What happened
On March 26, 2003, at 16:38 UTC, a serious runway incursion occurred at Naples Capodichino Airport involving two commercial aircraft. The first aircraft, a Boeing MD-82 (registration I-DAFV) operating flight AZA 1213, was taxiing from parking area A1 toward the runway 06/24 threshold. Simultaneously, a Fokker 100 (registration I-ALPL) operating flight ELG 324F was performing a back-track maneuver after completing push-back operations.
The ground controller authorized the Fokker 100 to enter the runway via taxiway A to proceed toward taxiway B. Concurrently, the tower controller, focused on the opposite end of the runway, authorized the Boeing MD-82 for takeoff. As the Boeing MD-82 reached a speed of approximately 100 knots, the crew identified the presence of the other aircraft on the runway in the opposite direction. The pilot immediately aborted the takeoff, bringing the aircraft to a stop at an estimated distance of 1,500 meters from the Fokker 100. There were no fatalities or injuries.
The investigation
The ANSV investigation examined the coordination between ground and tower controllers, the physical layout of the control tower, and the impact of ongoing airport maintenance. The investigation found that the ground controller had failed to follow internal standing instructions (IPI), which prohibit authorizing aircraft to enter the runway without ensuring the tower has been notified or that the aircraft contacts the tower directly.
Environmental factors were also assessed. Ongoing pavement maintenance in the apron area required aircraft to use alternative taxi routes, complicating traffic management. Additionally, the ground controller's workstation was oriented toward the runway 06 threshold, making the runway 24 threshold—located behind the controller—difficult to monitor visually. The investigation also noted that a high level of familiarity and professional rapport between the controllers may have led to a lack of rigorous verbal coordination regarding aircraft occupying the runway.
Findings
- The primary cause of the incursion was the unauthorized entry of the Fokker 100 onto the runway by the ground controller while the Boeing MD-82 had been cleared for takeoff.
- The ground controller did not follow the established procedure requiring the aircraft to contact the tower for runway entry authorization.
- Inadequate coordination and information exchange between the ground and tower controllers regarding taxi traffic and approaching aircraft created a misunderstanding.
- The physical positioning of the ground controller's station hindered the ability to monitor the entire runway area effectively.
- Ongoing maintenance work and altered taxi routes increased the complexity of ground movements.