” the investigation report said. “The board remains concerned that the incursions and the risk of collisions will continue until better defences are put in place.”
More than five million takeoffs and landings occur each year at Canadian airports, which means that runway incursions are relatively rare. But as the TSB report notes, “their consequences can be catastrophic.”
The deadliest aviation accident in history was the product of just such a mistake: 583 people died at a Canary Islands airport in March 1977 when a departing Boeing 747 hit a passenger plane still on the fogbound runway.
The TSB report released Wednesday presents the findings of the agency’s investigation into an incident that occurred on June 5, 2014, at Ottawa International Airport.
At 8:45 a.m., an Ornge air ambulance, with the call sign C-GYNM, was told by the airport control tower that it could taxi from its hangar toward Runway 25 on an adjoining strip of pavement, known as Taxiway Echo. The medevac helicopter, with two flight crew and two paramedics aboard, was headed to Pembroke for a patient transfer.
Three minutes later, the helicopter arrived at the taxiway’s “hold short line,” a safe distance back from the runway, where aircraft are supposed to stop and wait for further instructions.
The helicopter’s co-pilot contacted the control tower when the aircraft reached the line. The controller then told the helicopter crew to amend its assigned departure heading “while we wait.”
The pilot thought he had been told to “line up and wait,” which is the standard instruction given by controllers when they want an aircraft to enter the runway and prepare for takeoff. The co-pilot asked the air traffic controller to repeat the message as the pilot taxied toward the runway.
Fortunately, the controller saw what was happening and ordered the air ambulance to stop in its tracks just as a Federal Express Airbus was on its final approach to Runway 25. The helicopter halted just short of the runway, allowing the plane to land safely.
The helicopter was so close to the runway, however, that the Federal Express pilot was unsure if he had the space to squeeze by it and onto a taxiway. The airport controller asked the helicopter to back up and make room for the plane.
The air ambulance later took off for Pembroke.
The Transportation Safety Board investigated the unusual incident because of its ongoing concern about runway incursions.
Safety board investigators analyzed the cockpit voice recorder and conducted interviews with those involved. Their final report suggests that both the controller and the pilot made mistakes.
The air traffic controller, the board said, used an unusual phrase, “while we wait,” to instruct the helicopter crew to hold short of the runway. “If air traffic control uses non-standard phraseology, there is a risk of inconsistencies and miscommunication between air traffic control and the pilot,” the report concluded.
What’s more, the safety board said, the pilot likely became distracted after receiving a new heading for his flight, which meant that he didn’t check to see if the runway was clear before moving toward it. Instead of looking down the runway in both directions — as company policy demands — the pilot was making changes to his flight instruments.
“If flight crews do not follow company standard operating procedures before taxiing onto a runway, there is an increased risk of collision between aircraft,” the board concluded.
After the incident, Ornge issued bulletins to its flight crews, reminding them to ask for clarification if they have any doubt about the instructions received from a controller. It also reminded pilots that both crew members must understand a traffic control message before acting on it.
For its part, Nav Canada, the company that controls Canada’s civilian airspace, reviewed the event with its staff in November, and emphasized to controllers the importance of using standard phrases to communicate with aircrews.
Nav Canada spokesman Ron Singer said the company has been investing in technology to reduce the number of runway incursions as part of a concerted effort to address the problem.
At the Ottawa airport, he said, Nav Canada has installed a ground radar surveillance system that allows controllers to better monitor ground movements, and an alert system that sounds an alarm to warn of an impending runway incursion.
aduffy@ottawacitizen.com
查看原文...
