See projo.com's
re-enactment of the near-miss at T.F. Green Airport between United Airlines Flight 1448 and FedEx Flight 1662, followed by tense moments as another potential collision is prevented between the United jet and U.S. Airways Flight 2998. Editor's note: Pauses in communication between the control tower and pilots have been taken out to speed up the movie.
8.13.2000 An NTSB recreation reveals the confusion in a jetliner's cockpit and in the control tower at T.F. Green Airport that jeopardized the lives of hundreds of passengers
Journal Staff Writer
WARWICK -- For eight minutes
on a foggy night last December, T.F. Green Airport came dangerously close to its
first major air crash: a high-speed collision on the ground between a cargo jet
rolling at perhaps 175 mph and a jetliner that had gotten lost on the runway.
The Federal Express cargo jet lifted off the runway early, missing the United
jet that was partially obstructing the runway at about its midpoint.
But with one disaster averted, the control tower nearly caused another.
In the tension-filled minutes after the near-miss by FedEx, the tower twice cleared
a USAirways jet to take off on the runway where United remained stranded.
That could have endangered the lives of up to 300 passengers.
Though the controller knew United was lost in the fog, she had concluded the jet
was "not anywhere near the runway." But by monitoring radio traffic between the
tower and United, the USAirways pilot had deduced the opposite: that United might
be on or near the runway that the controller was clearing him to use for takeoff.
In twice refusing to risk lives on the chance that the controller was right and
he was wrong, the still-unidentified USAirways pilot may have averted a tragedy
at Green.
THE NEAR-COLLISION with Federal Express at about 8:35 that evening occurred
in part because the United pilot misreported his position to the controller. But
once FedEx was safely airborne, the dynamic on the airfield shifted.
The subsequent danger of a collision between United and USAirways occurred because
the sometimes argumentative controller seemed unable to deduce United's whereabouts
from the inconsistent and faulty information its pilot was reporting.
The actions of the United pilot that night remain the subject of an Federal Aviation
Administration investigation. After the incident, the controller was temporarily
relieved of duty, given additional training, and was back directing traffic at
Green in little more than two weeks.
Now, after an eight-month inquiry, the National Transportation Safety Board plans
to release its findings on the incident and post its report on its Web site in
the next several weeks. NTSB spokesman Paul Schlamm said the report is likely
to identify the flight crews and the controller and include their initial statements
and the answers they gave later to questions from NTSB investigators.
AS OF LAST WEEK, the most complete public record on the Dec. 6 incident
was a computer animation that the agency posted on the web in June, after a board
meeting on how to keep unauthorized aircraft off runways.
The agency synchronized the computer animation video with eight minutes of radio
traffic recorded at Green during the incident.
The video shows the United 757 -- the largest jet based at Green -- obstructing
the 7,166-foot-long runway at about the 4,500-foot mark. The Federal Express cargo
jet, a 727, lifted off before reaching that point.
It is difficult to know for certain whether FedEx and United would have collided
if FedEx was still on the ground at the 4,500-foot mark. But the position of the
lost jet, as shown in the computer animation, suggests that the left wing of the
FedEx jet might have struck the United cockpit.
The high-speed near-miss at Green was one of two incidents that the NTSB board
highlighted at its June 13 meeting in Washington, D.C. The incident came at a
time when the NTSB was calling attention to "runway incursions" and urging the
FAA to take all possible steps to reduce the danger.
(The worst disaster in aviation history was the result of a runway incursion in
foggy conditions. In March 1977, 582 people died in the collision of two 747s
on a runway in Tenerife, in the Canary Islands.)
The incursion at Green was one of four incidents the NTSB described when it wrote
to the FAA with its final recommendations on July 6, asking the agency to develop
a ground radar system that can prevent -- not merely predict -- collisions on
the airfield.
Obviously, the most dangerous runway incursions are those that occur when a pilot
has clearance to land or take off, as was the case at Green. But airports are
supposed to report an incursion any time an aircraft enters a runway without clearance.
Because air traffic is growing and airports of all sizes are getting busier, the
number of incursions is on the increase almost everywhere.
In the 12-month period ending May 31, Green compiled one of the worst runway-safety
records in the country. Green reported six runway incursions for the year, a tiny
number considering that Green's controllers handle more than 300,000 takeoffs
and landings a year. But only three other airports around the country reported
a higher frequency of incursions and the attendant risk to air passengers.
About two weeks after the NTSB meeting in June, the FAA said it would spend millions
to install ground radar systems at Green and 24 other small- to mid-sized airports.
The "Airport Surface Detection Equipment," or ASDE-X, would enable controllers
to instantly locate any plane on airport property, even in zero visibility.
Jim Peters, an FAA spokesman in New York, said last week that the agency plans
to award a contract for the 25 systems next month, and to release an airport-by-airport
schedule that will outline when each system is expected to go into service.
The news about ground radar was received with much fanfare by the Rhode Island
congressional delegation and the state Airport Corporation. But ground radar systems
are only as good as the controllers who monitor them; indeed, planes come close
to colliding on the ground even at airports that already have ground radar.
On the same Web page that graphically depicts the near-tragedy in Warwick, the
NTSB also posted a computer animation of a similar event in April 1999 at O'Hare
International, in Chicago.
O'Hare has ASDE-3 ground radar, a system even more sophisticated than the ASDE-X
that Green is in line to receive. Nonetheless, in April of last year, an Air China
747 on take-off nearly collided broadside with a Korean Air 747 that was crossing
the runway without permission.
In a futile if human reaction, someone in the tower or in one of the cockpits
screams "Stop!" when collision is imminent.
Traveling at almost 200 miles an hour and with just seconds remaining before impact,
the Air China pilot pulls up off the runway early and banks to the left, missing
the Korean Air jet by about 80 feet.
Asked whether ground radar will improve passenger safety at Green, Ted Drozdz,
chief aeronautics inspector, said last week, "We can only speculate as to whether
the ASDE-X system would have helped during the incident we had here on Dec. 6.
Obviously, we welcome any new technology that's going to help us. Is it going
to solve all of the problems? Probably not. But it sounds like a very interesting
piece of equipment and just another tool in the controller's inventory to help
control traffic in the air and on the ground."
MANY WHO VIEW the NTSB video come away surprised at the tone of the radio
traffic at Green on the night of Dec. 6, 1999. Controllers normally speak in a
flat, professional voice, devoid of emotion, but it was a harried and scolding
controller who presided over the near-collision, and who twice told USAirways
to take off on a runway that was obstructed.
Mayor Scott Avedisian, who viewed the video last week, said it and the NTSB report
will likely heighten concerns that many Warwick residents have about airport safety,
"especially at a time when [the Airport Corporation] is talking about longer runways,
more flights, international flights and larger planes."
"We would have had a major, major disaster on our hands" if USAirways had accepted
the tower's take-off instructions, Avedisian said.
Peters, the FAA spokesman, declined to identify the pilots or the controller last
week. The controller's name, he said, "is not releasable" under federal law because
the FAA did not find any errors in her instructions to the pilots.
Nonetheless, immediately after the incident, "The controller was decertified,
meaning you can't handle live traffic, underwent retraining for a period of time,
was recertified and returned to duty."
"At no time did the FAA contemplate taking any other action against this employee,
other than to put her through retraining," Peters said.
The agency alleged that the United pilot violated federal aviation rules and will
not release his name until its investigation is complete, Peters said.
Even the USAirways pilot, who may have saved lives, has not been publicly identified
by the investigating agencies or his employer.
Last week, USAirways spokesman David A. Castelveter said, "We're not able to provide
that name, for privacy reasons, but what we said [in December] and say now is
that we are extremely proud of the actions of this flight crew."
Watch a 
