Light aircraft 'not seen' by controllers on radar display
An investigation into an air accident near miss involving an Air Malta Boeing 737 and an Italian ultra-light aircraft has said that the fact that a radar return could be seen on the radar recordings but could not be seen on the radar display at the time of the incident "cannot be explained".
The near miss occurred in April last year and an accident was only avoided in the nick of time thanks to evasive action by the Air Malta pilot.
"While the intercom conversation and the controller statements confirm that the light aircraft was not observed on the radar displays, the radar recordings indicate otherwise. It may be surmised that, if the primary radar return was noted by the controllers, especially when this return changed course and came into the path of the DI (the Air Malta aircraft), then appropriate evasive action would have been taken by altering the course of the aircraft under positive control, namely DI. The investigation found no evidence that such action was taken," a report tabled in Parliament says.
It adds that although both radar manufacturer software engineers confirmed conclusively that the radar recordings of the occurrence were a faithful reproduction of what was actually displayed on the radar screens at the time of the incident, "whether or not any of the controllers on duty actually saw a primary radar return of the ultra-light aircraft cannot be determined".
There was, however, no evidence that the radar system was not functioning correctly during the course of the incident.
The report concluded that, among the causes of the accident near miss was the absence of a transponder on the light aircraft, lack of knowledge by the pilot of the light aircraft in emergency radio telephony procedures and "failure of air traffic controllers to observe the apparent radar plot of I-6293" (the light aircraft).
Among other recommendations, the investigators said Malta Air Traffic Services should use this report during recurrent training programmes to ensure awareness of the occurrence among air traffic control officers. "Furthermore an evaluation of work practices and standard operating procedures should be undertaken."
The pilot of the light aircraft had claimed he had slipped into the flight path of the Air Malta aircraft to make an emergency landing because of low fuel. However, no tests were taken to check whether this claim was true. The Italian pilot claimed he had unsuccessfully tried to contact Malta air traffic control on radio.
Chief Inspector of Accidents Capt. Denis Caruana has criticised the fact that substantial excerpts from the investigation report were leaked to The Sunday Times in contravention of the law.
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Major Anthony Abela
Jun 26th 2008, 14:23
Now that I have the published report, at first glance, it raises a number of points:
1. what a coincidence that radar recording playback confirmed a Primary radar Trajectory of the micro-aircraft on all six Displays was evident for about 30 NMiles. It all happened during Watch Change and when known traffic was very very low, possibly 1 Air Malta Flight from Rome.
2. STCA alarm came up, which means that the Radar Returns were not False Plots but Tracks
3. Any software engineer will understand that an audio alarm is more simplier to configure than a Visual Alarm wit Attributes.
4. The Emergency Location Transmitter was only heard after the Air Malta reported the conflicting traffic.
5. It is very evident that neither BAAI nor DCA have Radar Engineering Experts, and most likely not even MATS as they had to commission two of the Manufacturers Engineers.
The Safety Recommendations are very superficiaL.
The contributions by a number of Air Traffic Controllers during the last two weeks on this media hints that there is more to it, than a polising of "work practices", but what is needed is a drastic change in mentality.
DCA as Regulator must use its teeth.
major anthony abela
Jun 24th 2008, 22:13
Mr Adrian Allain,
It appears that your experience is not based on 3rd Generation Radar System which is used in Malta and most European Countries. You are still talking about raw radar displays. You are talking about Radar control using PLOTS, today we have Radar Tracks, thus False Plots are almost non-existence on the Radar Controller's Display.
What one should ask is, what lessons have we learned, if any? What steps did the DCA as Regulator imposed so that similar incidents are minimised to absolute minimum? What concrete procedures did the MATS Managment introduced since the incident, so that similar incidents are not repeated?
I am more than confinced that with the lack of action by the two mentioned bodies, today we are worst of than 15 months ago.
Is it true or not that since the incident, the Maltese authorities introduced procedures that ignores completely even Primary Tracks?
If so, our airspace is even unsafer than 15 months ago.
Adrian Allain
Jun 24th 2008, 19:17
Sometimes it is difficult enough to spot a light aircraft on primary radar, that you know is there somewhere because he has given you his position, but just cannot see in clutter and because it produces such a small radar return.
It would be so easy to miss a tiny aircraft that you are totally unaware of, are not expecting and consequently are not searching for.
I speak from experience.