37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 430987 |
Time | |
Date | 199903 |
Day | Mon |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : las.airport |
State Reference | NV |
Altitude | msl single value : 4000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Experience | flight time last 90 days : 561 flight time total : 7426 flight time type : 3788 |
ASRS Report | 430987 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 250 flight time total : 16000 flight time type : 13000 |
ASRS Report | 731293 |
Events | |
Anomaly | conflict : airborne less severe non adherence : clearance other anomaly other other spatial deviation |
Independent Detector | aircraft equipment : tcas other flight crewa other flight crewb |
Resolutory Action | controller : issued advisory flight crew : became reoriented flight crew : took evasive action |
Miss Distance | horizontal : 6000 vertical : 0 |
Supplementary | |
Problem Areas | FAA Flight Crew Human Performance ATC Human Performance |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
On fuzzy arrival from northwest (oak) approaching las, ATIS information showed gusty winds from south, landing runway 19L/right las with 'runway 25L available on request.' approach gave us descent to 10000 ft, 'expect visual to runway 19L.' abeam las, given descent to 8000 ft, then 5600 ft. About 8 NM east, cleared 'visual approach to runway 25L.' first officer acknowledged 'visual to runway 25L,' however both pilots were expecting runway 19L and continued approach profile to that runway until after switching to tower and given clearance to land on runway '25L.' realizing this was a different runway than they were headed towards, first officer attempted to clarify 'understand cleared to land runway 19L.' tower reconfirmed 'runway 25L.' about this time TCASII traffic alert sounded for aircraft at right, 3 O'clock, directing a descent. Crew turned left and climbed to clear traffic (which was on straight-in to runway 19L/right) and then continued approach (now to runway 25L). Nearest approach was approximately 1 NM to other aircraft (turboprop commuter). Remainder of approach to landing on runway 25L was relatively uneventful considering confusion as to how situation had developed. How did it happen: call it the 'case of unmet expectations.' told to expect runway 19L (not the normal runway at las) crew was focused on making good approach to unusual runway. Crew was not notified of ATIS change for runway change to landing on runway 25L, nor did approach inform them of change in plans to land on runway 25L. Either would have broken crews focus on runway 19L. Crewed did acknowledged 'runway 25L,' but heard 'runway 19L' (hearing what we expected to hear). It was our fault but we were also set up for it. How to prevent: 1) crews don't fixate on what you're expecting -- be alert for changes. 2) when changing runway configns, make sure all planes on approach are informed. Supplemental information from acn 431293: we were led down the 'rosey' path because of ATIS and approach telling us that we should expect runway 19L. Had approach told us a new ATIS was current, that would have broken the chain. The new ATIS would have told us that runway 25L was the active.
Original NASA ASRS Text
Title: A B737-300 CREW ATTEMPTS TO APCH AND LAND RWY 19L AT LAS AFTER THEY HAD BEEN ASSIGNED AND ACKNOWLEDGED RWY 25L FOR LNDG. A POTENTIAL CONFLICT OCCURS ON THAT APCH.
Narrative: ON FUZZY ARR FROM NW (OAK) APCHING LAS, ATIS INFO SHOWED GUSTY WINDS FROM S, LNDG RWY 19L/R LAS WITH 'RWY 25L AVAILABLE ON REQUEST.' APCH GAVE US DSCNT TO 10000 FT, 'EXPECT VISUAL TO RWY 19L.' ABEAM LAS, GIVEN DSCNT TO 8000 FT, THEN 5600 FT. ABOUT 8 NM E, CLRED 'VISUAL APCH TO RWY 25L.' FO ACKNOWLEDGED 'VISUAL TO RWY 25L,' HOWEVER BOTH PLTS WERE EXPECTING RWY 19L AND CONTINUED APCH PROFILE TO THAT RWY UNTIL AFTER SWITCHING TO TWR AND GIVEN CLRNC TO LAND ON RWY '25L.' REALIZING THIS WAS A DIFFERENT RWY THAN THEY WERE HEADED TOWARDS, FO ATTEMPTED TO CLARIFY 'UNDERSTAND CLRED TO LAND RWY 19L.' TWR RECONFIRMED 'RWY 25L.' ABOUT THIS TIME TCASII TFC ALERT SOUNDED FOR ACFT AT R, 3 O'CLOCK, DIRECTING A DSCNT. CREW TURNED L AND CLBED TO CLR TFC (WHICH WAS ON STRAIGHT-IN TO RWY 19L/R) AND THEN CONTINUED APCH (NOW TO RWY 25L). NEAREST APCH WAS APPROX 1 NM TO OTHER ACFT (TURBOPROP COMMUTER). REMAINDER OF APCH TO LNDG ON RWY 25L WAS RELATIVELY UNEVENTFUL CONSIDERING CONFUSION AS TO HOW SIT HAD DEVELOPED. HOW DID IT HAPPEN: CALL IT THE 'CASE OF UNMET EXPECTATIONS.' TOLD TO EXPECT RWY 19L (NOT THE NORMAL RWY AT LAS) CREW WAS FOCUSED ON MAKING GOOD APCH TO UNUSUAL RWY. CREW WAS NOT NOTIFIED OF ATIS CHANGE FOR RWY CHANGE TO LNDG ON RWY 25L, NOR DID APCH INFORM THEM OF CHANGE IN PLANS TO LAND ON RWY 25L. EITHER WOULD HAVE BROKEN CREWS FOCUS ON RWY 19L. CREWED DID ACKNOWLEDGED 'RWY 25L,' BUT HEARD 'RWY 19L' (HEARING WHAT WE EXPECTED TO HEAR). IT WAS OUR FAULT BUT WE WERE ALSO SET UP FOR IT. HOW TO PREVENT: 1) CREWS DON'T FIXATE ON WHAT YOU'RE EXPECTING -- BE ALERT FOR CHANGES. 2) WHEN CHANGING RWY CONFIGNS, MAKE SURE ALL PLANES ON APCH ARE INFORMED. SUPPLEMENTAL INFO FROM ACN 431293: WE WERE LED DOWN THE 'ROSEY' PATH BECAUSE OF ATIS AND APCH TELLING US THAT WE SHOULD EXPECT RWY 19L. HAD APCH TOLD US A NEW ATIS WAS CURRENT, THAT WOULD HAVE BROKEN THE CHAIN. THE NEW ATIS WOULD HAVE TOLD US THAT RWY 25L WAS THE ACTIVE.
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.