Go Back  PPRuNe Forums > Ground & Other Ops Forums > ATC Issues
Reload this Page >

Boy pilot died after tower gave suprise instruction

ATC Issues A place where pilots may enter the 'lions den' that is Air Traffic Control in complete safety and find out the answers to all those obscure topics which you always wanted to know the answer to but were afraid to ask.

Boy pilot died after tower gave suprise instruction

Old 14th Jul 2007, 10:16
  #1 (permalink)  
Thread Starter
 
Join Date: Nov 2005
Location: At the Dog and Duck
Posts: 54
Boy pilot died after tower gave suprise instruction

The Times Fri 13 Jul 07
A 16 year old pilot crashed on his second solo flight after being ordered by an air traffic controller to carry out an unusual manoeuvre.
He had become confused after receiving an unusual instruction.
As he was preparing to land he was put "in a situation for which his training and experience had not prepared him" after being instructed to carry out an unfamiliar and non-standard manoeuvre", the AAIB report said. He had received an instruction to perform a "go-around" which required him to make a left turn and fly North which would "certainly have been unexpected",
The report recommended that controllers should not issue complicated instructions that would require an aircraft in the final stages of landing to deviate from it's expected flight path unless there was an emergency.
Does anyone know why this go-around instuction was classed as an "unusual manoeuvre"?
And how do you feel that it is recommended that controllers should take into account the limited abilities of trainee pilots?
Magp1e is offline  
Old 14th Jul 2007, 10:30
  #2 (permalink)  
 
Join Date: Sep 2004
Location: South East
Posts: 143
Here is a link to the AAIB report.http://www.aaib.dft.gov.uk/publicati...0l__g_babb.cfm
lobby is offline  
Old 14th Jul 2007, 11:24
  #3 (permalink)  
 
Join Date: Aug 2000
Location: UK
Posts: 3,646
Does anyone know why this go-around instuction was classed as an "unusual manoeuvre"?
The Times has it somewhat simplified. The instruction was:

“Golf bravo bravo roger and er maintain runway centreline but go around er circuit height one thousand feet there’s fast traffic behind to land”.

followed soon by

"Er golf bravo bravo disregard that just take a left turn and fly north I’ll call you back in very shortly ”.
bookworm is offline  
Old 14th Jul 2007, 12:03
  #4 (permalink)  

Avoid imitations
 
Join Date: Nov 2000
Location: Wandering the FIR and cyberspace often at highly unsociable times
Posts: 12,427
I can't understand why an aircraft on finals was required to go around because of following traffic. The student pilot, presumably being the lower aircraft, surely had right of way and the following traffic should have been told to go around.
ShyTorque is offline  
Old 14th Jul 2007, 12:09
  #5 (permalink)  
Fly Conventional Gear
 
Join Date: May 2007
Location: Winchester
Posts: 1,602
Well quite.
Contacttower is offline  
Old 14th Jul 2007, 12:21
  #6 (permalink)  
 
Join Date: Nov 2002
Location: Up North
Posts: 177
"I can't understand why an aircraft on finals was required to go around because of following traffic. The student pilot, presumably being the lower aircraft, surely had right of way and the following traffic should have been told to go around."

At an airport with busy IFR traffic it can be hard to fit in VFR traffic between the jets. Sometimes I go for a gap with the VFR traffic then becoming No1, but on the understanding that if the IFR aircraft behind is catching up then the VFR ahead is sent around to hold north or south to wait for the next opportunity to land. This will not be done indefinitely and at some point a gap will be made for the VFR traffic but unless in emergency etc it will certainly not take priority.

I would sooner send a light aircraft around than a jet with 150 paying passengers!
Hootin an a roarin is offline  
Old 14th Jul 2007, 12:21
  #7 (permalink)  
 
Join Date: Dec 2005
Location: Wellington,NZ
Age: 62
Posts: 1,633
Just downloaded and read the report (Thanks, lobby.)
Was a little surprised to read that the ADC had a PPL issued in'96, as, (with hindsight, of course) it is very easy to perceive how the student could become confused by the instructions issued.
However, it is also easy to perceive from the report that the ADC was in a slight pressure situation with time running out to make a plan and make it work. Likely this affected his choice of wording to the Cessna pilot.

And how do you feel that it is recommended that controllers should take into account the limited abilities of trainee pilots?
At our place, when we have solo (pre-PPL) students, an "S" is written on the right hand box of the strip. There are instructions in the handbook specific to our unit ( sometimes known as "Local Unit Orders") that complicated and conditional clearances are to be avoided to student pilots, and a few other remarks the details of which escape me right now.

It seems to be effective.
Even without the ATCO flying training that used to occur routinely prior the end of the eighties, when cost cutting got real serious. We haven't had any flying training of ATC trainees for a number of years, now.

The local flight instructors are also very "on to it", and before students solo they are exposed to a very wide range of traffic sequencing related manoeuvers, which is necessary because of the range of commercial operations and large speed differences. I would estimate the average student here is probably the equivalent, in traffic situational awareness, to a low time PPL elsewhere, so it's a bit hard to gauge just how effective the local procedure is.

I would also recommend against more than one or maybe two pieces of info/instructions within the same transmission, (ICAO suggest a maximum of three, to regular pilots,) and a nice, slow, even delivery.
Tarq57 is offline  
Old 14th Jul 2007, 12:36
  #8 (permalink)  

Avoid imitations
 
Join Date: Nov 2000
Location: Wandering the FIR and cyberspace often at highly unsociable times
Posts: 12,427
I would sooner send a light aircraft around than a jet with 150 paying passengers!
One question: WHY?

Unfortunately this accident tragically shows what can happen when a low performance light aircraft flown by a low-time pilot is sent around from finals! Safety of flight should always take priority over perceived "other priorities", such as commercial pressure; we all know it often doesn't happen.
In any event, in this case the following traffic was merely another GA aircraft joining the pattern and the pilot would presumably have had no trouble whatsoever in going around and joining the normal visual circuit.

Last edited by ShyTorque; 14th Jul 2007 at 12:47.
ShyTorque is offline  
Old 14th Jul 2007, 12:52
  #9 (permalink)  
Thread Starter
 
Join Date: Nov 2005
Location: At the Dog and Duck
Posts: 54
Thanks Lobby, a very interesting read...Does this raise the question of when to allow a student to go solo?....He seemed confused by a number of instructions (including back-track). When operating in a shared circuit should he not be prepared to a good standard for instructions that would modify a standard circuit before the solo phase?

Last edited by Magp1e; 14th Jul 2007 at 13:04.
Magp1e is offline  
Old 14th Jul 2007, 12:57
  #10 (permalink)  
 
Join Date: Jan 2006
Location: UK
Posts: 35
...the ADC was concerned that N347DW’s high speed might
result in it having to go-around beneath G-BABB, a
situation he considered dangerous and which he intended
to resolve before it could occur.



According to the man on the desk, that's why.
perusal is offline  
Old 14th Jul 2007, 14:41
  #11 (permalink)  
Fly Conventional Gear
 
Join Date: May 2007
Location: Winchester
Posts: 1,602
What do people think of the suggestion that students (both ATCOs and pilots) should have a call sign addition of "student"?
Contacttower is offline  
Old 14th Jul 2007, 15:18
  #12 (permalink)  
 
Join Date: Oct 2002
Location: Silicon Hills
Posts: 234
Errr,
When I last instucted in the US, training in go-arounds was a pre-SOLO item. In other words, a student should be able to demonstrate the ability to perform a go around safely before he could be signed off for solo. All my students did....
vector4fun is offline  
Old 14th Jul 2007, 15:25
  #13 (permalink)  
 
Join Date: Apr 2004
Location: Stansted
Posts: 112
Yep..
"Cleared for the option" was one way my instructor could mess with my mind during pre-solo training as you didnt know what to expect, Bump'n'go, full stop or Go Around.
LRdriver II is offline  
Old 14th Jul 2007, 15:31
  #14 (permalink)  
 
Join Date: Oct 2000
Location: Berkshire, UK
Age: 75
Posts: 8,286
vector4fun. Agree 100%. I think it's outrageous that a youngster who couldn't hold a full driving licence here in the UK should be sent solo at a busy airfield when he apparently had difficulty coping with a very common situation. I can't see that the phraseology used by ATC has any bearing on the matter; I have used "non-book" on many occasions when dealing with inexperienced pilots with great success.

A dreadful waste of a life and my thoughts are with the young pilot's family and with the ATC people involved.
HEATHROW DIRECTOR is offline  
Old 14th Jul 2007, 15:32
  #15 (permalink)  
 
Join Date: Mar 2005
Location: MARS
Posts: 1,035
In the military a three figure callsign is used or the word Tyro. This gives everyone the clue!
Widger is offline  
Old 14th Jul 2007, 15:35
  #16 (permalink)  

Hovering AND talking
 
Join Date: Feb 2003
Location: Propping up bars in the Lands of D H Lawrence and Bishop Bonner
Age: 55
Posts: 5,711
Holes in the cheese?

When I was a student PPL, I felt very frustrated that my instructor didn't let me go solo until I could demonstrate engine-off landings, PFLs, go-arounds, low-level and/or restricted circuits and being asked to hold. I didn't go solo until nearly 40 hours under my belt.

I felt I was being unfairly and unnecessarily held back; even spoke to the Chief Pilot about it. However, this incident and another involving a student helicopter pilot who was asked to hold have made me think that the decision was wise. In the end, it made no difference to the number of hours in which I got my licence.

There is quite a bit of pressure and competition amongst students to go solo early on as a confidence booster (which I can understand) but, given there are many things that can make a circuit "non-standard", a few more hours to cover most eventualities should be given. In my case, a bird-strike!!!

All the controllers where I learned knew I was a student and I'm sure allowances were made.

My sympathies to the boy's family and all those involved as I am sure it will haunt them. However, having read the whole report, I can see a number of things which would have caused the holes in the cheese not to line up.

Cheers

Whirls
Whirlygig is offline  
Old 14th Jul 2007, 17:11
  #17 (permalink)  

Avoid imitations
 
Join Date: Nov 2000
Location: Wandering the FIR and cyberspace often at highly unsociable times
Posts: 12,427
Some info about the following aircraft type (gleaned from planeandpilotmag.com) :
Typical approach speeds are essentially the same as those for the Piper Mirage, 90 to 100 knots, and if you touch down at 80 knots, the manual suggests not to use reverse below 60 knots to avoid possible prop damage. That means you’ll only be in reverse for a few seconds should you elect to use it. Jones says he sticks to beta mode when he needs a little extra braking and prefers to stay away from full reverse altogether (that only delivers about 70% thrust anyway).
The airplane is a flexible machine, comfortable and stable if you need to shoot an ILS into DFW at 120 knots, but it will as easily accept an 80-knot short-field effort into an unobstructed 2,500-foot strip. There’s no reason any pilot with a modicum of time in Bonanzas, Centurions, Saratogas or the like shouldn’t adjust to the Meridian in a few hours.
I think it is important to put one thing in perspective. A student on his/her second solo is likely to be working to the limit of his capacity just to get the aircraft around the circuit and safely back on the ground. Anything above the norm is likely to overload him. I watched a good friend of mine crash a JP3A on his second solo. After a self determined go around from a steep approach, he received a message from the tower along the lines of "Land and report to the tower on landing". The second landing resulted in very severe PIO and a crash from about 150 feet onto the runway. Thankfully, he survived, despite sitting on a live ejection seat which could have gone off, due to damage to the cockpit floor. He wasn't lacking in natural ability, he proved that by going on to win the course flying prize and later became a fighter pilot and a B747 captain.

I felt obliged to intervene (I called across "No - let her land, please!"; I was sitting in the tower, observing) when the RAF tower controller told my first solo UAS student to go around and change frequency to the tower alternate simply because her finals call was very quiet. He wasn't impressed at first, but after she had landed safely I explained that she was unlikely to cope with a mandated go-around and fiddling with the radio. He saw my point.

Last edited by ShyTorque; 14th Jul 2007 at 18:07.
ShyTorque is offline  
Old 14th Jul 2007, 18:12
  #18 (permalink)  
 
Join Date: Jul 2004
Location: Surrey
Posts: 100
This is indeed a tragic case. Most posters appear to have read the AAIB report. But I do differ from the tone of some posts, especially Heathrow Director.
Apart from him not understanding 'backtrack', thinking he should do it on the taxiway, to me he seems to have done everything 'text book', until his failure to maintain flying speed in an entirely unexpected situation.
The radar shows he flew an excellent circuit, his responses on radio to ATC were clear and proper. On reporting 'downwind' he was told he was No.1 to land. In 1450 hours entirely private flying, to airfields of every size, including Gatwick, I have never had a 'number one to land' revoked. Of course we have all had to go around occasionally because of runway obstruction, but not for letting another aircraft to be No.1.
After reporting 'final' he was then told to go around, maintaining runway heading. I suggest that had he been left with this instruction, which he repeated correctly, there would have been no incident at all, I'm sure he was trained for this. But ATC reversed that instruction, telling him to turn North, which clearly left him in a situation, at very low level, he couldn't cope with.

My veiw is that this sad fatality was caused by the the two reversals of ATC instructions. One that he was No.1 to land, and secondly to go around on runway heading. Both of these were reversed, leaving a student in a postion for was totally unprepared.

There is no evidence from the AAIB report that the student, whatever his age, was not properly and responsibly trained and capable of a second solo.
MikeJ is offline  
Old 14th Jul 2007, 18:44
  #19 (permalink)  
Fly Conventional Gear
 
Join Date: May 2007
Location: Winchester
Posts: 1,602
I think it's outrageous that a youngster who couldn't hold a full driving licence here in the UK should be sent solo at a busy airfield when he apparently had difficulty coping with a very common situation.
I slightly resent the general assertion that 16 year olds shouldn't be sent solo. I myself went solo when I was 16 and on my third solo circuits session had to deal with lots of traffic spacing problems (usual GA scene on a Sunday afternoon: very busy uncontrolled airfield with everything from ultralights to twins wizzing round all at different speeds and some trying to do glide approaches ) involving going around at least twice, it is difficult. But it seems to me that the instructor in this case had every confidence in the boy and can't be blamed for sending him solo. From reading the report it sounded like the controller got a bit flustered and issued an odd instruction which was the main contributing factor in the accident.
Contacttower is offline  
Old 14th Jul 2007, 18:45
  #20 (permalink)  
Thread Starter
 
Join Date: Nov 2005
Location: At the Dog and Duck
Posts: 54
Mike,

I agree the "reversal in instructions" were a CONTRIBUTORY factor but certainly not the CAUSE as you put it. We're not apportioning blame here, just trying to understand factors which learnt by the rest of us will hopefully make us better controllers/instructors/pilots. I think it is a valid point that a student pilot operating in a potentially busy/mixed ac type circuit,should be able to react to the unexpected before going solo.
Magp1e is offline  

Thread Tools
Search this Thread

Contact Us - Archive - Advertising - Cookie Policy - Privacy Statement - Terms of Service - Do Not Sell My Personal Information

Copyright © 2018 MH Sub I, LLC dba Internet Brands. All rights reserved. Use of this site indicates your consent to the Terms of Use.