Near miss at KMSP - 14th June 2023

[Compton3fox]

Looks like another close call with one A/C taking off whilst another was instructed to G/A but misheard the instruction to fly right of the C/L....

https://www.cbsnews.com/minnesota/ne...s-msp-airport/


Juan Browne has his analysis out:

You Tube

Hard not to conclude that if the AA pilot had read back the instruction to fly left (as he heard it) the ATC would have corrected him. And when he did not read it back, if ATC had repeated the Fly Right instruction and insisted on a read back, this incident would not have happened.

[Liffy 1M]

Also the same "on the go" expression was used by the aircraft as in the recent Austin incident.

[BFSGrad]

This incident occurred about 2 hours prior to sunset with visibility 1 1/4 SM and ceiling overcast 3,000.

It appears this would be a loss of separation but what is the separation standard for this circumstance; i.e., two IFR aircraft, IMC, Class B, tower control? Recall during the KAPA Metro/Cirrus midair discussion, there was considerable squabbling about just what a tower does or doesn’t provide, with the basic mission being runway separation and airborne sequencing, but that circumstance was Class D, VMC.

[Equivocal]

I fail to understand the reluctance in the US to use standard phraseology and procedures. In this instance it may have made a huge difference to its handling by both ATC and pilots involved.

And, in common with other recent incidents, a crossed transmission, which was easily identified by those listening to off-air recordings, may have been completely unknown to the controller. I commented on this previously but I don't think anyone came up with an answer, but (in the US) does the controller hear an off-air rx feed?

Originally Posted by BFSGrad

It appears this would be a loss of separation but what is the separation standard for this circumstance

Perhaps rather strangely, it's quite possible that standard separation was maintained through most, and maybe all, of this incident. There are a wide range of separation standards - in these circumstances, the rule for a controller is to have one one of those standards in place at all times. Talking separation could be a bit of a red herring when compared to weaknesses in basic traffic management.

[ATC Watcher]

Perhaps rather strangely, it's quite possible that standard separation was maintained through most, and maybe all, of this incident. There are a wide range of separation standards

In this go around situation we are not talking about separation standards but collision avoidance. 2 very different things.
In this case , as you pointed out , standard phraseology and procedures (*) were not followed and resulted once again in this kind of situation. As Juan Browne correctly analysed, this is the US, rushed down procedures to accomodate and expedite increasing number of aircraft with a drastic controllers staff shortage . This is not going to end well I fear.

Note (*) : no read back= not received,, = repeat instruction ..

[jolihokistix]

Certain emergency commands to be voiced three times, even?

[Compton3fox]

Originally Posted by jolihokistix

Certain emergency commands to be voiced three times, even?

In the UK, an instruction to go around is repeated once and followed by the word acknowledge. A few weeks ago, i was given GA instructions and it went like this: My callsign, Go around, I say again, Go around, acknowledge. To which I replied, Callsign, Going around.

A similar procedure is in place for conditional line up instructions. For example. Speedbird 1, behind the Air France A320 from the other side, line up 27 right, behind. The acknowledgment needs to be read back with behind ..... line up 27R behind...

The UK is not perfect and I don't doubt there is lots they could learn from the US, especially around simplifying controlled airspace, but from a phraseology POV, the US could do well to adopt some of the UK standards.

I recall an aircraft landing at KDEN a few years ago with a problem and they used the phrase "Roll the Trucks". Unfortunately the call was missed and the AFS had no idea there was an emergency. If the standard Mayday x3 had been used, I am sure all would have Immediately been aware.

[BFSGrad]

Originally Posted by ATC Watcher

In this go around situation we are not talking about separation standards but collision avoidance. 2 very different things.

Given that the purpose of separation standards is collision avoidance, I don’t understand your distinction. Are you saying that once a pilot declares a go-around, ATC is no longer obligated to apply separation standards?

The 7110.65/5-8-4 (radar departures) requirement to maintain between arriving and departing aircraft a minimum of 2 miles if increasing to 3 miles within 1 minute would seem to apply in the KMSP incident. I don’t see any exclusion to this requirement if the arriving aircraft initiates a go-around. If the AA pilot had followed the offset-to-the-right instruction correctly, the end result would have been two airliners flying on the same heading, within 200 feet in altitude, with a lateral separation determined by how much the AA pilot decided to offset from the runway centerline. Not sure how this would have made much difference compared with the offset-to-left actual flight path.

This incident is a nearly identical to the Sarasota (KRSQ), Austin (KAUS), and Burbank (KBUR) incidents. In all of those, the NTSB referred to those incidents as loss of separation incidents.

[Gne]

FAA addressing the issue?

https://www.wxii12.com/article/faa-n...llers/44292581

But 5 gets you ten those who most need the refresher will be too busy trying to separate aircraft to attend the sessions. Wonder if the older controllers see it as an affront on their experience?

[Orange future]

“I recall an aircraft landing at KDEN a few years ago with a problem and they used the phrase Roll the Trucks”.

Indeed, and the first anyone knew about it was pax running around an active runway.

Roll the trucks. We are declaring an emergency. But my favorite….

“Center ABC”

“ABC Center go ahead”

“ABC we would ahh like to ahh put 350 ahh on request”

“ABC climb to 350”

What is so difficult about brief, precise and standardized R/T?

[Equivocal]

Given that the purpose of separation standards is collision avoidance, I don’t understand your distinction. Are you saying that once a pilot declares a go-around, ATC is no longer obligated to apply separation standards?

The 7110.65/5-8-4 (radar departures)......

I'm not sure that it's quite as straightforward as separation is done for collision avoidance, perhaps more for 'an orderly and expeditious flow of air traffic', and it's done by ATC. Collision avoidance is different and both pilots and ATC have obligations - conflating the two is unlikely to aid understanding.

As for the US rules, I'm afraid I'm not very familiar with them, but in terms of separation, section 7-2-1 could also be applicable (although without hearing full recordings it's not clear that all of the conditions were complied with). But the reality in this type of situation is that standard separation has become secondary and collision avoidance is the primary objective. The instructions to the aircraft going around whether to go left or right really doesn't make much difference during the critical period. I've no idea what equipment is available to the tower controller at KMSP to monitor where the aircraft are but I would be surprised if there is no form of radar-derived display of the airport and its surroundings, whatever, I can't help feeling a larger heading split might have been better if it had been possible (maybe traffic on other runways limited such an option). It surprises me also that on the recordings that we have that the pilots of the aircraft involved don't appear to have more interest in where they each are. Likewise, the controller doesn't sound in the slightest concerned about the developing traffic situation - is this something that happens every day?

All of this is just armchair analysis, of course, and I can't see what Gne has posted as the FAA's response, but one would hope that a proper investigation is done and that something is learned from the debacle.

[WillowRun 6-3]

Here's the FAA press release (link) as referenced by Gne:

https://www.faa.gov/newsroom/faa-lau...afety-campaign

FAA's announcement of new and/or additional training schedules is a result of the "Safety Summit" several weeks ago - of course its release so soon after the KMSP incident adds emphasis. The detailed subject-area subgroup meetings part of that FAA Summit were closed to the public (as SLF/attorney obviosuly I wasn't in) so exactly what FAA planned to do prior to this incident is not necessarily clear.

Also, with the Congress laboring to complete the necessary legislative reauthorization for FAA to continue to operate as a federal executive branch agency, and with the staff shortages of ATCOs a highly publicized item, and with the "results"* of the JFK and Austin incidents still pending, .... call me hot-headed if you like but if as legal counsel I had been engaged to be the "lawyer for the legislation" I would be kicking down doors to make sure the legislation moves very significantly on both issues. That is to say, on both staffing levels and R/T sloppiness.

*Results = in the case of AA106 crossing the runway, what is the outcome of why that occurred? Is the reported labor union position, that the new procedures were crammed down aviators' flight bags without adequate union participation and consultation, proven correct? (which personally I anticipate will be proven correct). And what was the situation with the ATCO in Austin? I want answers!!

(In some corporate law situations, an attorney will serve as "lawyer for the deal," not advising or representing either party, but looking out for the interests of the transaction as such. I know it sounds abstruse... it is, but real, regardless. So, lawyer for the legislation....)

[ATC Watcher]

Originally Posted by BFSGrad

Given that the purpose of separation standards is collision avoidance, I don’t understand your distinction. Are you saying that once a pilot declares a go-around, ATC is no longer obligated to apply separation standards?

....................... the NTSB referred to those incidents as loss of separation incidents.

Oh Boy ! not sure how to answer that without going into an ATC lecture. let me try ; In a nutshell , in a last minute go around situation with an aircraft departing below the aircraft going around ATC cannot provide 2 Miles and 1000ft,. What it can do is try prevent metal to metal contact. , hence the side step. Not always easy if you use parallel runways, and you cannot expect an aircraft at VRef to bank 45 degrees either. These are emergency situations .The separation STANDARDS ( 2 or 3 NM / 1000 ft ) cannot be applied .

That the NTSB call this a loss of separation is correct . Because to be in that situation the normal procedures failed . You should have got initially 2,5 or 3 NM longitudinal separation in the first place.
Now, if you clear an aircraft to depart with another one on 2,5 NM finals , you will get a small time margin between lift off at one end and touch down at the other end. If someone f@cks up, ATC or the pilots (delaying departure like in Austin) you may get into an emergency situation .

[ATC Watcher]

Originally Posted by WillowRun 6-3

I would be kicking down doors to make sure the legislation moves very significantly on both issues. That is to say, on both staffing levels and R/T sloppiness.

*Results = in the case of AA106 crossing the runway, what is the outcome of why that occurred? Is the reported labor union position, that the new procedures were crammed down aviators' flight bags without adequate union participation and consultation, proven correct? (which personally I anticipate will be proven correct). And what was the situation with the ATCO in Austin? I want answers!!
...)

AA106 : NATCA is generally very well informed and when they make a statement , it is generally correct and verfified.
Austin : Which anwers would you like ? hanging the controller in a public place ? The correct answer in my view is , lack of staff, combined with increasing amount of traffic post COVID, pressure to expedite and lack of proper supervision /training .
Here focus on Training and supervsion is probably the case, as I have heard from various sources. So let's not focus on individuals but rather on fixing the system , which is something the FAA has a very poor record of doing. Fixing the system will cause masive delays though, |Refresher training means taking out controllers from the rosters, Applying standard procedures and R/T will also seriously reduce capacity. This will be highly unpopular and the person ordering this will need strong political back up.

[WillowRun 6-3]

Originally Posted by ATC Watcher

AA106 : NATCA is generally very well informed and when they make a statement , it is generally correct and verfified.
Austin : Which anwers would you like ? hanging the controller in a public place ? The correct answer in my view is , lack of staff, combined with increasing amount of traffic post COVID, pressure to expedite and lack of proper supervision /training .
Here focus on Training and supervsion is probably the case, as I have heard from various sources. So let's not focus on individuals but rather on fixing the system , which is something the FAA has a very poor record of doing. Fixing the system will cause masive delays though, |Refresher training means taking out controllers from the rosters, Applying standard procedures and R/T will also seriously reduce capacity. This will be highly unpopular and the person ordering this will need strong political back up.

Taking these points in reverse order:
I disagree that the need to focus on fixing the system, and all that doing so will involve, means that nothing more needs to be addressed with regard to the individual ATCO involved in the Austin incident. The performance record of a given individual controller certainly is material and relevant to assessing, from the incident which occurred, changes at the system level that need to be made. While "just culture" is important it does not remove accountability in the specific sense of identifying what errors were made and whether there had been performance deficiencies identified previously. Though the wording I used was imprecise, the answers about the record I contend are necessary would be information to be disclosed to, and used by, the officials working to "fix the system." Just as the working group meetings of the FAA Safety Summit were closed to the public, information of this type also could, and should, be non-public.

As for JFK and AA106, if NATCA issued a statement, I haven't yet located it. I was referring to the Allied Pilots Association interactions with the airline, prior to the incident, with regard to the manner in which changes in procedure were to be introduced. The relevance is not to exonerate the crew, rather the point is that in an incident presenting this level of seriousness, some deference to the position taken by the pilots' collective bargaining representative is called for. And, while the change in procedures is not the only factor (based on the discussion in the pertinent thread here), in such a serious incursion incident getting all the factors understood correctly should hold high priority.

Just to reiterate, no, there wasn't any intent or suggestion previously about hanging any ATCO out to dry in public. It's about getting all the relevant information onto the "fix the system" conveyor belt.

[pilotmike]

Originally Posted by Orange future

“I recall an aircraft landing at KDEN a few years ago with a problem and they used the phrase Roll the Trucks”.

Indeed, and the first anyone knew about it was pax running around an active runway.

Roll the trucks. We are declaring an emergency. But my favorite….

“Center ABC”

“ABC Center go ahead”

“ABC we would ahh like to ahh put 350 ahh on request”

“ABC climb to 350”

What is so difficult about brief, precise and standardized R/T?

"ABC climb 235... oh!"

What's unclear about that?!

[ATC Watcher]

@ Willow Run 6-3 :

I disagree that the need to focus on fixing the system, and all that doing so will involve, means that nothing more needs to be addressed with regard to the individual ATCO involved in the Austin incident. The performance record of a given individual controller certainly is material and relevant to assessing, from the incident which occurred, changes at the system level that need to be made.

We basically say the same thing using different logic and words. Yes the reasons that caused the situation in Austin needs to be adressed , lessons from it learned and measures taken to prevent this from happening again. But the controller involved did not woke up in the morning saying : i am going to make an incident today . he has been selected for this job, trained and supervised, Why this apparently failed has to be anlaysed. That said he was not alone in this cock-up, the Southwest crew actions also need to be looked into and so does the Fedex to a lesser extend, more people contributed to this incident. The NTSB report will be very interesting to read I am sure. Werthere the FAA ( and the airlines involved) will take on board all its recommendations is another story.

While "just culture" is important it does not remove accountability

Just Culture , or its new name " Safety Culture" does not apply after an incident or accident. It is there only for prevention , by basically removing accountability for individuals reporting their own incidents that would not have been reported otherwise, so that we learn from them to improve the system . It does not apply after an incident or accident.has occurred which is the case here .But the original principle of Just Culture as defined by Prof Sidney Dekker is that focusing on the operator rather than looking for systemic issues is a normal management reaction to protect themselves from accountabilty.

​​​​​​​As for JFK and AA106, if NATCA issued a statement, I haven't yet located it.

My bad, I thought you were taking about NATCA, not APA . Did not see their statement. As a complete aside, while looking for it ( did not find it ) on their web site I see they are planning to go on strike with a 99% mandate..Interersting times..

[Uplinker]

No doubt; the UK CAP 413 style sounds anal and un-cool, but it minimises mistakes and confusion. We generally have extremely good, and extremely clear ATC.

We have to remember that speaking to each other casually as if we were in a bar or at a barbecue, might not survive intact over a low-fi radio link, which is always subject to distortion and interference. So while standard words and phrases might seem unnecessarily petty, they are used for very good reasons - to avoid confusion and mishearings over low quality radio links, which can lead to incidents and accidents. Words have also been selected carefully so as not to sound like other words over a distorted link; hence we say "affirm" or "negative" instead of "yes" or "no", for example.

Had ATC in this instance spoken more slowly, with slightly longer spaces between the words, the aircraft going around might have heard the instruction more clearly. Had the aircraft also spoken more slowly and used standard phraseology to read-back, and had ATC then questioned the lack of proper read-back, the mistake would most likely have been corrected.

[giggitygiggity]

Originally Posted by Equivocal

I fail to understand the reluctance in the US to use standard phraseology and procedures. In this instance it may have made a huge difference to its handling by both ATC and pilots involved.

To me it seems that the need to give the impression on the radio that you're the worlds coolest and most experienced pilot trumps any other matter. Just seems to be akin to a secret society mentality, if you don't know the nicknames and code-words, you're not one of the cool guys.

[FUMR]

It is an unfortunate tendency that machoism seems to prevail over safety in the USA. You just gotta sound cool bro. It's nothing new, I've been listening to it for a long long time. However, most, but not all, American crews flying in Europe observe better R/T discipline.