New Delhi: The Aircraft Accident Investigation Bureau (AAIB) has urged the Airports Authority of India (AAI) to sensitive Air Traffic Controllers (ATCOs) about Standard Operating Procedures (SOPs) to be followed during handing over and taking over of duties.
The AAIB was probing a 2024 airprox incident in Indian airspace when two aircraft came close to each other.
Handing Over (HOW) and Taking Over (TOW) refer to the change of duty of an ATCO at the end of a shift.
In its 41-page final report on the airprox incident involving two Boeing 777 aircraft operated by EL AL Israel Airlines and Qatar Airways in the Mumbai Flight Information Region (FIR), the agency has made various recommendations, as reported by Deccan Herald.
The two aircraft came closer than their stipulated separation distance on March 24, 2024. Qatar Airways’ flight QTR8E was flying from Doha to Male, while EL AL Israel Airlines’ flight ELY 081 was en route to Bangkok from Tel Aviv.
“Non-adherence to the safety critical SOPs by all DATCOs (Duty Air Traffic Controllers) was the main contributory factor to this serious incident,” the AAIB said in the report that was made public this week.
The three DATCOs involved had disregarded one or more SOPs, the report noted. AAIB recommended that AAI should sensitise all involved ATCOs about the SOPs and safety-critical lapses that lead to such a serious incident through relevant training.
The probable cause of this serious incident is attributed to the departure from the basic requirement of procedural control technique — scanning and updating of the Flight Progress Strips (FPS) for conflict detection — and over-reliance on the secondary mechanism — the alert generated by the secondary system or the Automated System (CCWS), the AAIB has said.
The aircraft positions were also not updated as required by the system, the report has noted.
“In addition, non-adherence to the safety essential procedure as documented in the MATS-1 and MATS-2 related to Handing Over (HOW) and Taking Over (TOW) and briefing,” it added.
MATs refer to Manual of Air Traffic Services.
The probe agency mentioned that DATCO-1 and DATCO-2 gave contradictory versions of the HOW and TOW briefings to the investigation team.
“This clearly indicates lacunae in the existing HOW and TOW briefing methodology being followed by AAI and highlights the need for improvement,” the report said.
“Therefore, it is recommended that AAI should evaluate the effectiveness of the current HOW and TOW procedures followed by ATCOs in India in light of this serious incident, and devise appropriate measures to ensure the effectiveness of HOW and TOW briefings in the interest of aviation safety,” it said.
DATCO-1 or the first air traffic controller, did not discuss/supervise the developing conflict between Flight QTR8E and ELY081 with the On-the-Job Trainee, it has been detected.
“Therefore, it is recommended that AAI should strengthen On-the-Job Training (OJT) supervision protocols to ensure that OJT Instructors maintain effective oversight of trainee controllers, particularly during traffic conflict situations,” the report said.
The investigation revealed that DATCO-2, or the second air traffic controller, had sufficient time to detect the conflict but did not do, and DATC0-3 was also unable to do so.
“The conflict between Flight QTR8E and Flight ELY081 came to notice only when the Automated System detected it and an AC alert was generated. This shows over-dependencies of all ATCOs (Air Traffic Controllers) on the alerts generated by the Automated System,” the report said.
