By Jan W. Steenblik, Technical Editor
Air Line Pilot, May 2003, p. 12

That unforgettable event, which killed 583 people, set a tragic record that still stands, a quarter century later—the worst fatal accident in the history of civil aviation. The Tenerife accident shocked the world and jolted the aviation community into a sharper understanding of the catastrophic potential of runway incursions.

Before the Tenerife accident, the FAA didn’t even have a definition for "runway incursion"; today, the agency has a dedicated Runway Safety Program Office.

But preventing runway incursions has been a vexing problem. Since 1990, five fatal runway incursion accidents involving airliners have occurred in the United States. Given the current demands on airport capacity—forecast to continue to increase in the years to come—the task will continue to be challenging, requiring a multifaceted effort. Runway incursions remain on the NTSB’s "Most Wanted" list of aviation safety improvements.

Now, however, the FAA and other aviation "stakeholders," including ALPA, have embarked on a new approach to reducing runway incursions.

In 1998, Vice-President Al Gore, Transportation Secretary Federico Peña, and FAA Administrator Jane Garvey announced the creation of the Safer Skies Program in response to recommendations that the Gore Commission and the National Civil Aviation Review Commission issued in 1997. The Safer Skies Program led to the creation of the government/industry Commercial Aviation Safety Team (CAST), whose mission is to reduce the airline fatal-accident rate by 80 percent over a 10-year period ending in 2007.

Under the CAST structure, a Joint Safety Analysis Team (JSAT) uses a data-driven analytical process to look at a specific aviation safety problem—for example, runway incursions. The JSAT, which includes ALPA representatives, spends several months conducting an exhaustive study of the problem and developing a list of recommended "interventions" to mitigate the problem.

After CAST accepts the JSAT’s report, CAST creates a Joint Safety Implementation Team (JSIT) "to develop, prioritize, and coordinate an agenda to implement the interventions" that the JSAT has recommended.

Thus far, CAST has approved safety interventions for six accident categories—controlled flight into terrain (CFIT), approach-and-landing accident reduction (ALAR; see "Staying Out of the Rocks," July/August 2002), loss of control, uncontained engine failure, turbulence, and runway incursions.

CAST has so far approved 46 interventions—16 already implemented, and 30 in the process of being completed. Safety experts estimate that when all 46 safety enhancements are implemented, they will reduce the risk of fatalities in the U.S. airline fleet by almost 70 percent by 2007.

On March 13, 2003, CAST approved the 187-page Results and Analysis Report of the Runway Incursions JSIT. Representing the Association on the JSIT were Capt. Mack Moore (United), chairman of ALPA’s Airport Ground/Environment Group; Capt. Alan Campbell (Delta, Ret.); Capt. Marty Coddington (Express One, Ret.), a former member of ALPA’s Air Traffic Services Group; John O’Brien, director of ALPA’s Engineering and Air Safety Department; and Charlie Bergman, ALPA staff engineer.

The Runway Incursions JSIT analyzed 115 intervention strategies that the JSAT had recommended, plus another 37 developed for general aviation. To determine the priority of these individual recommendations, the JSIT multiplied the "overall effectiveness" of each intervention by the "feasibility" of implementing it. Thus, the JSIT selected for implementation only the interventions promising the most "bang for the buck."

From the overall scores, the JSIT developed 22 "safety enhancements" incorporated into seven detailed implementation plans, each dealing with a particular project area. The safety enhancements with completion date in parentheses, which follow, are being completed. Those without completion dates are awaiting resources for implementation.

The purpose of this project is to recommend that all FAR Part 121 and Part 135 operators "establish, document, train to, and follow standard operating procedures (SOPs) for ground operations." Operators should train to proficiency on their SOPs and ensure that they are used. These SOPs should be developed from a survey of industry "best practices." They also should be adapted for single-pilot (FAR Part 91) operations. Recommendations for "best practices" for ground vehicle operations in the aircraft movement area should also be developed and incorporated into training programs.

Seven specific actions are included under this heading:

• The FAA created a template for SOPs for ground operations for all FAR Part 121 and Part 135 operators to use in creating SOPs for each participant airline (completed in January 2003).

• The FAA will revise FAA Advisory Circular (AC) 120-74, Flight Crew Procedures during Taxi Operations, to include the template described above (completed in April 2003).

• The FAA will provide appropriate guidance to FAA principal operations inspectors to ensure that the SOP template (contained in the revised AC 120-74 as an addendum) is incorporated into operators’ training and operations manuals (to be done when the revised AC is published).

• The Air Transport Association (ATA) will include the proposed SOP template items in policy manuals and training programs "as appropriate for the scope of the operation" (to be completed 6 months after publication of the revised AC).

• The FAA created a template of "best practices" for ground operations to be used by single-pilot general aviation flights (completed in February 2003).

• The FAA also created a "best practices" template for mechanics and others who tow or otherwise move aircraft within the aircraft movement area (completed in February 2003).

• The American Association of Airport Executives (AAAE) developed recommended "best practices" for vehicular operations in the aircraft movement area and disseminated them for use in driver training (to be completed in October 2003).

This project is intended to ensure that air traffic controllers receive thorough training in basic ATC skills, resource management skills, situational awareness, and teamwork. This training will involve high-fidelity ATC tower simulators, memory aids, on-the-job training, and computer-based instruction.

This project includes five specific action items:

• The FAA will survey nationally available resources and requirements for use of memory aids, techniques, and tools (completed in March 2003).

• The FAA will develop training regarding the limitations of memory and develop ways to improve memory (to be completed in March 2004).

• The FAA will look at existing course curriculums for tower controllers to ensure emphasis on scanning techniques, anticipated separation, and setting priorities among control tasks (completed in March 2003).

• The FAA will require all tower controllers to complete approved training that emphasizes team effectiveness and situational awareness "in an operational environment" (to be completed in March 2005).

• The FAA will develop high-fidelity tower simulators to support mandatory recurrent proficiency training for all tower controllers.

Five areas of activity are detailed for ATC procedures:

• The FAA will put into practice national, standardized requirements for tower controllers "to ensure uniform, effective, and sustained situational awareness practices" relating to airport surface operations (to be completed in May 2003).

• The FAA will review runway incursion data to determine what effect capacity-enhancement procedures—the agency’s current procedures regarding reduced separation on final approach and land-and-hold-short operations (LAHSO)—have on surface incidents and runway incursions.

• The FAA will delete or change unnecessary and/or confusing phraseology used for surface movement operations.

• The FAA will amend the last two sentences of FAR Part 91.129(i), which deal with takeoff, landing, and taxi clearances.

• The FAA will require pilots to read back ATC instructions to enter a specific runway or hold short of a specific runway, and all taxi-into-position-and-hold instructions (to be completed in March 2005).

This is the project that involves developing and implementing technological systems, including datalink, that are designed to provide and/or enhance air traffic controllers’ situational awareness of the airport surface and movement on it. Examples of these systems include, but are not limited to, the Airport Movement Area Safety System (AMASS), Airport Surface Detection Equipment (ASDE-X), Automated Dependent Surveillance—Broadcast (ADS-B), Next-Generation Air-Ground Communications System (NEXCOM), Surface Movement Advisor (SMA), and Airport Target Identification System (ATIDS).

Four broad areas of activity come under this project:

• The FAA is developing a "roadmap" for an airport surface systems architecture that includes, but is not limited to, sensor systems, displays (both groundbased and aboard aircraft), and communications systems (both voice and data). This roadmap (to be completed in 2003) should be consistent with future updates of the National Airspace System (NAS) Architecture Plan.

• The FAA should periodically release Broad Agency Announcements (BAAs) to solicit industry ideas and concepts for new or enhanced technology tools to enable enhanced surveillance, information, communications, and conflict detection for ATC (ongoing and continuous).

• The FAA should provide active and/or passive airport surface surveillance at all FAA ATC towers and provide conflict-alerting capabilities as they become available. (Surface surveillance covers a wide range of potential solutions and is not limited to radar. This capability can be provided through active sensors, e.g., ADS-B; or passive sensors, e.g., magnetic/infrared sensors.) This effort has already been completed at some U.S. airports, and should be completed by 2011 at all with FAA towers.

• The FAA should implement digital datalink in terminal areas to enable automatic transmission of ATC instructions and information (between the ground and aircraft operating on the airport surface) to aircraft equipped with datalink-capable avionics. Pilots of aircraft not equipped with such avionics will see no degradation in current service. Operators will not be required to install any new equipment unless mandated by the FAA through the rulemaking process. This activity has already begun at selected U.S. airports and should be completed by May 2011.

This project area deals with developing and installing airport visual aids that provide clear guidance (taxi route, runway entrance, runway exit, and construction area avoidance) for flight crews and other persons operating aircraft and vehicles on the aircraft movement area. This project is intended to provide unambiguous visual signals to convey runway occupancy clearances and to convey runway occupancy status to the pilots of aircraft on final approach. Such visual aids are intended to comply with appropriate aviation standards and be visible under all meteorological conditions.

Four action items come under this project area:

• The FAA will provide clear and unambiguous runway occupancy clearance signals (variable message signs) for runway entrances at airports that comply with FAR Part 139 (airport certification) and serve FAR Part 121 operations.

• The FAA will develop, evaluate, and install taxi route and runway holding position markings, signs, and lights to improve the all-weather conspicuity of these visual aids.

• The FAA will develop, evaluate, and install a visual signal to indicate runway occupancy to flight crews on final approach to that runway.

• The FAA will develop, evaluate, and install automated "smart lighting" systems to indicate taxi routes and runway exits for appropriate airports.

The purpose of this project area is to incorporate runway incursion training into flight crew qualifications, approved training, and other pilot training programs, with an emphasis on increasing pilots’ ability to recognize and avoid situations that could lead to runway incursions.

Six action items are planned to change pilot training:

• The FAA Runway Safety Program Office will compile runway safety materials currently available from government, industry, academia, and the Department of Defense and make that material available for education, training, and awareness of pilots (completed in March 2003).

• The FAA’s Flight Standards Service will issue guidance as necessary directing all flight standards district offices, aviation safety inspectors, and principal operations inspectors to place increased significance on pilots’ performance regarding ground operations during all pilot flight training (completed in January 2003).

• The FAA will increase the number of airport surface movement tasks on all written and practical test standards for pilots (completed in March 2003).

• The FAA will draft and publish advisory circulars recommending methods for airline/operator training and standardization programs to cover

—methods to establish aircraft position using all available resources and tools (charts, ATC, inter/intra-crew communication);

—guidance regarding situational awareness, including knowledge and understanding of the relevant elements of the pilots’ surroundings, including the pilots’ aircraft location, other aircraft on short final, aircraft systems, and the pilot’s intentions;

—guidance on the importance of adequate pretaxi planning and briefing, including before taxi out and after landing; and

—background information for SOPs and training programs to ensure pilots understand the rationale behind those procedures and programs.

These advisory circulars were completed in March 2003.

• The FAA will specifically include taxi operations and ATC taxi instructions in AC 120-35C, Line-Oriented Flight Training (to be completed in November 2003).

• The FAA will modify language in AC 120-51D, Crew Resource Management Training, to provide guidance for clear delineation of captain training on command oversight and first officer responsibilities for monitoring during airport surface movements (to be completed in November 2003).

Using moving-map technology to improve the situational awareness of drivers of ground vehicles on the aircraft-movement area is the focus of this project.

Four specific actions are included:

• The FAA will encourage operators of FAR Part 139 certificated airports to install, on specified ground vehicles, systems that have an airport-surface moving-map display with own position (provided by GPS). The agency will also encourage these airport operators to direct installation of these systems in ground vehicles that transit aircraft movement areas.

• The FAA will encourage these same airport operators to upgrade moving-map displays in ground vehicles by adding air and ground traffic, reported by ADS-B and TIS-B, to the displays.

• The FAA will encourage FAR Part 139 airport operators to upgrade moving-map displays in ground vehicles by adding runway occupancy advisory systems to those displays.

• The FAA will encourage these airport operators to add datalinked taxi-clearance and clearance-limit functions to moving-map displays in ground vehicles.

This project has been, in some regards, the most contentious. Its purpose is to improve pilot situational awareness using "moving map" cockpit displays of the airport surface.

Some nine different action items are included under this project area:

• The FAA will encourage commercial operators to install in cockpits airport-surface moving-map displays with "own ship" position (provided by GPS) in all next-generation, newly manufactured, and specified existing airliners.

• The FAA will coordinate with the appropriate government agencies to collect airport survey data, validate that data, apply airport attributes (e.g., taxiway and runway labels), and disseminate the airport databases for use in cockpit moving-map displays of airport surfaces.

• The FAA will encourage head-up display (HUD) manufacturers to provide airport-surface moving-map displays with "own ship" position (provided by GPS) for their HUDs.

• The FAA will encourage airlines to upgrade cockpit moving map displays to add air and ground traffic to cockpit surface-map displays (to be completed by 2015). (ADS-B and TIS-B will make this possible.)

• The FAA will encourage HUD manufacturers to add air and ground traffic to HUD moving-map displays.

• The FAA will encourage airlines to upgrade cockpit moving-map displays by adding runway occupancy advisory systems to them (to be completed by 2008).

• The FAA will encourage HUD manufacturers to add runway occupancy advisory systems to their HUD moving-map displays.

• The FAA will encourage airlines to add datalinked taxi-clearance and clearance-limit map displays to their cockpit moving-map displays.

• The FAA will encourage HUD manufacturers to add graphical taxi-clearance and clearance-limit functions to their HUD moving-map displays.

So what’s contentious about these plans to install moving-map displays in airline cockpits?

In the Association’s view, the fact that the JSIT did not reach consensus that the FAA should mandate this equipment was particularly regrettable because, as the JSIT report itself said, "The Runway Incursion JSIT determined that the moving-map display systems were the most powerful intervention for runway incursion prevention [emphasis added]…. Pilot deviations account for more than half of all runway incursions. The RI JSIT estimated that nearly half of these deviations can be prevented [by] using a moving-map display with only GPS own-ship position….

"The RI JSIT determined that a moving-map display with own-ship position and airport traffic displayed (e.g., ADS-B/TIES-B) would have been highly effective in preventing the runway incursion accidents and incidents [that] the RI JSAT considered.

"Further enhancements such as runway occupancy alerting and graphical taxi clearances would provide additional benefits."

The report continued, "While cost remains the biggest barrier to implementation, a phased approach …minimizes cost and provides an immediate and measurable safety benefit."

Despite ALPA’s disappointment that moving-map displays have yet to be declared necessary equipment in airline cockpits, the Runway Incursion JSIT has put together a unique historic document.

The group was the first of the CAST JSAT and JSIT teams to focus on incident data analysis as the primary source for generating safety enhancements, paving the way for future risk-mitigation methodology.

These words from the Runway Incursions JSIT report may well prove prophetic: "As industry and government collectively move toward a National Strategic Plan for Aviation Safety, they will be required to increasingly move from a reactive to a preventive model of mishap elimination.

"Achieving the next order of magnitude reduction of risk in aviation may require an expanded focus on other sources of data (e.g., incident data as well as accident data) to identify the precursors of catastrophe.

"The move from studying primarily accident data to a reliance on incident data will require improved data-collection systems, procedures, and protections among all the stakeholders within the aviation community."

Something ALPA has been saying for a long time.