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Wrong-Surface Events

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Category: Runway Incursion Runway Incursion
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Description

The U.S. Federal Aviation Administration (FAA), the European Union Aviation Safety Agency (EASA) and the International Air Transport Association (IATA) are among the regulators and industry organisations that have warned since 2017 about an increasing trend of what are variously described as wrong-surface events, incorrect-airport surface approaches and landings, or Wrong Runway Use.

FAA defines a wrong-surface event as occurring “when an aircraft lands or departs, or tries to land or depart, on the wrong runway or on a taxiway. It also occurs when an aircraft lands or tries to land at the wrong airport.”

Background

From fiscal year 2016 (the 12 months ended 30 Sept. 2016) through fiscal year 2018 (the 12 months ended 30 Sept. 2018), there were 557 wrong-surface landing/approach events in the U.S. National Airspace System that were reported to FAA. During the same period, there were 464 wrong-surface departure events. More than 85 percent of the events in both categories involved general aviation aircraft and occurred during daylight hours. Between 2007 and 2017, there were 82 events of incorrect-airfield approaches and landings reported by European operators, according to an EASA Safety Information Bulletin issued on 19 Feb. 2018.

An IATA review of its Safety Trend Evaluation, Analysis and Data Exchange System (STEADES) database produced 164 incorrect-lineup reports from air carrier operations that were suitable for analysis. This number is equal to about one report per 156,088 flights or about one report every four-and-a-half days, according to IATA Safety Report 2018. The most significant recent example of a wrong-surface event was Air Canada Flight AC759 on approach to San Francisco International Airport. (A320 / B789 / A343, San Francisco CA USA, 2017) On 7 July 2017, the crew of an Airbus A320, cleared for an approach and landing on runway 28R at San Francisco in night VMC, lined up for the visual approach for which it had been cleared on the occupied parallel taxiway instead of the runway extended centreline and only commenced a go-around at the very last minute, having descended to about 60 feet agl whilst flying over two of the four aircraft on the taxiway. In the weeks after the Air Canada event, FAA issued a Safety Alert for Operators (SAFO 17010 SAFO 17010) regarding incorrect airport surface approaches and landings, and the FAA Safety Team (FAASTeam) issued a since-expired FAASTeam Notice on wrong-surface landings. The FAA notices were followed in 2018 by notices and bulletins from EASA and IATA.

Common Factors

Event investigations cited by FAA reveal some common factors. Airports with parallel runways are prone to wrong-surface landings. Parallel runways with different dimensions and/or surface colour may confuse pilots, and offset parallel runways also have proven problematic, with pilots erroneously landing on the more prominent of the surfaces. Other factors cited included pilot “expectation bias” that leads them to identify the runway they are expecting versus the runway assigned by air traffic control, as well as fatigue, cockpit distractions, visual illusions, wrong visual cues and reduced situational awareness.

Recommendations

IATA, EASA and FAA all have made recommendations for pilots, airlines and air traffic controllers to mitigate the risk of wrong-/incorrect-surface events. Among the recommendations are:

  • Maintaining situational awareness;
  • Flying a stabilised approach;
  • Adhering to standard operating procedures and applying crew resource management to continuously monitor visual and instrument references during approach;
  • Using automation levels appropriate to the situation;
  • Planning and briefing the approach;
  • Identifying airports where the risk of such events may be elevated; and,
  • Being prepared to go around.

Related Articles

Further Reading

EASA

FAA

IATA

  • Operations Notice No. 01/2018. "Incorrect Airport Surface Approaches and Landings", 25 May 2018.