37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 292693 |
Time | |
Date | 199501 |
Day | Mon |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | atc facility : dbl |
State Reference | CO |
Altitude | msl bound lower : 14000 msl bound upper : 14000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zdv |
Operator | general aviation : corporate |
Make Model Name | Gulfstream III |
Operating Under FAR Part | Part 91 |
Navigation In Use | Other Other |
Flight Phase | climbout : intermediate altitude |
Route In Use | departure other |
Flight Plan | IFR |
Aircraft 2 | |
Make Model Name | Any Unknown or Unlisted Aircraft Manufacturer |
Operating Under FAR Part | other : unknown |
Flight Phase | cruise other |
Person 1 | |
Affiliation | Other |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time total : 14775 |
ASRS Report | 292693 |
Person 2 | |
Affiliation | Other |
Function | flight crew : first officer |
Qualification | pilot : atp |
Events | |
Anomaly | conflict : airborne less severe non adherence : required legal separation non adherence : published procedure non adherence : clearance other spatial deviation |
Independent Detector | other controllera |
Resolutory Action | controller : issued new clearance other |
Consequence | Other |
Miss Distance | horizontal : 5280 vertical : 300 |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
At XA50 the PNF contacted ground for airport information and IFR clearance to sba. The filed route was 'ege direct dbl J-60 hec direct fim direct.' after all checklist items the PNF requested and received taxi clearance. During taxi, we were advised our clearance was available, the PNF copied it. It read 'cleared to rlg VOR via IFR departure procedure maintain 14000 ft, contact den 134.5 out of 10000 ft squawk XXXX.' after a review of the procedure by both pilots, we were cleared for takeoff. The takeoff and initial climb were routine, the problem developed after leaving 10000 ft and turning northbound on the 322 degree radial of dbl. The PNF was attempting to contact den center when I became convinced we should go 'to' dbl. I turned sbound and we were leveling at 14000 ft when contact with ZDV was established. The events as I remember them went like this: a female voice asked our position and altitude. A male voice came on advising us to make 'immediate turn north.' we complied and were also advised traffic 10 O'clock at 14300 ft. No crewmember saw any traffic. After a bit more confusion, we received our en route clearance proceeding with no more problems. After a discussion with the other pilot, we feel the factors affecting our flight were: 1) filed route and cleared route were different. 2) radio work can be distracting. We both agree there is no excuse for the 'dumb and deadly' wrong turn. Callback conversation with reporter revealed the following information: reporter states that self- imposed time pressure existed for gulfstream III flight crew during departure from ege airport. The reporter was concerned about fading daylight under an overcast sky. Visibility was critical because mountainous terrain surrounded the airport, and there was a history of an occasional 'deer on the runway.' prior to departure, the flight crew had reviewed the IFR departure procedure but, reporter indicated that the deteriorating conditions may have influenced the time and attention delegated to the task. On climb out, reporter (PF) became confused between the flight planned route and the actual ATC clearance received. He wanted to question the PNF, but the PNF was busy establishing radio contact with center. Published procedure was in front of PF (not the norm), but this was a high workload time and he did not divert his attention from flying the aircraft. Reporter states that a similar situation has happened before. Reporter feels that PNF needs to be more actively involved and assertive. Reporter, clearly, still took responsibility for his mistake, though.
Original NASA ASRS Text
Title: THE PF BECAME CONFUSED BTWN THE FLT PLANNED RTE, AND THE RTE THAT THE FLC WAS CLRED TO FLY. THIS ULTIMATELY LED TO LESS THAN LEGAL SEPARATION.
Narrative: AT XA50 THE PNF CONTACTED GND FOR ARPT INFO AND IFR CLRNC TO SBA. THE FILED RTE WAS 'EGE DIRECT DBL J-60 HEC DIRECT FIM DIRECT.' AFTER ALL CHKLIST ITEMS THE PNF REQUESTED AND RECEIVED TAXI CLRNC. DURING TAXI, WE WERE ADVISED OUR CLRNC WAS AVAILABLE, THE PNF COPIED IT. IT READ 'CLRED TO RLG VOR VIA IFR DEP PROC MAINTAIN 14000 FT, CONTACT DEN 134.5 OUT OF 10000 FT SQUAWK XXXX.' AFTER A REVIEW OF THE PROC BY BOTH PLTS, WE WERE CLRED FOR TKOF. THE TKOF AND INITIAL CLB WERE ROUTINE, THE PROB DEVELOPED AFTER LEAVING 10000 FT AND TURNING NBOUND ON THE 322 DEG RADIAL OF DBL. THE PNF WAS ATTEMPTING TO CONTACT DEN CTR WHEN I BECAME CONVINCED WE SHOULD GO 'TO' DBL. I TURNED SBOUND AND WE WERE LEVELING AT 14000 FT WHEN CONTACT WITH ZDV WAS ESTABLISHED. THE EVENTS AS I REMEMBER THEM WENT LIKE THIS: A FEMALE VOICE ASKED OUR POS AND ALT. A MALE VOICE CAME ON ADVISING US TO MAKE 'IMMEDIATE TURN N.' WE COMPLIED AND WERE ALSO ADVISED TFC 10 O'CLOCK AT 14300 FT. NO CREWMEMBER SAW ANY TFC. AFTER A BIT MORE CONFUSION, WE RECEIVED OUR ENRTE CLRNC PROCEEDING WITH NO MORE PROBS. AFTER A DISCUSSION WITH THE OTHER PLT, WE FEEL THE FACTORS AFFECTING OUR FLT WERE: 1) FILED RTE AND CLRED RTE WERE DIFFERENT. 2) RADIO WORK CAN BE DISTRACTING. WE BOTH AGREE THERE IS NO EXCUSE FOR THE 'DUMB AND DEADLY' WRONG TURN. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: RPTR STATES THAT SELF- IMPOSED TIME PRESSURE EXISTED FOR GULFSTREAM III FLC DURING DEP FROM EGE ARPT. THE RPTR WAS CONCERNED ABOUT FADING DAYLIGHT UNDER AN OVCST SKY. VISIBILITY WAS CRITICAL BECAUSE MOUNTAINOUS TERRAIN SURROUNDED THE ARPT, AND THERE WAS A HISTORY OF AN OCCASIONAL 'DEER ON THE RWY.' PRIOR TO DEP, THE FLC HAD REVIEWED THE IFR DEP PROC BUT, RPTR INDICATED THAT THE DETERIORATING CONDITIONS MAY HAVE INFLUENCED THE TIME AND ATTN DELEGATED TO THE TASK. ON CLBOUT, RPTR (PF) BECAME CONFUSED BTWN THE FLT PLANNED RTE AND THE ACTUAL ATC CLRNC RECEIVED. HE WANTED TO QUESTION THE PNF, BUT THE PNF WAS BUSY ESTABLISHING RADIO CONTACT WITH CTR. PUBLISHED PROC WAS IN FRONT OF PF (NOT THE NORM), BUT THIS WAS A HIGH WORKLOAD TIME AND HE DID NOT DIVERT HIS ATTN FROM FLYING THE ACFT. RPTR STATES THAT A SIMILAR SIT HAS HAPPENED BEFORE. RPTR FEELS THAT PNF NEEDS TO BE MORE ACTIVELY INVOLVED AND ASSERTIVE. RPTR, CLRLY, STILL TOOK RESPONSIBILITY FOR HIS MISTAKE, THOUGH.
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.