ZID RADAR AND ASSOCIATE HDOF CTLR FAIL TO OBSERVE DEVELOPING CONFLICT BTWN B737 AND F2TH-WRONG ALT FOR DIRECTION OF FLT; DURING RTE DEVS DUE TO WX. CTLR TIME ON POS BLAMED.

Date: 2003-09 · Aircraft: B737 Undifferentiated or Other Model · Phase: cruise

Anomalies: atc-issue-all-types|conflict-airborne-conflict|deviation-discrepancy-procedural-published-material-policy|inflight-event-encounter-weather-turbulence|other-wrong-alt-for-direction-of-flt

Synopsis

ZID RADAR AND ASSOCIATE HDOF CTLR FAIL TO OBSERVE DEVELOPING CONFLICT BTWN B737 AND F2TH-WRONG ALT FOR DIRECTION OF FLT; DURING RTE DEVS DUE TO WX. CTLR TIME ON POS BLAMED.

Narrative

ACFT #1 WAS EBOUND AT FL410. ACFT #2 WAS WBOUND AT FL410. TSTMS WERE IN AND ADJACENT TO THE SECTOR. NUMEROUS ACFT WERE IN THE SECTOR. MULTIPLE SEPARATION SITS AT VARIOUS ALTS AND LOCATIONS. I OVERLOOKED ACFT #2 TURN LONG BACK ON COURSE FROM A DEV. ACFT #1 AND #2 PASSED 3 MI ABEAM EACH OTHER ON PARALLEL COURSES. FLOW CTL: SECTOR HAD HIGH VOLUME COUNTS FOR THE 2 HRS I WORKED IT BEFORE THE ERROR. REROUTING REQUESTED; BUT MARGINALLY ACTED UPON. '70' COUNTS PER HR. TIME ON POS: I WAS ON POS FOR 1 HR 57 MINS AT THE TIME OF THE ERROR. A RECENT CHANGE IN FACILITY POLICY HAS INCREASED THE FATIGUE FACTOR GREATLY. I WAS MENTALLY EXHAUSTED AT THE TIME OF THE ERROR. SUPPLEMENTAL INFO FROM ACN 595011: THE F2TH WAS APPROVED WRONG ALT FOR DIRECTION OF FLT AT FL410 DEVIATING L OFF COURSE; DIRECT TTH CAP BQS2 MCI WHEN ABLE. RADAR CTLR WAS ADVISED OF THIS COORD. RADAR CTLR ADVISED THE F2TH TO PROCEED DIRECT CAP WHEN ABLE. THIS PUT THE F2TH IN CONFLICTION WITH THE BOEING 737 AT VHP THAT WAS EBOUND AT FL410. WX WAS IN THE AREA WHICH FORCED MORE TFC THAN USUAL INTO THE SECTOR. TFC MGMNT DID NOTHING TO HELP THE SECTOR. FATIGUE WAS A FACTOR IN THAT THE RADAR CTLR HAD BEEN WORKING BUSY TFC FOR 2 HRS. THIS LONG TIME ON POS WAS A RESULT OF A MANDATED STAFFING REQUIREMENT THAT 75% OF ALL CTLRS IN THE AREA BE PLUGGED IN AT ALL TIMES; NO MATTER WHAT THE TFC LEVEL. SECTORS ARE OPEN AND D-SIDES OPEN THAT DO NOT NEED TO BE. THIS JUST INCREASES TIME ON POS AND WHEN IT GETS BUSY AND YOU NEED SECTORS OPEN THERE ARE NO BREAKS AVAILABLE TO GET PEOPLE OUT THAT HAVE BEEN AT SECTORS FOR LONG PERIODS OF TIME.

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Source: NASA Aviation Safety Reporting System (public domain). Reports are voluntary submissions and are not verified by NASA.