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Attributes | |
ACN | 457213 |
Time | |
Date | 199912 |
Day | Wed |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : jfk.airport |
State Reference | NY |
Altitude | msl single value : 2000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : n90.tracon tower : atl.tower |
Operator | common carrier : air carrier |
Make Model Name | B747-400 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | climbout : initial |
Route In Use | departure sid : kennedy 7 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 213 flight time total : 17000 flight time type : 1544 |
ASRS Report | 457213 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : multi engine pilot : instrument pilot : flight engineer pilot : commercial pilot : atp |
Experience | flight time last 90 days : 200 flight time total : 16000 flight time type : 3000 |
ASRS Report | 457410 |
Events | |
Anomaly | non adherence : clearance non adherence : published procedure other anomaly other other spatial deviation |
Independent Detector | other controllera |
Resolutory Action | controller : issued alert controller : issued new clearance flight crew : became reoriented none taken : detected after the fact |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Cleared for kennedy 7 departure, bridge climb. Legs page of FMC showed waypoints cri - gayel with a discontinuity between them, as it should be. I later closed up the discontinuity, out of habit, I suppose. Thus, the first officer and autoplt were programmed to go to gayel immediately after cri, and not maintain the 220 degree heading. The controller noticed our premature right turn and told us to level at 3000 ft, which we did, then assigned a left turn to 210 degrees (or 220 degrees). We could have avoided this error by doing a departure briefing, during which I am sure we would have noticed the lack of a 'vectors' segment. This briefing is air carrier SOP, but I don't believe it was done on this occasion. Supplemental information from acn 457410: after evaluation, we noticed the kennedy 7 is a vector departure and LNAV should not have been engaged. This is inconsistent with other vector departures such as the palace departure at dtw. It cannot be selected in the FMC thus forcing the pilots to use heading select. Supplemental information from acn 457292: on dec/wed/99, I was part of a B747-400 augmented crew on air carrier flight abc from jfk to ZZZ. I was riding in the jump seat while the working crew made the departure. Due to a programming error, they made a wrong turn while executing the 'bridge climb' out of jfk. They had selected the jfk 7 departure from the FMC departure page. That departure depicts only the initial left turn then a route discontinuity. The captain closed the discontinuity, which presented them with a left turn followed by an immediate right turn to gayel intersection. The crew made an autoplt departure and it flew the departure as programmed. One half way through the right turn, kennedy departure asked for and received an immediate left turn back to the proper departure vector heading. Although the crew briefed the departure, they missed the 'bridge climb' portion of the departure and relied on the FMC to fly the departure. On this departure that is probably not a good idea. The autoplt was slow to react and almost overshot the canarsie radial. Not only that, as pilots, I think we tend to lose some of our edge when the autoplt is doing the work. It is obvious that a more thorough briefing of the departure would have prevented the excursion. More alert backup from those of us in the jump seats may have also prevented the right turn. However, there is one built-in trap that could be eliminated. The kennedy 7 departure is a 'vectored' departure, and as such should probably not be listed on the departure/arrival page of the FMC. Because of the existence of the departure in the FMC, the crew failed to notice the second section of the climb. Dtw departures are 'vectored' and they are not listed on the departure/arrival page for dtw.
Original NASA ASRS Text
Title: B747 CREW HAD TRACK DEV ON THE KENNEDY 7 SID FROM JFK.
Narrative: CLRED FOR KENNEDY 7 DEP, BRIDGE CLB. LEGS PAGE OF FMC SHOWED WAYPOINTS CRI - GAYEL WITH A DISCONTINUITY BTWN THEM, AS IT SHOULD BE. I LATER CLOSED UP THE DISCONTINUITY, OUT OF HABIT, I SUPPOSE. THUS, THE FO AND AUTOPLT WERE PROGRAMMED TO GO TO GAYEL IMMEDIATELY AFTER CRI, AND NOT MAINTAIN THE 220 DEG HDG. THE CTLR NOTICED OUR PREMATURE R TURN AND TOLD US TO LEVEL AT 3000 FT, WHICH WE DID, THEN ASSIGNED A L TURN TO 210 DEGS (OR 220 DEGS). WE COULD HAVE AVOIDED THIS ERROR BY DOING A DEP BRIEFING, DURING WHICH I AM SURE WE WOULD HAVE NOTICED THE LACK OF A 'VECTORS' SEGMENT. THIS BRIEFING IS ACR SOP, BUT I DON'T BELIEVE IT WAS DONE ON THIS OCCASION. SUPPLEMENTAL INFO FROM ACN 457410: AFTER EVALUATION, WE NOTICED THE KENNEDY 7 IS A VECTOR DEP AND LNAV SHOULD NOT HAVE BEEN ENGAGED. THIS IS INCONSISTENT WITH OTHER VECTOR DEPS SUCH AS THE PALACE DEP AT DTW. IT CANNOT BE SELECTED IN THE FMC THUS FORCING THE PLTS TO USE HDG SELECT. SUPPLEMENTAL INFO FROM ACN 457292: ON DEC/WED/99, I WAS PART OF A B747-400 AUGMENTED CREW ON ACR FLT ABC FROM JFK TO ZZZ. I WAS RIDING IN THE JUMP SEAT WHILE THE WORKING CREW MADE THE DEP. DUE TO A PROGRAMMING ERROR, THEY MADE A WRONG TURN WHILE EXECUTING THE 'BRIDGE CLB' OUT OF JFK. THEY HAD SELECTED THE JFK 7 DEP FROM THE FMC DEP PAGE. THAT DEP DEPICTS ONLY THE INITIAL L TURN THEN A RTE DISCONTINUITY. THE CAPT CLOSED THE DISCONTINUITY, WHICH PRESENTED THEM WITH A L TURN FOLLOWED BY AN IMMEDIATE R TURN TO GAYEL INTXN. THE CREW MADE AN AUTOPLT DEP AND IT FLEW THE DEP AS PROGRAMMED. ONE HALF WAY THROUGH THE R TURN, KENNEDY DEP ASKED FOR AND RECEIVED AN IMMEDIATE L TURN BACK TO THE PROPER DEP VECTOR HDG. ALTHOUGH THE CREW BRIEFED THE DEP, THEY MISSED THE 'BRIDGE CLB' PORTION OF THE DEP AND RELIED ON THE FMC TO FLY THE DEP. ON THIS DEP THAT IS PROBABLY NOT A GOOD IDEA. THE AUTOPLT WAS SLOW TO REACT AND ALMOST OVERSHOT THE CANARSIE RADIAL. NOT ONLY THAT, AS PLTS, I THINK WE TEND TO LOSE SOME OF OUR EDGE WHEN THE AUTOPLT IS DOING THE WORK. IT IS OBVIOUS THAT A MORE THOROUGH BRIEFING OF THE DEP WOULD HAVE PREVENTED THE EXCURSION. MORE ALERT BACKUP FROM THOSE OF US IN THE JUMP SEATS MAY HAVE ALSO PREVENTED THE R TURN. HOWEVER, THERE IS ONE BUILT-IN TRAP THAT COULD BE ELIMINATED. THE KENNEDY 7 DEP IS A 'VECTORED' DEP, AND AS SUCH SHOULD PROBABLY NOT BE LISTED ON THE DEP/ARR PAGE OF THE FMC. BECAUSE OF THE EXISTENCE OF THE DEP IN THE FMC, THE CREW FAILED TO NOTICE THE SECOND SECTION OF THE CLB. DTW DEPS ARE 'VECTORED' AND THEY ARE NOT LISTED ON THE DEP/ARR PAGE FOR DTW.
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.