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'The System Was of Little Use When It Was Needed Most'

Air Safety Week, Sept 26, 2005

Remarks of NTSB Acting Chairman Mark Rosenker of Sept. 13:

"Since the people in this room own and operate a lot of runways, this seems like an excellent place to spend some time discussing our mutual interest in accident prevention ...

"We've had about two of these most serious incidents every month for the past two years. Any one of these events has the potential to be a very significant accident. ...

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"On June 9 of this year at Boston's Logan International Airport, an Aer Lingus Airbus A330 and a US Airways Boeing B737 nearly collided at the intersection of runway 9 and runway 15R. Because of an air traffic control coordination error, both pilots were issued nearly simultaneous takeoff clearances. The aircraft passed through the intersection at flying speed with about 170 feet of lateral separation. The Aer Lingus flight was airborne, and only a quick decision by the US Airways crew to delay liftoff and pass beneath the Airbus prevented what could easily have been a terrible accident.

"The air traffic control tower at Logan is equipped with the FAA's AMASS ... However, the system did not alert tower controllers of their mistake. Investigation revealed that because of nuisance alert problems identified during system development, the AMASS software is not configured to detect conflicts between aircraft operating on converging runways at Logan or any other airport.

"On July 6 at John F. Kennedy airport in New York, a pilot deviation occurred when Israel Air flight 102, a B767, was instructed to taxi to runway 22R via taxiway H, and then turn left onto taxiway B. [The aircraft] did not turn left onto taxiway B and crossed runway 22R without authorization. [An] Airborne Express DC-8 freighter had been cleared for takeoff on the same runway ... According to the [Airborne Express] pilot, his aircraft did overfly the B767 with clearance of less than 75 feet at the nose and as little as 45 feet at the tail.

"AMASS did not alert the controllers to the mistake that was made by the [Israel Air] pilot because it was raining heavily at the time. Under such conditions, the radar that supplies surveillance data to the AMASS processor generates excessive amounts of false targets because of the precipitation. To compensate for this, AMASS is placed into 'limited mode,' which disables much of its conflict detection and warning capability in order to prevent nuisance alarms. As a result, the system was of little use when it was needed most."

Source: NTSB

Government Industry

'The System Was of Little Use When It Was Needed Most'

Air Safety Week, Sept 26, 2005

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