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Safety Recommendation Details

Safety Recommendation A-91-104
Details
Synopsis: ON FEBRUARY 1, 1991, AT 1807 PACIFIC STANDARD TIME, USAIR FLIGHT 1493 (USA1493), N388US, A BOEING 737-300 (B-737), COLLIDED WITH SKYWEST FLIGHT 5569(SKW5569), N683A, V, A FAIRCHILD METROLINER (SA-227-AC), WHILE USA1493 WAS LANDING ON RUNWAY 24 LEFT AT LOS ANGELES INTERNATIONAL AIRPORT (LAX), LOS ANGLES, CALIFORNIA. SKW5569 WAS POSITIONED ON THE SAME RUNWAY, AT INTERSECTION 45, AWAITING CLEARANCE FOR TAKEOFF. AS A RESULT OF THE COLLISION, BOTH AIRPLANES WERE DESTROYED. ALL 10 PASSENGERS AND 2 CREWMEMBERS ABOARD THE METROLINER AND 20 PASSENGERS AND 2 CREWMEMBERS ABOARD THE B-737 WERE FATALLY INJURED.
Recommendation: THE NTSB RECOMMENDS THAT THE FEDERAL AVIATION ADMINISTRATION: MODIFY AIR TRAFFIC CONTROL PROCEDURES AT THE LOS ANGELES INTERNATIONAL AIRPORT TO: (A) SEGREGATE ARRIVALS AND DEPARTURES TO SPECIFIC RUNWAYS; (B) PROVIDE REDUNDANCIES AS INTENDED IN THE NATIONAL OPERATION POSITION STANDARDS IN THE CONTROL TOWER.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Action
Mode: Aviation
Location: LOS ANGELES, CA, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA91MA018AB
Accident Reports: Runway Collision of USAIR Flight 1493, Boeing 737 and Skywest Flight 5569 Fairchild Metroliner
Report #: AAR-91-08
Accident Date: 2/1/1991
Issue Date: 12/3/1991
Date Closed: 2/10/1994
Addressee(s) and Addressee Status: FAA (Closed - Acceptable Action)
Keyword(s):

Safety Recommendation History
From: NTSB
To: FAA
Date: 2/10/1994
Response: THE BOARD NOTES THAT THE FAA HAS CONTINUED TO REFINE THE RUNWAY USE AGREEMENT BETWEEN THE LOS ANGELES TERMINAL RADAR APPROACH CONTROL (TRACON) AND THE AIRPORT TRAFFIC CONTROL TOWER. ADDITIONALLY, THE FAA HAS ESTABLISHED AN ARRIVAL SECTOR TO PROVIDE EARLY SPACING AND SEQUENCING OF ARRIVALS FROM THE NORTH, WHICH REDUCES CONTROLLER WORKLOAD AND SATISFIES FREQUENCY CONGESTION CONCERNS VOICED AT THE INTERNATIONAL OPERATORS AND CHIEF PILOTS MEETING HELD AT AT LOS ANGELES, CALIFORNIA. THE BOARD FURTHER NOTES THAT THE FAA CONTINUES TO SUPPORT THE CHANGES TAKING PLACE AT THE LOS ANGELES TOWER AND TRACON AND TAKEN EVERY AVAILABLE OPPORTUNITY TO DISCUSS AND PROMOTE UNDERSTANDING ON THIS ISSUE THROUGH USER FORUMS, CHIEF PILOT MEETINGS, AND INDUSTRY MEETINGS. BASED ON THIS INFORMATION, THE BOARD CLASSIFIES RECOMMENDATION A-91-104 "CLOSED--ACCEPTABLE ACTION."

From: FAA
To: NTSB
Date: 10/5/1993
Response: ON MARCH 2, 1993, THE FAA OUTLINED SPECIFIC ACTIONS IT HAD TAKEN TO ADDRESS THIS RECOMMENDATION. SINCE THEN, THE FAA HAS CONTINUED TO REFINE THE RUNWAY USE AGREEMENT BETWEEN THE LOS ANGLES TRACON AND THE AIRPORT TRAFFIC CONTROL TOWER. THE FAA HAS ALSO ESTABLISHED AN ADDITIONAL ARRIVAL SECTOR TO PROVIDE EARLY SPACING AND SEQUENCING OF ARRIVALS FROM THE NORTH. THE IMPROVEMENT MITIGATES CONTROLLER WORKLOAD AND SATISFIES FREQUENCY CONGESTION CONCERNS VOICED AT THE INTERNATIONAL OPERATORS AND CHIEF PILOTS MEETING HELD AT LOS ANGLES, CALIFORNIA. THE FAA CONTINUES TO SUPPORT THE CHANGES TAKING PLACE AT THE LOS ANGELES TOWER AND TRACON. THE FAA TAKES EVERY AVAILABLE OPPORTUNITY TO DISCUSS AND PROMOTE UNDERSTANDING ON THIS ISSUE THROUGH USER FORUMS, CHIEF PILOT MEETINGS, AND INDUSTRY MEETINGS.

From: NTSB
To: FAA
Date: 4/8/1993
Response: THE BOARD IS ENCOURAGED BY THE CHANGES TAKING PLACE AT THE LOS ANGELES INT'L AIRPORT. THESE CHANGES ARE VIEWED AS A POSITIVE APPROACH TO ENSURING THAT AIR TRAFFIC OPERATIONS CONTINUE IN A SAFE & EFFICIENT MANNER. BASED ON THIS INFO, THE BOARD REQUESTS THAT THE FAA CONTINUE TO ENDORSE THE CHANGES BEING IMPLEMENTED AT THE LAX TRACON & ATCT. PENDING FURTHER INFO, RECOMMENDATION A-91-104 IS CLASSIFIED AS "OPEN--ACCEPTABLE ALTERNATE RESPONSE."

From: FAA
To: NTSB
Date: 3/2/1992
Response: THE FAA HAS EXAMINED THE AIR TRAFFIC CONTROL PROCEDURES AT LOS ANGELES INTERNATIONAL AIRPORT AND IS CONFIDENT THAT AIR TRAFFIC IS BEING MANAGED IN A SAFE AND EFFICIENT MANNER. CONSEQUENTLY, THE FAA DOES NOT INTEND TO SEGREGATE ARRIVALS AND DEPARTURES TO SPECIFIC RUNWAYS. THE LOCAL ASSIST CONTROLLER PROVIDES AN EXTRA SET OF EYES AND EARS TO MONITOR THE TRAFFIC SITUATION. THE LOCAL ASSIST CONTROLLER PERFORMS COORDINATION WITH OTHER POSITIONS IN THE TOWER AND TRACON. THE LOCAL ASSIST CONTROLLER SEQUENCES THE DEPARTURE STRIPS FOR THE LOCAL CONTROLLER ALLOWING THE LOCAL CONTROLLER TO DEVOTE FULL ATTENTION TO THE TRAFFIC SITUATION. WHEN THE LOCAL ASSIST CONTROLLER POSITION IS NOT STAFFED, THE ASSOCIATED GROUND CONTROLLER IS THEN RESPONSIBLE FOR THE SEQUENCING OF THE DEPARTURE STRIPS. SUPERVISORS ARE TASKED WITH ENSURING THT GROUND CONTROL IS ONLY GIVEN THIS RESPONSIBILITY WHEN TRAFFIC VOLUME IS SUFFICIENTLY LOW THAT ALL STRIPS CAN BE SEQUENCED.