New ATC Documentary on BBC2
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Did anybody carch the programme mentioned at the end of tonight's episode?
Thought I heard someting about the lo-cost sector of the market.
Sounded like channel 4 in ten minutes, but kids flipped the remote before i heard the rest.
Any clues?
Thought I heard someting about the lo-cost sector of the market.
Sounded like channel 4 in ten minutes, but kids flipped the remote before i heard the rest.
Any clues?
Everybody's gotta be somewhere
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Does anyone know what the current situation is with regards to the Controller?
I've just watched the program and am as appalled as BS and Wedge that the Controller, under crazy conditions, is being blamed. What were the Management thinking????
Oggy. program referred to is on BBC4 - I only get 1 and 2 so who knows!
dd
I've just watched the program and am as appalled as BS and Wedge that the Controller, under crazy conditions, is being blamed. What were the Management thinking????
Oggy. program referred to is on BBC4 - I only get 1 and 2 so who knows!
dd
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Brockenspectre
The program suggested that the Captain was being checked by his boss, who was in in the right hand seat, ie, a more senior pilot acting as examiner AND first officer (possible nightmare scenario there).
The captain, it seems, wanted to obey the TCAS, which is what we are all trained to do, but he was overuled by the examiner.
Like your other writer, I feel for the poor ATCO, there can be no way he carries any of the blame. He was just the last link in a very flawed chain.
The program suggested that the Captain was being checked by his boss, who was in in the right hand seat, ie, a more senior pilot acting as examiner AND first officer (possible nightmare scenario there).
The captain, it seems, wanted to obey the TCAS, which is what we are all trained to do, but he was overuled by the examiner.
Like your other writer, I feel for the poor ATCO, there can be no way he carries any of the blame. He was just the last link in a very flawed chain.
More than just an ATCO
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Can't remember where I saw it, either on another thread here, or in a report at work, but there was a statement that many of the old Eastern Block states required the pilot to follow ATC instructions, even when conflicting with the RA.
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As I interpreted it, they weren't blaming only the Danish ATCO on duty at the time, but also the confusion caused on the flight deck of the Tu154, SkyGuide management, the Tu154 Chief Pilot and one or two other aspects.
It did make the point, though, that there was a whole chain of error factors and that the chain could have been broken at any one point.
Like the Reason Model - watching that programme with a sense of mounting horror, watching all the holes in the swiss cheese line up...
The thing that really got to me (as a pilot) was the report that the Russian crew were alive for a further two minutes after impact, all the way down to the ground, and that the 757 carried on from the impact for quite some distance/time (5 minutes?) knowing that, minus a tail, there was only one way they were going to go...
Horrible thought. I know many pilots whose two most fervent prayers are that, if aviation kills them, it is quick and clean, and that people don't think they died being a ********.
It did make the point, though, that there was a whole chain of error factors and that the chain could have been broken at any one point.
Like the Reason Model - watching that programme with a sense of mounting horror, watching all the holes in the swiss cheese line up...
The thing that really got to me (as a pilot) was the report that the Russian crew were alive for a further two minutes after impact, all the way down to the ground, and that the 757 carried on from the impact for quite some distance/time (5 minutes?) knowing that, minus a tail, there was only one way they were going to go...
Horrible thought. I know many pilots whose two most fervent prayers are that, if aviation kills them, it is quick and clean, and that people don't think they died being a ********.
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Interesting comment Lon, although I'd better not comment further given that the press are watching....
Fairly early in my ATC career I was talking to a passenger a/c which crashed... it too was being flown by a captain being "checked out" from the RH seat. It was quite different circumstances to the one portrayed last night but it makes you wonder. Peter X will never forget - I know for sure.
Huggy.... remember the Vanguard which crashed in Belgium? The guy talked all the way down from cruising level. What effect that must have had on the ATCO I dread to think.
Fairly early in my ATC career I was talking to a passenger a/c which crashed... it too was being flown by a captain being "checked out" from the RH seat. It was quite different circumstances to the one portrayed last night but it makes you wonder. Peter X will never forget - I know for sure.
Huggy.... remember the Vanguard which crashed in Belgium? The guy talked all the way down from cruising level. What effect that must have had on the ATCO I dread to think.
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Yes, by far the best programme out of the three in the series, and a comprehensive account of the terrible sequence of events that led to the tragedy.
If it highlighted one thing to me more than any other, it was that pilots must always, always follow the TCAS when they are in an RA situation. There is a school of thought that says that controllers should only give avoiding action in the horizontal plane in such a situation, and let the TCAS take care of the vertical element. Controllers have no way of knowing how the TCAS systems on each aircraft will "agree" to resolve the conflict, and the result can often be differing instructions from the voice in the cockpit and the voice on the ground. Pilots should always follow the TCAS, but there is bound to be a split-second of doubt when ATC is telling you the opposite.
However, this is in no way criticism of Peter X, who was entirely a victim of bad management and circumstance - the incident could have happened to any ATCO. I only hope that he is not charged.
If it highlighted one thing to me more than any other, it was that pilots must always, always follow the TCAS when they are in an RA situation. There is a school of thought that says that controllers should only give avoiding action in the horizontal plane in such a situation, and let the TCAS take care of the vertical element. Controllers have no way of knowing how the TCAS systems on each aircraft will "agree" to resolve the conflict, and the result can often be differing instructions from the voice in the cockpit and the voice on the ground. Pilots should always follow the TCAS, but there is bound to be a split-second of doubt when ATC is telling you the opposite.
However, this is in no way criticism of Peter X, who was entirely a victim of bad management and circumstance - the incident could have happened to any ATCO. I only hope that he is not charged.
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A very disturbing, but in my opinion, excellent programme. The makers seemed to have based it on facts and there seemed to be little uniformed comment.
It was interesting to see the news reports from just after the event where many (including a DHL spokesman) were quick to blame the Russian's saying they had repeatedly ignored ATC instructions. If the programme was accurate then the first they knew about a problem (apart from the TCAS warning) was 43 seconds before impact. If any blame can be laid on the Russian crew it is that they chose to follow the ATC command rather than TCAS. The disagreement between the RH and LH seats is a classic example of CRM failing.
It was interesting to see the news reports from just after the event where many (including a DHL spokesman) were quick to blame the Russian's saying they had repeatedly ignored ATC instructions. If the programme was accurate then the first they knew about a problem (apart from the TCAS warning) was 43 seconds before impact. If any blame can be laid on the Russian crew it is that they chose to follow the ATC command rather than TCAS. The disagreement between the RH and LH seats is a classic example of CRM failing.
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At the risk of upsetting a lot of people, could those who are blaming the management please explain why they think the management bear more responsibility than the controller and the Russian training captain involved.
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LTP's point is a good one; best practice must surely be that controllers only give avoiding action TURNS rather than level changes. Whether or not the controller in question felt that this was an avoiding action scenario is arguable.
As for the chain of events [and although I'm a controller myself] I have to say that I disagree that the controller was entirely free from blame. He was one of the last links in "the chain", and could have told the engineers to get lost. I fully accept that he should never have been placed in that position to start with, but he must shoulder at least a modicum of responsibility as he chose to continue providing two different services singlehandedly even knowing that the system was seriously degraded.
I have been through the "then you'll be unplugged!" scenario, it leaves a very bad taste in your mouth - bottom line is, however, it's my licence and my responsibility and I'll call it as I see it.
As for the chain of events [and although I'm a controller myself] I have to say that I disagree that the controller was entirely free from blame. He was one of the last links in "the chain", and could have told the engineers to get lost. I fully accept that he should never have been placed in that position to start with, but he must shoulder at least a modicum of responsibility as he chose to continue providing two different services singlehandedly even knowing that the system was seriously degraded.
I have been through the "then you'll be unplugged!" scenario, it leaves a very bad taste in your mouth - bottom line is, however, it's my licence and my responsibility and I'll call it as I see it.
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Fair points 1261.
I suppose the question is did he act reasonably at all times and to the best of his ability. The answer has to be no, but at the same time he was not negligent in my view.
He did make mistakes, but understandable mistakes, and he is only human after all.
Re: the telephones - he could, and should, have told them to get lost, but he was trying to cooperate and would have felt he was being unhelpful not to.
The real error was his failure to call his colleague back when things got busy. But again, he was I suppose only trying to be cooperative with those around him. He was not being negligent in my opinion. It's easy with the benefit of hindsight to point out where he went wrong, and when he took those decisions he could have had no idea of their ramifications. Stating the obvious I know, but it's worth bearing in mind that this was just another quiet evening and he would not have been anticipating any of the circumstances that contrived to cause this terrible accident.
I do feel the utmost sympathy for him, I suspect many good controllers would have acted as he did and if just one chink in the armour had remained disaster would have been averted. Like almost all aviation accidents. He will have to live with this for the rest of his life, and with the knowledge that he was just unlucky for this to occur while he was on duty, and incredibly unlucky in that if things had been just a little different (ie the Boeing had been 20ft higher) it would have gone down as just a very dangerous airprox.
One lesson that I think should not be forgotten from this accident is that the Captain should always call the shots whoever is on the flight deck. The apparent argument between him and the more senior check Captain was crucial to the accident, the Captain of the TU knew he was being checked and could not have felt good about contradicting a direct command from a senior pilot. But his reaction to follow the TCAS RA was the correct one. The Captain's decision should never be compromised. Even if all around him think it's the wrong decision - and even if it is the wrong decision.
I suppose the question is did he act reasonably at all times and to the best of his ability. The answer has to be no, but at the same time he was not negligent in my view.
He did make mistakes, but understandable mistakes, and he is only human after all.
Re: the telephones - he could, and should, have told them to get lost, but he was trying to cooperate and would have felt he was being unhelpful not to.
The real error was his failure to call his colleague back when things got busy. But again, he was I suppose only trying to be cooperative with those around him. He was not being negligent in my opinion. It's easy with the benefit of hindsight to point out where he went wrong, and when he took those decisions he could have had no idea of their ramifications. Stating the obvious I know, but it's worth bearing in mind that this was just another quiet evening and he would not have been anticipating any of the circumstances that contrived to cause this terrible accident.
I do feel the utmost sympathy for him, I suspect many good controllers would have acted as he did and if just one chink in the armour had remained disaster would have been averted. Like almost all aviation accidents. He will have to live with this for the rest of his life, and with the knowledge that he was just unlucky for this to occur while he was on duty, and incredibly unlucky in that if things had been just a little different (ie the Boeing had been 20ft higher) it would have gone down as just a very dangerous airprox.
One lesson that I think should not be forgotten from this accident is that the Captain should always call the shots whoever is on the flight deck. The apparent argument between him and the more senior check Captain was crucial to the accident, the Captain of the TU knew he was being checked and could not have felt good about contradicting a direct command from a senior pilot. But his reaction to follow the TCAS RA was the correct one. The Captain's decision should never be compromised. Even if all around him think it's the wrong decision - and even if it is the wrong decision.
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It was my understanding (not from the BBC program) that the Russian check pilot insisted on following ATC instructions, because that is the rule in Russia. 
The underlying problem is that TCAS has been brought into the avaiation system without a clear understanding of how it works to those on the ground and in the air. Nor has it been properly integrated into ATC procedures. Furthermore, the ICAO rules on TCAS are open to different interpretations - perhaps why the Russian wanted to follow ATC instructions instead of TCAS?
I thought I understood TCAS, until I attended a 2 day briefing, and my eyes were opened - wide.
TCAS works, and works well - however, it is imperative that once a pilot commences an RA, that s/he inform ATC immediately, and that ATC DO NOT ATTEMPT to resolve the problem once an RA has been declared. It is this last bit which is very difficult for a controller to accept, and to follow. After all, controllers spend their whole time actively trying to prevent flights banging into each other, and never to just sit and watch it happen. However, once a TCAS RA is commenced, both pilots must follow it and ATC must keep quiet - then it will work.
There is still a huge lack in training controllers to do this, and in making clear operational instructions that they must do so. I doubt Peter X had received such instruction, otherwise I am sure he would have told the Russian pilot "follow your TCAS" and not tried to intervene.
It is also very worrying to hear controllers speaking of telling pilots about potential traffic which may cause a TCAS RA, and suggesting/implying the pilot should then avoid following it, if forewarned. A pilot must follow an RA. If he doesn't TCAS will detect the lack of change of profile and instruct the other pilot to a greater deviation. Most nuisance RAs (as they are called) can be resolved by asking a pilot to reduce his rate of climb/descent, so that TCAS does not generate the RA in the first place.
When I attended the TCAS briefing, I was disappointed that many of the controllers feel affronted by TCAS, and that it is a suggestion that they have failed in their job. Well sadly, sometimes it is, but that can't be a bad thing if it stops people being killed, can it? It should be appreciated, though, that TCAS works with information which a controller does not have, and which is more up-to-the-second than the information displayed on the ATC screen. Nuisance RAs which are a problem, can be resolved by a more active profile management by the flight crews, and improvements to the FMS software to reduce rates of climb/descent when close to the target level.
Better TCAS information and training for controllers and pilots is essential, especially in an increasingly crowded sky, to avoid a repitition of what happened at Ueberlingen.
The underlying problem is that TCAS has been brought into the avaiation system without a clear understanding of how it works to those on the ground and in the air. Nor has it been properly integrated into ATC procedures. Furthermore, the ICAO rules on TCAS are open to different interpretations - perhaps why the Russian wanted to follow ATC instructions instead of TCAS?
I thought I understood TCAS, until I attended a 2 day briefing, and my eyes were opened - wide.
TCAS works, and works well - however, it is imperative that once a pilot commences an RA, that s/he inform ATC immediately, and that ATC DO NOT ATTEMPT to resolve the problem once an RA has been declared. It is this last bit which is very difficult for a controller to accept, and to follow. After all, controllers spend their whole time actively trying to prevent flights banging into each other, and never to just sit and watch it happen. However, once a TCAS RA is commenced, both pilots must follow it and ATC must keep quiet - then it will work. There is still a huge lack in training controllers to do this, and in making clear operational instructions that they must do so. I doubt Peter X had received such instruction, otherwise I am sure he would have told the Russian pilot "follow your TCAS" and not tried to intervene.
It is also very worrying to hear controllers speaking of telling pilots about potential traffic which may cause a TCAS RA, and suggesting/implying the pilot should then avoid following it, if forewarned. A pilot must follow an RA. If he doesn't TCAS will detect the lack of change of profile and instruct the other pilot to a greater deviation. Most nuisance RAs (as they are called) can be resolved by asking a pilot to reduce his rate of climb/descent, so that TCAS does not generate the RA in the first place.
When I attended the TCAS briefing, I was disappointed that many of the controllers feel affronted by TCAS, and that it is a suggestion that they have failed in their job. Well sadly, sometimes it is, but that can't be a bad thing if it stops people being killed, can it? It should be appreciated, though, that TCAS works with information which a controller does not have, and which is more up-to-the-second than the information displayed on the ATC screen. Nuisance RAs which are a problem, can be resolved by a more active profile management by the flight crews, and improvements to the FMS software to reduce rates of climb/descent when close to the target level.
Better TCAS information and training for controllers and pilots is essential, especially in an increasingly crowded sky, to avoid a repitition of what happened at Ueberlingen.
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Well, TCAS works well most of the time. We have too many documented reports of when TCAS didn't work. Everything was done correctly by the flight crew, but the machine was doing things that were not healthy... It is NOT a perfect piece of equipment...
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Scott H. Voigt
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regards
Scott H. Voigt
NATCA Southwest Regioin
Safety and Technology Chairman
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Name me a piece of equipment that does work perfectly. And how many reports constitutes "too many"?
Put simply, having TCAS is more useful than not having it. ICAO needs to ensure that all pilots know to follow TCAS when its instructions are contradicted by ATC, and all ATCOs need to provide turns rather than climb/descent for avoiding action.
TCAS did not cause the Lake Constance accident. One factor was the Russian crew failing to follow it.
Incidentally, and given 20/20 hindsight, if the controller wanted to spend some time on the other screen, why would he not give the Tu154 1000' descent immediately he got on his screen - then he knew there could be no conflict. Instead, he had only two aircraft to play with, and had them at the same level...
Put simply, having TCAS is more useful than not having it. ICAO needs to ensure that all pilots know to follow TCAS when its instructions are contradicted by ATC, and all ATCOs need to provide turns rather than climb/descent for avoiding action.
TCAS did not cause the Lake Constance accident. One factor was the Russian crew failing to follow it.
Incidentally, and given 20/20 hindsight, if the controller wanted to spend some time on the other screen, why would he not give the Tu154 1000' descent immediately he got on his screen - then he knew there could be no conflict. Instead, he had only two aircraft to play with, and had them at the same level...
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Hug...agree totally.You have answered your own question earlier when you said the holes where lining up and the chain could have been broken at any stage.As to giving descent..I agree...he could also have called his mate back into the ops room(we are encouraged to do so).Management could also have had some sort of "quality assurance" in place whereby it could be shown that to remove a principal piece of equipment e.g. direct dial telephones the standby equipment would be serviceable and routing the calls correctly. As to TCAS ...I may be dim ..but is there a stage in the process where(as it appears on the documentary)the second aircraft is not responding in the manner agreed by the two transponders that one says (electronically) ****** this lets look for another solution and changes its' mind...for example BOTH aircraft now descending.TCAS thinks lets try CLIMBING one?
Bring back fam flights!!
Bring back fam flights!!