CALLBACK Masthead

Number 313
November 2005
A Monthly Safety Bulletin from The Office of the NASA Aviation Safety Reporting System
P.O. Box 189, Moffett Field, CA 94035-0189

The Language Factor

While a broad range of communication issues are commonly cited in incidents reported to ASRS, the following reports focus on a single issue - the effect of non-standard situations on personnel whose English may be limited to "standard" aviation terminology.

People with a limited command of English often rely upon the context of the situation to aid their understanding and to prompt their use of certain phraseology. As noted in the following reports, a change in the normal sequence of events can result in a potentially dangerous miscommunication.

On a Roll

When language factors detract from precise communications, it is vital to clear up any ambiguity before acting. This B757 crew's experience at a foreign airport was a case in point that led to some "sound" advice.

  • Engine start was uneventful until the after start flows were accomplished. At that point we experienced a problem with the left bleed air valve. The MEL (Minimum Equipment List) showed this as a "return to gate" item. At this point, I told the mechanic we needed to be towed back in. His response sounded like he was asking us to release the parking brake; however, neither of us quite understood what he had said about the brakes. I asked him if he was asking us to release the parking brake, to which he responded, "Release parking brake." I released the parking brake and the tug operation commenced.

    With the tug operation underway, I turned my attention towards the logbook, thinking about how I was going to write up this problem. The First Officerwas looking over the MEL. What seemed like a few seconds after we began to be tugged, the First Officer asked, "Where is this guy taking us?" I looked up I saw the end of the paved ramp approaching rapidly and heard the First Officer say something about stopping the aircraft. At that point we were both simultaneously on the brakes. After leaving about 20 feet of skid marks on the ramp, the aircraft came to a stop with the nose wheel approximately eight feet from the end of the paved surface... without the tug connected!

    When the aircraft was stopped and the engines shut down, my next concern was the location of the mechanic and whether he was okay. He was.

    Although this mechanic speaks fairly good English, I was truly surprised at the level of communication breakdown that had just occurred. The mechanic told me he thought I was telling him that I was releasing the parking brake.

    Once we started rolling he did not tell us to stop, but instead simply unplugged his headset and got out of the way.

    What lessons can be learned or relearned from all of this? First of all this is a reminder of something we all know, that being towed is an operation which requires someone to be monitoring the aircraft. Secondly, never assume anything. Since we never saw the tug pull away (it pulled away while we were in the books) and we were told to release the parking brake, we thought we were under tow.

    During approach briefings, simulator training, and line non-normal operations flight, someone is always assigned the task of monitoring the aircraft. Let this serve as a reminder to do the same during tow operations.

    Thank goodness no one was hurt, no metal was bent, and no careers were put in jeopardy, but we sure came darn close.

If flight crews involved in international operations heed the preceding advice, similar incidents can be avoided. Unfortunately, the admonition didn't get out soon enough for this A330 crew. The similarity to the first report is startling and serves to reinforce the caution that "it can happen to you."

  • A cargo door light annunciated during pushback and engine start. The Captain instructed the ground crew to stay connected because they would have to tow us back to the gate. The Captain stated to the ground crew (through the interphone), "Confirm tow bar connected." The ground coordinator stated, "OK." The Captain then stated that he was releasing the brakes and did so. We started to move. When I looked up, we were passing our gate and increasing speed. We then noticed the wing walker giving us the stop signal. I said, "I don't think we're connected." The Captain and I were reluctant to apply the brakes for fear of snapping and damaging the nose gear. Soon, the Captain decided that we had traveled far enough and applied the brakes. We then returned to the gate under our own power, having realized that the tow bar had been disconnected.

    I believe the incident was primarily caused by the inability of the ground crew to understand English. We were also busy dealing with checklists and abnormal procedures. There were no injuries or damage.
Clearly Not Cleared

In this Air Traffic Controller's report, a foreign pilot misinterpreted what appeared to be a clearly stated question. It just happened to come when the pilot was expecting to hear something else.

  • Aircraft #2 was cleared to land on Runway 18R. Aircraft #1 (a foreign carrier) was told to, "Taxi into position on Runway 27 and hold. Traffic landing Runway 18R." Upon issuing a wind check, I realized that aircraft #1 had a seven knot tailwind. I asked if the wind was going to be a problem. He acknowledged with his call sign for what I thought was receipt of my transmission, but then he throttled up and started the departure roll. Aircraft #2 was over the numbers on flare. I attempted to cancel the takeoff roll and then proceeded to send aircraft #2 around. By the time aircraft #2 reached the crossing intersection, he was approximately 400 feet AGL and aircraft #1 was approximately 200 feet off his right, approaching rotation speed.

    I believe that language was the problem. After reviewing the tapes, I do not see how my question of the tailwind component was misunderstood as, "Cleared for takeoff".... I guess the pilot figured that since he was in position and hold on the runway that my next transmission to him would be a takeoff clearance.

Runway

Domestic RVSMDomestic RVSM Wake Turbulence Reporting Reminder

As announced in the February, 2005 CALLBACK (#305), The FAA has requested that pilots submit reports (via NASA/ASRS) on wake turbulence incidents that occur in RVSM airspace (FL290 - 410 inclusive) in the lower 48 states of the United States, Alaska, Offshore Airspace, and the San Juan FIR.

Reporting Procedures:

Pilots reporting specifically on wake turbulence incidents should submit two forms: (1.) The NASA ASRS General reporting form for Pilots (NASA ARC 227B). The “Type of Event/Situation” block on this form should be annotated with the words, “Wake Turbulence.” (2.) The FAA “Supplemental Wake Turbulence Information” form.

Both forms are available for download from the “Safety Reporting” section of the FAA’s RVSM Documentation Web Page: http://www.faa.gov/ats/ato/rvsm_documentation.htm by following the links at the bottom of the page.

Pilots reporting on wake turbulence incidents are encouraged to file individual NASA ASRS reports even if a report has been filed through their Aviation Safety Action Program (ASAP).

Electronic CALLBACK

As noted in the last issue of CALLBACK, ASRS is now providing an automated CALLBACK E-mail subscription service (still FREE) in lieu of the paper copy. We will continue to offer a print version for those who want to continue receiving paper copies. With the e-mail subscription our readers will receive a monthly e-mail notice that informs subscribers that the new issue of CALLBACK is available and provides a link to the online version of CALLBACK. Also provided within this e-mail notice is a link to a PDF version of CALLBACK, links to the CALLBACK Archive, ASRS Reporting Forms, and the ASRS Home Page. ASRS’s goal is to give readers immediate access to our newsletter, and to ASRS resources.

To sign up for the CALLBACK E-mail notice please go to http://asrs.arc.nasa.gov/publications/callback.html. Fill out a short form and hit submit. Current subscribers to the printed copy will have the option to opt out and only receive the e-mail service. We encourage you to assist us in cutting cost by opting out of the printed version of CALLBACK if you are capable of receiving the e-mail notification subscription service. Our first distribution of the e-mail service will begin with the December issue of CALLBACK.

Meet the Staff

Continuing the staff introductions initiated in the previous issue of CALLBACK, this month the spotlight falls on…

Ted "Astaire" Fancher

Picture of Ted FancherCaptain Fancher joined the ASRS staff in 2003 as an Aviation Safety Analyst. Ted flew for a major air carrier for 38 years, gaining domestic and international experience in a variety of large transport aircraft, including the Convair 340, DC6,7, and 8, B727, B757, B767, B747, and B747-400. He also served on the Air Line Pilot’s Association Air Safety Committee. Captain Fancher’s primary avocation outside of work activities is in the field of competitive model aircraft design, construction, and competition.

He has been the United States National Champion in Control Line Precision Aerobatics four times and a member of the U.S. team at three World Championship competitions. A man of many talents, Ted also enjoys performing song and dance numbers in productions staged by local community theatre groups.

ASRS Alerts Issued in September 2005
Subject of Alert
 No. of Alerts
Aircraft or aircraft equipment
 8
Airport facility or procedure
 9
ATC procedure or equipment
 7
Company policy or maintenance procedure
 3
TOTAL
 27
September 2005 Report Intake
 Air Carrier/Air Taxi Pilots
2,247
 General Aviation Pilots
823
 Controllers
104
 Cabin/Mechanics/Military/Other
179
 TOTAL
3,353
313