What happened
On the evening of February 3, 2019, two aircraft were taxiing through Amsterdam Airport Schiphol when a near collision occurred at a taxiway junction. The first aircraft, an Airbus 320-200 with registration G-EZWY, had recently landed on runway 18R and was proceeding toward its parking stand. Simultaneously, an Airbus 320neo, registration SE-DOY, had landed on runway 18C and was taxiing toward gate C10.
Approximately 90 seconds before the encounter, the ground controller issued instructions to the SE-DOY crew to give way to the G-EZWY at an upcoming junction. While the crew acknowledged the instruction, their read-back was incomplete, failing to specify the exact location or direction of the oncoming traffic. As the two aircraft approached the intersection in darkness, the SE-DOY crew failed to notice the G-EZWY. A collision was only averted when the captain of the G-EZWY performed an emergency stop, narrowly missing the wingtip of the oncoming aircraft by only a few meters.
The investigation
The investigation examined the roles of the flight crews and air traffic control, as well as the environmental conditions at Schiphol. Investigators looked into why the instruction to give way was not effectively executed and why the ground controller did not intervene when the incomplete read-back occurred. The study also evaluated the effectiveness of ground radar and visual monitoring capabilities during nighttime operations at a complex airport layout.
Findings
Several contributing factors led to the near miss:
- The ground controller provided the separation instruction too early and did not provide follow-up instructions as the aircraft approached the junction.
- The SE-DOY crew did not properly recall or verify the location of the priority aircraft, and the first officer was focused on airport maps rather than external visual scanning.
- The ground controller did not challenge the incomplete read-back from the SE-DOY crew.
- Darkness and heavy background lighting at the complex intersection made it difficult for both crews to identify the other aircraft.
- Visual monitoring by the controller was limited by the distance from the tower and the inherent limitations of the ground radar system in detecting changes in aircraft speed during the night.
Safety action
To improve safety, it is recommended that controllers actively repeat stop instructions and maintain continuous communication with crews until a clear picture of the situation is established. Furthermore, flight crews should verify any instructions that contain ambiguity, especially when navigating complex intersections in low-visibility conditions.