POTENTIAL CONFLICT BTWN 2 ACR'S OCCUR WHEN THE PIC OF B737-500 TURNS THE WRONG DIRECTION WHEN GIVEN A NEW HEADING BY CTLR AT ZOA; CA.

Date: 2003-10 · Aircraft: B737-500 · Phase: climb

Anomalies: deviation-track-heading-all-types|deviation-discrepancy-procedural-clearance

Synopsis

POTENTIAL CONFLICT BTWN 2 ACR'S OCCUR WHEN THE PIC OF B737-500 TURNS THE WRONG DIRECTION WHEN GIVEN A NEW HEADING BY CTLR AT ZOA; CA.

Narrative

ON CLBOUT OF RNO WE WERE GIVEN A TURN 30 DEGS OFF COURSE. WE WERE CLBING TO FL330. I WAS FLYING AND THOUGHT THE TURN WAS TO THE R. AFTER ROLLING OUT THE FO ASKED ME IF WE HAD BEEN GIVEN A R OR L TURN. I SAID I THOUGHT IT WAS TO THE R; AND FOR HIM TO ASK CTR. JUST AS HE WAS ABOUT TO; CTR CAME ON AND TOLD US TO START A TIGHT TURN TO 090 DEGS AND ALSO GAVE ANOTHER CARRIER JET A TURN. WE WERE PASSING APPROX FL300 AT THIS POINT. I IMMEDIATELY MANUALLY TURNED TO 090 DEGS. DURING THE TURN WE GOT A TA SAYING 'TFC; TFC' ONE TIME. I SAW THE OTHER JET AT A DISTANCE AT APPROX 5-6 MI. I ONLY SAW HIM BRIEFLY BECAUSE THE TCASII WAS ON THE 5 MI SCALE AND THE ALT INDICATED CLOSE TO OURS. I BELIEVE THE OTHER CARRIER JET WAS AT FL310 AND LEVEL. AFTER A SHORT PERIOD WE WERE RECLRED ON COURSE AS WELL AS THE OTHER CARRIER JET. I WAS JUST ABOUT TO ASK THE CTLR IF THIS WAS A 'DEAL' WHEN THE OTHER CARRIER ASKED HIM WHAT THE REASON FOR HIM TURNING WAS. THE CTLR STATED WE HAD TURNED THE WRONG WAY. WE APOLOGIZED AND THE CTLR SAID 'DON'T WORRY ABOUT IT.' THE REST OF FLT WAS UNEVENTFUL. 1) EARLIER WE HAD BEEN GIVEN DIRECT TO FRIANT BY DEP AND IT WAS NOT ON OUR RTE. THE CTLR IN THE INCIDENT ALSO GAVE US DIRECT FRIANT AFTER THE CONFLICT UNTIL WE INQUIRED AND THEN GAVE US DIRECT REBRG. IT MADE ME WONDER; SINCE FRIANT WAS TO OUR R; DID I HAVE IT IN MY MIND TO TURN R SINCE DEP HAD TRIED TO GIVE IT TO US? 2) WHAT WAS THE DIRECTION OF THE TURN GIVEN? I THOUGHT R; THE FO AND THE CTLR THOUGHT L. I GUESS ONLY THE TAPE CAN TELL. SOME CONTRIBUTING FACTORS ARE: CTLR'S VOICE OR OUR RECEPTION WAS ONLY ABOUT 4 BY 4; THE COCKPIT WAS A LITTLE MORE NOISY TO ME THAN OTHER ACFT. 3) I SHOULD HAVE HAD THE TCASII ON THE 15 MI RANGE. THIS WOULD HAVE GIVEN ME BETTER SITUATIONAL AWARENESS AND PERHAPS LET ME SEE THE CONFLICT SOONER. BIG LESSON LEARNED HERE. 4) THE FO AND I SHOULD HAVE COMMUNICATED BETTER AND CHALLENGED EACH OTHER TO MAKE SURE WE HEARD NOT WHAT WE WANTED TO HEAR; BUT WHAT WAS ACTUALLY SAID. 5) I THINK THE CTLR FELT BAD BECAUSE HE DID NOT NOTICE OUR TURN IN THE WRONG DIRECTION UNTIL WE WERE ESTABLISHED ON IT. 6) THE INCIDENT CAUSED ME ANGER AT MYSELF AND SOME DELAYED STRESS BECAUSE I WAS TRYING TO FLY THE ACFT CORRECTLY AND; IF THE TURN WAS INDEED THE WRONG WAY; MADE A 'SIMPLE' MISTAKE THAT COULD HAVE HAD A POTENTIAL REAL CONFLICT. THIS HAS SHOWN ME WHEN REALLY BIG EVENTS OR MISTAKES HAPPEN TO ME OR SOMEONE ELSE A GREAT DEAL OF STRESS CAN OCCUR AFTER THE INITIAL INCIDENT. BELIEVE IT OR NOT; WRITING THIS ASAP RPT IS VERY THERAPEUTIC AND HELPS ME TO ANALYZE AND LEARN THINGS. 7) I LEFT A MESSAGE WITH COMPANY ATC SPECIALIST; PER THE FOM TO ADVISE HIM. I ALSO CALLED DISPATCH TO LOCATE ANOTHER ATC SPECIALIST; BUT THEY WERE GONE FOR THE NIGHT. THIS WAS A VERY HUMBLING EXPERIENCE AND REINFORCES MY BELIEF IN CRM AND WORKING TOGETHER AS A CREW. I THINK COM BTWN THE CREW IS PARAMOUNT AND IF SOMETHING DOESN'T SOUND OR LOOK RIGHT; SPEAK UP BEFORE IT IS TOO LATE.

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