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|
Attributes | |
ACN | 189045 |
Time | |
Date | 199109 |
Day | Tue |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | atc facility : cos |
State Reference | CO |
Altitude | msl bound lower : 9500 msl bound upper : 10000 |
Environment | |
Flight Conditions | IMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | Light Transport, Low Wing, 2 Turboprop Eng |
Flight Phase | cruise other |
Route In Use | enroute : direct enroute airway : cos |
Flight Plan | IFR |
Aircraft 2 | |
Operator | general aviation : personal |
Make Model Name | Small Aircraft, Low Wing, 1 Eng, Fixed Gear |
Flight Phase | climbout : intermediate altitude |
Route In Use | enroute : direct |
Flight Plan | IFR |
Person 1 | |
Affiliation | government : faa |
Function | controller : departure |
Qualification | controller : radar |
ASRS Report | 189045 |
Person 2 | |
Affiliation | government : faa |
Function | oversight : supervisor |
Qualification | controller : radar |
Events | |
Anomaly | conflict : airborne less severe non adherence : required legal separation non adherence : published procedure |
Independent Detector | aircraft equipment other aircraft equipment : unspecified other controllera |
Resolutory Action | controller : issued new clearance other |
Consequence | Other |
Miss Distance | vertical : 500 |
Supplementary | |
Primary Problem | ATC Human Performance |
Air Traffic Incident | Operational Error Intra Facility Coordination Failure |
Situations | |
ATC Facility | procedure or policy : unspecified |
Narrative:
I was working the entire approach control at colorado springs. No other positions were open. The position is called radar south. I was advised by tower of a large number of aircraft taxiing out takeoff, and that 4 would be doing multiple ILS approachs due to IFR WX. I then advised my supervisor that it was going to get busy. He only acknowledged my statement. Along with the aircraft getting ready to depart, I already had 2 training IFR aircraft, 4 itinerant arrs, and 4 IFR over flts. At this point I was already quite busy. Within a couple mins the aircraft were departing and I getting more traffic than I felt I could safely handle. I again advised my supervisor of my situation and requested that a second radar scope be opened at the radar north position. He set up the north scope and was attempting to receive a brief from myself. This brief was very insufficient and inadequate due to continuous interruptions from aircraft calling on frequency, tower trying to call off departures, and denver center calling to coordination. At this point the supervisor took the frequencys for north and started transmitting. I came off the frequency for north and continued to talk to planes on south frequencys. At this point there were aircraft now on the wrong frequencys due to the split radar positions, and I was attempting to get aircraft over to north frequency that the north controller needed to speak to. I then noticed air carrier X and an air taxi, sbound to pueblo at 100 and small aircraft Y out of 90 for 100 MSL northbound. Earlier small aircraft Y checked in out of 80 for 100 MSL. Both aircraft were still separated by more than 3 mi but the distance was closing. I immediately went to air carrier X, and issued a turn of 220 degree to insure separation. I received no reply. Now there was less than 3 mi so I went to small aircraft Y and instructed him to maintain present altitude, maintain 95 MSL. He complied and this is where the error occurred. During this same time air carrier X was calling north, since he hadn't been put on my frequency and advised the controller that he observed a target 500 ft below on TCASII equipment. Air carrier X never deviated in altitude or in heading. I was still unaware that air carrier X was not on my frequency. After the 2 aircraft had passed I climbed small aircraft Y to 100 MSL and again went to air carrier X to descend him to 90 but got no answer. The north controller then told me that air carrier X was in his frequency. Factors contributing to this situation: not enough staffing to prevent 1 individual from becoming overwhelmed and getting help too late. Having to ask for help from a supervisor who should already be aware of the situation and be prepared to help before it gets too busy. The situation occurred because: the briefing was insufficient and inadequate. It was just too busy with planes calling, tower calling pff departures, and adjacent facs calling to give a satisfactory briefing. The supervisor opening the north scope never said he assumed the position, but instead took the frequencys and started transmitting. I realize the intentions were good because this would relieve some of the burden I had, but to take a position without a complete brief is not wise. Since I was too busy to tell him who was or was not on his frequency, he was unaware that air carrier X was on his frequency. Because I was extremely busy and attempting a brief under adverse conditions, this led to my lack of continuous scanning to see the potential conflict that was getting ready to occur. Suggestions to help this from occurring again: have 2 scopes kept open during the busiest time of the day to ensure sufficient help is available. At colorado springs, 1 min it's slow and the next quite busy without much warning. More staffing! From X:30 to Y:30 am there was just myself and a supervisor. According to daily traffic count those are the busiest hours of the day, every day. Not only is this inadequate, but trying to get adequate breaks becomes difficult.
Original NASA ASRS Text
Title: ACR X HAD LTSS FROM SMA Y. SYS ERROR.
Narrative: I WAS WORKING THE ENTIRE APCH CTL AT COLORADO SPRINGS. NO OTHER POSITIONS WERE OPEN. THE POS IS CALLED RADAR S. I WAS ADVISED BY TWR OF A LARGE NUMBER OF ACFT TAXIING OUT TKOF, AND THAT 4 WOULD BE DOING MULTIPLE ILS APCHS DUE TO IFR WX. I THEN ADVISED MY SUPVR THAT IT WAS GOING TO GET BUSY. HE ONLY ACKNOWLEDGED MY STATEMENT. ALONG WITH THE ACFT GETTING READY TO DEPART, I ALREADY HAD 2 TRAINING IFR ACFT, 4 ITINERANT ARRS, AND 4 IFR OVER FLTS. AT THIS POINT I WAS ALREADY QUITE BUSY. WITHIN A COUPLE MINS THE ACFT WERE DEPARTING AND I GETTING MORE TFC THAN I FELT I COULD SAFELY HANDLE. I AGAIN ADVISED MY SUPVR OF MY SITUATION AND REQUESTED THAT A SEC RADAR SCOPE BE OPENED AT THE RADAR N POS. HE SET UP THE N SCOPE AND WAS ATTEMPTING TO RECEIVE A BRIEF FROM MYSELF. THIS BRIEF WAS VERY INSUFFICIENT AND INADEQUATE DUE TO CONTINUOUS INTERRUPTIONS FROM ACFT CALLING ON FREQ, TWR TRYING TO CALL OFF DEPS, AND DENVER CENTER CALLING TO COORD. AT THIS POINT THE SUPVR TOOK THE FREQS FOR N AND STARTED XMITTING. I CAME OFF THE FREQ FOR N AND CONTINUED TO TALK TO PLANES ON S FREQS. AT THIS POINT THERE WERE ACFT NOW ON THE WRONG FREQS DUE TO THE SPLIT RADAR POSITIONS, AND I WAS ATTEMPTING TO GET ACFT OVER TO N FREQ THAT THE N CTLR NEEDED TO SPEAK TO. I THEN NOTICED ACR X AND AN AIR TAXI, SBOUND TO PUEBLO AT 100 AND SMA Y OUT OF 90 FOR 100 MSL NBOUND. EARLIER SMA Y CHKED IN OUT OF 80 FOR 100 MSL. BOTH ACFT WERE STILL SEPARATED BY MORE THAN 3 MI BUT THE DISTANCE WAS CLOSING. I IMMEDIATELY WENT TO ACR X, AND ISSUED A TURN OF 220 DEG TO INSURE SEPARATION. I RECEIVED NO REPLY. NOW THERE WAS LESS THAN 3 MI SO I WENT TO SMA Y AND INSTRUCTED HIM TO MAINTAIN PRESENT ALT, MAINTAIN 95 MSL. HE COMPLIED AND THIS IS WHERE THE ERROR OCCURRED. DURING THIS SAME TIME ACR X WAS CALLING N, SINCE HE HADN'T BEEN PUT ON MY FREQ AND ADVISED THE CTLR THAT HE OBSERVED A TARGET 500 FT BELOW ON TCASII EQUIP. ACR X NEVER DEVIATED IN ALT OR IN HDG. I WAS STILL UNAWARE THAT ACR X WAS NOT ON MY FREQ. AFTER THE 2 ACFT HAD PASSED I CLBED SMA Y TO 100 MSL AND AGAIN WENT TO ACR X TO DSND HIM TO 90 BUT GOT NO ANSWER. THE N CTLR THEN TOLD ME THAT ACR X WAS IN HIS FREQ. FACTORS CONTRIBUTING TO THIS SITUATION: NOT ENOUGH STAFFING TO PREVENT 1 INDIVIDUAL FROM BECOMING OVERWHELMED AND GETTING HELP TOO LATE. HAVING TO ASK FOR HELP FROM A SUPVR WHO SHOULD ALREADY BE AWARE OF THE SITUATION AND BE PREPARED TO HELP BEFORE IT GETS TOO BUSY. THE SITUATION OCCURRED BECAUSE: THE BRIEFING WAS INSUFFICIENT AND INADEQUATE. IT WAS JUST TOO BUSY WITH PLANES CALLING, TWR CALLING PFF DEPS, AND ADJACENT FACS CALLING TO GIVE A SATISFACTORY BRIEFING. THE SUPVR OPENING THE N SCOPE NEVER SAID HE ASSUMED THE POS, BUT INSTEAD TOOK THE FREQS AND STARTED XMITTING. I REALIZE THE INTENTIONS WERE GOOD BECAUSE THIS WOULD RELIEVE SOME OF THE BURDEN I HAD, BUT TO TAKE A POS WITHOUT A COMPLETE BRIEF IS NOT WISE. SINCE I WAS TOO BUSY TO TELL HIM WHO WAS OR WAS NOT ON HIS FREQ, HE WAS UNAWARE THAT ACR X WAS ON HIS FREQ. BECAUSE I WAS EXTREMELY BUSY AND ATTEMPTING A BRIEF UNDER ADVERSE CONDITIONS, THIS LED TO MY LACK OF CONTINUOUS SCANNING TO SEE THE POTENTIAL CONFLICT THAT WAS GETTING READY TO OCCUR. SUGGESTIONS TO HELP THIS FROM OCCURRING AGAIN: HAVE 2 SCOPES KEPT OPEN DURING THE BUSIEST TIME OF THE DAY TO ENSURE SUFFICIENT HELP IS AVAILABLE. AT COLORADO SPRINGS, 1 MIN IT'S SLOW AND THE NEXT QUITE BUSY WITHOUT MUCH WARNING. MORE STAFFING! FROM X:30 TO Y:30 AM THERE WAS JUST MYSELF AND A SUPVR. ACCORDING TO DAILY TFC COUNT THOSE ARE THE BUSIEST HRS OF THE DAY, EVERY DAY. NOT ONLY IS THIS INADEQUATE, BUT TRYING TO GET ADEQUATE BREAKS BECOMES DIFFICULT.
Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.