Near CFIT because PIC didn't understand FL

[Aluminium shuffler]

Have I read the comments correctly? An abysmal lack of airmanship leads to a very close brush and it turns into a "why the US is so much smarter" thread! Given the number of runway excursions, landings on incorrect runways and airports that occur Stateside and cock ups many Americans make around the rest of the world and at home (ATC to visiting aircraft) due to sloppy RT, please explain why they are seen as the higher standard. As many said, 2000' isn't a FL anywhere, and even then it's irrelevant to the discussion. A clearance to FL200 cannot be interpreted as 2000' by anyone competent, so what the hell has this got to do with nationalities?

[Pace]

AS

Its not got to do with nationalities. Cockups occur in CAT as well as in Private as well as with ATC. As far as I have seen there is no safety benefits over FAA or EASA statistically only harmonisation between the two systems reduces the chance of mistakes

I fail to understand why ATC knowing something was wrong with the understanding of the clearance then recleared the aircraft to FL300 from FL200?

Surely they should have said " Climb immediately to 6000 feet (or whatever) on 1002 (or whatever) Read back
Their reaction was to reclear the aircraft from FL200 to FL300 which hardly indicates anything wrong or urgent

Pace

[Chesty Morgan]

Originally Posted by porterhouse

Frankly I am surprised no one picked on another problem here - I don't know where the boundary in Europe lies but in the US you are not allowed to use flight-level terminology if you are below 18000 feet

How do you ever get cleared to a flight level?

[Pace]

I don't know where the boundary in Europe lies but in the US you are not allowed to use flight-level terminology if you are below 18000 feet

All over the place hence a standardisation over Europe is much needed

It could be the very reason that they were not used to FLs at low level that they used that terminology incorrectly

Pace

[Hawker 800]

AS

Its not got to do with nationalities. Cockups occur in CAT as well as in Private as well as with ATC. As far as I have seen there is no safety benefits over FAA or EASA statistically only harmonisation between the two systems reduces the chance of mistakes

I fail to understand why ATC knowing something was wrong with the understanding of the clearance then recleared the aircraft to FL300 from FL200?

Surely they should have said " Climb immediately to 6000 feet (or whatever) on 1002 (or whatever) Read back
Their reaction was to reclear the aircraft from FL200 to FL300 which hardly indicates anything wrong or urgent

Pace

Pace

This was a CAT flight. I agree though (and I fly for a UK AOC on a Hawker in addition to a bit of 'private' BizJet flying in the same type) that private operators generally have very high standards, often better than AOC operators. Don't think that the majority are cowboys...

ATC cleared them to FL300 and expedite. They were trying to salvage the situation, probably understanding the problem.

The Controller was concerned that the aircraft had levelled out at 2,000 ft and was tracking towards high ground in the Slieve Mish area of Co. Kerry. The controller then instructed the Flight Crew to climb to Flight Level Three Zero Zero and to expedite their climb until they were through four thousand feet.

It could be the very reason that they were not used to FLs at low level that they used that terminology incorrectly

No excuse for not being aware of MSA or local procedures. Even if it was their first trip across the pond, you'd think that their company would have a briefing sheet for Europe and the North Atlantic that they would read. I'll guarantee that they've sat through a Simcom, FSI or CAE International Procedures course. If they'd have listened, maybe this wouldn't have happened.

At 14.36:51 hrs the Flight Crew replied "We were cleared only to Flight Level Two Zero Zero". Shannon Low Level Control persisted "Okay sir that’s copied but your passing altitude...your current altitude". At 14.36:59 hrs the Flight Crew replied "And we confirm that we are cleared up to Flight Level Zero Two Zero… Two Thousand feet".

Worrying. Even more worrying is that the crew were self admittedly confused as to the cleared level, and didn't ask....

According to the Pilot’s Report Form "Our altitude climb instruction was "climb level Two Hundred". We read back the clearance and began the departure. As we began to climb we had some confusion as to what the altitude clearance limit was as we were unsure what level Two Hundred meant. We levelled at Two Thousand feet to ensure we didn't exceed any altitude limits. We contacted departure control and informed them we were level, they questioned what altitude we were climbing through and we clarified that we were level. There was some question from ATC regarding what altitude we were cleared up to by Kerry and we informed the controller that we were unsure but were level at Two Thousand. He further cleared us to Flight Level Three Zero Zero and to expedite through Four Thousand Five Hundred, and we immediately began climbing. The flight continued on without incident".

[Bergerie1]

Aluminium shuffler, I wasn't suggesting things in the USA were better, in fact, having flown, there some things are worse (please don't jump down my throat, everyone). The fact is we can always improve air safety by progressively removing those things that incline people more likely to make mistakes. And a uniform Transition Altitude, in my opinion, would help.

[RAT 5]

"Our altitude climb instruction was "climb level Two Hundred". We read back the clearance and began the departure. As we began to climb we had some confusion as to what the altitude clearance limit was as we were unsure what level Two Hundred meant. We levelled at Two Thousand feet to ensure we didn't exceed any altitude limits.

The correct time to solve that conundrum was before the wheels left the ground; i.e. during the read back.

[ROSUN]

Did confusion set in because one of the waypoints was 020?

[Uplinker]

Sorry to shout, but

IF IN DOUBT, CHECK.

If we are ever in doubt about, or mishear a clearance, we must ask for clarification.

I do this and I don't mind if it makes me seem stupid; it's a hell of a lot less stupid than flying into a hill.

[philbky]

I live in Kerry and am well aware of the terrain surrounding the airport. Standing at the airport, many of the mountains are either in full view or partly shrouded in cloud depending on the day. Taken in conjunction with the heights and spot heights on the charts,it should have been blindingly obvious that the mountains are higher than 2000ft in close proximity to the departure end of 26 on a direct track to VENER.

Judging from the statement in the report that the Kerry controller told the Shannon low level controller that "he's just gone into cloud there now", in conjuction with the diagram of the departure, again it should have been blindingly obvious that the mountain tops exceeded the bottom of the clouds which were at circa 2000 feet.

Regardless of any confusion over the delivery of the cleared height, there is a clear lack of planning and situational awareness evidenced in the report.

Equally as worrying is the delay in installing and implementing the operationof ATM equipment in Kerry tower. Unfortunately this is a cultural thing here with examples of projects, both public and private, in many fields of everyday life being started in response to a need and then delayed time after time for no explicable reason.

[Basil]

IF IN DOUBT, CHECK.

Yup, no matter how many 'looks' you get from the captain or, in the past, smartass comments from other crew, don't even ask "Should I clarify that?" JDI!

[Dimitrii]

I bet the mic problem got them out of understanding mode into just get it back to them mode.

There followed three unsuccessful attempts by the EIKY Tower Controller to obtain a read back of the clearance from the Flight Crew. Finally, the Flight Crew transmitted “Ah let me try this mic is this any better” to which the EIKY Tower Controller responded “Affirm initially I got the start of your transmission and then it blanked out just a blank sound dead air so if you can just give the read back again please”.

[+TSRA]

No, he couldn't have been a North American pilot precisely because of the above. No NA pilot will use flight level for such low altitudes.

Porterhouse, a NA pilot would use FL terminology below FL180 in Europe where the transition altitude is as low as 2,000 feet in some locations.

Originally Posted by porterhouse View Post

Frankly I am surprised no one picked on another problem here - I don't know where the boundary in Europe lies but in the US you are not allowed to use flight-level terminology if you are below 18000 feet

How do you ever get cleared to a flight level?

In NA you only get cleared to a Flight Level if operating above 18,000 feet.

From there ATC will nominate the lowest useable flight level based on the local altimeter setting. FL180 for 29.92 and above, FL190 for 29.91 - 28.92, and FL200 for anything below 28.91.

This is why I see part of what this incident crew did wrong. They're used to hearing a Flight Level as being much, much higher. Then they read that a Flight Level can start as low as 2,000 feet in Europe and suddenly they are confused by a clearance.

What they should have done above all else is to slow their process down. Maybe they did check the MSA but in the flurry of everything else, they forgot. Maybe one of them did read somewhere that they could expect to hear "Flight Level Two Hundred," but then forgot what that means. Maybe, just maybe, they put their trust into the controller who (seemingly to the crew) gave them a clearance to below the MSA and below the local transition altitude. But not knowing all the local regulations, they accepted it...then, when being questioned about what altitude they were at, they read the clearance back as it made sense to them, with a quick jab across the cockpit to say "but here that means this." From there, the spiral began.

Frankly, I'm surprised at the number of "super pilots" who obviously have never read back a clearance wrong, have never forgotten the MSA, or who accepted a clearance without fully understanding it. I guess these "sky gods" all work in a part of the industry where they either never leave home or always fly to the same destinations.

I remember my charter flying well; and I remember being utterly confused and bewildered some of the time by the flow of new information I was suddenly expected to be an expert on. Perhaps that's why I'm willing to throw these guys a bone and say that, while it was a serious mistake with fatal implications that I personally would have clarified before leaving the ground, I understand why they did it and it in no way makes them less of a pilot than I.

[His dudeness]

What amazes me, is that I either overread the info on previous flights/sleep patterns/time acclimate to local time or it is not in the report...

THIS is EXACTLY the fukc up one expects when you are out of your comfort zone fatigue wise. Of course, thats just my opinion, however...

The broken mic will certainly not have helped to create a, say, comfortable atmosphere.

And +TSRA is right, the amount of info can overwhelm one, especially in types without APU.

Together with the ever increasing BS "they" (e.g. Eurocontrol and local ATC provider) throw at one (CTOTs, TOBT etc.etc.), this is an accident waiting to happen (not saying it has anything to do with this one...)

[Pace]

We all make mistakes in the heat of the moment! In most cases it's nothing! no big deal just slap each others wrists in other cases that mistake can be very serious or even fatal

Private jets or CAT EASA or FAA we all do it

I remember that Ryanair operated 737 landing at the disused military airfield next to Londonderry an airfield I flew to a lot at that time.

How could both Crew on a RyanAir operated 737 mistake the two airfields ?

Having made an identification mistake to then carry on to a landing on a disused runway with two crew and loads of visual cues was hard to get my head around! But it happened. If it had been a private jet there would be cries of cowboy pilots

All the passengers had to be bussed out and across to the active airport and the aircraft removed empty after the runway had been cleaned and inspected

Pace

[Chesty Morgan]

Originally Posted by +TSRA

NA you only get cleared to a Flight Level if operating above 18,000 feet.

From there ATC will nominate the lowest useable flight level based on the local altimeter setting. FL180 for 29.92 and above, FL190 for 29.91 - 28.92, and FL200 for anything below 28.91.

The same everywhere. You missed my point - How would you get cleared to a flight level if you weren't allowed to ever mention flight level below the TA?

It was however, tongue in cheek.

[clunckdriver]

Regardless of the circumstances in this case why cant the EU who mandate what size a cucumber must be can come up with a standard transition level ?{as in Canada, F/L 180, which puts the aircraft above the big rocks} some of the transition levels are simply too low given the rate of climb/descent of many aircraft in service in this day and age, it also prevents the QFE holdouts from trying to remove the top 300 feet of the local lumps. {Well not all the time, but it does reduce the chances of hitting a grain elevator as done by a certain exchange pilot a few years back}

[Pace]

Regardless of the circumstances in this case why cant the EU who mandate what size a cucumber must be can come up with a standard transition level ?{as in Canada, F/L 180, which puts the aircraft above the big rocks} some of the transition levels are simply too low given the rate of climb/descent of many aircraft in service in this day and age, it also prevents the QFE holdouts from trying to remove the top 300 feet of the local lumps. {Well not all the time, but it does reduce the chances of hitting a grain elevator as done by a certain exchange pilot a few years back}

Totally agree, We have the Alps and FL180 would be a good starting point. It is ridiculous that there is so much variation.
There was talk from EASA of having a standard transition level then it died a death

Pace

[23c]

Dear Pace. Please get your facts right. The incident you refer to at Ballykelly in 2006 was not operated by Ryanair. They had subbed the flight to Eirjet who operated an A320, not a B738. I am not a fan of RYR but I do take issue with your derisory comments of their crew without bothering to check the facts.

[His dudeness]

Dear Pace. Please get your facts right. The incident you refer to at Ballykelly in 2006 was not operated by Ryanair. They had subbed the flight to Eirjet who operated an A320, not a B738. I am not a fan of RYR but I do take issue with your derisory comments of their crew without bothering to check the facts.

So he talked about Ryan instead of Eirjet, and 320 instead of a 737.

The point he was trying to make was a different one and you know that.

If I were a pompous git, I´d say I take issue with that.

But I´m not.