37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
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Attributes | |
ACN | 777896 |
Time | |
Date | 200803 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : dca.airport |
State Reference | DC |
Altitude | msl single value : 10000 |
Environment | |
Flight Conditions | VMC |
Aircraft 1 | |
Controlling Facilities | tracon : pct.tracon tower : hou.tower |
Operator | common carrier : air carrier |
Make Model Name | B737-300 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | descent : intermediate altitude |
Route In Use | arrival star : eldee |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Experience | flight time last 90 days : 150 flight time total : 6000 flight time type : 1900 |
ASRS Report | 777896 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Experience | flight time last 90 days : 210 flight time total : 10000 flight time type : 5850 |
ASRS Report | 777903 |
Events | |
Anomaly | altitude deviation : crossing restriction not met non adherence : clearance non adherence : published procedure other anomaly |
Independent Detector | other flight crewa |
Resolutory Action | controller : issued new clearance flight crew : became reoriented |
Consequence | faa : reviewed incident with flight crew |
Supplementary | |
Problem Areas | ATC Human Performance Flight Crew Human Performance Company |
Primary Problem | Flight Crew Human Performance |
Situations | |
Chart | star : eldee 3 rnav dca |
Narrative:
During cruise flight to dca we reviewed all 25 NOTAMS for dca. For the eldee three RNAV arrival which we were filed; we had to modify multiple altitude parameters in the FMC to comply with the NOTAMS. We deleted the 13000 ft at pugee and replaced it with 12000A. We deleted 12000 ft at capps. We changed wzrrd from 10000 ft to 10000A. We deleted the 9000 ft for daric. In addition to inputting the changes in the FMC; I made notes on my chart in order to reduce the confusion from all the changes. While on the eldee arrival; ATC was issuing holding instructions to aircraft ahead of us to hold at druzz. The efc times they were giving were for 40 min holds. I was mentally setting up for the hold and calculating the fuel burn as we would not have enough fuel to hold for 40 mins. As we approached druzz we could see the other aircraft in the holding pattern and I asked ATC if we were going to get any holding. They said no and we continued on the arrival. After druzz we were cleared to descend via the arrival. We were given a frequency change prior to wzrrd and I checked in stating that we were at 10000 ft descending on the arrival. We were level at 10000 ft as we passed wzrrd. The captain and I noted that it was our last step down altitude and commented on how eldee had 8000 ft but that was for runway 19. As we arrived at eldee the controller called and said 'I guess you are not descending on the arrival.' the captain replied I thought the 8000 ft was for runway 19. He told us to descend to 6000 ft. When we landed and parked at the gate; I looked at the arrival and saw at eldee it had 8000 ft and right below it said 'landing ronald reagan washington' (runway 19) and a line below that said 'at 210 KT.' it was apparent while at the gate that the 8000 ft restr applies to eldee and the 210 KT is for runway 19. I have flown this arrival several times; what was different this time was all the NOTAMS for the arrival. I believe I diverted too much attention to ensuring all the NOTAMS were complied with and missed thoroughly reading the entire note at eldee. I mentioned the information earlier about the holding and NOTAMS to give an idea of our workload. I have 2 recommendations that I hope would keep other crews from making the mistake I made. First: due to the excessive NOTAMS that pertain to this arrival; I think it would be prudent not to issue 'descend via' instructions. Second; I think it might help reduce any confusion if at eldee it stated the speed first after the 8000 ft rather than a runway. Ie; '210 KT runway 19' vice seeing runway 19 below the 8000 ft like I did and incorrectly thinking the 8000 is for the specific runway.
Original NASA ASRS Text
Title: BECAUSE OF NUMEROUS NOTAMS ON THE DCA ELDEE THREE RNAV ARR; AN ACR CREW WAS CONFUSED ABOUT THE APPLICABILITY OF OLD DATA AND NEWER NOTAM DATA.
Narrative: DURING CRUISE FLT TO DCA WE REVIEWED ALL 25 NOTAMS FOR DCA. FOR THE ELDEE THREE RNAV ARR WHICH WE WERE FILED; WE HAD TO MODIFY MULTIPLE ALT PARAMETERS IN THE FMC TO COMPLY WITH THE NOTAMS. WE DELETED THE 13000 FT AT PUGEE AND REPLACED IT WITH 12000A. WE DELETED 12000 FT AT CAPPS. WE CHANGED WZRRD FROM 10000 FT TO 10000A. WE DELETED THE 9000 FT FOR DARIC. IN ADDITION TO INPUTTING THE CHANGES IN THE FMC; I MADE NOTES ON MY CHART IN ORDER TO REDUCE THE CONFUSION FROM ALL THE CHANGES. WHILE ON THE ELDEE ARR; ATC WAS ISSUING HOLDING INSTRUCTIONS TO ACFT AHEAD OF US TO HOLD AT DRUZZ. THE EFC TIMES THEY WERE GIVING WERE FOR 40 MIN HOLDS. I WAS MENTALLY SETTING UP FOR THE HOLD AND CALCULATING THE FUEL BURN AS WE WOULD NOT HAVE ENOUGH FUEL TO HOLD FOR 40 MINS. AS WE APCHED DRUZZ WE COULD SEE THE OTHER ACFT IN THE HOLDING PATTERN AND I ASKED ATC IF WE WERE GOING TO GET ANY HOLDING. THEY SAID NO AND WE CONTINUED ON THE ARR. AFTER DRUZZ WE WERE CLRED TO DSND VIA THE ARR. WE WERE GIVEN A FREQ CHANGE PRIOR TO WZRRD AND I CHKED IN STATING THAT WE WERE AT 10000 FT DSNDING ON THE ARR. WE WERE LEVEL AT 10000 FT AS WE PASSED WZRRD. THE CAPT AND I NOTED THAT IT WAS OUR LAST STEP DOWN ALT AND COMMENTED ON HOW ELDEE HAD 8000 FT BUT THAT WAS FOR RWY 19. AS WE ARRIVED AT ELDEE THE CTLR CALLED AND SAID 'I GUESS YOU ARE NOT DSNDING ON THE ARR.' THE CAPT REPLIED I THOUGHT THE 8000 FT WAS FOR RWY 19. HE TOLD US TO DSND TO 6000 FT. WHEN WE LANDED AND PARKED AT THE GATE; I LOOKED AT THE ARR AND SAW AT ELDEE IT HAD 8000 FT AND RIGHT BELOW IT SAID 'LNDG RONALD REAGAN WASHINGTON' (RWY 19) AND A LINE BELOW THAT SAID 'AT 210 KT.' IT WAS APPARENT WHILE AT THE GATE THAT THE 8000 FT RESTR APPLIES TO ELDEE AND THE 210 KT IS FOR RWY 19. I HAVE FLOWN THIS ARR SEVERAL TIMES; WHAT WAS DIFFERENT THIS TIME WAS ALL THE NOTAMS FOR THE ARR. I BELIEVE I DIVERTED TOO MUCH ATTN TO ENSURING ALL THE NOTAMS WERE COMPLIED WITH AND MISSED THOROUGHLY READING THE ENTIRE NOTE AT ELDEE. I MENTIONED THE INFO EARLIER ABOUT THE HOLDING AND NOTAMS TO GIVE AN IDEA OF OUR WORKLOAD. I HAVE 2 RECOMMENDATIONS THAT I HOPE WOULD KEEP OTHER CREWS FROM MAKING THE MISTAKE I MADE. FIRST: DUE TO THE EXCESSIVE NOTAMS THAT PERTAIN TO THIS ARR; I THINK IT WOULD BE PRUDENT NOT TO ISSUE 'DSND VIA' INSTRUCTIONS. SECOND; I THINK IT MIGHT HELP REDUCE ANY CONFUSION IF AT ELDEE IT STATED THE SPD FIRST AFTER THE 8000 FT RATHER THAN A RWY. IE; '210 KT RWY 19' VICE SEEING RWY 19 BELOW THE 8000 FT LIKE I DID AND INCORRECTLY THINKING THE 8000 IS FOR THE SPECIFIC RWY.
Data retrieved from NASA's ASRS site as of May 2009 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.