Runway Incursion: The Human Factors
Table of Contents
Summary
The following report was presented by Flight Safety Foundation (FSF) with the European Regions Airline Association (ERA) during the 14th European Aviation Safety Seminar (EASS) on March 11-13, 2002 in Budapest, Hungary. It was based on the Honeywell study - "An Analysis of Runway Incursion Occurrences Worldwide, 1990-2002". Data sources included official reports from accident investigation bodies in Australia, Canada, the Netherlands, UK, US, UK CAA and Airclaims.[1]
Study Findings
Analysis of data from 71 runway-incursion occurrences (aircraft- aircraft) worldwide shows the following findings:
- 70% involved crew deviations from standard operating procedures (SOP) and 46% involved failure by an air traffic controller to provide separation.
- 34% occurred in darkness or twilight, implying a risk two times higher than conditions of daylight (25% of occurrences)
- 23% of occurrences were in visibility less than reported runway visual range of 1,200 feet
- Extremely high correlation between types of risk factors involved in the 71 runway-incursion occurrences to the types of risk factors identified in studies of controlled flight into terrain and approach-and-landing accidents.
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| (Image embedded from Clubcontroltower on 12 Sep 2009) |
Scenarios
| Runway-incursion occurrences happened most frequently in the following scenarios | |
|---|---|
| Aircraft surface movement where taxiway crosses a runway | 33% |
| Simultaneous takeoff and landing operations on the same runway | 11% |
| Taking off or landing on the wrong parallel runway or lining up for takeoff on the wrong parallel runway | 13% |
| Take off and landing occurring simultaneously on intersecting runways | 13% |
| (Image embedded from Flightglobal on 12 Sep 2009) |
Flight Crew Related Factors
| Analysis of flight crew related factors | Occurrences |
|---|---|
| Failure to maintain adequate look-out | 41% |
| Poor position awareness | 40% |
| Poor traffic awareness | 45% |
| Communication – such as improper readback, mishearing and/or improper phraseology | 31% |
| Inadequate crew resource management | 31% |
| Inadequate crew monitoring / challenging | 31% |
| Tactical decision-making in the cockpit | 39% |
| “Press-on-it” – taxiing the aircraft despite crew uncertainty about position or ATC clearance | 20% |
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| (Image embedded from Clubcontroltower on 12 Sep 2009) |
Air Traffic Controllers Related Factors
| Analysis of ATC-related factors | Occurrences |
|---|---|
| Inadequate visual monitoring | 32% |
| Inadequate awareness of conflicting traffic | 38% |
| Incorrect service / instructions | 41% |
| Failure to provide separation | 46% |
| Inadequate ATC procedures provided to controllers | 17% |
| Controller deviations from ATC procedures | 29% |
| Poor controller decision making | 32% |
| Poor ATC communications | 32% |
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| (Image embedded from Fear of Flying on 12 Sep 2009) |
Recommendations
The US Federal Aviation Authority compiled the following recommendations into a report on Runway Safety to address ten areas of concern: Policy, Procedures, Training, Awareness, Communication & Co-ordination, Monitoring, Database, Equipment, Diagrams and Other: [2]
ATC PROCEDURES
- Taxi to position procedures
- Intersection departures
- Cross-runway authorizations
- Blanket clearances
- Readback of “Hold Short”
- No ATC clearance in position
TRAINING
- Annual recurrent training
- Professional Communications
- Position hand-over procedures
- Runway scanning techniques
- Conduct Crew Resource Management (CRM) training
COMMUNICATIONS/COORDINATION
- Professional communications part of annual recurrent training for controllers and specialists
- Training on Hearback/Readback errors
- Eliminate ambiguous pilot-controller communication
SYSTEM MONITORING
- Development and application of an Incursion monitoring program
- Ensure that aviation authorities conduct a more vigorous monitoring of ATS communications
- Install inductive loop systems at high-risk sites
- National standard for incursion warning system RIMCAS software
AIRPORT DIAGRAMS
- Diagrams of controlled airports to be made available at low or no cost
- Improved airport lay-out to remove confusing runway and taxiway patterns
- Upgrade airport signage and markings
- Airport Infrastructure and Information
OTHERS
- Develop standard taxi routes
- Runway surveillance technology
- Incident reporting
- Runway safety reviews
References
1. Flightsafety "Study of 71 Runway-incursion Occurrences Worldwide" Retrieved on 12 Sep 2009
2. FAA Runway Safety Report Retrieved on 12 Sep 2009
Want to know more?
- Recommendations
- This page shows recommendations of Transport Canada's Sub-Committee on Runway Incursions.
- Runway Incursions and Prevention Initiatives in Canada
- An overview of Transport Canada's initiatives on preventions of runway incursion.
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page revision: 6, last edited: 29 Sep 2009 09:34
