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|
Attributes | |
ACN | 593204 |
Time | |
Date | 200309 |
Day | Sat |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : las.airport |
State Reference | NV |
Altitude | agl single value : 0 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : l30.tracon tower : las.tower |
Operator | common carrier : air carrier |
Make Model Name | A320 |
Operating Under FAR Part | Part 121 |
Flight Phase | descent : approach landing : roll |
Route In Use | approach : visual |
Flight Plan | IFR |
Aircraft 2 | |
Controlling Facilities | tower : las.tower |
Operator | common carrier : air carrier |
Make Model Name | B737 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Flight Phase | descent : approach landing : roll |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp pilot : cfi pilot : commercial pilot : instrument pilot : flight engineer |
Experience | flight time last 90 days : 150 flight time total : 9500 flight time type : 500 |
ASRS Report | 593204 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Events | |
Anomaly | incursion : landing without clearance non adherence : far non adherence : published procedure |
Independent Detector | other controllera |
Resolutory Action | none taken : detected after the fact |
Supplementary | |
Problem Areas | FAA Flight Crew Human Performance Company |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Upon arrival at a major airport, we were cleared for a visual approach to follow another air carrier's B737 to the runway. I don't recall the approach controller ever telling us to contact the tower, but I can't say for certain that I wasn't told to contact the tower at the OM, as they frequently do. In any case, I did not contact the tower and landing without clearance. My first awareness of what had happened came when I heard the controller clear someone else for the approach as we were rolling out on the runway. Thinking it was odd for the tower controller to be clearing someone for an approach, I looked down and realized I had never switched the radio to the tower frequency. I did so and advised the tower that we were intending to hold short of the close parallel runway as we entered the high speed turnoff. Tower, not surprisingly, responded with 'roger, aircraft X, how do you hear this transmitter?' I answered 'loud and clear,' and the tower cleared us to cross and contact ground control. Nothing else was ever said about the incident by ATC. I believe 2 factors may have contributed to this incident beyond the obvious failure by me to use correct procedures. The first is the common practice of telling arriving aircraft to contact the tower at a future point, such as the OM, rather than simply having them contact the tower now. This reduces the workload on the controller, but increases the workload on the air crew. I don't know whether the system is safer overall by placing the burden on the air crew or the controller, but I do know of other incidents where pilots have landing without clearance because of this. The second factor in this particular incident is the rest requirements in the FARS. Our airline schedules us for 6 cross country flts in a week with typically 11-12 hours off between flts. That's plenty of time to get decent rest, except that a series of 5 hour flts followed by 11 hours rest means that your schedule changes every single day. We fly a morning flight, a red-eye, an evening, a mid-day, a morning, and finally a red-eye. By the end of the week, your diurnal rhythm is hopelessly compromised and getting any rest on your 12 hour break is difficult. This flight was the 5TH in the series for me, and I got less than 2 hours of sleep before it. I believe the rest requirements need to be dramatically simplified (who can read all those exceptions about reduced rest and compensatory rest and all?) and need to take into account diurnal rhythm.
Original NASA ASRS Text
Title: A320 CREW LANDED AT LAS WITHOUT CONTACTING THE TWR. THIS OCCURRED AFTER A SERIES OF COAST-TO-COAST FLTS THAT THE ACR SCHEDULED.
Narrative: UPON ARR AT A MAJOR ARPT, WE WERE CLRED FOR A VISUAL APCH TO FOLLOW ANOTHER AIR CARRIER'S B737 TO THE RWY. I DON'T RECALL THE APCH CTLR EVER TELLING US TO CONTACT THE TWR, BUT I CAN'T SAY FOR CERTAIN THAT I WASN'T TOLD TO CONTACT THE TWR AT THE OM, AS THEY FREQUENTLY DO. IN ANY CASE, I DID NOT CONTACT THE TWR AND LWOC. MY FIRST AWARENESS OF WHAT HAD HAPPENED CAME WHEN I HEARD THE CTLR CLR SOMEONE ELSE FOR THE APCH AS WE WERE ROLLING OUT ON THE RWY. THINKING IT WAS ODD FOR THE TWR CTLR TO BE CLRING SOMEONE FOR AN APCH, I LOOKED DOWN AND REALIZED I HAD NEVER SWITCHED THE RADIO TO THE TWR FREQ. I DID SO AND ADVISED THE TWR THAT WE WERE INTENDING TO HOLD SHORT OF THE CLOSE PARALLEL RWY AS WE ENTERED THE HIGH SPD TURNOFF. TWR, NOT SURPRISINGLY, RESPONDED WITH 'ROGER, ACFT X, HOW DO YOU HEAR THIS XMITTER?' I ANSWERED 'LOUD AND CLR,' AND THE TWR CLRED US TO CROSS AND CONTACT GND CTL. NOTHING ELSE WAS EVER SAID ABOUT THE INCIDENT BY ATC. I BELIEVE 2 FACTORS MAY HAVE CONTRIBUTED TO THIS INCIDENT BEYOND THE OBVIOUS FAILURE BY ME TO USE CORRECT PROCS. THE FIRST IS THE COMMON PRACTICE OF TELLING ARRIVING ACFT TO CONTACT THE TWR AT A FUTURE POINT, SUCH AS THE OM, RATHER THAN SIMPLY HAVING THEM CONTACT THE TWR NOW. THIS REDUCES THE WORKLOAD ON THE CTLR, BUT INCREASES THE WORKLOAD ON THE AIR CREW. I DON'T KNOW WHETHER THE SYS IS SAFER OVERALL BY PLACING THE BURDEN ON THE AIR CREW OR THE CTLR, BUT I DO KNOW OF OTHER INCIDENTS WHERE PLTS HAVE LWOC BECAUSE OF THIS. THE SECOND FACTOR IN THIS PARTICULAR INCIDENT IS THE REST REQUIREMENTS IN THE FARS. OUR AIRLINE SCHEDULES US FOR 6 XCOUNTRY FLTS IN A WK WITH TYPICALLY 11-12 HRS OFF BTWN FLTS. THAT'S PLENTY OF TIME TO GET DECENT REST, EXCEPT THAT A SERIES OF 5 HR FLTS FOLLOWED BY 11 HRS REST MEANS THAT YOUR SCHEDULE CHANGES EVERY SINGLE DAY. WE FLY A MORNING FLT, A RED-EYE, AN EVENING, A MID-DAY, A MORNING, AND FINALLY A RED-EYE. BY THE END OF THE WK, YOUR DIURNAL RHYTHM IS HOPELESSLY COMPROMISED AND GETTING ANY REST ON YOUR 12 HR BREAK IS DIFFICULT. THIS FLT WAS THE 5TH IN THE SERIES FOR ME, AND I GOT LESS THAN 2 HRS OF SLEEP BEFORE IT. I BELIEVE THE REST REQUIREMENTS NEED TO BE DRAMATICALLY SIMPLIFIED (WHO CAN READ ALL THOSE EXCEPTIONS ABOUT REDUCED REST AND COMPENSATORY REST AND ALL?) AND NEED TO TAKE INTO ACCOUNT DIURNAL RHYTHM.
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.