View Full Version : JAL pilot, 2 controllers face charges over near-miss

I. M. Esperto
8th May 2003, 00:22

JAL pilot, 2 controllers face charges over near-miss

A pilot and two air traffic controllers face charges over a near miss between two Japan Airlines (JAL) passenger planes in 2001 that injured 83 people, law enforcers said Wednesday.

Mainichi Shimbun
Shaken passengers console each other at Haneda Airport in January 2001 after a JAL plane in which they were travelling nearly collided with another plane mid-air.

Police sent investigation reports to prosecutors Wednesday, accusing the 43-year-old captain, and a 28-year-old and 34-year-old air traffic controller of professional negligence resulting in injuries and violating the law that prohibits actions that endanger air traffic.

Police took the action after concluding the accident was triggered by an erroneous instruction that the controllers gave the captain and the pilot's ignorance of an instruction given by his aircraft's Traffic Alert and Collision Avoidance System (TCAS).

This is the first time that police have filed accusations against a pilot and air traffic controllers over a near-miss incident. Prosecutors will carefully examine the investigation documents and thoroughly question the three and witnesses before deciding whether or not to indict them.

The accident occurred on Jan. 31, 2001. JAL Flight 970 bound for Naha from Tokyo's Haneda and Flight 958 bound for Narita from Pusan barely avoided a midair collision above Shizuoka Prefecture.

The 28-year-old male air traffic controller, who was undergoing training at the time, mistakenly ordered Flight 907 to descend even though he was supposed to give the instruction to another aircraft. A 34-year-old female controller, who was serving as an instructor, also overlooked his mistake.

The TCAS on Flight 907, a Boeing 747-400, activated because it was approaching Flight 958, and instructed the cockpit crew to climb. Nevertheless, the captain chose to descend in accordance with the controller's order rather than the TCAS alarm.

At the same time, Flight 958, a DC-10, followed an instruction by its TCAS to descend. As a result, both aircraft descended and came alarmingly close to each other. The altitude difference is estimated to have been only 20 to 60 meters, investigators said.

Eighty-three passengers and crewmembers on Flight 907 were injured when it descended extremely sharply.

Police are seeking criminal charges against the three after some 57 of those injured filed criminal complaints with law enforcers, investigators said. Investigators have concluded the 28-year-old controller should have taken care to prevent the accident even though he was a trainee, and that the older controller should have monitored the positions of all the aircraft she was controlling.

Police chose to seek charges against the captain on the grounds that he failed to follow a TCAS instruction, which could have led to a fatal accident. (Mainichi Shimbun, Japan, May 7, 2003)

8th May 2003, 01:38
Seems very unfair on the captain. The Japanese prosecutors are probably going to take months to deliberate on a decision which was, literally, made in a split second.

The controllers made an error on the callsign; the pilot followed their command. If there is a conflict, which takes precedence? Can it be proven that had the crew followed the TCAS, the collision would also have been avoided?

8th May 2003, 01:38
I. M. Esperto: The TCAS on Flight 907, a Boeing 747-400, activated because it was approaching Flight 958, and instructed the cockpit crew to climb. Nevertheless, the captain chose to descend in accordance with the controller's order rather than the TCAS alarm.
Police chose to seek charges against the captain on the grounds that he failed to follow a TCAS instruction, which could have led to a fatal accident.I thought the airline's then SOP were not to follow TCAS if visual separation could be maintained, and that was what the 744 captain was trying to do. If he was following his company's SOP, where's the interest in prosecuting him? Maybe I've missed something here.

I. M. Esperto
8th May 2003, 01:54
I lived in Japan for 3 years. The Japanese courts are different than our justice system. We shall see.

8th May 2003, 02:46
IME it would be interesting to know a bit more about these differences in court practice/legal systems as pertaining to aviation.
Anything you could share?
Thanks in advance.

8th May 2003, 03:40
Click Here For Link (http://www.j-club.net/japan/Articles/Article31.htm)

Is the search for scapegoats or the truth?

A long-standing disagreement between pilots and investigators has resurfaced following the reportedly reluctant attitude taken by the pilot of JAL Flight 907 toward the initial investigation into last Wednesday's near collision involving his plane and another JAL aircraft.

The latest dispute is a typical example of what frequently happens following an air traffic incident. The pilots involved often end up at odds with investigators regarding a question that inevitably crops up: Should steps be taken to ensure that similar incidents do not occur, while also determining the cause of the incident; or should measures be implemented to define criminal responsibility?

The Construction and Transport Ministry's investigation into last week's incident has determined that it was caused by mistaken instructions issued by two air traffic controllers.

Forty-two people on board Flight 907, bound for Naha from Tokyo's Haneda airport, were injured when the pilot--in accordance with the air traffic controllers' orders--put his plane into a steep descent. After narrowly averting a disaster, the aircraft returned to Haneda.

However, investigators at the airport were angry when the plane's pilot, Capt. Makoto Watanabe, demanded a lawyer be present if he was to be questioned about the incident. In addition, he initially refused to comply with a Metropolitan Police Department request to question him.

"Why doesn't he cooperate with police? After all he caused the incident!"

"He says he cannot speak unless a lawyer is with him. What does he think he is--privileged?"

These comments were typical of the 50 e-mails and phone calls the JAL Captains Association, a pilots labor union, received during the first two days following the incident.

According to the union, immediately after Flight 907 touched down at Haneda, three investigators boarded the plane and walked into the cockpit in an attempt to question Watanabe.

Eventually, three of the flight crew members, including the copilot, were asked to deplane, leaving Watanabe alone with the investigators.

At the time, injured passengers--some seriously hurt--were still on board the plane. The investigators asked Watanabe to accompany them to the police station for questioning. But he maintained that his first duty was to report what had happened to the ministry.

According to the union, the investigators and Watanabe argued for an hour about whether he should go to the police station.

In the end, all four crew members, including Watanabe, contacted the union, and a union lawyer arrived at the airport at 8 p.m. It was then decided that questioning would be conducted on another day.

This argument was one of the reasons JAL's briefings on the details of the near collision were initially confused.

"The public thinks that police investigations clarify the cause of an incident. But what police do is investigate crimes. We believe an investigation into the cause of an incident should come first," said Tsutomu Watanabe, deputy chairman of the union.

He said the union would cooperate with the ministry's Aircraft Accident Investigation Commission (AAIC) in determining what had happened and why. However, he added that it was only natural for the pilot to want legal representation to protect his rights, given that the police would treat him as a suspect.

The Japan Federation of Flight Crew Unions, which comprises 10 labor organizations and bodies from airline companies, quoted Watanabe as saying: "It was good that all the passengers and crew members made it back alive due to the right maneuvers taken and the efforts of all those were involved. I believe I acted correctly."

One reason for Watanabe's behavior is the delicate position a pilot is placed in when flight incidents occur.

According to a lawyer experienced in these cases, when a flight incident occurs a pilot is open to four different punishments:

-- If a pilot were to make a false report to the AAIC, the pilot would be punished.

-- A pilot is open to criminal charges, such as professional negligence resulting in injury or death or both if found culpable by a police investigation.

k Certification of professional skills issued under Aviation Law may be canceled.

k The employing airline may punish the pilot.

"Criminal investigations should be conducted on a voluntary basis--the top priority for a captain is to cooperate with the Aircraft Accident Investigation Commission," the lawyer said.

"The captain in last week's JAL incident was only complying with investigations by the relevant organizations in the order of priority."

In the United States, which is very experienced in investigating air transport incidents, the National Transportation Safety Body (NTSB) investigates incidents so that similar incidents do not reoccur. The NTSB frequently exempts pilots and crew members from criminal charges to arrive at the truth.

But in Japan, the AAIC and police hold separate investigations into air traffic incidents. And for its part, the police want to preserve the incident site as it is and question those who were involved as soon as possible.

National Public Safety Commission Chairman Bunmei Ibuki said Friday, "we must ask (pilots and crew members) to comply with police requests to submit to voluntary questioning, so that the police can fulfill their duties."

Meanwhile, Construction and Transport Minister Chikage Ogi, said: "We should undertake a complete investigation to determine what went wrong. Finding out who was responsible comes after that."

She reiterated a suggestion made by Takashi Sasagawa, special minister in charge of science and technology, that the cause of an incident should be discovered by exempting those involved from criminal charges, as is the case in the United States.

The investigation headquarters of the Metropolitan Police Department's Tokyo Airport Police Station questioned the four JAL 907 flight crew members, including Capt. Makoto Watanabe for three hours on Friday.

According to police, Watanabe did not initially agree to answer questions immediately following the incident because he "could not decide by himself" whether to do so as he is a member of an organization.

"Aviation incidents do not stem from one factor. They occur as a result of a chain of several factors," aviation critic Soichi Kaji said.

"Therefore, rather than assigning criminal responsibility, the priority of an investigation should be to prevent the recurrence of similar incidents."

However, Kaji added that there was an aspect about Wednesday's incident that derived from the long-standing conflict between JAL management and the company's labor unions.

"However, the captain was not the pilot of a private jet. He should have been aware of the fact that he was in charge of the lives of more than 400 people, instead of primarily thinking of himself as a union member," Kaji said.

Whereas in the United States, immunity from criminal charges is guaranteed during an NSTB investigation so that similar incidents can be averted, it is not the case in Japan, Kaji said, adding, "Therefore, we have no alternative but to cooperate with the police requests during an investigation."


Pilots, investigators have long history of disputes

By Yomiuri Shimbun

Pilots and investigators have often been at odds over the causes of flight problems that jeopardize safety.

One example concerns an incident involving a Japan Airlines jetliner that occurred in June 1997. The aircraft rocked violently over the Chita Peninsula, Aichi Prefecture, while descending to land at Nagoya airport. Twelve passengers and crew members on board were injured and one of the injured crew members later died as a result.

It is suspected that the aircraft's autopilot system was accidentally disengaged when the pilot abruptly pulled back on the control stick, sending the aircraft into a series of violent pitches.

The case is still under investigation.

According to the Japan Federation of Flight Crew Unions, the pilot was questioned by police about the incident for seven days straight. He was not allowed to contact a lawyer, the council said, adding that he eventually became ill as a result of the marathon interrogation.

In January 1988, a YS-11 operated by Toa Domestic Airways, the forerunner of Japan Air System, overshot the runway at Yonago airport in Tottori Prefecture during takeoff. The aircraft dived into the Nakaumi lagoon, injuring 10 passengers.

The then Transport Ministry Aircraft Accident Investigation Commission (AAIC) concluded that the horizontal stabilizer of the aircraft were not functioning correctly as they had frozen up due to cold weather.

Although the pilot and flight-deck personnel were referred to prosecutors on suspicion of professional negligence resulting in injury, they were not indicted.

A flight operated by the forerunner of Air Nippon, an affiliate of All Nippon Airways that specializes in short-distance domestic flights, made a poor landing at Nakashibetsu airport in eastern Hokkaido in March 1983, injuring 52 passengers and crew members.

The AAIC determined that the cause was pilot error.

The pilot protested the commission's conclusion, saying, "The investigation does not appear to have been conducted scientifically or rationally."

The crew unions council has alleged that police investigators influence those conducted by the AAIC.

"The commission's investigations tend to draw the same conclusions as those reached by police investigations, which are commonly conducted far in advance (of AAIC investigations)," a council official said. "We demand that the commission operate independently from the police in dealing with aircraft incidents and place its priority on investigations designed to work out preventive measures."

In many cases, pilots involved in investigations have suffered financial losses because their employers frequently suspended them during investigations and cut their pay regardless of whether the pilots were deemed responsible for the incidents.

Article By:__Yomiuri Shimbun

The Australia / Japan Connection_ -_ This page is part of the J-Club Website.


8th May 2003, 04:01
To follow TCAS or ATC instructions? This bears an uncanny resemblance to the 757/154 mid air last year over Europe. Would be nice of those involved in investigating both incidents got together and produced some sort of joint conclusion/guidance/ruling etc.

8th May 2003, 04:58
Wasn't one of the (many tragedies) in that accident the fact that it took place after the final report on the JAL/JAL incident had already been published?

I. M. Esperto
8th May 2003, 05:40
I sent the story to an American flight instructor buddy of mine living in Japan. I'll let you know his opinion.

When I was there, I was in the navy, and The Status of Forces agreement governed us. The civilian types in Air America etc., were constantly amazed by the Justice System.

I. M. Esperto
8th May 2003, 19:33
Here's the reply from my friend living in Japan. He is a linguist fluent in Japanese and Chinese.

" Aircrew in most Asian countries are held on criminal charges even in the slightest incidents. Japan is the most egregious example. Being a potential criminal is a stigma of the profession.
There is no such thing as an "accident", and CRIMINAL responsibility is always adjudicated.
The even try aircrew posthumously just to rectify the universe.
Japan is basically a ground (railway and real estate/construction) based, non-air minded and anti-aviation society, see the old piece "Why Japan is Not an Air Power" (1940) for the reason.
The anti-Aviation Law of 1937 is still basically in effect, sharply limiting private flying incidently.
I have posted many protests to this old practice.
In the malaysian Air accident at Fukuoka, the injured flight crew were held incommunicado and raked over the coals in a hospital police ward.
Any forced landing in japan becomes a major incident with a criminal investigation, press coverage etc."

Notice, and take heed.

Marcellus Wallace
8th May 2003, 20:16
IME, I think your friend means the "Garuda Indonesia incident at Fukuoka". Just correcting a mistake there.

Buster Hyman
8th May 2003, 20:42
A very serious, but interesting dilemma. From a laymans point of view, the Japanese Police believe TCAS is infallible & to disobey it's "recommendation" is criminal. I assume the Capt. made his decision based upon the ATC advice. Isn't this covered in your training guys? Conflicting info & how to deal with it?

In this case & the 757 over EU, TCAS was correct, but are we ready to blindly follow what any computer tells us to do. Not just TCAS, any system. Yes there was significant human error in this case, but why do we persist with humans in the cockpit (metaphorically) if the systems are so perfect?

Sorry, rant over.:rolleyes:

9th May 2003, 00:19
To quote a pervious correspondent:
"Japan is basically a ground (railway and real estate/construction) based, non-air minded and anti-aviation society, see the old piece "Why Japan is Not an Air Power" (1940) for the reason."
Er, what about Pearl Harbour?

I. M. Esperto
9th May 2003, 02:16
My contact is very knowledgeable about Japan, and he is a CFI. He has lived there for many years, and I trust his statement. He has a Japanese wife.

Apparently post war Japan is much different than pre-war regarding aviation.

They had to hire American pilots to fly much of JAL flights.

12th May 2003, 15:46
From Aviation Week & Space Technology 07/29/02

Japan Debates TCAS When Controllers Err


A report on the worst near-collision in Japanese airline history--one with 677 lives at stake--has aroused public concern about the quality of the nation's air traffic control system, especially because what went wrong in the skies west of Tokyo was hauntingly similar to the July 1 tragedy in Germany.

The incident occurred Jan. 31, 2001, near Yaizu and involved a Japan Airlines 747-400 (Flight 907) that had taken off from Tokyo's Haneda airport bound for Naha, Okinawa, and a JAL DC-10-40 (Flight 958) heading from Pusan, South Korea, to Tokyo's Narita airport.

The report cites human error, panic, confusion and training inadequacies that led the two wide-body transports to cross with a vertical distance of just 20-60 meters (66-197 ft.) and horizontal distance of 105-165 meters at an altitude of 35,300-35,600 ft. The Transport Ministry is recommending that pilots rely on instructions given by their traffic-alert and collision avoidance system (TCAS) units ahead of those from air traffic controllers.

THE JULY 12 REPORT by the Aircraft and Rail Accident Investigation Committee of the Ministry of Land, Infrastructure and Transport concluded that the Japanese ATC conflict alert system, called CNF, functioned inadequately. It also said Japanese and International Civil Aviation Organization TCAS regulations are inadequate, as are JAL's TCAS training and regulations.

JAL Flight 907 (JA-8904) took off from Haneda at 3:36 p.m. local time.The weather was calm with good visibility, which helped prevent a collision because the pilots could see each other's aircraft.

The 747 was cleared to 39,000 ft. toward Yaizu about 60 mi. west of Tokyo. The DC-10 (JA-8546) was flying east at 37,000 ft. via Kowa VOR/DME station.

The airspace around the city of Yaizu was managed by two controllers at the Tokyo Air Traffic Control Center: a 26-year-old trainee and his 32-year-old instructor. The trainee had two years of experience and began his shift 75 min. before the incident. He controlled 14 aircraft between 3:43 and 3:52 p.m. and transmitted 37 times, including 18 ATC instructions. The supervisor had 10 years of experience and had been on the job for 40 min. when the incident occurred.

The committee said first notice of the incident occurred at 3:54:15 p.m. when a CNF conflict alert signal appeared on the trainee's radar screen concerning Flights 907 and 958. However, the trainee was focusing on American Airlines Flight 157 because it was approaching JAL Flight 907. The investigation showed that he forgot about the presence of JAL Flight 958. (Flight 157 subsequently played no part in the incident.)

When he did focus on it, he attempted to resolve the conflict between Flights 958 and 907 by having the DC-10 descend from 37,000 ft. to 35,000 ft. But he nervously mixed up the flight numbers of the two JAL aircraft, calling on Flight 907 to descend to FL350.

At the time, the 747 Flight 907 was climbing through 36,900 ft. and turning left while the DC-10 was flying level at 37,000 ft. at a 095-deg. heading.

The 747 crew had already seen the contrail of the DC-10 at 11 o'clock. When the trainee called on them to descend, the 747 captain was puzzled as to why an ascending aircraft would be instructed to descend under the circumstances. Nonetheless, he followed the controller's instructions and responded, "JAL 907, we descend to FL350. The other traffic is in sight."

Initially, the controller did not make the mental connection that he had ordered the wrong aircraft to descend and took the Flight 907 acknowledgment as confirmation of his order. Meanwhile, the DC-10 crew had no way of knowing that the descend order was actually meant for them. They maintained their course. Since he could see that the DC-10 was not descending as he intended, the trainee tried to establish a horizontal separation between the aircraft. This time, at 3:54:38 p.m., he correctly called to "JAL 958" to turn to 130 deg., then to 140 deg. But his voice was so low that the DC-10 crew did not hear the instruction and failed to respond.

THE ROCKWELL COLLINS TTR 920 TCAS units in both aircraft showed a traffic advisory (TA) alert at 3:54:18 p.m. It changed to a resolution advisory (RA) at 3:54:34 p.m. in the DC-10 and 3:54:35 p.m. in the 747--about the time the controller was issuing his new order for Flight 958 to turn.

The TCAS RA prompted the crew of both aircraft to take evasive action--the 747 crew to climb by 1,500 fpm. and the DC-10 crew to descend by 1,500 fpm.

The supervisor controller took command at 3:54:57 p.m., but she also became momentarily distracted by the CNF alert and didn't focus on the DC-10, the investigators reported. She instructed Flight 907 to climb and intended to call for Flight 958 to descend. But she mistakenly called for "JAL 957" to descend, the report said. That elicited no response because there was no such flight in the area.

So at 3:55:02 p.m. she tried again, this time instructing Flight 907 to climb to FL390. The 747's TCAS unit instructed it to increase its climb rate to 2,500 fpm. So the aircraft was initially given a descend instruction by ATC to 35,000 ft. and several seconds later got just the opposite instruction--to climb--from its TCAS unit. Twenty-five seconds after the initial ATC instruction to descend, the tower also told the crew to climb.

The 747 captain (age 40, with 7,747 total hours, including 3,758 hr. in 747s) said he was concerned that his engines couldn't spool up fast enough to make an effective climb, so he elected to continue to descend, thereby neglecting the instructions of his own TCAS unit and the tower.

When he caught sight of the approaching DC-10, he increased his rate of descent to 4,060 fpm. He crossed safely beneath the DC-10 at 3:55:11 p.m.

The DC-10 crew had responded to the RA alert by pitching down and deploying speed brakes. However, the 45-year-old captain (6,584 total hours; 5,690 hr. in the DC-10) could see the contrail of the approaching 747 and realized the two aircraft could collide. The captain said later that he couldn't figure out why both
aircraft had been instructed to descend.

His 49-year-old first officer (4,333 total hours; 3,874 hr. in DC-10s) also saw the contrail and simultaneously with the captain pulled back on his yoke. The two exchanged no words as they performed this action and as the captain increased thrust. A moment later they saw the 747 pass beneath them.

The DC-10 captain told the controllers at 3:55:21 p.m. that he had experienced an RA signal and critical near-collision. The supervisor controller replied, simply, "Roger, 90 . . . 8," giving the wrong flight number again.

At 3:55:32 p.m., the 747 captain reported that the DC-10 had flown on and that the emergency had passed. The supervisor responded, "Roger."

Passengers in the DC-10, though shaken, were unhurt and the flight proceeded to Narita. But the situation in the 747 was a different story.

THE CAPTAIN HAD JUST turned off the Fasten Seatbelt sign when the drama began. His evasive action included a vertical acceleration of -0.55g to +0.59g. Of the 411 passengers on board, 344 had kept their seatbelts fastened. Fifty-three of these people were injured, mostly lightly. But 35 of the 67 whose seatbelts were unfastened were injured. Seven passengers and two cabin attendants were injured severely, mainly when they hit the ceiling or other people fell on them.

The severity of the situation was illustrated by two 112-lb. service carts that hit the ceiling. One jammed itself into the overhead support structure; the other fell on passengers. The crew elected to return to Haneda for medical aid, where the flight was met by 43 ambulances and 155 rescue staff.

The ATC trainee and supervisor were suspended from their duties, as was the 747 captain. The DC-10 captain continued in service.

The investigations committee cited 14 reasons for the incident, including a distracted trainee handling traffic, his and his supervisor's failure to remember that Flight 985, the DC-10, was in the airspace, and the fact that both controllers were upset by activation of the tower's CNF alert system. The committee said that normally the CNF would turn on 3 min. before a collision, but its activation was delayed because the 747 was turning left.

THE FINDINGS ALSO cited the trainee for erroneously instructing the 747 to descend, and the lack of sufficient training by the 747 crew of a TCAS event. The 747 crew also was cited for descending contrary to the TCAS instructions. The dangers of service carts flying around the cabin were cited, along with the fact that some passengers elected not to wear their seatbelts.

Beyond those immediate findings, the committee said there was insufficient mutual understanding between controllers and pilots, and a vague description of the relationship between TCAS instructions and ATC instructions. Favorable visibility and the prompt action by the pilots are credited with having prevented the situation from becoming more serious.

Prior to the report, and the midair crash in Germany, the Japanese public was said to have taken ATC expertise for granted. The revelation that a trainee and his supervisor could forget the existence of an aircraft, mix up flight numbers, repeat a wrong call number and not recognize their own mistakes has raised a public debate about the safety of the ATC system.

The committee said Japan's rules are too vague regarding the relationship between controllers and TCAS. Besides improving Japan's CNF system, the committee has also pushed for a "TCAS first" principle. The Transport Ministry has signaled its agreement with those conclusions.

But relying on TCAS has prompted some dissent among pilots, who question the reliability of the systems. They are concerned that crews will be punished if they follow TCAS instructions rather than those of air traffic controllers.

Japanese prosecutors said they are considering filing charges against the trainee and supervisor for negligence.

The ministry said it expects to field a system by 2004 that will use digital displays to show the controller's instructions in the cockpit.

ŠJuly 29, 2002, The McGraw-Hill Companies Inc

12th May 2003, 22:54
Several contributers to this thread have asked the question, "Should a pilot comply with ACAS (ie TCAS II) Resolution Advisories (RA) or with instructions from ATC?"

The answer can be found in the guidance material published by ICAO - for international application - where two critical paragraphs state:

"When simultaneous, conflicting instructions to manoeuvre are received from ATC and an RA, the RA (should be) followed", and,

"If a justified decision is made not to follow an RA, the resulting existing vertical rate (must not be made) in a direction opposite to the sense of the displayed RA."

Earlier text, published circa 1997, contained similar advice but used slightly different words.

Of course, ICAO expects contracting States to reflect these guidelines in its regulations so that pilots and controllers know what to expect.

Increased emphasis is now being brought to bear by ICAO on States to require commercial air transport operators to address, "Policy, instructions, procedures and training requirements for the avoidance of collisions and the use of the airborne collision avoidance system" and on the expectation that pilots who receive an RA will comply with it unless doing so would jeopardise the safety of the aeroplane.

Because ICAO Standards and Recommended Practices concerning ACAS (TCAS II) apply only to the larger commercial air transport (CAT) aeroplanes, there is no direct connection between operations manual contents and guidelines on the one hand, and other aircraft that have ACAS/TCAS II, such as corporate/business aeroplanes, the smaller CAT aeroplanes, and some helicopters on the other. Nevertheless, until ICAO addresses this anomaly directly (and they are aware of it), we must hope that pilots who fly these other types will also follow the ICAO guidelines so that everyone applies the same procedures.

13th May 2003, 01:00
seems as if we acually are only human.... I live in Japan now and Japanese people have a very difficult time making their own decisions- this is installed in them from JHS Junior High School.

The cultural differences have been apparant in other accidents also. I wrote a paper on CRM for the University of Glasgow and the results suggested that the cultural difference between countires and pilots play a bit part in the undermining of the CRM principle.

The Japanese Co-Pilot will rather follow instructions implictly from the Captain rather than disagree. Very bad in some circumstances. In other countries this is still true, but not but not as strong in my research.


Flying Bagel
13th May 2003, 22:39
From what I understood, before this accident, JL SOP's stated that in any dispute between the controller and a RA advisory, the pilot in command shall follow the advice of the controller in that instance. Can anyone verify or falsify this claim?

Buster Hyman
13th May 2003, 22:40
Cheers Nugget!:ok: Now you've answered that question, I've another. If climb or descend is so risky, considering the aforementioned events, why isn't the SOP for collision avoidance simply, veer left or right? If everyone was trained to go left, wouldn't that mean an instant avoidance? Okay, if the aircraft were on converging paths, I see where this would probably not be a good thing, but in those circumstances, your approach speed is way lower.:confused:

Bawbag. If ICAO, IATA, whoever, can insist on a standard language, English, in International Aviation, would it be asking too much for a cultural change, with regard to CRM for example? We're probably going off topic here, sorry.

13th May 2003, 23:01
Not wanting to change the subject, but somehow I'm much more shocked that the two controllers are also brought up on charges... As far as the incident is described, they only committed a simple mistake in call-signs! Being branded a criminal for an honest mistake is scary, no?

14th May 2003, 16:23

I believe that the accuracy of cuurent TCAS is not good enough to issue a heading for collision avoidance, but is certainly good enough, based on mode C, to tell you whether to climb or descend.

Also, as I have read from a study done in the 80's, I believe, turning away actually increases the chance of a collision over simply climbing or descending wings level, because the wings suddenly take up more area vertically as the A/C banks in an attempt to turn away.

14th May 2003, 17:02

They might be able to assemble a decent television, but it sounds as though they are about 30 years behind in the Flight Safety department. Prosecute first, investigate later. Wow, what a concept! Perhaps all captains should be provided with a knife so they can do the honourable thing after an in flight-incident.
Me thinks,not the place you'd want to do this job. :cool:

14th May 2003, 17:30
OK, let's start from the beginning!

Separation between aircraft operating for commercial air transport is, for the most part, arranged by the air traffic service provider. Generally, this works pretty well, but separation can break down either when an incorrect instruction is given or when a pilot fails to comply, eg through misunderstanding or a self-generated manoeuvre.

It follows that the last thing a pilot should do - unless he has visually sighted a conflicting aircraft and has absolutely no doubt whatsoever that if he/she does nothing a collision will result - is to initiate a climb, descent or turn. If the pilot does this, separation may well be eroded with a third aircraft, and of course the controller's tactical plan will have been upset.

Even the latest version of TCAS II (Version 7) cannot display accurately the relative position of a proximate aircraft in the horizontal plane, so pilots are still instructed not to initiate turn manoeuvres on the basis of what the TCAS display shows them.

Since its introduction, TCAS II has worked well: the modern version is extremely reliable and - to the best of my knowledge - all reported 'compatible' events (where a 'climb' advisory is posted to one crew and a 'descend' advisory to the other) have been exactly as programmed to provide the maximum vertical margin as the aircraft pass their 'closest point of approach'. The algorithms in TCAS II Version 7 have removed many of the 'nuisance' alerts that were evident in earlier versions. What really matters is that pilots should all be trained to the same rules - as described in my earlier post.

TCAS III, that included horizontal advisories, never quite got past the 'breadboard' stage. Thanks to the FAA, I was able to 'fly' this trials version in one of their B727s (many years ago), and it worked impressively well during encounter scenarios, but certification of this product was a long way off. The historical record of TCAS II shows that it works so well (though of course it isn't perfect) that there simply is no case for requiring aircraft operators to pay for a TCAS III.

Also, it often happens that ATC like to achieve separation by requiring one aeroplane to change altitude/flight level when there is plenty of time before both conflicting aircraft get near to one another, but to require a change of heading when time to 'closest point of approach' is short, which is when TCAS II Resolution Advisories may be posted. In such circumstances (ATC turn instruction, TCAS II climb/descend advisory) there is no conflict between the two and so a pilot can execute both simultaneously.

14th May 2003, 19:52
Except for the fact that TCAS procedures require the pilot to level the wings and execute the climb/descent!

Turning in the maneuvre will decrease your max climbrate (though it will increase descentrate) and the G-forces required to turn and pull the nose up will make the maneuvre uncomfortable and possible dangerous for the cabin. Also, systems where the RA requirement is displayed on the EADI (horizon) are based on wings level.

So a turn and TCAS are actually in conflict with each other procedure-wise.

Buster Hyman
14th May 2003, 20:08
Thanks for explaining that guys. I'll just stay on the ground here then & pass the loadsheets on to you guys, if that's okay???:ooh: :ooh: ;)

16th May 2003, 16:57
Maybe it's about time that areas which mandate the carriage of TCAS, also make it compulsory to obery a TCAS RA ahead of any contradictory ATC instruction. Then these incidents/accidents would not occur.

It beggars belief that some pilots are still manoeuvring in direct contradiction to their TCAS RA (this JAL incident, the crash over Germany). How many more people need to die before this gets sorted out??? :*

16th May 2003, 22:29
There was a heap of discussion about this sort of thing here (http://www.pprune.org/forums/showthread.php?s=&threadid=84083&highlight=tcas+thread)
Very sad that this still isn't crystal clear :hmm:

Vortex Thing
16th May 2003, 23:12
Sorry to show my lack of experience but from what I have been taught so far if everyone always followed TCAS and ignored ATC instructions then the a/c is safer than vice versa.

Surely if the TCAS is not reliable enough that we still need to interpret its RA and TAs then it is just giving us confusing information at a time when we should have absolute clarity.

I mean if that is the case then aren't we better of without it.

Are there any examples of accidents that have been caused by following the TCAS?

If there aren't any then surely if it says tfc tfc climb climb I'd have thought that climbing might get me out of the problem.

Whilst I did see threads that suggest you may want to do otherwise if you can positively visually seee the conflicting tfc this does not take into account the full chain.

What if there are three ac involved. You could be in the situation where thinking you can see the conflicting traffic and actaully seeing the third a/c.

Not saying that computers are infallible but they are unlikely to make this mistake and we are. So isn't this why we have TCAS?


21st May 2003, 21:38
Does anyone know if the report is available in english on the web?

21st May 2003, 21:55
You have got to be kidding, right? It's not even available in Japanese.

Look, the J's are secretive about everything. The official report will read like a Readers Digest article when it is published.

I was working there at the time. The CA did screw up royally, and we got all kinds of TCAS memoes afterwards. Put this to rest. In Japan, it's a crime to violate a reg, period. They had two years to study the incident for safety sake. Now, it's time to prosecute. The end.

22nd May 2003, 15:57
FlyMD I'm kinda with you on this, but more specifically I am amazed that the trainee is facing charges. Certainly within Maastricht trainees work without a license of their own, they work using the license of their coach at the time. Therefore all responsibility for the safety of air navigation lies with the coach. While training a student a couple of years ago, we had a situation leading to a loss of separation (4.7NM) and, quite rightly the ensuing investigation was centred, from an ATC perspective at least, around me as coach. I can't see under what grounds the Japanese authorities can hold the trainee responsible.

Mind you, I can't see that there was any criminal negligence here anyway. Poor controlling, yes, but criminal? As far as the TCAS/ATC discussion is concerned, I was under the impression, (please correct me if I am wrong, for I often am) that different operating agencies had different guidelines for this, which was a factor in the Swiss mid-air.