Air Canada approached taxiway at SFO

1123heavy

Amazing that things like this are still occurring. Just goes to show that we can never, ever, be too sure of our business in this game. No matter what technological advancements we make.

Air Canada A320 approaching RWY 28R inadvertently lines up for the parallel taxiway C. There were 4 aircraft lined up on C at the time.

Audio available here from 25:40 onwards: http://archive-server.liveatc.net/ksfo/KSFO-Twr-Jul-08-2017-0630Z.mp3

Transcript:

"AC759: "Tower, just want to confirm. This is Air Canada 759. We see lights on the runway there. Across the runway. Can you confirm are we cleared to land?"

SFO TOWER: "Confirmed cleared to land. Runway 28 Right. There's no one on 2-8 Right but you."

"Where's this guy going? He's on the taxiway," the other pilot said.

SFO TOWER: "Air Canada, go around."

AC759: "Going around. Air Canada 759."

SFO TOWER: Air Canada looks like you were lined up for Charlie there. Fly heading 280. Climb maintain 3,000."

AC759: "Heading 2-8-0, 3,000 Air Canada 759."

UA001 PILOT: "United One, Air Canada just flew directly over us."

SFO TOWER: "Yeah, I saw that.""

My initial suspicions were that perhaps there was an error in the aircraft's IRS, telling the crew they were in line with the RWY when in fact it was the taxiway. The AC guys themselves were the first to notice something was amiss anyway.

This image below shows they were dead on taxiway C. Seems peculiar.

images.jpg

faoiarvok

1123heavy wrote: »

My initial suspicions were that perhaps there was an error in the aircraft's IRS, telling the crew they were in line with the RWY when in fact it was the taxiway. The AC guys themselves were the first to notice something was amiss anyway.

They were on a visual approach, so may not have been referring to nav instruments at all at this stage.

Growler!!!

Absolutely no reason to be doing a visual approach in a busy enviornment like that. Confirmation bias of seeing what they expect to see not what is actually there.

smurfjed

This is scary, why were they doing a visual approach without backup?

duskyjoe

The ILS has just in recent days gone back on the air for Rwy 28R......having said that they had the option of an overlay rnav appt as back up while executing a visual. From memory the approach lights are working fine for 28R but not for 28L......how air Canada lined up for C taxiway is beyond me. Just for info NORCAL tracon fire aircraft at approaches so the Swiss cheese model may have come into play with a rushed approach. Just my 2c

tricky D

I wonder is there any merit in making C slightly crooked like F, though F is considerably shorter so much less likely to confuse.

Also the fire station and United hangar are pretty close to the taxiway and this proximity is fairly apparent while waiting to line up for 28R when visibility is good.

1123heavy

faoiarvok wrote: »

They were on a visual approach, so may not have been referring to nav instruments at all at this stage.

Well yes, but they were shortcut to the visual later on in the approach from what I believe. The FMC would have been programmed for an approach onto 28R regardless of whether they went visual or not late on ...

faoiarvok

1123heavy wrote: »

Well yes, but they were shortcut to the visual later on in the approach from what I believe. The FMC would have been programmed for an approach onto 28R regardless of whether they went visual or not late on ...

Ok, I may have misunderstood that section of the comms, thought they were on finals and thought that would mean they wouldn't be required to monitor nav instruments. Not a pilot, totally open to correction.

Even if they were flying purely visually, you would imagine that different colour lights on taxiways/runways, approach lights, PAPIs, etc should make it pretty clear which one is the runway?! Though I did see it reported elsewhere that 28L was closed, which may have contributed to confusion.

1123heavy

http://www.ctvnews.ca/video?clipId=1165295&playlistId=1.3497833&binId=1.810401&playlistPageNum=1

I think this is an extremely plausible suggestion and it is amazing how all of the facts (offset approach, pilots not used to even being on C and so not aware it is normal for aircraft to be in line with it when landing on 28R) can give a totally different perspective.

ElNino

Good explanation but I am not sure many people will believe what he said about there being no chance that the plane could have landed on the taxiway.

There was another possible contributing factor that he didn't mention which was that 28L was out of service and the lights were turned off. So the pilots may have visually thought that 28R was actually 28L and that they were line up with 28R to its right which was actually the taxiway.

circular flexing

http://avherald.com/h?article=4ab79f58&opt=0

On Jul 11th 2017 the Canadian TSB reported the crew of C-FKCK asked ATC to confirm landing clearance as they were seeing lights when the aircraft was 0.6nm before the runway threshold. The controller was coordinating with another facility when a flight crew of another airliner taxiing on taxiway C queried ATC where AC-759 was going and stated it appeared the aircraft was lined up with taxiway C. AC-759 had already overflown taxiway C by about 0.25nm when ATC instructed the aircraft to go around. 4 aircraft were on taxiway C at the time of the occurrence. It is estimated that AC-759 overflew the first two aircraft by 100 feet, the third by about 200 feet and the last by 300 feet. The closest lateral proximity between AC-759 and one of the aircraft on taxiway C was 29 feet. The NTSB is investigating the occurrence.

1123heavy

circular flexing wrote: »

http://avherald.com/h?article=4ab79f58&opt=0

Close.

plodder

I saw a post somewhere else that made a good point. There wasn't any realistic chance that this flight would have tried to land on top of four planes ready to take off. But what if the taxiway was empty at the time? The pilot wouldn't have asked what the lights were, and might have just continued with the landing, and then who knows what might have happened?

Buffman

Some videos showing night approaches to SFO 28R to give an idea of what AC759 may have seen (minus the waiting aircraft on C) . Taxiway C is the green 'line' to the right of Runway 28R.

https://www.youtube.com/watch?v=rNMtMYUGjnQ

https://www.youtube.com/watch?v=MnzNvhQxu90

plodder wrote: »

There wasn't any realistic chance that this flight would have tried to land on top of four planes ready to take off.

They're estimating 100 ft (30.48 m) vertical clearance of the first two aircraft. To give that some perspective, those two aircraft (B789 & A343) have a height of 55 ft 10 in (17.02 m) and 55 ft 6 in (16.91 m) respectively.

USAir Flight 1493 would be a past example of a landing aircraft colliding with an aircraft waiting for takeoff.

plodder wrote: »

But what if the taxiway was empty at the time? The pilot wouldn't have asked what the lights were, and might have just continued with the landing, and then who knows what might have happened?

Presumably, if he landed on the taxiway centreline and kept it there, other than going through the stop bars (red 'traffic light' for pilots) protecting the intersecting runways 1L/19R and 1R/19L, it would have been a relatively 'normal' landing.

1123heavy

It is very hard to imagine how the two can be confused from the video above. Anyway aircraft landing on taxiways has happened plenty of times before and US carriers are no strangers to it ...

https://www.flightglobal.com/news/articles/continental-757-crew-misidentified-lights-before-taxiway-222721/

After its approach, the Continental 757 touched down on taxiway Z near the intersection of taxiway R. None of the 154 passengers and crew was injured.

http://avherald.com/h?article=42187f22 (Delta B763)

The approach and landing was accelerated, the crew received clearance to land on runway 27R in night conditions but good visibility, however touched down on taxiway M, which runs north of and parallel to runway 27R. The airplane slowed safely.

plodder

Buffman wrote: »

Some videos showing night approaches to SFO 28R to give an idea of what AC759 may have seen (minus the waiting aircraft on C) . Taxiway C is the green 'line' to the right of Runway 28R.

https://www.youtube.com/watch?v=rNMtMYUGjnQ

https://www.youtube.com/watch?v=MnzNvhQxu90

They're estimating 100 ft (30.48 m) vertical clearance of the first two aircraft. To give that some perspective, those two aircraft (B789 & A343) have a height of 55 ft 10 in (17.02 m) and 55 ft 6 in (16.91 m) respectively.

USAir Flight 1493 would be a past example of a landing aircraft colliding with an aircraft waiting for takeoff.



Presumably, if he landed on the taxiway centreline and kept it there, other than going through the stop bars (red 'traffic light' for pilots) protecting the intersecting runways 1L/19R and 1R/19L, it would have been a relatively 'normal' landing.

and what if another plane or planes entered the taxiway during the landing?

Buffman

plodder wrote: »

But what if the taxiway was empty at the time? The pilot wouldn't have asked what the lights were, and might have just continued with the landing, and then who knows what might have happened?

plodder wrote: »

and what if another plane or planes entered the taxiway during the landing?

If the taxiway became occupied after landing, the potential opportunity for avoiding action from one or both aircraft may be increased, but you'd still be risking another potential Tenerife.

A poster on another site mentioned a similar near miss in 1988 at Gatwick after a One-Eleven landed on the taxiway. The other aircraft on the taxiway tried to escape onto the grass but got stuck. Luckily the One-Eleven stopped with 190 m to spare.

https://www.gov.uk/aaib-reports/2-1989-bac-1-11-g-aywb-and-boeing-737-ei-biz-12-april-1988

ElNino

The NTSB has issued a new update and the near miss was even closer than anyone thought.

They say that the Air Canada plane flew as low as 59ft over the the first plane on the taxiway which was a 787. The 787's tail is 56ft tall so they came within 3 feet of causing the biggest accident in aviation history.

I can't see the 2 pilots having much of a future in aviation.

View Profile

ElNino wrote:

They say that the Air Canada plane flew as low as 59ft over the the first plane on the taxiway which was a 787. The 787's tail is

So they flew 59ft over the top of the tail then!

1123heavy

View Profile wrote: »

So they flew 59ft over the top of the tail then!

Tail is 56 ft. They reached 59ft

View Profile

Ouch! How the crew didn't visually recognise the aircraft sooner is amazing! Should have been clearly evident a mile out!

Buffman

ElNino wrote: »

The NTSB has issued a new update and the near miss was even closer than anyone thought.

That was close.:eek:

Pretty annoying that the CVR was allowed to be overwritten before it could be accessed.

From looking at that NTSB radar and video data, for once the tabloid melodrama may be justified.

Deep Thought

anyone on here actually flown as PIC into this airport? just wondering that their thoughts are as pilots

thomasj

Looking forward to seeing the episode of air crash investigation on this ....
.

View Profile

Would be a fairly short and boring episode IMHO.

tnegun

1123heavy wrote: »

Tail is 56 ft. They reached 59ft

Wonder what sort of angle would the aircraft of been at? The altitude is measured in the nose right?

thomasj

View Profile wrote:

Would be a fairly short and boring episode IMHO.

You'd be surprised what they could get out of the investigation findings , plus it's a Canadian production so I could imagine based on the level of local interest they'll do an episode

circular flexing

thomasj wrote: »

You'd be surprised what they could get out of the investigation findings , plus it's a Canadian production so I could imagine based on the level of local interest they'll do an episode

Do they do Air Crash Investigation for near misses?

thomasj

circular flexing wrote:

Do they do Air Crash Investigation for near misses?

They have done them for near misses before. Mainly because the investigation part was the more interesting .

thomasj

Obviously there's always more than 1 factor in a crash or nearmiss but I'll be interested to see what they say about ATC. With all modern technology these days it seemed like ATC was relying on the pilots views and vice versa. Surely ATC would have had radar etc That doesn't sound right.

duskyjoe

I am sure Norcal Tracon will get a mention in the NTSB final report. They are the controlling agency of all aircraft into SFO until 10nm from the threshold. SFO approaches are notorious for getting vectored onto final approach above the standard descent profiles to ensure separation on tight parallel approaches plus sequencing ......I wonder with all that in mind, at night and the ILS28R off the air that evening( I think) did all the holes line up on the Swiss cheese model with disorientation for the crew involved? Where they ended up circa 60ft above other aircraft on the taxiway below can only summarised as frightening.