37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 296137 |
Time | |
Date | 199502 |
Day | Sat |
Local Time Of Day | 0001 To 0600 |
Place | |
Locale Reference | atc facility : eja |
State Reference | FO |
Altitude | msl bound lower : 33000 msl bound upper : 33000 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | artcc : sked |
Operator | common carrier : air carrier |
Make Model Name | Commercial Fixed Wing |
Operating Under FAR Part | Part 121 |
Navigation In Use | Other |
Flight Phase | cruise other |
Route In Use | enroute : direct |
Flight Plan | IFR |
Aircraft 2 | |
Make Model Name | Commercial Fixed Wing |
Operating Under FAR Part | other : unknown |
Flight Phase | cruise other |
Route In Use | enroute : direct |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 220 flight time total : 18050 flight time type : 2377 |
ASRS Report | 296136 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : instrument pilot : commercial |
Events | |
Anomaly | altitude deviation : excursion from assigned altitude conflict : airborne less severe non adherence : required legal separation non adherence : published procedure non adherence : clearance |
Independent Detector | aircraft equipment other aircraft equipment : unspecified |
Resolutory Action | flight crew : took evasive action |
Consequence | other |
Miss Distance | horizontal : 3000 vertical : 1000 |
Supplementary | |
Primary Problem | ATC Human Performance |
Air Traffic Incident | Operational Error Inter Facility Coordination Failure |
Narrative:
Air carrier X, a regular scheduled flight operating mia-dze (buenos aires), operating about 1 hour late because of job action of maiquetia (venezuela) control and barranquilla (ba) columbia control. Takeoff from mia was very near maximum weight requiring maximum altitude of FL290. After fuel burn, climbed to FL330 at maximum recommended weight. At the time of incident, we were still near maximum weight for altitude (climb performance limited). Cockpit lighting was reduced to mostly integral instrument lights, exterior lighting was beacons, strobes, navigation and logo lighting on. TCASII was on with range set at maximum (40 mi), radar was off. Flight attendant had just set crew meal on my lap. TCASII sounded traffic. All exterior lights were immediately turned on. TCASII sounded climb, climb, now. Autoplt was disconnected, climb initiated and thrust was immediately and aggressively applied. Ivsi showed red arc from about 1500 ft up to 3000 ft down. TCASII RA stopped reading FL340. Traffic Y passed and we descended back to FL330. First officer observed traffic as it passed off right wing at 1/2 mi or less range. Near miss was broadcast to control. During RA maneuver egt limits were exceeded on engines #2, #3, and 4. N1 limit exceeded on egt #2. Maintenance was required at eze. Egt indicators have amber lights which come on 15 degrees below limit. When lights cane on, power was reduced. No passenger or cabin crew were injured or alarmed during RA. In spite of the hour, I felt good and alert after taking a 4-5 hour nap prior to duty. Conclusion: we just passed dagan intersection, the flight information region between ba and bogota control and were changing frequency from ba to bogota control so would not have heard traffic's position report at eja. Unknown traffic was northbound at wrong altitude. Traffic always seems heavy between eja and ba. There have been too many near misses in sa and the chances are not getting any better. (How do you change a culture?) I don't know any way to change my operation to make it any safer. My next trip down here will be my last, transferring to different aircraft and domicile. Position reports in sa are made in native tongue and sometimes not understood.
Original NASA ASRS Text
Title: ACR X TCASII RA HAD LTSS FROM ACFT ASSIGNED SAME ALT. SYS ERROR. EVASIVE ACTION TAKEN.
Narrative: ACR X, A REGULAR SCHEDULED FLT OPERATING MIA-DZE (BUENOS AIRES), OPERATING ABOUT 1 HR LATE BECAUSE OF JOB ACTION OF MAIQUETIA (VENEZUELA) CTL AND BARRANQUILLA (BA) COLUMBIA CTL. TKOF FROM MIA WAS VERY NEAR MAX WT REQUIRING MAX ALT OF FL290. AFTER FUEL BURN, CLBED TO FL330 AT MAX RECOMMENDED WT. AT THE TIME OF INCIDENT, WE WERE STILL NEAR MAX WT FOR ALT (CLB PERFORMANCE LIMITED). COCKPIT LIGHTING WAS REDUCED TO MOSTLY INTEGRAL INST LIGHTS, EXTERIOR LIGHTING WAS BEACONS, STROBES, NAV AND LOGO LIGHTING ON. TCASII WAS ON WITH RANGE SET AT MAX (40 MI), RADAR WAS OFF. FLT ATTENDANT HAD JUST SET CREW MEAL ON MY LAP. TCASII SOUNDED TFC. ALL EXTERIOR LIGHTS WERE IMMEDIATELY TURNED ON. TCASII SOUNDED CLB, CLB, NOW. AUTOPLT WAS DISCONNECTED, CLB INITIATED AND THRUST WAS IMMEDIATELY AND AGGRESSIVELY APPLIED. IVSI SHOWED RED ARC FROM ABOUT 1500 FT UP TO 3000 FT DOWN. TCASII RA STOPPED READING FL340. TFC Y PASSED AND WE DSNDED BACK TO FL330. FO OBSERVED TFC AS IT PASSED OFF R WING AT 1/2 MI OR LESS RANGE. NEAR MISS WAS BROADCAST TO CTL. DURING RA MANEUVER EGT LIMITS WERE EXCEEDED ON ENGS #2, #3, AND 4. N1 LIMIT EXCEEDED ON EGT #2. MAINT WAS REQUIRED AT EZE. EGT INDICATORS HAVE AMBER LIGHTS WHICH COME ON 15 DEGS BELOW LIMIT. WHEN LIGHTS CANE ON, PWR WAS REDUCED. NO PAX OR CABIN CREW WERE INJURED OR ALARMED DURING RA. IN SPITE OF THE HR, I FELT GOOD AND ALERT AFTER TAKING A 4-5 HR NAP PRIOR TO DUTY. CONCLUSION: WE JUST PASSED DAGAN INTXN, THE FLT INFO REGION BTWN BA AND BOGOTA CTL AND WERE CHANGING FREQ FROM BA TO BOGOTA CTL SO WOULD NOT HAVE HEARD TFC'S POS RPT AT EJA. UNKNOWN TFC WAS NBOUND AT WRONG ALT. TFC ALWAYS SEEMS HVY BTWN EJA AND BA. THERE HAVE BEEN TOO MANY NEAR MISSES IN SA AND THE CHANCES ARE NOT GETTING ANY BETTER. (HOW DO YOU CHANGE A CULTURE?) I DON'T KNOW ANY WAY TO CHANGE MY OP TO MAKE IT ANY SAFER. MY NEXT TRIP DOWN HERE WILL BE MY LAST, TRANSFERRING TO DIFFERENT ACFT AND DOMICILE. POS RPTS IN SA ARE MADE IN NATIVE TONGUE AND SOMETIMES NOT UNDERSTOOD.
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.