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|
Attributes | |
ACN | 577484 |
Time | |
Date | 200303 |
Day | Tue |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : las.airport |
State Reference | NV |
Altitude | msl single value : 5000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : l30.tracon tower : msy.tower |
Operator | general aviation : corporate |
Make Model Name | Global Express |
Operating Under FAR Part | Part 91 |
Navigation In Use | other |
Flight Phase | climbout : intermediate altitude |
Route In Use | departure other departure sid : las |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : corporate |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 105 flight time total : 14500 flight time type : 1500 |
ASRS Report | 577486 |
Person 2 | |
Affiliation | company : corporate |
Function | flight crew : first officer |
Qualification | pilot : instrument pilot : multi engine pilot : atp pilot : cfi pilot : commercial |
Experience | flight time last 90 days : 150 flight time total : 6300 flight time type : 400 |
Events | |
Anomaly | non adherence : clearance other anomaly other other spatial deviation |
Independent Detector | other controllera |
Resolutory Action | controller : issued alert controller : issued new clearance flight crew : returned to intended or assigned course |
Consequence | faa : reviewed incident with flight crew |
Supplementary | |
Problem Areas | Maintenance Human Performance Flight Crew Human Performance Aircraft |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Utilizing the pre departure clearance feature of our FMS, we requested a clearance from las to teb. We received the digital clearance which identically matched the computer flight plan we had on board. The route on the pre departure clearance showed the las 1 departure and our entire route exactly, or so we thought! After departure from runway 19L, departure control asked us when we were going to make our right turn for the aaces 2 departure. We advised him that we were cleared via the las 1 departure, and he said that we should have been given the aaces 2, and he then cleared us to our next fix on our flight plan. During the upper altitude climb segment, I reviewed the pre departure clearance page of the FMS and saw the routing clearance just as before, and I discovered an additional message. In the upper corner of the page above the filed route was the word 'AACES2,' and just below was our full route clearance which began with the las 1 departure. I realized that we must have made the error of seeing what we expected to see and failed to southeast the aaces 2 notation. I also realized that the full routing was what had been filed and that the aaces 2 note must have superseded that portion of the initial route. I immediately called clearance delivery via radio and asked for a phone number so that I could speak with a controller. When las tower answered, I explained that we had just departed and described the mistake that we had made and I asked to speak with the appropriate controller. He said that everyone was busy, but he thanked us for calling and said that he would relay our apology to departure control. In summary, we made the error of flying the wrong SID. The following describes what I believe are the reasons for the mistake and the corrective actions to prevent a recurrence. Reasons: pre departure clearance's and their interps are new to our crew. The manufacturer of the FMS inadequately describes the full format for pre departure clearance's and the various items that it can contain. We saw what we expected to see and did not see what we did not expect to see. Remedy: learn as much as possible about the entire pre departure clearance system, formats, and hardware. Be more diligent and more attentive and expect to see the unexpected.
Original NASA ASRS Text
Title: CPR JET CREW HAD A TRACK DEV DEPARTING LAS BECAUSE OF PDC FORMAT RECOGNITION ERROR.
Narrative: UTILIZING THE PDC FEATURE OF OUR FMS, WE REQUESTED A CLRNC FROM LAS TO TEB. WE RECEIVED THE DIGITAL CLRNC WHICH IDENTICALLY MATCHED THE COMPUTER FLT PLAN WE HAD ON BOARD. THE RTE ON THE PDC SHOWED THE LAS 1 DEP AND OUR ENTIRE RTE EXACTLY, OR SO WE THOUGHT! AFTER DEP FROM RWY 19L, DEP CTL ASKED US WHEN WE WERE GOING TO MAKE OUR R TURN FOR THE AACES 2 DEP. WE ADVISED HIM THAT WE WERE CLRED VIA THE LAS 1 DEP, AND HE SAID THAT WE SHOULD HAVE BEEN GIVEN THE AACES 2, AND HE THEN CLRED US TO OUR NEXT FIX ON OUR FLT PLAN. DURING THE UPPER ALT CLB SEGMENT, I REVIEWED THE PDC PAGE OF THE FMS AND SAW THE ROUTING CLRNC JUST AS BEFORE, AND I DISCOVERED AN ADDITIONAL MESSAGE. IN THE UPPER CORNER OF THE PAGE ABOVE THE FILED RTE WAS THE WORD 'AACES2,' AND JUST BELOW WAS OUR FULL RTE CLRNC WHICH BEGAN WITH THE LAS 1 DEP. I REALIZED THAT WE MUST HAVE MADE THE ERROR OF SEEING WHAT WE EXPECTED TO SEE AND FAILED TO SE THE AACES 2 NOTATION. I ALSO REALIZED THAT THE FULL ROUTING WAS WHAT HAD BEEN FILED AND THAT THE AACES 2 NOTE MUST HAVE SUPERSEDED THAT PORTION OF THE INITIAL RTE. I IMMEDIATELY CALLED CLRNC DELIVERY VIA RADIO AND ASKED FOR A PHONE NUMBER SO THAT I COULD SPEAK WITH A CTLR. WHEN LAS TWR ANSWERED, I EXPLAINED THAT WE HAD JUST DEPARTED AND DESCRIBED THE MISTAKE THAT WE HAD MADE AND I ASKED TO SPEAK WITH THE APPROPRIATE CTLR. HE SAID THAT EVERYONE WAS BUSY, BUT HE THANKED US FOR CALLING AND SAID THAT HE WOULD RELAY OUR APOLOGY TO DEP CTL. IN SUMMARY, WE MADE THE ERROR OF FLYING THE WRONG SID. THE FOLLOWING DESCRIBES WHAT I BELIEVE ARE THE REASONS FOR THE MISTAKE AND THE CORRECTIVE ACTIONS TO PREVENT A RECURRENCE. REASONS: PDC'S AND THEIR INTERPS ARE NEW TO OUR CREW. THE MANUFACTURER OF THE FMS INADEQUATELY DESCRIBES THE FULL FORMAT FOR PDC'S AND THE VARIOUS ITEMS THAT IT CAN CONTAIN. WE SAW WHAT WE EXPECTED TO SEE AND DID NOT SEE WHAT WE DID NOT EXPECT TO SEE. REMEDY: LEARN AS MUCH AS POSSIBLE ABOUT THE ENTIRE PDC SYS, FORMATS, AND HARDWARE. BE MORE DILIGENT AND MORE ATTENTIVE AND EXPECT TO SEE THE UNEXPECTED.
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.