Global Action Plan for the Prevention of Runway Excursions

Part 1 - Recommendations

Part 2 - Guidance and Explanatory Material

Global Action Plan for the

Prevention of Runway Excursions

VALIDATED BY COORDINATED BY

Organisations that supported the initiative

VALIDATING ORGANISATION SIGNATURE

Patrick Ky, Executive Director EASA

Gilberto Lopez Meyer,

Senior Vice President, Safety and Flight Operations

IATA

Luis Felipe de Oliveira, Director General ACI World

Simon Hocquard, Director General CANSO

COORDINATING ORGANISATIONS SIGNATURE

Hassan Shahidi, President and CEO FLIGHT SAFETY FOUNDATION

Eamonn Brennan, Director General EUROCONTROL

Global Action Plan for the Prevention of Runway Excursions 3

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ACKNOWLEDGEMENTS

We would like to acknowledge the following people and organisations that led the working groups and validation process

of this Action Plan and without which it would not have been possible:

We would like to acknowledge the following people and organisations that have actively contributed to the production of

this Action Plan:

› Thomas Landers, Gulfstream Aerospace

› Khalid Abaran, Groupe ADP

› Yannick Malinge, Airbus

› Shayne Campbell, CANSO

› Dragos Munteanu, IATA

› Captain Tom Becker, TUI y

› Alexander Krastev, EUROCONTROL

› Andrew Badham, UK CAA

› Gerard van Es, NLR

› Aigars Krastins, EASA

› Michelle Low, EASA

› Jim Fee, FAA

› Mark Millam, VP FSF

› Lisa Sasse, Chair FSF BAC

› Captain Harry Nelson, Chair FSF IAC

› Captain Pascal Kremer, Chair FSF EAC

› Captain Mike Gillen, United Airlines

› Dai Whittingham, UKFSC

› Ian Witter, Heathrow Airport

› Harald De Borger, Brussels Airport

› Davy Van Hyfte, Brussels Airport

› Patricia Fellay, Geneve Airport

› Nele De Greef, Brussels Airport

› Pieter Schaap, Amsterdam Airport

› Pedro Reis, Lisbon Airport

› Karel Mündel, Prague Airport

› Corina Stiubei, EBAA

› Peter Rix, ECA

› Moritz Bürger, ECA

› Captain Johan Glantz, EBAA

› Captain Andrew Elbert, Ryanair

› Captain Simon Player, Ryanair

› Captain Christopher Williams, easyJet

› Captain Peter Malady, easyJet

› Captain Sven Paesschierssens, easyJet

› Captain Bill Curtis, Presage Group

› Captain Mattias Pak, Cargolux

› Captain Chris Beaumont, BALPA

› Richard, Weeks, NetJets

› Captain Ed Pooley, FSF EAC

› Florence-Marie Jegoux, DGAC/DSAC/MEAS

› Oliview Teyssandier, DSNA

› Ruben Marco, ENAIRE

› Antony Delclos, DGAC/DSAC/MEAS

› Arkadi Merkulov, ICAO

› Stijn de Graa, EUROCONTROL

› Patricia Ithier, DSNA

› Captain André Vernay, DGAC/DSAC/MEAS

› Paul Adamson, ICAO

› Günter Kind, DFS

› Steve Carlson, NATS

› Daryl Rowlands, NATS

› Alberto Ottomaniello, EASA

› Emmanouil Vardakis, EASA

› Emmanuel Isambert, EASA

› Giovanni Cima, EASA

› Hette Hoekema EASA

› Vasileios Stefanioros, EASA

› Daniel Ivan, Romanian CAA

› Diego García, AESA

› Olga Maria Martinez Canovas, AENA S.M.E.

› Gregory Bulkley, Boeing

› Stephen Burrington, Boeing

› Gunter Ertel, Boeing

› Cedric Descheemaeker, Airbus

› Lars Kornstaedt, Airbus

› Daniel Lopez Fernandez, Airbus

› Thierry Bourret, Airbus

› Captain Gilbert Savary, Airbus

› Captain Shaun Wildey, Airbus

› Olivier Donchery, NAVBLUE

› Djamila Bunouf, NAVBLUE

› Ratan Khatwa, Honeywell

› Caio Cramer, Embraer

› Stéphane Picaut, Dassault

› Captain Rick Wynen, NAV Canada

› Captain Paul Bombala, NAV Canada

› Ray Gélinas, NAV Canada

› Captain Rafael Rastrello, Latam Airlines

› Captain Ricardo Virgílio, Latam Airlines

› Virginio Corrieri, ALTA

› Captain Graeme Smyth, NAV Canada

› Jose R. Fernandez, IATA

› Rodolfo Volpini, ENAV

› Felice De Lucia, ENAV

› Damon Knight, Air Navigation Solutions

The Global Action Plan for the Prevention of Runway Excursions initiative is coordinated by:

›

Tzvetomir Blajev, Operational Safety Coordinator EUROCONTROL, FSF Regional Director Europe.

Global Action Plan for the Prevention of Runway Excursions 5

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STATEMENT OF COMMITMENT

Notwithstanding specic aviation risks in 2020 associated

with the COVID-19 pandemic, the rate and number of runway

excursions worldwide remained steady in the last decade.

Data show the industry has reduced the rate of commercial

aviation runway excursion accidents, but the absolute num-

ber of accidents and incidents and their severity still indicate

a very high risk.

In a study of incident and accident data dedicated to this

action plan process, the International Air Transport Associa-

tion (IATA) reported that between 2005 and the rst half of

2019, 23 percent (283) of accidents in IATA’s global accident

database involved a runway excursion. This was the most

frequent end state, followed by gear-up landing/gear collapse

(15 percent) and ground damage (12 percent).

Managing the runway excursion risk is one of the best exam-

ples of how dierent aviation segments cannot achieve success

alone. Runway excursion risk and resilience management rely

on a system of tightly coupled factors for success, and that

system depends on a joint and coordinated eort of all the avi-

ation players. The complexity of runway excursion prevention

comes also from the fact that the eect of the risk and resilience

factors is highly cumulative — runway condition maintenance

and reporting, aircraft performance and operations, collabo-

rative approach path management and adherence to robust

policies for safe descent and approach planning, stabilised

approach, safe landing and go-around are some examples.

The jointly owned risk requires joint solutions. This is why the

industry came together, within a dedicated working group, to

discuss and agree on the most important actions to address

the runway excursion risk. The result is a list of recommenda-

tions that represent the industry consensus on the best prac-

tices and intervention beyond simple regulatory compliance.

The recommendations are mainly generic, and it will be up

to the responsible organisations to decide specic details for

possible implementation, after taking local conditions and

specic context into account.

Addressing both the risk and the resilience factors has been

a guiding principle of the working group that reviewed acci-

dent and incident data, single scenarios and best practices,

and suggestions on risk and resilience management.

The recommendations are the result of the combined and

sustained eorts of organisations representing all segments

of aviation. The organisations that contributed to this action

plan are committed to enhancing the safety of runway op-

erations by advocating the implementation of the recom-

mendations that it contains. These organisations include,

but are not limited to, aerodrome operators, air navigation

service providers, aircraft operators, aircraft manufacturers,

R&D organisations, regulators, international organisations

and associations.

Global Action Plan for the Prevention of Runway Excursions 7

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Global Action Plan for the Prevention of Runway Excursions 9

INTRODUCTION AND BACKGROUND

This document contains Part 1 and Part 2 of the Global Action

Plan for the Prevention of Runway Excursions (GAPPRE).

Part I contains the agreed recommendations to the following

civil aviation organisations: aerodrome operators, air navi-

gation service providers (ANSPs), aircraft operators, aircraft

manufacturers, regulators, the International Civil Aviation

Organization (ICAO) and addressees of the research and de-

velopment (R&D) recommendations (States, international

organisations and the industry).

Part 2 provides explanatory and guidance material, and re-

lated best practices for the recommendations listed in this

document. The guidance and explanatory material (GEM) are

provided as appendixes to this document.

The recommendations and the (GEM)were developed by six

dedicated working groups and were extensively reviewed

and validated by:

■

Airports Council International — World (ACI World);

■

The Civil Air Navigation Services Organisation (CANSO);

■

The European Union Aviation Safety Agency (EAA); and,

■

The International Air Transport Associaon (IATA).

The development of the GAPPRE recommendations is based

on the following principles:

■

Provide recommendations that address actions beyond

regulatory compliance — the recommendations in this

action plan are not exhaustive in managing the runway

excursion risk and resilience. It is fundamental that organ-

isations shall be compliant to international, regional and

national rules and regulations.

■

Base recommendations on consensus — a recommen-

dation is included in the action plan only if there was a

consensus for it during the drafting and the subsequent

validation process.

■

Embrace further data analytics — suggest to actors that

they make better use of existing data and fuse and analyse

larger volumes of heterogeneous data.

■

Address both longitudinal and lateral runway excursions.

■

Include runway excursion mitigations.

■

Promote technology embedded in systemic solutions —

promote technological solutions that are clearly integrated

with the respective training, procedures, standardisation,

certication and oversight.

■

Provide R&D recommendations for issues with clear poten-

tial high-risk mitigation benets but without the maturity

to be implemented within the next 10 years.

■

Promote a set of selected proven ecient solutions, which

are not yet standard (still not used by all actors) but that

have been proven to be ecient in reducing the risk of run-

way excursions, based on data analysis and lessons learnt.

■

Provide functional recommendations — leave the design

of specic implementation solutions to the industry.

■

The verb “should” is used to signify that, while a recom-

mendation does not have the force of a mandatory pro-

vision, its content has to be appropriately transposed at

the local level to ensure its implementation.

The development of the GEM is based on the following

principles:

■

Provide further context to the targeted audience in order

to facilitate the implementation of the recommendations

contained in Part 1.

■

Provide explanation, wherever possible, of the recom-

mendation drivers.

■

Incorporate advice for both normal and non-normal op-

eration within the GEM targeted at the operational actors.

■

Use the principles of conservatism and defence in depth.

■

Address organisations such as aircraft operators, airports

and ANSPs rather than individuals like pilots and air trac

controllers.

The GEM content should not be seen as limiting or prescrip-

tive. It is based on best practices and materials shared by the

industry in support for GAPPRE implementation. The bound-

aries set by national regulators and internationally accepted

provisions should be respected.

The GEM will be continually updated and made available

through the safety knowledge management process of SKY-

brary (www.skybrary.aero).

The organisations to which this action plan is addressed

should:

■

Organise a review of the respective recommendations

and assess their relevance against their local conditions

and specic context.

■

Consult the best practices for implementing the selected

recommendations and seek support, if needed, from the

GAPPRE coordinating partners.

■

Conduct an appropriate impact assessment (including

safety assessment) when deciding on the specic action

to implement the recommendations.

■

Implement the specic action/change and monitor its

eectiveness.

■

Share the lessons learnt with the industry.

Global Action Plan for the Prevention of Runway Excursions 11

GLOBAL ACTION PLAN FOR THE

PREVENTION OF RUNWAY EXCURSIONS

PART 1

RECOMMENDATIONS

Recommendations to Aerodrome Operators 12

Recommendations to Air Navigation Service Providers 14

Recommendations to Aircraft Operators 16

Recommendations to Aircraft Manufacturers 22

Recommendations to Regulators and ICAO 25

R&D recommendations for States, international organisations and the Industry 28

List of abbreviations and acronyms 29

RECOMMENDATIONS TO AERODROME OPERATORS

REF Recommendation Action by

Implementation

Date

ADR1

Ensure that runways are constructed, resurfaced and repaired

in accordance with the national or regional (e.g. EASA) reg-

ulations, so that eective friction levels and drainage are

achieved.

Aerodrome Operator Ongoing

ADR2 An appropriate program should be eectively implemented

to ensure the removal of contaminants from the runway sur-

face as rapidly and completely as possible to minimize accu-

mulation and preserve friction characteristics.

Aerodrome Operator End of 2023

ADR3 If provided, ensure that approach radio navigation aids (e.g.

ILS) and visual aids (e.g. AGL, PAPIs and surface markings) are

maintained in accordance with ICAO Standards and Recom-

mended Practices.

An appropriate method for the inspection and assessment of

markings deterioration should be implemented.

Aerodrome Operator End of 2023

ADR4 Ensure that the runway holding positions are clearly marked,

signed and if required, lit. If intersection takeos are conduct-

ed, install at the relevant runway holding positions signs to

indicate the Takeo Run Available (TORA).

Aerodrome Operator End of 2023

ADR5

Ensure robust procedures are in place for calculating tem-

porary reduced declared distances e.g. due to work in pro-

gress on the runway. When reduced declared distances are

in operation, ensure that the temporary markings, lighting

and signs accurately portray the reduced distances and that

they are well communicated in a timely manner to the state's

aeronautical information services for publication and to the

relevant ATS units.

Aerodrome Operator End of 2023

ADR6

Ensure that the procedures to assess runway surface con-

ditions according to ICAO Global Reporting Format include

reactive as well as proactive surface assessment to make sure

hazardous changes are all identied and communicated in a

timely manner.

Aerodrome Operator End of 2021

ADR7 Ensure robust procedures are in place for communicating in-

formation regarding changing surface conditions as frequent-

ly as practicable to the appropriate services according to the

ICAO Global Reporting Format. Roles, responsibilities of stake-

holders and coordination procedures should be formalised.

Aerodrome Operator End of 2021

ADR8 In accordance with ICAO standards (and regional, e.g. EASA

regulations), wind sensors and wind direction indicators

(wind socks) should be sited to give the best practicable indi-

cation of conditions along the runway and touchdown zones.

Aerodrome Operator End of 2025

ADR9 Consider equipping for digital transmission of ATIS as appro-

priate to ensure that ATIS information is updated in a timely

manner.

Aerodrome Operator. End of 2025

REF Recommendation Action by

Implementation

Date

ADR10

If installed, RWY centreline lights should also be used togeth-

er with the runway edge lights whenever runway edge lights

are switched on and when the runway is in use.

Aerodrome Operator End of 2023

ADR11

Ensure appropriate coordination with the meteorological

service provider, the ANSP and the aircraft operators to reg-

ularly assess the relevancy of weather data, in particular at

large aerodromes where there could be spatial dierences

in weather data.

Aerodrome Operator End of 2023

ADR12 Ensure runway exits are appropriately named according to a

logic of succession of numbers and letters avoiding possible

ambiguity.

Aerodrome Operator End of 2025

ADR13

Runway surroundings should be considered when designing

or modifying strips or RESA. It is necessary to consider the

local constraints against ICAO provisions and regional (e.g.

EASA) regulations so as to ensure relevant mitigation.

Aerodrome Operator Ongoing

ADR14

Information related to air operations hazard or specicities

in the airport vicinity should be identied and addressed to

pilots in the Local Runway Safety Team (LRST) and published

through an appropriate means.

Aerodrome Operator End of 2023

ADR15

Runway condition codes assessed should be compared

against braking action reports by the pilots to ensure the ac-

curacy of the information provided to the pilots.

Aerodrome Operator End of 2023

ADR16

Consider using Approach Path Management (APM) in coordi-

nation with local ATC and aircraft operators. Associated issues

should be addressed by the LRST.

Aerodrome Operator End of 2023

Global Action Plan for the Prevention of Runway Excursions 13

RECOMMENDATIONS TO AIR NAVIGATION SERVICE PROVIDERS

REF Recommendation Action by

Implementation

Date

ANSP1

ANSPs should ensure the importance of stabilised approach,

its elements and compliance with nal approach procedures

and aircraft energy management are included in initial and

refresher training of ATCOs conducted by ANSPs and ATCO

Training Organisations, as well as in AFISOs training, as

applicable.

Air Navigation

Service Provider

End of 2023

ANSP2

With regard to assignment of or change to runway assign-

ment for arriving or departing trac:

ANSP2 a. Whenever the runway change is pre-planned, notify

it as early as practicable together with the expected time of

the change to ight crews, including by adding relevant in-

formation in ATIS, where available.

ANSP2 b. As far as practicable, avoid changing the assigned

runway to aircraft on approach or taxiing for departure.

ANSP2 c. ANSPs should ensure ATCOs are aware that RWY

changes create additional workload, increase vulnerability to

error and ight crews need time to re-brief and prepare for it.

ANSP2 d. ANSPs should ensure that the runway conguration

change procedure/process takes account of the above points

and of the tailwind information as appropriate.

ANSP2 e. When operationally possible, accept the ight crew

preference for a runway when requested “due to performance

limitations”.

Air Navigation

Service Provider

End of 2023

ANSP3

ANSPS should:

ANSP3 a. Review available data (e.g. occurrence reports, go-

around / missed approach data etc.) with the aim of identify-

ing the ANSP-related runway excursion contributing factors

and relevant mitigations, for example enhanced airspace

design and procedures and ATCO training and procedures.

ANSP3 b. Share at network level the identied runway excur-

sion contributing factors and relevant mitigations.

Air Navigation

Service Provider

End of 2023

ANSP4

Review processes covering the provision of essential infor-

mation on aerodrome conditions such as weather, wind and

runway surface conditions (e.g. when ‘wet’ or contaminated)

to ensure:

ANSP4 a. A consistent, timely and accurate broadcast of aer-

odrome information.

ANSP4 b. The integrity of the essential information supply

chain from the originator (e.g. Met Oce/Aerodrome Opera-

tor) to the user (e.g. ight crews, ATS, Met Oce, aerodrome

operator and AIS provider).

ANSP4 c. Training on the use of ATIS/D-ATIS is provided to

relevant operational sta.

ANSP4 d. Compliance with the ICAO Global Reporting Format

for runway surface conditions assessment and reporting, in-

cluding the training of the relevant ANSP personnel.

Air Navigation

Service Provider

End of 2021

REF Recommendation Action by

Implementation

Date

ANSP5

ANSP5 a. ANSPs should ensure that ight crews are informed

of the Takeo Run Available (TORA) or the Landing Distance

Available (LDA) if these dier from the published data using

appropriate means. The information should include any alter

native runways which may be available.

ANSP5 b. ATS providers should collaborate with the aero-

drome operators to determine the runway entries from which

intersection takeos may be performed, and develop coordi-

nated procedures for such operations.

Air Navigation

Service Provider

End of 2023

ANSP6

Participate in runway excursion safety information sharing

at network level to facilitate, using just culture principles, the

free exchange of relevant information on actual and potential

safety deciencies.

Air Navigation

Service Provider

End of 2023

ANSP7

If installed, RWY centreline lights should also be used togeth-

er with the runway edge lights whenever runway edge lights

are switched on and when the runway is in use.

Air Navigation

Service Provider

End of 2023

ANSP8

Consider equipping for digital transmission of ATIS, as appro-

priate (e.g. via telephone or other means).

Air Navigation

Service Provider

End of 2025

Global Action Plan for the Prevention of Runway Excursions 15

RECOMMENDATIONS TO AIRCRAFT OPERATORS

REF Recommendation Action by

Implementation

Date

OPS1

Aircraft operators should participate in safety information

sharing networks with all relevant stakeholders. This should

facilitate the free exchange of relevant runway safety informa-

tion including identied risks, safety trends and good practices.

Aircraft Operator Ongoing

OPS2

Aircraft operators should include and monitor aircraft parame-

ters related to potential runway excursions in their Flight Data

Monitoring (FDM) programme.

Whenever standardised FDM markers are provided by the

industry, aircraft operators should use them with priority to

ensure the eectiveness of risk mitigation and safety assur-

ance associated with runway excursion barriers and to allow

comparability on an industry level.

Aircraft Operator End of 2023

OPS3

Aircraft operators and training providers should include re-

alistic, evidence- and competency-based scenarios into their

training programmes requiring threat and error management

for runway excursion prevention during both takeo and

landing.

This should include evidence- and competency-based recur-

rent simulator training programmes which are representative

in terms of environmental conditions, including crosswind,

landing on contaminated/slippery runways and poor visibility

adapted with simulator representativeness.

Representativeness of simulators should be assessed and their

limitations communicated (in order to avoid negative training)

Aircraft Operator End of 2023

OPS4

Aircraft operators should incorporate appropriate technical

solutions to reduce runway excursion risks, where available

(including Runway Overrun Awareness and Alerting System

(ROAAS), and runway veer o awareness and alerting systems,

when and if available). If technical solutions are not available,

operators should implement appropriate SOPs and TEM strat-

egies which support ight crews in eectively preventing run-

way excursions.

Aircraft Operator End of 2027

OPS5

If technically feasible, aircraft operators should equip their air-

craft eet with data-link systems (e.g. ACARS) enabling them

to digitally obtain the latest weather information (e.g. D-ATIS

or METAR). The use of this technical means has to be support-

ed by adequate SOPs enabling all pilots on the ight deck to

familiarise themselves with the latest weather conditions with-

out impeding aircraft and ight path monitoring.

Aircraft Operator End of 2025

OPS6

Aircraft operators should implement policies for ight crews

not to accept ATC procedures and clearances which have the

potential to decrease safety margins to an unacceptable lev-

el for the ight crew thereby increasing the risk of runway

excursions. This includes such procedures and clearances

which increase the likelihood of having an unsafe approach

path management with consequences for safe landing, e.g.

which bear the risk of being unstabilised at the landing gate

or high-energy approaches.

Aircraft Operator End of 2027

REF Recommendation Action by

Implementation

Date

These policies should be further supplemented by the imple-

mentation of eective SOPs and ight crew training.

Flight Crews should be required to report such risks within

their operators SMS and the aircraft operator should further

report such risks to the ANSPs via established reporting sys-

tems. (see OPS1)

OPS7

Aircraft operators should implement policies for safe descent

and approach planning, stabilised approach, safe landing and

go-around and should ensure that these are implemented

in their training. Aircraft operators should dene which ele-

ments of these policies have to be included and highlighted

during the approach briengs by ight crews.

Aircraft Operator End of 2023

OPS8

Aircraft operators should implement policies or SOPs for

ight crews not to conduct takeo or approach following

any runway change until the appropriate set-up, planning,

performance calculations (for multi-pilot operations this in-

cludes independent calculations and cross-checks by at least

two pilots) and re-briengs are completed. When a takeo

runway change is received whilst taxiing, the above should

be performed by ight crew without rushing and when the

aircraft is stationary.

Runway-excursion related TEM should be addressed in the

brieng every time a runway change is expected, probable

or actually occurs.

Aircraft Operator End of 2023

OPS9

Aircraft operators should implement policies or SOPs for

ight crews to request a more favourable runway for takeo

or landing for any reason, which may aect the safety of the

ight and to advise the safety reasons to ATC.

Aircraft Operator End of 2023

OPS10 Aircraft operators should implement policies or SOPs requir-

ing ight crews to conrm prior to commencing the takeo

or landing phase that the actual conditions (weather and air-

craft conguration) are better or at least correspond to the

values used for performance calculations. When conditions

are predicted to approach operational limitations, ight crews

should be required to identify the limiting parameters and

incorporate this into their TEM brieng.

Aircraft Operator End of 2023

OPS11

Aircraft operators should dene company cross- and tailwind

limits which are specic to each type of aircraft operated.

Moreover, specic guidance on the runway conditions and

the gust components should be claried.

Aircraft operators should establish clear policies to allow

their ight crews to reduce the established limits whenever

deemed necessary for safety reasons in actual ight operation.

Aircraft Operator End of 2023

Global Action Plan for the Prevention of Runway Excursions 17

REF Recommendation Action by

Implementation

Date

OPS12 Aircraft operators should publish specic guidance and training

for their ight crews on crosswind takeo and landing techniques,

especially in wet, slippery or contaminated runway conditions.

This should include the correct touchdown and stopping tech-

niques, which incorporate all available control and deceleration

devices as well as TEM topics and methods for eective monitor-

ing and intervention by the PM.

Aircraft manufacturers advice should be incorporated, if available.

Aircraft Operator End of 2023

OPS13

OPS13 a. Aircraft operators should ensure their policies or SOPs

require ight crews to perform independent performance cal-

culations. This should also include independent cross-checks of

the load and trim sheet and the actual TORA/TODA from the AIS

(e.g. if reduced by NOTAM) with TORA/TODA used to calculate the

takeo performance. This independent calculation should also be

applied following a runway change.

OPS13 b. Aircraft operators should ensure their policies or SOPs

include ight crew gross-error checks and crew cross-checks prior

to any data input and prior to executing any data input in the FMS.

Aircraft Operator End of 2023

OPS14

Aircraft operators should publish SOPs and guidance which in-

corporate runway excursion mitigation associated with rejected

takeo decision making and rejected takeo manoeuvres.

Appropriate training should be provided.

Aircraft Operator End of 2023

OPS15 Aircraft operators should develop SOPs which include an assess-

ment, possibly prior to the top of descent, of landing performance

based upon latest and best-available weather information. This

calculation should not be performed using dispatch weather in-

formation. Flight crews should be informed of the type of landing

distance data available (factored or unfactored) and of which cor-

relating safety factors are used.

When possible, the crew should complete descent, approach,

landing planning, set-up and briengs prior to the top-of-descent.

Aircraft Operator End of 2023

OPS16 Aircraft operators should develop a clear go-around policy which

should be further supplemented by a set of SOPs and guidance

materials to put this policy into action. This go-around policy

should enable every ight crew member on the ight deck to

call for a go-around at any time unless an emergency situation

dictates otherwise.

In all cases, the SOPs should require both pilots to have and retain

the required visual reference below DA/MDA with a go around

call mandatory if either pilot loses it. A go-around should also

be mandatory if the approach becomes unstabilised below the

specied approach/landing gate.

Recurrent simulator training should be provided on the compe-

tencies of safe go-around in various stages during the approach

and landing, including shortly prior or during touchdown (before

activation of thrust reversers).

Aircraft Operator End of 2023

REF Recommendation Action by

Implementation

Date

OPS17

Aircraft operators should require the ight crew to carefully

evaluate operational safety before selecting/accepting an ap-

proach and landing runway including the following: weather

conditions (in particular cross and tailwind), runway condition

(dry, wet or contaminated/slippery), inoperable equipment and

aircraft and ight crew performance in order to reduce runway

excursion risks.

Aircraft Operator End of 2023

OPS18

Aircraft operators should clearly dene stabilised approach,

landing and go-around polices in their operations manual.

These polices have to be aligned with regulations requirements

and manufacturers guidance. Supplementing SOPs should in-

clude the requirement for completion of the landing checklist

and ying with the nal approach speed latest at the dened

approach/landing gate. These SOPs should include appropriate

means for the pilot monitoring (PM) to eectively monitor and,

if needed, intervene.

To properly implement the dened policies and SOPs, aircraft

operators have to deliver appropriate training.

Aircraft Operator End of 2023

OPS19 Aircraft operators should publish SOPs and guidance and pro-

vide training highlighting the importance of active monitoring

and eective intervention by the pilot monitoring (PM) during

descent, approach, approach path management and landing.

Actions to be taken by the PM and required reactions by the PF

should be clearly documented in the ocial publication (e.g.

SOPs or Operations Manual, FCOM, etc). These publications

should include guidance how to achieve eective PM perfor-

mance, independent of rank and experience.

Aircraft Operator End of 2023

OPS20 Aircraft operators should publish SOPs and guidance for their

pilots not to conduct auto-land approach manoeuvres at air-

ports when low visibility procedures (LVP) are not in force,

unless:

• the ILS critical and sensitive areas are protected,

• ATC had been informed and reassurance of ILS sensitive

area protection had been received

• specic precautions have been taken and risk analysis has

been performed. More information is available in the guid-

ance material.

• the aircraft is demonstrated as robust to non-protection of

ILS sensitive area.

Aircraft Operator End of 2023

Global Action Plan for the Prevention of Runway Excursions 19

REF Recommendation Action by

Implementation

Date

OPS21 Aircraft operators should clearly dene their policy for a safe

landing and publish it in their SOPs and Operations Manuals.

This policy should clearly dene acceptable touchdown limits

and prohibit intentional long and short landings, e.g. to mini-

mise runway occupancy or minimise taxi time to the gate. The

supplementing SOPs and guidance should include means,

methods and responsibilities with regard to how a crew will

identify and act on such limits.

Appropriate classroom and simulator training should be

provided.

Aircraft Operator End of 2023

OPS22 Aircraft operators should publish SOPs and guidance for land-

ing techniques that are aligned with ICAO Global Reporting

Format and manufacturer’s guidance for all runway states and

environmental conditions.

Aircraft operators should require their ight crew to always fa-

vour a go-around or diversion rather than to attempt a land-

ing when approaching wet, slippery/contaminated runways

without appropriate stopping margin and/or in limiting wind

situations.

Appropriate training should be provided including training in

the ICAO Global Reporting Format.

Aircraft Operator End of 2021

OPS23

Aircraft operators should publish SOPs for their ight crews

when runway conditions are uncertain or actual or anticipated

slippery wet, slippery or contaminated, to fully use all decelera-

tion means, including speed brakes, wheel braking and reverse

thrust irrespective of noise-related restrictions, until a safe stop

is assured, unless this causes controllability issues.

Aircraft Operator End of 2021

OPS24 Aircraft operators should publish SOPs and guidance and pro-

vide training highlighting the importance of active monitoring,

including monitoring of the activation of the stopping devices

on landing, and eective intervention during landing associat-

ed with pilot monitoring duties and performance.

Appropriate training should be provided.

Aircraft Operator End of 2023

OPS25

Aircraft operators should dene policies and procedures to ad-

dress bounced landings. Whenever available, aircraft operators

should take into account and include manufacturers’ guidance.

Moreover, aircraft specic and appropriate training, including

simulator training, should be provided for ight crews.

Aircraft Operator End of 2023

OPS26

Aircraft operators should develop guidance on whether a

change of control during landing roll out has to take place and

require their ight crews to brief and agree on the planned run-

way exit, taking into account the friction status of both runway

and runway exit, whenever available.

When a change of control is necessary during roll-out, this

should be performed below taxi speed and when the aircraft

trajectory is stable.

Aircraft Operator End of 2023

REF Recommendation Action by

Implementation

Date

OPS27

Aircraft operators should implement policy, technical solu-

tions or SOPs which conrm that the aircraft is lining up on the

planned runway, its centreline and via the correct intersection.

Aircraft Operator End of 2023

OPS28 Aircraft operators should publish SOPs and guidance for their

ight crew not to accept line-up, backtrack or takeo clear-

ances until pre-takeo preparation (including cabin secure),

procedures and checklists are completed to the appropriate

point which permits the accomplishment of the associated

manoeuvre without delay and until they have reported “ready

for departure” to ATC.

Aircraft operators should publish an explicit SOP for “rolling

takeos”.

Aircraft Operator End of 2023

OPS29 Aircraft operators should foster a culture that stimulates safe

behaviour, which encourages risk-averse decision-making by

ight crews.

Aircraft Operator Ongoing

OPS30 Aircraft operators should, when determining their TEM strate-

gies and SOPs, identify runways with a remaining safety margin

of less than 400m/1200ft after application of all required safety

factors as safety critical.

Aircraft Operator End of 2023

OPS31

Aircraft operators should monitor go-around policy compli-

ance through their FDM programmes and establish go-around

safety performance indicators (SPIs) for monitoring through

their SMS. In addition to monitoring go-arounds, aircraft oper-

ators should also monitor discontinued approaches.

Aircraft Operator End of 2023

OPS32 Aircraft operators should:

1) Dene an unstable approach followed by landing as a man-

datory reporting event by the ight crew and;

2) Minimise the need to report a go-around due to an unstable

approach unless there is another signicant event in relation

to the go-around, e.g. ap overspeed.

Aircraft Operator End of 2023

OPS33

Aircraft operators, for aircraft equipped with EFBs and when

technically feasible, should systematically compare the EFB

takeo performance loggings with the relative FDM data to

identify the takeo runway excursion risks.

Aircraft Operator End of 2023

OPS34

Aircraft operators, for aircraft equipped with EFBs and when

technically feasible, should visualise on the EFB the FULL RWY

with its planned TO RWY holding position to increase the sit-

uational awareness of the crew for the intended T/O position.

Aircraft Operator End of 2023

OPS35

Aircraft operators should consider observational procedures

(e.g. Line Operations Safety Audits) to identify runway excur-

sion safety risks precursors and best practices which cannot be

captured by the traditional reporting or FDM.

Aircraft Operator End of 2023

Global Action Plan for the Prevention of Runway Excursions 21

RECOMMENDATIONS TO AIRCRAFT MANUFACTURERS

REF Recommendation Action by

Implementation

Date

MAN1

Aircraft manufacturers should present takeo and landing

performance information for dispatch and time-of-arrival for

the full range of reportable runway conditions, using com-

mon and shared terminology and to agreed standards, set

out in FAA ACs 25-31 and 25-32.

Aircraft Manufacturer End of 2025

MAN2

Training material promulgated by aircraft manufacturers and

aircraft training providers should emphasize the necessity

of making best use of deceleration means, including speed

brakes, wheel braking and reverse thrust in a timely manner,

until a safe stop is assured, and in particular when conditions

are uncertain or when runways are wet or contaminated by

applying full braking devices, including reverse thrust, until

a safe stop is assured.

Aircraft Manufacturer End of 2023

MAN3

On-board real time performance monitoring and alerting sys-

tems that will assist the ight crew with the land/go-around

decision and alert when more deceleration force is needed

during the landing roll should be made widely available.

Aircraft Manufacturer End of 2027

MAN4

The aviation industry should develop systems and ight crew

manuals to help ight crews calculate landing distances easily

and reliably in normal and non-normal conditions. Systems

should have a method to apply recommended assumptions.

All landing distance computing tools available for the aircraft

(FMS, EFB) and on-board real time performance monitoring

and alerting systems (e.g. ROAAS, etc.) should be consistent

with the overall harmonized set of data used for landing

performance assessment. Whenever consistency between

on-board alert triggering thresholds and landing distance

computation methods available to the crew cannot be en-

tirely achieved, means to determine these thresholds for the

planned conditions and guidance to the ight crew on a rec-

ommended course of action should be provided.

Aircraft Manufacturer End of 2025

MAN5

Electronic Flight Bag manufacturers and providers should de-

velop user interfaces for the calculation and data entry of the

takeo and landing performance data, designed to minimise

the possibility of errors introduced by the pilot.

EFB systems should enable the ight crew to perform inde-

pendent determination of takeo and landing data and to im-

plement, where possible, an automatic cross-check of inputs

and to ensure correct insertion of the data in the avionics.

EFB systems should use terminology and presentation of data

consistent with aircraft systems and aircraft documentation

to the extent practical.

Standard Operating procedures should be developed to sup-

port a cross-check of performance data by both pilots

Aircraft Manufacturer End of 2025

MAN6

Manufacturers should monitor and analyse (worldwide) run-

way excursions involving the aeroplanes they support and

share the lessons learned – where feasible.

Aircraft Manufacturer Ongoing

REF Recommendation Action by

Implementation

Date

MAN7

Manufacturers should provide information about eective

crosswind landing and takeo techniques including in low

visibility when required.

Aircraft Manufacturer End of 2023

MAN8

Manufacturers should consider a function able to:

• Use aircraft data to compute braking action (i.e. maximum

achievable tire-runway friction when braking is friction

limited).

• Display it to the crew to assist pilot's braking action report

to air trac control (PiRep).

• Convey it, just after landing, to airport operators and to

the aircraft operator(s).

Aircraft Manufacturer End of 2027

MAN9

Manufacturers should consider to make available ight deck

functionality enabling an accuracy of the 3D aircraft trajectory

with regards to the runway (including the touch-down point),

especially for degraded visibility landings.

For example, in order to satisfy this recommendation manu-

facturers could consider to make available:

• Expanded automatic landing.

• Functions that provide additional information to the ight

crew to improve positional awareness of the aircraft rela-

tive to the landing runway.

Aircraft Manufacturer End of 2027

MAN10

Aircraft manufacturers and FDA service providers should pro-

vide adequate interfaces and consider developing additional

services for Flight Data Analysis, to help operators identify

precursors to runway excursions.

For example, this could include services to identify:

• Discrepancies on runway surface conditions (comparing

experienced conditions with ATC reported ones)

• Reduced aircraft performance margins at landing

or takeo,

by comparing actual data (such as deceleration and distanc-

es) with the expected aircraft performance according to man-

ufacturer models.

Aircraft Manufacturer End of 2027

MAN11

Manufacturers should consider a real-time takeo perfor-

mance monitoring function in order to reduce the risk of run-

way excursion during takeo, including aircraft performance

related or wrong position scenarios.

Aircraft Manufacturer End of 2027

MAN12

Manufacturers should consider to make available systems

that provide ight path and energy state awareness in order

to aid the ight crew to better anticipate and maintain stabil-

ity throughout the entire approach.

Aircraft Manufacturer End of 2027

MAN13

Manufacturers should provide recommendations in their

operational documentation for the use of automatic braking

when landing on wet or contaminated runways, when appro

priate, to minimize delays in brake application.

Aircraft Manufacturer. End of 2021

Global Action Plan for the Prevention of Runway Excursions 23

REF Recommendation Action by

Implementation

Date

MAN14

Manufacturers should consider to make available on-board

real time stabilized approach monitoring systems that pro-

vide alerts when there is a deviation from stable approach

criteria. In those cases where other alerting systems are used

in combination (e.g. ROAAS), the alerting systems must be

consistent to avoid unnecessary go-arounds.

Aircraft Manufacturer End of 2027

MAN15

Manufacturers should provide on-board real time means to

enhance position awareness with respect to runways on nal

approach and ground operations to addresses risks of aircraft

lining up on:

• The incorrect runway for landing or departure.

• A taxiway for landing or departure.

• The incorrect intersection for departure.

Aircraft Manufacturer End of 2027

MAN16

Whenever new functionality is created that is not supported

by existing regulatory guidance, that functionality should be

preferably supported by development of a MOPS by a stand-

ards organization.

Aircraft Manufacturer Ongoing

RECOMMENDATIONS TO REGULATORS AND ICAO

REF Recommendation Action by

Implementation

Date

REG1

Regulators should ensure that:

• The national/regional regulations are in line with the rel-

evant ICAO standards and recommended practices; and

• All infrastructure, practices and procedures relating to

runway operations are designed and remain in compli-

ance with such national/regional regulations.

Regulators Ongoing

REG2

Regulators should enhance the focus on the prevention of

runway excursions in their oversight activities by taking into

account best practices (e.g. GAPPRE), in addition to their na-

tional/regional regulatory requirements.

Regulators Ongoing

REG3

Ensure that the risk of runway excursion is included as part

of runway safety in the State Safety Plan and provide safety

performance indicators to monitor/demonstrate the eec-

tiveness of any State or industry initiatives.

Regulators Ongoing

REG4

As part of their oversight activities, Regulators should ensure

close cooperation between ground handling service provid-

ers, aircraft operators, aerodrome operators and air naviga-

tion service providers, with regard to the prevention of run-

way excursions. This cooperation will be a part of an eective

implementation of SMS of the relevant organisations, veried

by the respective regulator through regular assessments and

safety performance indicator monitoring.

Regulators Ongoing

REG5

Ensure that any noise mitigation rules required to be imple-

mented by aerodromes should be subject to regular and co-

ordinated hazard identication and risk assessment, to ensure

they do not increase the likelihood of runway excursions, in

particular in relation to operations on contaminated runways.

Regulators Ongoing

REG6

Ensure a continued focus on training for pilots, air trac con-

trollers, AFISOs, and aerodrome personnel, which includes

runway excursion prevention. Ensure the continuous review

and improvement of the respective training programmes by

the regulator and Training Organisations, through the use of

performance indicators.

Regulators End of 2022

REG7

Assess the performance of aircraft operators’ processes for:

• Safety data collection (e.g. ight data monitoring and

reporting).

• Identication and analysis of precursors and causal

factors.

Ensure that aircraft operators are participating in safety data

sharing programs, e.g. Data4Safety.

Regulators End of 2022

REG8

As part of safety promotion, ensure GAPPRE is shared with

relevant stakeholders to ensure that the causal and contrib-

utory factors of runway excursion continue to be understood,

enabling organisations to further enhance eective runway

excursion prevention measures.

Regulators Ongoing

Global Action Plan for the Prevention of Runway Excursions 25

REF Recommendation Action by

Implementation

Date

REG9

States should assess the performance and success of safety

information sharing networks among all users of the aviation

system including the extent of free exchange of information

on actual and potential safety deciencies.

Regulators Ongoing

REG10

States should establish a national runway safety forum/net-

work which includes representatives from aircraft operators,

ANSPs, aerodromes and regulators where best practices and

learning can be shared. The National forum/network should

include key representatives from Local Runway Safety Teams.

National best practices should be shared regional/globally

through regional/global knowledge platforms.

Regulators End of 2022

REG11

States should measure the eectiveness of the GAPPRE rec-

ommendations, for example by collaboratively developing

harmonised performance indicators or success factors.

Regulators End of 2022

REG12

REG12 a. Regulators and ICAO should consider and adopt

regulatory measures for preventing visual confusion during

line-up between runway edge and centreline lights leading

to misalignment with the runway centreline. This should also

take into account the eects of low visibility and runway

contamination and the eect of using various light colours

and patterns to dierentiate the runway centreline and edge

lighting systems.

REG12 b. Regulators and ICAO should consider the guidance

needs of the individual aircraft, and adopt provisions that dis-

associate the installation of taxiway centreline lights from the

aerodrome trac density.

ICAO and Regulators End of 2025

REG13

Except where runway TDZ lights are provided, regulators and

ICAO should upgrade to a standard the use of simple TDZ

lighting as an aid to enhance landing (touch down point)

accuracy.

ICAO and Regulators End of 2025

REG14

ICAO should investigate improvements in marking and light-

ing systems that may enhance the simple TDZ lighting system.

ICAO End of 2025

REG15

ICAO should consider to upgrade to a standard the introduc-

tion of runway centreline lights for:

• CAT I runways;

• Runways used for takeo with RVR of the order of 400m

or higher when the runway is used by high-speed aircraft,

particularly where the width between the runway lights is

greater than 50 m.

ICAO End of 2025

REG16

Support the development of approved signal in space SBAS

models to allow certication of automatic landing on LPV 200

procedures as part of a broader initiative to promote and en-

courage the development of LPV 200 IFR procedures on a

wider set of runways.

Regulators

REF Recommendation Action by

Implementation

Date

REG17

Regulators and ICAO should launch initiatives or working

groups having the objective to dene a rulemaking base-

line for video based navigation to supplement (and/or re-

place) traditional navigation means in the visual segment.

Such capacity would allow enhancing availability of advance

functions such as automatic landing and veer-o prevention

warnings.

ICAO and Regulators End of 2025

Global Action Plan for the Prevention of Runway Excursions 27

RECOMMENDATIONS FOR R&D

REF Recommendation Action by

Implementation

Date

R&D1

Investigate a awareness and alerting system when an aircraft

experiences abnormal/signicant lateral deviation during -

nal stages of the landing.

States, international

organisations and

the Industry

End of 2030

R&D2

Conduct research on transport-category aircraft, to extend

automatic landing capacity to any runway states.

States, international

organisations and

the Industry

End of 2030

R&D3

Improve methods for assessing runway micro texture.

Make pilots and aerodrome operators aware of the impact of

a poor micro texture and of the shortfalls of current industry

practice.

States, international

organisations and

the Industry

End of 2030

R&D4

Develop models for assessing runway wetness, particularly

the depth.

States, international

organisations and

the Industry

End of 2030

R&D5

Explore the accuracy of and develop new automatic runway

condition monitoring systems.

States, international

organisations and

the Industry

End of 2030

R&D6

Research ways to improve graded area of wet runway strips

to mitigate the damage to aircraft when veering o a runway.

States, international

organisations and

the Industry

End of 2030

R&D7

Research and develop functions that provide additional ight

path and energy information (e.g. such as FPV symbology) in

order to help the ight crew to better anticipate and maintain

stability at the gate and below

States, international

organisations and

the Industry

End of 2030

R&D8

R&D eorts should be conducted to develop on-board real

time stabilised approach monitoring (upstream of ROAAS

function at higher altitudes eg FL 200). Such systems should

ensure that they are harmonized with other systems such as

ROAAS and Runway Awareness and Advisory System (RAAS).

States, international

organisations and

the Industry

End of 2030

LIST OF ABBREVIATIONS AND ACRONYMS

ACARS Aircraft Communications Addressing and Reporting System

AFISO Aerodrome Flight Information Service Ocer

AGL Aeronautical Ground Lighting

ANSP Air Navigation Service Provider

APM Approach Path Management

ATC Air Trac Control

ATCO Air Trac Control Ocer

ATIS Automatic Terminal Information System

ATS Air Trac Services

DA Decision Altitude

EASA European Union Aviation Safety Agency

EFB Electronic Flight Bag

FAA Federal Aviation Administration

FCOM Flight Crew Operating Manual

FDA Flight Data Analysis

FDM Flight Data Monitoring

FL Flight Level

FMS Flight Management System

FPV Flight Path Vector

GAPPRE Global Action Plan for the Prevention of Runway Excursions

GNSS Global Navigation Satellite System

GRF ICAO Global Reporting Format

ICAO International Civil Aviation Organisation

IFP Instrument Flight Procedure

ILS Instrument Landing System

LDA Landing Distance Available

LPV Localiser Performance with Vertical Guidance

LRST Local Runway Safety Team

LVP Low Visibility Procedures

MDA Minimum Descent Height

METAR Meteorological Terminal Air Report

MOPS Minimum Operational Performance Standard

NOTAM Notice to Airmen

PAPI Precision Approach Path Indicator

PM Pilot Monitoring

R&D Research and Development

RAAS Runway Awareness and Advisory System

RESA Runway End Safety Area

ROASS Runway Overrun Awareness and Alerting System

RWY Runway

SBAS Satellite-based Augmentation System

SMS Safety Management System

SOPs Standard Operating Procedures

SPI Safety Performance Indicators

TDZ Touchdown zone

TEM Threat and Error Management

TODA Takeo distance available

TORA Takeo Run Available

Global Action Plan for the Prevention of Runway Excursions 29

Global Action Plan for the Prevention of Runway Excursions 31

GLOBAL ENHANCED ACTION PLAN FOR

THE PREVENTION OF RUNWAY EXCURSIONS

PART 2

GUIDANCE AND EXPLANATORY MATERIAL

Appendix A — Aerodrome Operators 33

Appendix B — Air Navigation Service Providers 43

Appendix C — Aircraft Operators 59

Appendix D — Aircraft Manufacturers 111

Appendix E — Regulators and ICAO 123

Appendix F — R&D recommendations 125

Intentionally left blank

Global Action Plan for the Prevention of Runway Excursions 33

APPENDIX A

GUIDANCE AND EXPLANATORY MATERIAL

FOR AERODROME OPERATORS

GEM Recommendation ADR1 34

GEM Recommendation ADR2 34

GEM Recommendation ADR3 35

GEM Recommendation ADR4 36

GEM Recommendation ADR5 36

GEM Recommendation ADR6 36

GEM Recommendation ADR7 37

GEM Recommendation ADR8 38

GEM Recommendation ADR9 39

GEM Recommendation ADR10 39

GEM Recommendation ADR11 39

GEM Recommendation ADR12 40

GEM Recommendation ADR13 40

GEM Recommendation ADR14 41

GEM Recommendation ADR16 41

34 Appendix A — Aerodrome Operators

Recommendation ADR1: Ensure that run-

ways are constructed, resurfaced and repaired

in accordance with the national or regional

(e.g., EASA) regulations, so that eective fric-

tion levels and drainage are achieved.

Recommendation ADR2: An appropriate

program should be eectively implemented

to ensure the removal of contaminants from

the runway surface as rapidly and complete-

ly as possible to minimise accumulation and

preserve friction characteristics.

What

Regarding runway surface characteristics, design surface ele-

ments are included in regulations. Those design targets give

specications which ensure the runway surface is suitable

for takeos and landings. Regulations usually include more

stringent design targets as recommendations. These would

usually ensure even safer conditions and therefore should

be met as closely as possible. The basic surface elements

consist of:

■

The slopes;

■

Grooves features; and,

■

The texture of pavement.

Why

Regarding the slopes

Runways should meet the slope specications in order to

support aircraft manufacturer performance limitations and

enable the safe movement of aircraft, in addition to facili-

tating water drainage. The latter acts towards the preser-

vation of required adherence when braking/turning on the

runway surface at the appropriate speed. In particular, the

transverse slope enables the water to drain away from the

runway centreline.

Regarding runway grooving

Grooved surfaces reduce both dynamic and viscous hydro-

planing by further diminishing the watery surface area in

contact with the tyre.

Regarding the texture of pavement

Adequate macro and micro texture ensure a minimum coef-

cient of friction and therefore enough adherence.

How

Recommendations concerning surface slopes and other

physical features are provided in International Civil Aviation

Organization (ICAO) Annex 14 and ICAO Aerodrome Design

Manual, Doc 9157, Part 1.

What

Removal of contaminants on the runway should be per-

formed as soon as possible. Means of removal should be

adapted to ensure eciency, and the surface condition

should then be checked against pre-determined minimum

requirements. Three types of contamination are concerned:

Temporary contamination that build up due to weather phe-

nomenon (snow, ice, etc.), long term contamination such as

rubber deposits with oily particles, and contamination that

may or may not fade over time, depending on its nature and

the environmental conditions (for example, sand).

Why

During periods of continuous contamination, it is essential

to stay ahead of the curve so as not to get overwhelmed

by accumulated contamination over time. Rapid removal

should help in preserving the friction characteristics of the

runway. If performed well, it will ensure that braking actions

and steering capabilities of aircraft are not adversely aected

when taking o or landing.

How

Each type of contamination should be considered separately

if necessary (for water contamination, refer to Recommenda-

tion ADR1).

Winter contaminants

Ice, frost, snow and slush should be removed to enable safe

operations. A combination of mechanical, chemical or other

means can be used to ensure as much as possible is removed

according to:

■

The nature of the contamination (slush, ice, snow, frost);

■

The depth of the contaminant;

■

The solidity of the contaminant;

■

The time of protection needed;

■

The frequency and intensity of the contamination; and,

■

Temperature and humidity evolution.

Rubber deposits

Among other parameters, rubber deposit accumulation de-

pends on the trac (number of landings), runway tempera-

ture and runway roughness. The severity of the phenomenon

is also increased when dealing with heavy aircraft.

Global Action Plan for the Prevention of Runway Excursions 35

■

Supposing no change in the trac pattern, contaminant

removal should be planned regularly at a given frequency.

■

One should be careful regarding the means used to re-

move the rubber deposits: For example, very high pressur-

ised water can accelerate the runway surface deterioration

if the removal is performed too frequently. Less aggressive

approaches exist to remove the rubber deposits:

› Cryogenic removal, which is suitable for small surface

accumulation as no “runway size” means are known

today; and,

› Chemical spreading (environmentally friendly).

■

One way to dene the most appropriate action could be

by assessing the rubber deposit accumulation over time,

matching the trac (i.e., utilization of the runway) against

friction characteristics. On a graph, a curve could be drawn

where friction starts to deteriorate over time. This curve

could be used to determine the best moment to start the

removal. Over time, and when the trac changes, the

frequency of removal should be adapted.

What

The recommendation emphasizes the necessity to follow

ICAO standards and recommendations for visual and radio

navigation aids maintenance and consolidate best practices

for the inspection of markings.

Why

The availability of location information supported by signs,

lights and markings, both along the runway and at the hold-

ing points, provides the ight crew with enhanced situational

awareness as they indicate where the aircraft is relative to the

airport layout. This information is benecial in reducing the

likelihood of runway excursions, particularly as the presence

of the aids will assist ight crew in ensuring the takeo roll

commences at the correct location. Also, lighting, radio navi-

gation aids (e.g., instrument landing system (ILS), aeronautical

ground lighting (AGL), precision approach path indicator

(PAPI)) and runway markings all help ight crews to y an

adequate ight path to the expected touchdown point on

the runway, thus avoiding long and short landings.

How

Lightings and signs are already thoroughly covered through

the current regional regulations. Markings should also be

inspected for any sign of changes:

Rubber deposits

■

Markings should be inspected visually to ensure they are

not becoming obscured by rubber deposits, specically

in the touchdown zone, with a frequency that must be

related to the trac density, the use of the runway and

the meteorological conditions at the airport.

Degradation of markings

Not all markings shall be assessed equally during inspection:

The emphasis should be on critical areas where marking is

known to deteriorate quickly. Again, touchdown zone (TDZ)

markings and the runway centreline should be inspected

at a higher frequency; runway centerline markings help in

reducing the risk of veer-os, and TDZ markings can reduce

the risk of overruns. In any case, the frequency should be

adequate to ensure visual identication is maintained. The

rest of the markings not subject to an accelerated deterio-

ration, or critical in regard to veer-os and overruns risks,

can follow a program of planned maintenance based on

the age of the marking, the weather conditions and the

volume of trac.

Here is some guidance that can help in performing eective

inspection of markings:

■

Inspections are realised by individuals familiar with char-

acteristic deteriorations of markings (training);

■

Sucient light is present for adequate visual assessment;

and,

■

For aerodromes where markings are deteriorating ab-

normally fast (aggressive environmental conditions or

excessive run-over), further advanced methods based on

chromaticity and retro-reectivity can be developed.

The inspection of markings can take into account the fol-

lowing references:

■

“Development of Methods for Determining Airport Pave-

ment Marking Eectiveness”, DOT/FAA/AR-TN03/22.

■

Aireld Marking Handbook, in APPENDIX D: Criteria for

Maintenance, in dened a threshold pass/fail limit for

white and yellow paint.

Radio-navigation and lighting

Radio-navigation aids and lighted visual aids should be

checked periodically for alignment and synchronicity in order

to ensure there are no conicts in the information provided

to the ight crew.

Recommendation ADR3: If provided, ensure

that approach radio navigation aids (e.g., ILS)

and visual aids (e.g., AGL, PAPIs and surface

markings) are maintained in accordance with

ICAO Standards and Recommended Practices.

An appropriate method for the inspection and

assessment of markings deterioration should

be implemented.

36 Appendix A — Aerodrome Operators

What

All intersecting taxiways intended to be used for departure

should be equipped with signs properly illuminated and vis-

ible, indicating the takeo run available (TORA).

Why

The updated TORA from the entrance taxiway should be indi-

cated as a last resort prior to takeo. As such, any inadequacy

with the required distances calculated for performance can

be addressed during the takeo brieng.

How

Implementation of TORA information signs in conformity with

the applicable regulation (Figure 1).

Refer to ICAO Annex 14 for signage implementation and de-

sign standards.

What

Should the runway declared distances be temporarily reduced

for any reason, for example during maintenance or construction

work, signs, markings and lighting should be carefully planned

to ensure the correct temporary information is displayed. These

reduced distances need to be carefully determined as they

are used in aircraft performance calculations by the aircraft

operators. Temporarily reduced runway distances must also be

carefully communicated to ight crew by Notices to Airmen

(NOTAMs) and/or Aeronautical Information Publication Sup-

plements (AIP SUP), to air trac services (ATS) for inclusion in

automatic terminal information service (ATIS) broadcasts, ight

brieng material or live radio communication.

Why

Temporarily reduced declared distances require extra atten-

tion. A number of occurrences have taken place in which

ight crews had not detected a change and planned a takeo

or landing based on the normal declared distances.

How

Signage

Variable message signs displaying text specic to temporary

changes may be useful in certain circumstances. It is also

good practice to cover any previous and permanent signs

that present conicting information, so there is only one

sign present.

What

When a meteorological degradation is expected, the aero-

drome operator will ensure that it is prepared to evaluate

the surface conditions promptly to transmit relevant data to

the air navigation services provider (ANSP) and through the

appropriate aeronautical information channels.

Why

Pilots aware of the latest runway surface conditions perform

more relevant preparations for takeo and landing.

How

Proactive aspects of assessment should include:

■

A regular and formalized monitoring of the weather to

ensure prompt reactivity; and,

■

Assessments should be performed at least when there

is a change according to the signicant change criteria

stated in ICAO Doc 9981. Additional occasions, when the

assessment should be performed in the aftermath of any

removal of the contaminant, should be identied and for-

malized in clear procedures.

Recommendation ADR4: Ensure that the

runway holding positions are clearly marked,

signed and if required, lighted. If intersection

takeos are conducted, install at the relevant

runway holding positions signs to indicate the

Takeo Run Available (TORA).

Figure 1. The design specications are in line with

the corresponding ones of ICAO Annex 14, Volume I

2500 m 2500 m

INTERSECTION TAKE-OFF

Extracted from EASA CS-ADR-DSN

Recommendation ADR5: Ensure robust pro-

cedures are in place for calculating temporary

reduced declared distances (e.g., due to work

in progress on the runway). When reduced de-

clared distances are in operation, ensure that

the temporary markings, lighting and signs ac-

curately portray the reduced distances and that

they are well communicated in a timely manner

to the state’s aeronautical information services

for publication and the relevant ATS units.

Recommendation ADR6: Ensure that the

procedures to assess runway surface condi-

tions according to the Global Reporting For-

mat (GRF) include reactive as well as proactive

surface assessment to make sure hazardous

changes are all identied and communicated

in a timely manner.

Global Action Plan for the Prevention of Runway Excursions 37

Assessments

A combination of additional means of assessments can be

used to support visual observations by trained personnel:

■

Friction measurements along the runway with adapted

mobile equipment;

■

Probe alerts (directly implemented on the runway) meas-

uring humidity/temperature and depth of the contami-

nants; and,

■

Pilot reports.

Data transmission

Friction measurements are not used by ight crews to calcu-

late landing performance requirements. Therefore, the airport

operator and the ANSP should not provide them with this

information for states following EASA regulations: Only GRF

shall be used. Item “S” of a SNOWTAM shall be lled with “NR”

in this case (see below).

If the contamination is asymmetrical on the runway (with

the left side or right side of the runway more prominent), it

could be specied as additional information in item “T” of a

SNOWTAM (see below).

Training

When a equipment or a procedure are required to be used

only during a part of the year, ensure that personnel are

trained outside of that season for that equipment/procedure

so that skills can be maintained. This should be emphasised

right before that season, especially when new approaches

are introduced for the rst time. Seasonal training is nec-

essary to:

■

Identify all personnel involved in the process of assessment

and transmission;

■

Identify the role of all personnel; and,

■

Plan for multiple training sessions if necessary, in advance

and with practical tests until the entire process demon-

strates error-proof transmission.

Feedback

Runway condition codes (RCCs) should be compared against

braking action reported by the pilots to ensure improvement

of the involved processes. This is especially important when

reports are converging and do not match RCC.

What

Enhance the assessment and transmission cycles of runway

surface conditions.

Why

It is necessary to ensure ecient cycles of transmission.

Therefore, roles of all stakeholders must be dened and

agreed upon to avoid possible missing steps contributing to

increased delay. Delays generate hazardous situations when

operational readiness is regularly impacted. Transmission of

data during changing conditions may benet from more fre-

quent cycles of measurement. However, it should be carefully

balanced with higher risks generated by the frequent inter-

ruptions of movements as a consequence of the unavailability

of the runway during measurement.

How

Methods are being developed that cannot supplant “usual”

assessment but can give additional information on runway

conditions without impacting the arrival or the departing

sequence. They rely on the use of aircraft braking action data

collected from actual landings. The data are automatical-

ly updated and made available to airports and/or air trac

Recommendation ADR7: Ensure robust pro-

cedures are in place for communicating infor-

mation regarding changing surface conditions

as frequently as practicable to the appropriate

services, according to the GRF. Roles, responsi-

bilities of stakeholders and coordination pro-

cedures should be formalised.

(COM

heading)

(Abbreviated

heading)

(PRIORITY

INDICATOR)

(DATE AND TIME OF

FILING)

(ORIGINATOR’S

INDICATOR)

(ADDRESSES)

(SWAA* SERIAL NUMB ER) (LOCATION

INDICATOR)

(OPTIONAL GROUP)(DATE/TIME O F ASSESSMENT)

SNOWTAM

(AERODROM E LOCATION INDICATOR)

(DATE/TIME O F ASSESSMENT (Ti me of complet ion of assess ment in UTC))

(LOWER RUNWAY DESIGNATION NU MBER)

(WIDTH OF RU NWAY TO WHICH T HE RUNWAY CONDITION APPLY, IF LESS THAN PUBLI SHED

WIDTH)

(REDUCED RUN WAY LENGTH, IF LES S THAN PUBLISHED L ENGTH (m))

(DRIFTIN G SNOW ON TH E RUNWAY)

(LOOSE SAND O N THE RUNWAY)

(CHEMICAL TR EATMENT ON THE RUNWAY)

(SNOW BANKS O N THE RUNWAY)

(if present, di stance from the runway c entre line (m) followed by “ L”, “R” or “ LR” as applicab le)

(SNOW BANKS O N THE TAXIWAY)

(SNOW BANKS AD JACENT TOTHE TAXIWAY)

(TAXIWAY CONDITION S)

(APRONCONDITIONS)

(MEASURED F RICTION COEFFICI ENT)

(PLAIN -LANGUAGE REMAR KS)

NOTES:

1. *Ente r ICAO nationali ty letters a s given in ICAO Doc 7910, Par t 2 or otherw ise applic able aerodr ome identifi er.

2. Info rmation on oth er runways, rep eat B to H

3. Info rmation in th e situationa l awareness se ction repea ted for each runw ay, taxiway and apr on. Repeat as ap plicable w hen report ed.

4. Word i n brackets ( ) not to b e transmit ted.

5. For le tters A) to T) ref er to the Instru ctions for th e completi on of the SNOWTAM For mat paragrap h 1, item b).

(RUNWAY CONDITION C ODE (RWYCC) ON EACH RUN WAY THIRD)

(PER CENT COVERAGE C ONTAMINANT FOR EACH R UNWAY THIRD)

(DEPTH (mm) OF LOOS E CONTAMINANT FOR EAC H RUNWAY THIRD)

(CONDITIO N DESCRIPTION OVER TOTAL RUNWAY LENGTH)

(Observed on e ach runway third, star ting from thresho ld having the lower run way designation nu mber)

(From Runway C ondition As sessment Ma tric (RCAM) 0, 1, 2,3, 5, or 6)

(Serial nu mber)

Aeroplane performance calculation section

Situational awareness section

COMPACTED SNOW

DRY

DRY SNOW

DRY SNOW ON TOP OF C OMPACTED SNOW

DRY SNOW ON TOP OF I CE

FROST

ICE

SLUSH

STANDING WATER

WATER ON TOP OF COMPACTED SNOW

WET

WET ICE

WET SNOW

WET SNOW ON TO P OF COMPACTED SNOW

WET SNOW ON TO P OF ICE

T) )

/ /

Item “S” Highlighted

(COM

heading)

(Abbreviated

heading)

(PRIORITY

INDICATOR)

(DATE AND TIME OF

FILING)

(ORIGINATOR’S

INDICATOR)

(ADDRESSES)

(SWAA* SERIAL NUMB ER) (LOCATION

INDICATOR)

(OPTIONAL GROUP)(DATE/TIME O F ASSESSMENT)

SNOWTAM

(AERODROM E LOCATION INDICATOR)

(DATE/TIME O F ASSESSMENT (Ti me of complet ion of assess ment in UTC))

(LOWER RUNWAY DESIGNATION NU MBER)

(WIDTH OF RU NWAY TO WHICH T HE RUNWAY CONDITION APPLY, IF LESS THAN PUBLI SHED

WIDTH)

(REDUCED RUN WAY LENGTH, IF LES S THAN PUBLISHED L ENGTH (m))

(DRIFTIN G SNOW ON TH E RUNWAY)

(LOOSE SAND O N THE RUNWAY)

(CHEMICAL TR EATMENT ON THE RUNWAY)

(SNOW BANKS O N THE RUNWAY)

(if present, di stance from the runway c entre line (m) followed by “ L”, “R” or “ LR” as applicab le)

(SNOW BANKS O N THE TAXIWAY)

(SNOW BANKS AD JACENT TOTHE TAXIWAY)

(TAXIWAY CONDITION S)

(APRONCONDITIONS)

(MEASURED F RICTION COEFFICI ENT)

(PLAIN -LANGUAGE REMAR KS)

NOTES:

1. *Ente r ICAO nationali ty letters a s given in ICAO Doc 7910, Par t 2 or otherw ise applic able aerodr ome identifi er.

2. Info rmation on oth er runways, rep eat B to H

3. Info rmation in th e situationa l awareness se ction repea ted for each runw ay, taxiway and apr on. Repeat as ap plicable w hen report ed.

4. Word i n brackets ( ) not to b e transmit ted.

5. For le tters A) to T) ref er to the Instru ctions for th e completi on of the SNOWTAM For mat paragrap h 1, item b).

(RUNWAY CONDITION C ODE (RWYCC) ON EACH RUN WAY THIRD)

(PER CENT COVERAGE C ONTAMINANT FOR EACH R UNWAY THIRD)

(DEPTH (mm) OF LOOS E CONTAMINANT FOR EAC H RUNWAY THIRD)

(CONDITIO N DESCRIPTION OVER TOTAL RUNWAY LENGTH)

(Observed on e ach runway third, star ting from thresho ld having the lower run way designation nu mber)

(From Runway C ondition As sessment Ma tric (RCAM) 0, 1, 2,3, 5, or 6)

(Serial nu mber)

Aeroplane performance calculation section

Situational awareness section

COMPACTED SNOW

DRY

DRY SNOW

DRY SNOW ON TOP OF C OMPACTED SNOW

DRY SNOW ON TOP OF I CE

FROST

ICE

SLUSH

STANDING WATER

WATER ON TOP OF COMPACTED SNOW

WET

WET ICE

WET SNOW

WET SNOW ON TO P OF COMPACTED SNOW

WET SNOW ON TO P OF ICE

T) )

/ /

Item “T” Highlighted

38 Appendix A — Aerodrome Operators

control (ATC). The data can be considered provided there is

appropriate access to the information in a timely manner and

that the information is accurate enough. Communication

between actors should be clearly dened to ensure the role

of each stakeholder in the process is clearly understood.

What

Wind sensors consist of multi-directional anemometers meas-

uring the direction of the wind and its speed. Their location

may inuence their measurements, and that should be tak-

en into consideration when they are positioned. Windsocks

should follow equivalent requirements with the objective to

give information directly to pilots.

Why

Provision of accurate wind data is important for both landings

and takeos. Tail winds and crosswinds have contributed to

numerous runway excursions and accidents.

Figure 2. Example automatic braking action data collection and transmission process

Medium to poor

ACARS message automatically

sent to NAVBLUE

Runway condition information

Pilots

Airports

operators

Airline

operations

center

Air trac controller

Incoming aircraft

Courtesy of NAVBLUE – RunwaySense/

Figure 3. Example of braking action data monitoring

TOULOUSE BLAGNAC

14L/32R

EVOLUTION

14L/32R

14R/32L

LANDINGS

Medium to poor

2 minutes ago

Medium to poor

runway average

Medium to poor

Medium

14L

0 250 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000

Medium to poor Medium

ENTER RUNWAY CLEANING

32R

AIB1983

A321 | 11:27

AIB9925

A320 | 11:18

AIB1903

A320 | 11:08

AIB1582

A320 | 11:03

AIB4585

A320 | 10:56

Courtesy of NAVBLUE – RunwaySense

Recommendation ADR8: In accordance

with ICAO standards (and regional, e.g. EASA

regulations), wind sensors and wind direction

indicators (wind socks) should be sited to give

the best practical indication of conditions

along the runway and touchdown zones.

Global Action Plan for the Prevention of Runway Excursions 39

How

In order to ensure appropriate indication of winds, imple-

mentation of the equipment should take into consideration

the following ICAO references:

■

ICAO Manual 8896: Manual of Aeronautical Meteorological

Practice; and,

■

ICAO Annex 3: Meteorological Service for International

Air Navigation.

An aeronautical meteorologist should lead related imple-

mentations in coordination with the aerodrome operator

and the ANSP.

What

ATIS may still be prepared manually in some large aero-

dromes. ATIS should be prepared and published automat-

ically on the basis of a computerized program scheduled at

a known frequency rate.

Why

Having automatic D-ATIS (digital ATIS) ensures that:

■

Pilots will receive the information in the same format every

time, as digital ATIS reports are standardized;

■

There will be a greater frequency of publication to ensure

up-to-date information to pilots;

■

The ATC workload will be reduced; and,

■

The report has an increased range and can be consulted

long before getting close to the airport.

How

The aerodrome operator or ANSP (whoever is in charge of

this type of equipment) should consider equipping the aer-

odrome with data link systems that allow ight crews to ob-

tain the latest weather without one pilot leaving the active

frequency (e.g., D-ATIS using an Aircraft Communications,

Addressing and Reporting System (ACARS)). ATIS shall be

issued at least every 30 minutes.

What

When it is required to switch on the runway edge lights,

during the night or in reduced visibility conditions, runway

centreline lights should also be switched on, even though the

visibility conditions do not necessarily call for the centreline

lights to be on. Of course, this applies to aerodromes already

equipped with centreline lights.

Why

It improves the awareness of the pilot as to where he/she

is positioned relative to the centreline of the runway when

visibility is reduced but still above CAT II minima or at night. It

gives additional information about aircraft not lined up with

the runway and hence reduces the risk of lateral excursion.

How

Two approaches can be followed:

■

When the aerodrome lighting system is being designed,

updated or recongured, it is possible to couple the

centreline lights with the edge lights to make sure they

can only be switched together.

■

For airports not equipped with a coupled system, where

groups of lights can only be switched separately, opera-

tional procedures should be in place for ATC so that edge

lights are not illuminated without the centreline lights.

Note: Whatever the approach used, associated technical re-

quirements such as the switch-over times must be according to

the more restrictive centreline lights.

What

Meteorological data such as wind or visibility data may some-

times dier from what the pilots observe. When such dierenc-

es are abnormally frequent, appropriate coordination involving

the meteorological services oce, the ANSP and the aero-

drome operator should be in place to ensure discrepancies

are analysed for possible recommendations to be established.

Why

The objective is to ensure that the data transmitted to the

pilots describe appropriately the conditions they will en-

counter when taking o or landing. As such, takeos and

landings do not present hazards generated by the possible

diverging information.

Recommendation ADR9: Consider equip-

ping for digital transmission of ATIS as ap-

propriate to ensure that ATIS information is

updated in a timely manner.

Recommendation ADR10: If installed, run-

way centreline lights should also be used to-

gether with the runway edge lights whenever

runway edge lights are switched on and when

the runway is in use.

Recommendation ADR11: Ensure appro-

priate coordination with the meteorological

service provider, the ANSP and the aircraft

operators to regularly assess the relevancy of

weather data, in particular at large aerodromes

where there could be spatial dierences in

weather data.

40 Appendix A — Aerodrome Operators

How

It is essential to encourage pilots and ANSPs to report any

gap observed by pilots between actual conditions and trans

mitted conditions.

The transmission of these operational feedbacks to the mete-

orological oce can be formalized in an appropriate protocol

in coordination with the ANSP.

Recommendations could include actions such as the rede-

ployment of a directional anemometer.

What

Taxiways connected to the runway should be named in a

logical order represented by successive letters or successive

numbers (associated with the same letter) so that the latest

number or letter matches the end of the runway.

Why

Providing a logical sequence of taxiway intersections assists

pilots in determining their position on the runway and identi-

fying the correct entry/exit point. This may support both the

correct identication of the start of roll and the approximate

estimation of the runway length left.

How

The sequencing of the taxiways should appear in the name of

these taxiways along the runway in a clear and unambiguous

logical order of succession.

Example: Z5-Z6-Z7-Z8 representing the four exits of the

runway from the rst to the last, Z8 is at the runway end. Z1 to

Z3 are only used for line-ups (Figure 4).

Refer to “from the brieng room” document: A case study

established for Paris-CDG airport:

https://www.skybrary.aero/bookshelf/books/3088.pdf

What

When designing or modifying RESA and/or strips at an airport,

it is important to take into consideration runway surround-

ings, including the area beyond graded strips.

Why

Runway surroundings can mitigate the consequences of an

excursion if they are properly taken into consideration in the

design process.

How

Local ground consideration

Unmodied grounds should be taken into consideration

when designing runway surroundings beyond the graded

runway strip so as to mitigate the eects of a runway excur-

sion. A safety assessment should be done to reach the best

scenario development for the strips and RESAs as regard

safety objectives.

Aircraft arresting system

The assessment of the implementation of an aircraft arresting

system (AAS), in accordance with the most recent ICAO deter

minations on AAS implementation, can be initiated as it could

prove to be an appropriate solution where RESA distances

are not enough to reach safety objectives. A detailed set of

mitigation measures to runway excursion risks (operational,

physicals) can be found in the ICAO PANS-ADR Appendix to

Chapter 4: Physical characteristics of aerodromes.

Recommendation ADR12: Ensure runway

exits are appropriately named according to

a logic of succession of numbers and letters

avoiding possible ambiguity.

Figure 4. Extract of Paris-CDG AD 2 LFPG ADC 02 (aeronautical information)

27R

06L

K8K7

K3K2K1

CCC

Recommendation ADR13: Runway sur-

roundings should be considered when design-

ing or modifying strips or runway end safety

areas (RESAs). It is necessary to consider the

local constraints against ICAO provisions and

regional (e.g., EASA) regulations so as to en-

sure relevant mitigation.

Global Action Plan for the Prevention of Runway Excursions 41

Communication and publications

Auxiliary sources of aeronautical information available to

pilots highlighting specic hazards not necessarily men-

tioned in the AIP can be developed locally by an aerodrome

in coordination with ANSPs, and local operators. They cannot

and should not replace the regulated reference aeronautical

information (AIP, AIC, NOTAMS, etc.).

The “CASH” solution in France is an example. Developed by the

French civil aviation authority, CASH (Collaborative Aerodrome

Safety Highlights) is a collective safety initiative, which aims to

draw the attention of commercial and general aviation pilots to

the aeronautical context and the main threats associated with

an aerodrome. The identication of these threats is the result

of collaborative work between platform operators (air opera-

tors, aerodrome operator, ANSP, ying clubs, meteorological

services, etc.) obtained by comparing the elements of their

safety management systems (SMS). The members of the local

safety team of each platform validate this information and it

is published on Internet, accessible to all users of the platform.

More information can be found at:

https://www.ecologie.gouv.fr/en/

collaborative-aerodrome-safety-highlights-eng

Other examples of this kind of initiative in Europe include:

■

The familiarization manual for air operators at the

Andorra-La Seu d’Urgell Airport. It includes relevant and

detailed information about airport procedures, aerodrome

ight information service, special orography and distur-

bances in the vicinity. It involves a detailed study of par-

ticular factors that may aect the operation.

■

At Gstaad Airport (LSGK), pilots wishing to y in must be

familiar with the various peculiarities associated with air

trac operations into and out of LSGK, including the rela-

tively short landing runway with nearby obstacles around

and along its axes and the non-standard trac pattern

with regular glider activity.

More information can be found at:

https://www.gstaad-airport.ch/wpcontent/up-

loads/2020/07/200101_pilots_brieng_v10.pdf

What

The decision-making processes involving the aerodrome

operator and the ANSPs regarding the occupancy of the

runways and any other factors possibly aecting the arrival

sequence, should be assessed and optimized to reduce the

impact of such decisions on approach path management and

any last-minute alterations of the approach path.

Why

Aircraft energy management during the approach in reaction

to last-minute changes, short windows, etc. can drastically

aect the speed, braking and control of the aircraft during

landings.

How

Runway interventions such as runway inspection, snow

removal, intertwined departures and arrivals on the same

runway or interdependent runways should be addressed,

and their impact assessed, in coordination with ANSPs and

the major based airlines.

A dedicated collaborative decision-making cell (CDM) can be

developed; it would include the major stakeholders stated

above. When degrading conditions are expected (weather,

abnormal trac, etc.), the CDM could be summoned. The

stakeholders would then assess data and implement in real

time the appropriate course of action collaboratively to en-

sure the impact on the arrival sequence is kept to a minimum.

More information regarding the establishment of a CDM can

be found in the following:

https://www.eurocontrol.int/concept/

airport-collaborative-decision-making

Recommendation ADR14: Information re-

lated to air operations hazards or specicities

in the airport vicinity should be identied and

addressed to pilots in the local runway safety

team (LRST) and published through an appro-

priate means.

Recommendation ADR16: Consider using

approach path management in coordination

with local ATC and aircraft operators. Associ-

ated issues should be addressed by the LRST.

Left intentionally blank

Global Action Plan for the Prevention of Runway Excursions 43

APPENDIX B

GUIDANCE AND EXPLANATORY MATERIAL

FOR AIR NAVIGATION SERVICE PROVIDERS

Preface 44

Stabilised approach and correct departure performance calculation and aircraft set up 45

Learning from data analysis and safety information exchange 49

Provision of safety critical information to ight crew 51

Correct alignment on the runway 57

44 Appendix B — Air Navigation Service Providers

Preface

Recognising that aircraft operators are the subject of most

of the safety recommendations included in the current edi-

tion of the Action Plan, it is also important to realise that air

navigation service providers (ANSPs) have a role to play and

should contribute to runway excursion risk reduction.

Air trac controllers (ATCOs) routinely contribute to the

prevention of runway excursions by helping ight crews y

stabilised approaches by adhering to procedures and, for

instance, avoiding short-cuts that prevent ight crews from

losing necessary altitude and speed during the approach.

Moreover, through the provision of safety-signicant, es-

sential information about changes to surface wind, reduced

runway lengths and runway surface conditions, ATCOs and

aerodrome ight information service ocers (AFISOs) ensure

that ight crews have the latest aerodrome information avail-

able to enable safe takeos and landings.

However, breakdowns in these ATC/FIS functions can have

undesired outcomes. For instance, sub-optimal control tech-

niques, such as late descent and inappropriate speed control,

can contribute to aircraft ying unstabilised approaches with

an increased risk of runway excursion. In addition, interrup-

tions, omissions or errors in the ow of essential information

may deprive ight crews of operational safety decision-

making information at critical stages of ight.

The following guidance material is intended to explain the ra-

tionale behind the relevant recommendations of the GAPPRE

and to provide guidance on their practical implementation.

The guidance material refers to relevant International Civil

Aviation Organization (ICAO) standards and recommend-

ed practices (SARPs), meant to be transposed in national/

regional regulations. In some instances, ‘case study examples’

are provided to amplify and provide additional reference to

the issue being considered.

ANSPs, AFIS providers and ATCO/AFISO training organisations

are invited to review the guidance material and, where ap-

propriate, amend their training programmes and operating

procedures and/or practices, as well as related information

processing and dissemination tools.

Global Action Plan for the Prevention of Runway Excursions 45

Stabilised approach and correct departure performance calculation and aircraft set up

Why should ANSPs follow the recommendations?

It’s well accepted throughout the aviation industry that a

prerequisite for a safe landing is a stabilised approach. Re-

gional and national regulations, as well as ICAO Procedures

for Air Navigation Services – Aircraft Operations (PANS OPS,

Doc 8168) or International Air Transport Association (IATA)

Operational Safety Audit (IOSA) standards clearly demand

stable approach policies and reect the criteria for a stable

approach concept as sparked by the Flight Safety Foundation

Approach and Landing Accident–Reduction (ALAR) Tool Kit

more than 20 years ago.

Approach path management is a collaborative task shared

by ight crews and ATCOs/AFISOs. It includes aircraft tra-

jectory and energy management. Although pilots play the

major role and have the overall responsibility for it, air trac

services (ATS) can aect both elements by timely provision

of information to ight crews that will help them anticipate

the approach path to be own, speed restriction, vectoring

(including short cuts) and altitude clearances. Thus, ATCO/

AFISO can contribute in a positive (uneventful approach and

landing) or negative way (unstabilised approach that may

be followed by a go-around or, in the worst case, a runway

excursion) to the execution of this critical phase of ight.

Investigations of numerous incidents and accidents have

led to the conclusion that mismatch of actual runway con-

ditions and pilots’ aircraft performance calculations and air-

craft set-up for departure could inuence the risk of runway

excursions. ATS pressure on ight crew and late runway

changes can be a contributing factor.

What can ANSPs do to implement the recommendations?

ATCO/AFISO should be aware of the following elements of

a stabilised approach indicating an aircraft is on the correct

ight path:

■

Instrument landing system (ILS) approach — ILS within

1 dot of the localiser and glide slope on primary ight

display/navigation display;

■

Visual approach — wings level at 500 feet above ground

level (AGL);

■

Circling approach — wings level at 300 feet AGL;

■

Only small heading and pitch changes required;

■

Speed within +20/-0 knots of reference speed;

■

Aircraft must be in proper landing conguration;

■

Maximum sink rate of 1,000 feet per minute; and,

■

In instrument meteorological conditions — stable by 1,000

feet AGL; in visual meteorological conditions — stable by

500 feet AGL.

ATC procedures and techniques should take into account

the following:

Vectoring versus published arrival procedures. Routine

vectoring of aircraft o a published arrival procedure to shorten

the ight path should be avoided. Unexpected shortcuts may

Recommendation ANSP1: Ensure the importance of a stabilised approach, its elements, compliance

with nal approach procedures and aircraft energy management are included in initial and refresher

training of ATCOs conducted by ANSPs and ATCO training organisations, as well as in AFISOs training,

as applicable.

Recommendation ANSP2: With regard to assignment of or change to runway assignment for ar-

riving or departing aircraft:

ANSP2 a: Whenever the runway change is pre-planned, notify it to the ight crews as early as prac-

ticable, together with the expected time of the change, including by adding relevant information in

automatic terminal information service (ATIS) broadcasts, where available.

ANSP2 b: As far as practicable, avoid changing the assigned runway to aircraft on approach or taxiing

for departure.

ANSP2 c: Ensure ATCOs are aware that runway changes create additional workload, increase vulner-

ability to error, and that ight crews need time to re-brief and prepare for them.

ANSP2 d: Ensure that the runway conguration change procedure/process takes account of the

above points and of the tailwind information, as appropriate.

ANSP2 e: When operationally possible, accept the ight crew’s preference for a runway when re-

quested due to performance limitations.

46 Appendix B — Air Navigation Service Providers

lead to insucient time and distance remaining to maintain

the desired descent prole and may result in the aircraft being

high on the approach. Close-in turns to nal, including visual

approach positioning, which does not permit the ight crew

to execute a stabilised approach, should be avoided.

Speed control instruction. Inappropriate speed control

instructions that are incompatible with aircraft performance

should be avoided. When assigning a speed restriction,

the ATCO should take into account the distance to go, the

required vertical prole below Flight Level (FL) 100 and any

signicant head wind or tail wind components at altitude.

The objective is to allow the pilot to manage the energy

state of their aircraft in a way that will ensure a stabilised

approach. Assigning speed control close-in to the runway

may lead to unstable approaches. ANSPs, when developing

stabilised approach training, should consider the need to

include specic training on aircraft energy management and

its limits. Involvement of aircraft operators in the design and

delivery of the training will enhance ATCO knowledge of the

impact of speed restrictions and energy management on the

overall approach path management by ight crew and ATC.

Distance to go information. When providing vectors, it

is necessary to initially advise (and where appropriate,

periodically provide) ight crews with estimated track miles

to go. In terminal manoeuvring areas/control zones (TMAs/

CTRs) where a ‘standard’ vectoring pattern for nal approach

is used and this is well known to ight crews, provision of

estimated track miles to go may be limited to non-standard

situations, short cuts and ights by aircraft operators that

do not operate regularly to that aerodrome. Misinformation

on track miles prevents crews from managing their descent

eectively, and where the actual track miles are less than

advised, this can lead eventually to circumstances conducive

to an unstabilised approach.

Descent instructions. Delaying descent and keeping aircraft

unduly high may result in ight crews requesting additional

track miles, which may interfere with the planned sequence

of landing and departing aircraft and/or contribute to high-

energy unstabilised approaches.

Flight crew brieng. ATCOs and AFISOs should understand

the importance of the ight crew approach brief. This has a

single common objective — to preview what will or might

happen during an imminent approach and landing. There is

no such thing as a typical brieng, but the time to complete

the majority of them might be within the range of two to six

minutes, and it can be expected to be conducted 10 minutes

before reaching the top-of descent point. Any approach re-

brieng that might have to be conducted later would be at

risk of being interrupted by either ATC communications and/

or aircraft management priorities.

Approach type change. A change of instrument approach

without adequate prior notication is undesirable at any

time after an aircraft has left the higher of cruise altitude or

(typically) FL100 in descent to destination. A ‘late’ change from

a precision to a non-precision approach can be signicant and

may not always be feasible unless additional track miles are

provided.

Runway change. Last minute runway changes, even to a

parallel runway, should be avoided. To comply with the

company’s operating procedures and requirements, the

ight crew must have time to properly brief the approach

and missed approach procedure to the runway to be used.

Even though a pilot may accept a runway change, the result

may be an unstable approach.

Runway selection. Runway selection for operations should be

based on safety considerations (e.g., best length and/or wind

conditions) and not primarily on capacity, ATC convenience

or environmental/noise abatement reasons. However, it is

recognised that at some locations for a variety of reasons, the

latter factors do inuence the selection of the runway in use.

In these circumstances, it is incumbent on ATC to monitor the

situation carefully and advise ight crews, for instance, about

tail winds. There is a balance to be struck, but when in doubt,

safety considerations must assume primacy.

Controllers should accommodate crew requests for runways

most aligned with the wind. When changing the runway con-

guration due to wind, ATCO should follow a dened proce-

dure, articulate the last aircraft to land on the current runway

and rst aircraft to land on the ‘new’ runway. The procedure

should be implemented promptly. When AFIS is provided at

an aerodrome, the AFISO should timely communicate to the

ight crew the runway being used at the aerodrome.

Compliance with nal approach procedures. It includes but

is not restricted to the following:

■

According to ICAO Doc 4444, PANS ATM (PANS – Air Traf-

c Management)§ 4.6.3.6, ‘Only minor speed adjustments

not exceeding plus/minus 40 km/h (20 kt) IAS [indicated air-

speed] should be used for aircraft on intermediate and nal

approach.’

■

According to ICAO Doc 4444, PANS ATM § 4.6.3.7, ‘Speed

control should not be applied to aircraft after passing a point

7 km (4 nm) from the threshold on nal approach.’

■

According to ICAO Doc 4444, PANS ATM § 8.9.3.6, ‘Aircraft

vectored for nal approach should be given a heading or a

series of headings calculated to close with the nal approach

track. The nal approach vector should enable the aircraft to

be established in level ight on the nal approach track prior

to intercepting the specied or nominal glide path if an MLS

[microwave landing system], ILS or radar approach is to be

made, and should provide an intercept angle with the nal

approach track of 45 degrees or less.’

■

NOTE: The ight crew has a requirement to y a stabilised

approach (airspeed and conguration) typically by 5 km (3

nm) from the threshold (Doc 8168, PANS-OPS, Volume I, Part

III, Section 4, Chapter 3, 3.3 refers).

Global Action Plan for the Prevention of Runway Excursions 47

■

According to ICAO Doc 4444, PANS ATM in 6.7.3.2, Re-

quirements and procedures for independent parallel ap-

proaches § 6.7.3.2.3, ‘When vectoring to intercept the ILS

localizer course or MLS nal approach track, the nal vector

shall enable the aircraft to intercept the ILS localizer course

or MLS nal approach track at an angle not greater than 30

degrees and to provide at least 2 km (1.0 nm) straight and

level ight prior to ILS localizer course or MLS nal approach

track intercept. The vector shall also enable the aircraft to be

established on the ILS localizer course or MLS nal approach

track in level ight for at least 3.7 km (2.0 nm) prior to inter-

cepting the ILS glide path or specied MLS elevation angle.’

ILS-sensitive area during CAT II/III training approaches when

LVO [low visibility operations] are not in force. Some aircraft

operators conduct ILS CAT II/III approaches during non-LVO

for training purposes. The presence of vehicles or aircraft in the

ILS sensitive area can cause undesirable autopilot behaviour

at low altitude. In addition, these operations may compromise

the regular ow of trac/sequencing. Permission to conduct

a training ight (e.g., CAT II/III training approach) in good

weather may be requested by the aircraft operator/ight crew

as advised in the aeronautical information publication (AIP).

If required to protect an ILS-sensitive area, ATC may reject

such a request or interrupt the current procedure according

to the trac situation at the time.

ANSP radar display marker. In some ATC facilities, controllers

are provided with a ‘Screen Interception Marker’. The marker

arrow is displayed on the radar approach screen to support

the interception of the nal approach track. The marker is

located in accordance with ICAO PANS ATM (so as to provide

30 seconds of straight and level ight at 180 kts). Operational

procedures specify that it should be considered as the nal

point for the ATCO to provide a straight and level ight

(Figure 5).

To complement the stabilised approach awareness train-

ing for controllers, many ANSPs utilise their routine brieng

facilities (e.g., operational information folders) to highlight

runway excursion prevention issues (including stabilised ap-

proaches) to controllers on a periodic basis. Further to that:

■

Immediate post-runway-excursion incident/accident

awareness can be provided by means of a written or oral

brieng by supervisors/watch managers as part of watch

handover/takeover.

■

Information gathered in the context of recommendations

ANSP3 and ANSP6 can also be analysed and the outcomes

(e.g., lessons learnt, operational changes, etc.) notied to

ATS sta through the routine brieng processes.

■

ATCOs/AFISOs should be aware of the ight crew task de-

mand and workload during the approach phase of ight.

To this end, familiarisation ights and/or ight simulator

sessions for ATS sta should be considered.

Important note. Recommendations ANSP1 and ANSP2

(and the guidance material provided above) are closely

linked to the following three (3) recommendations for

aircraft operators. ANSPs should also review the relevant

guidance material provided in Appendix C, which contains

additional information and guidance that can help achieve

the objectives of recommendations ANSP1 and ANPS2.

Recommendation OPS6. Aircraft operators should

implement policies for ight crews not to accept ATC

procedures and clearances which have the potential

to decrease safety margins to an unacceptable level

for the ight crew, thereby increasing the risk of run-

way excursions. This includes such procedures and

clearances, which increase the likelihood of having

an unsafe approach path management with conse-

quences for safe landing, e.g. which bear the risk of

being unstabilised at the landing gate or high- energy

approaches.

These policies should be further supplemented by

the implementation of eective SOPs and ight crew

training.

Flight crews should be required to report such risks

within their operator’s safety management system

(SMS), and the aircraft operator should further re

port such risks to the ANSPs via established reporting

systems.

Recommendation OPS8. Aircraft operators should

implement SOPs or policies for ight crews not to

conduct takeo or approach following any runway

change until the appropriate set-up, planning, per-

formance calculations (for multi-pilot operations, this

includes independent calculations and cross-checks

by at least two pilots) and re-briengs are completed.

When a takeo runway change is received whilst tax-

iing, the above should be performed by ight crew

without rushing and when the aircraft is stationary.

Figure 5. Example the ‘Screen Interception Marker’

arrow (in the red circle)

48 Appendix B — Air Navigation Service Providers

Runway-excursion related threat and error man-

agement (TEM) should be addressed in the brieng

every time a runway change is expected, probable

or actually occurs.

Recommendation OPS9. Aircraft operators should

implement policies or SOPs for ight crews to request

a more favourable runway for takeo or landing for

any reason which may aect the safety of the ight

and to advise the safety reasons to ATC.

Further guidance/advice in support of the recommendations

ANSP1 and ANSP2, and the points addressed in this section

1 of Appendix B, can be found in the reference materials

listed below.

Reference materials

ICAO Doc 4444 - PANS ATM.

European Commission Regulation No 923/2012 on Standard-

ised European Rules of the Air – SERA, and associated Accept-

able Means of Compliance and Guidance Material.

European Commission Regulation 2017/373 on ATM/ANS

Common Requirements and associated Acceptable Means of

Compliance and Guidance Material.

SKYbrary resources

Stabilised Approach Awareness Toolkit for ATC;

Flight Deck Procedures – A Guide for Controllers;

Top 10 Stabilised Approach Considerations for Air Trac

Controllers; and,

Runway Excursion Portal.

CANSO,

Runway Excursions – An ATC Perspective on unstable

approaches.

Avoiding unstable approaches – Important Tips for ATCOs.

DGAC, France: Three (3) documents (accessible on

SKYbrary):

Unstabilised Approaches;

Synthesis on Unstabilised Approaches; and,

Stabilised Approaches Good Practice Guide.

Flight Safety Foundation (FSF) ALAR Toolkit, brieng notes:

4.1, 4.2, 7.1 and 8.1.

FSF, Runway Excursion Risk Awareness Tool, May 2009.

IATA, Runway Excursion Risk Reduction Toolkit.

EUROCONTROL HindSight 12 and HindSight 19 magazines.

International Federation of Air Line Pilots’ Associations

(IFALPA) Position Paper: IFALPA Runway Safety Policy – Ref

09POS01.

Global Action Plan for the Prevention of Runway Excursions 49

Learning from data analysis and safety information exchange

Why should ANSP follow the recommendations?

Accidents and incidents in the aviation industry are rare

events and in order to achieve the desired further improve-

ment in safety, it is necessary to learn from normal operations

(e.g., from go-around and missed approach events). Moreo-

ver, even a large ANSP may not have sucient information to

make reliable conclusions from the investigation of reported

safety occurrences. Therefore, it is important to analyse the

available data from normal operations, which can reveal po-

tential systemic contributors to runway excursions, such as

airspace design and procedures (e.g., controlled airspace/

sector boundaries, standard instrument arrival procedures

(STARs), nal approach procedures). In addition, it may be

helpful for the ANSP to pool knowledge of the runway ex-

cursion risk and identify risk reduction measures based on

other ANSPs’ experience and lessons learnt.

In most runway excursion related events, ANSPs do not have

the full picture. Therefore, it is necessary to cooperate with

aircraft and aerodrome operators in order to identify all rel-

evant causal and contributory factors and design successful

risk mitigation strategies. This approach provides huge safety

and economic benets, not only for ANSPs, but also for the

entire industry. It allows stakeholders that contribute to run-

way risk to learn from each other, understand the dierent

perspectives of runway safety events and create a shared

mental picture of the threats and hazards that pilots and air

trac controllers have to cope with in daily operation.

What can ANSP do to implement the

recommendation?

Sector interfaces and the ability to control the speed and

descent proles should be taken into consideration while

trying to remove or minimise airspace design contribution

to excursion risk. ANSPs should consider utilising reported

data from aircraft operators about unstabilised approaches

in order to consider systemic changes to sector management

(e.g., handover and ow rates), airspace design and associ-

ated procedures and runway conguration management

to reduce the runway excursion risk. This pre-supposes that

aircraft operators are willing to provide this information to

ANSPs in the rst instance. Cooperation through local runway

safety teams (LRSTs) may assist in this regard and ANSPs can

address the issue within the wider context of their SMS.

Some runway excursions can be prevented by ight crews

executing a go-around when needed. Safe and timely go-

arounds are dependent on two main factors: ight crew

decision-making and execution. However, ATC actions can

also inuence both of these processes, for instance, when

initiating the execution of a go-around, ATCOs should use the

standard PANS ATM (12.3.4.18) phraseology, ‘GO-AROUND’

(ight crew response ‘GOING AROUND’), and in European

airspace, applicable Standardised European Rules of the Air

(SERA) phraseologies, rather than alternatives such as ‘break-

o the approach’ or ‘execute missed approach,’ which may

lead to misunderstanding.

Some ANSPs record and then analyse go-arounds/missed

approaches; any ATS contribution to unstabilised approaches

may be identied qduring this process. Event replays that

include surveillance information and audio recordings are

another useful source of information to help ATCOs learn

lessons from reported events.

Exchanging runway safety information provides signicant

safety benets to all stakeholders. It allows ANSPs to learn not

only from their own experiences but also from the experienc-

es of others. Having direct contact with other stakeholders

allows ANSPs to get rst-hand information. It also provides

an opportunity to ask specic questions and communicate

on specic issues related to runway excursions without losing

precious time.

ANSPs can participate in safety information sharing in several

ways as part of ongoing SMS activities, such as:

■

Set up safety information exchange with other ANSPs;

Recommendation ANSP3: ANSPs should:

ANSP3 a:. Review available data (e.g., occurrence reports, go-around/missed approach data) with the

aim of identifying the ANSP-related runway excursion contributing factors and relevant mitigations;

for example, enhanced airspace design and procedures and ATCO/AFISO training and procedures.

ANSP3 b: Share at network level the identied runway excursion contributing factors and relevant

mitigations.

Recommendation ANSP6: Participate in runway excursion safety information-sharing at network

level to facilitate using just culture principles and the free exchange of relevant information on actual

and potential safety deciencies.

50 Appendix B — Air Navigation Service Providers

■

Set up safety information exchange agreements with air-

craft operators or other stakeholder groups;

■

facilities, such as SKYbrary (www.skybrary.aero);

■

Join one of the existing safety information exchange

networks, such as EVAIR (EUROCONTROL Voluntary ATM

Incident Reporting); IATA STEADES; Flight Safety Foun-

dation; and,

■

By being an active member of LRSTs.

Important note: Recommendations ANSP3 and ANSP6 (and the

guidance notes provided above) are closely linked to the following

recommendation for aircraft operators. ANSPs should also review

the relevant guidance material provided in Appendix C, which

contains additional information and guidance that can help

achieve the objectives of Recommendations ANSP3 and ANSP6.

Recommendation OPS1. Aircraft operators should

participate in safety information sharing networks

with all relevant stakeholders. This should facilitate

the free exchange of relevant runway safety infor-

mation including identied risks, safety trends and

good practices.

Reference materials

European Commission Regulation No 923/2012 on Standard-

ised European Rules of the Air – SERA, and associated Accept-

able Means of Compliance and Guidance Material.

European Commission Regulation 2017/373 on ATM/ANS

Common Requirements and associated Acceptable Means of

Compliance and Guidance Material.

ICAO Doc 9981 Procedures for Air Navigation Services

– Aerodromes.

Global Action Plan for the Prevention of Runway Excursions 51

Provision of safety critical information to ight crew

Why should ANSPs follow the recommendations?

For the safe execution of approach, landing and takeo,

a ight crew relies largely on the information supplied by

ATS. Provision of timely, accurate and up-to-date informa-

tion about the aerodrome weather, wind, runway surface

conditions and declared distances (e.g., TORA and LDA) will

enable ight crew to assess correctly the situation and take

safe decisions for takeo, approach and landing or diversion

to an alternate aerodrome.

Use of automated information transmission tools (e.g., ATIS,

D-ATIS) increases the reliability of the information delivery

process and contributes to reduced likelihood of ight crew

distraction during the most critical phases of ight – approach

and landing and takeo.

What can ANSPs do to implement the

recommendations?

Essential information is provided through three main types of

media: (AIPs, NOTAMs); ATIS/D-ATIS; and radio telephony. In

certain circumstances, aerodrome signage can supplement

the written and/or oral data.

ICAO Doc 4444, PANS ATM provisions on the

provision of essential information:

7.5.2 Essential information on aerodrome conditions shall

include information relating to the following:

a) construction or maintenance work on, or immedi-

ately adjacent to the movement area;

b) rough or broken surfaces on a runway, a taxiway

or an apron, whether marked or not;

snow, slush or ice on a runway, a taxiway or an

apron;

d) water on a runway, a taxiway or an apron;

e) snow banks or drifts adjacent to a runway, a taxi-

way or an apron;

other temporary hazards, including parked aircraft

and birds on the ground or in the air;

failure or irregular operation of part or all of the

aerodrome lighting system;

h) any other pertinent information.

7.5.3 Essential information on aerodrome conditions shall

be given to every aircraft, except when it is known

Recommendation ANSP4: Review processes covering the provision of essential information on

aerodrome conditions such as weather, wind and runway surface conditions (e.g., when ‘wet’ or con-

taminated) to ensure:

ANSP4 a: A consistent, timely and accurate broadcast of aerodrome information.

ANSP4 b: The integrity of the essential information supply chain from the originator (e.g., Met Oce/

aerodrome operator) to the user (e.g., ight crews, ATS, Met Oce, aerodrome operator and aeronau-

tical information service (AIS) provider).

ANSP4 c: Training on the use of ATIS/D-ATIS is provided to relevant operational sta.

ANSP4 d: Compliance with the ICAO Global Runway Format for runway surface conditions assessment

and reporting, including the training of the relevant ANSP personnel.

Recommendation ANSP5:

ANSP5 a: Ensure that ight crews are informed of the takeo run available (TORA) or the landing

distance available (LDA) if these dier from the published data using appropriate means. The infor-

mation should include any alternative runways, which may be available.

ANSP5 b: ATS providers should collaborate with aerodrome operators to determine the runway

entries from which intersection takeos may be performed, and develop coordinated procedures

for such operations.

Recommendation ANSP8: Consider equipping for digital transmission of ATIS, as appropriate (e.g.,

via telephone or other means).

52 Appendix B — Air Navigation Service Providers

that the aircraft already has received all of or part of

the information from other sources. The information

shall be given in sucient time for the aircraft to make

proper use of it, and the hazards shall be identied as

distinctly as possible.

Note: “Other sources” include NOTAM, ATIS broadcast,

and the display of suitable signals.

7.5.4 When a not previously notied condition pertaining

to the safe use by aircraft of the manoeuvring area

is reported to or observed by the controller, the ap-

propriate aerodrome authority shall be informed and

operations on that part of the manoeuvring area ter-

minated until otherwise advised by the appropriate

aerodrome authority.

It is incumbent on all personnel involved in the ow of “es-

sential” information to ensure not only the quality of the data

but also the integrity of the processes and procedures that

ensure its onward transmission to ATS.

Formal arrangements between data providers and ANSP/

aerodrome operators/AIS providers (e.g., in the form of a con-

tract or service level agreement [SLA]) should be introduced

to support and enable the relevant data exchange.

In turn, ATS working together with partners, should ensure

the timely provision and delivery of the information to ight

crews to assist in their operational decision-making.

The reception of ATIS via data link allows both pilots to listen

to ATS communications during critical high workload phases

of ight, thus increasing situational awareness and reducing

the likelihood of distraction-induced mistakes, lapses or con-

fusion. Furthermore, depending on the trac density and the

complexity of the approach, it may assist ight crews with the

go-around/landing decision-making process by providing the

latest changes to the runway condition and local weather,

which is subject to the equipment being set up to allow this

data to be send to the pilot automatically.

Annex 11, Air Trac Services, Chapter 4 (Flight Information

Services) states variously that ATIS/D-ATIS broadcasts shall

include:

■

signicant runway surface conditions (e.g. when the run-

way is ‘wet’ or the presence of other contaminants such

as snow, slush, ice, rubber, oil) and, surface wind direction

and speed, including signicant variations;

■

any available information on signicant meteorological

phenomena in the approach and climb-out areas includ-

ing wind shear, and information on recent weather of op-

erational signicance;

■

“other essential operational information”. Reduced run-

way lengths for landing and takeo fall into this category

of data.

In accordance with section 4.1.3 of Appendix 3 to ICAO Annex

3, the surface wind direction and speed is to be averaged

over two minutes for wind displays in ATS units. The wind

information is to refer to conditions along the runway for

departing aircraft and to conditions at the touchdown zone

for arriving aircraft. Specically, according to ICAO Annex 11,

Chapter 4, ATIS broadcasts shall include: ‘surface wind direc-

tion and speed, including signicant variations and, if surface

wind sensors related specically to the sections of runway(s) in

use are available and the information is required by operators,

the indication of the runway and the section of the runway to

which the information refers.’

To ensure that ATIS/D-ATIS provide operational and safety

benets, it is essential that the relevant operational AIS/ATC

sta is competent to use ATIS/D-ATIS equipment and under-

stand and apply the broad principles for the operation of

these systems as described in Annex 11, Chapter 4.

ATIS/D-ATIS Note: Depending on the organisational/

operational structure, ANSPs or AISPs may be responsible for

the provision of ATIS/D-ATIS.

Weather/wind data update. According to ICAO Doc 4444 –

PANS ATM, paragraph 6.6.4:

At the commencement of nal approach, the following infor-

mation shall be transmitted to aircraft:

Signicant changes in the mean surface wind direction

and speed;

Note. Signicant changes are specied in Annex 3,

Chapter 4. However, if the controller possesses wind

information in the form of components, the signicant

changes are:

• Mean headwind component: 19 km/h (10 kt);

• Mean tailwind component: 4 km/h (2 kt);and,

• Mean crosswind component: 9 km/h (5 kt).

the latest information, if any, on wind shear and/or

turbulence in the nal approach area; and,

c) The current visibility representative of the direction of

approach and landing or, when provided, the current

runway visual range value(s) and the trend.

Furthermore, ICAO Annex 3, § 4.1.5.2 states that wind gusts of

5 kts or more above the mean wind speed shall be reported

when noise abatement procedures are in force, otherwise

wind gusts of 10 kts or more above the mean wind speed

shall be reported. A wind below 1 kt will be considered as

‘calm’. This information is essential to pilots in their process

decision-making.

Example case study

https://www.skybrary.aero/index.php/

B773,_Auckland_Airport_New_Zealand,_2007

Global Action Plan for the Prevention of Runway Excursions 53

Runway surface condition assessment and reporting. The

ICAO methodology envisages:

■

Assessment by trained runway assessors (aerodrome oper-

ator’s personnel) and reporting — by means of a uniform

runway condition report (RCR) — of the runway surface

conditions, including contaminants, for each third of the

runway length. This includes contaminants categorisation

according to their eect on aircraft braking performance

and information coding in a runway condition assessment

matrix (RCAM).

■

RCAM use by aircraft manufacturers to determine the ap-

propriate performance data for specic runway surface

conditions and provision of approved data and guidance

material to aircraft operators for the safe operation of the

aircraft on dry, wet and contaminated runway surfaces.

■

Provision of the RCR information to the end users (by AIS)

in an improvedSNOWTAMform.

■

Provision of the RCR information to the ight crews by ATS

by means ofATIS, voice communication andCPDLC. The

information shall be presented according to the direction

of the aircraft movement, with the rst runway third being

the one nearest to the aircraft approaching to land.

■

Use of the reported runway condition data in conjunc-

tion with the performance data provided by the aircraft

manufacturer to determine — along with other informa-

tion such as, but not limited to,weatherconditions and

theweightof the aircraft — if landing or takeo operations

can be conducted safely.

■

Flight crews shall report the braking action experienced

when dierent from the expected one.

This solution shall be applied as of 5 November 2021. In the

EU, it is to be implemented as of 12 August 2021.

Runway surface condition reporting. The need to report and

promulgate runway surface conditions is specied in Annex

14, Volume I, 2.9.1, which stipulates that information on the

condition of the movement area and the operational status

of related facilities will be provided to the appropriate AIS

units, and similar information of operational signicance to

the ATS units, to enable those units to provide the necessary

information to arriving and departing aircraft.

Currently, the primary means of communication are ATIS and

ATC Radiotelephony, in addition to SNOWTAM.

In addition to normal operational and weather information in

the ATIS message, the following information about the run-

way condition should be mentioned whenever the runway

is not dry (Runway Condition Code [RWYCC] 6):

■

Operational runway in use at time of issuance;

■

RWYCC for the operational runway, for each runway third

in the operational direction;

■

Condition description, coverage and depth (for loose

contaminants);

■

Width of the operational runway to which the RWYCC

applies, if less than the published width;

■

Reduced length, if less than the published runway length;

■

Drifting snow;

■

Loose sand;

■

Operationally signicant snowbanks;

■

Runway exits, taxiways and apron if POOR; and,

■

Any other pertinent information in short, plain language.

One inherent weakness in the ATIS system is the currency of

the information. This is because ight crews generally listen

to ATIS on arrival, some 20 minutes before landing, and in

rapidly changing weather, the runway conditions may alter

dramatically in such a time span.

The aerodrome operator usually transmits information of

operational signicance relating to runway conditions to

ATC, and ATC, in turn, provides this information to the ight

crew if dierent from the ATIS. At present, this procedure

appears to be the only one that is able to provide timely

information to the ight crew, especially in rapidly changing

conditions.

According to the ICAO Doc 9981 PANS Aerodromes, Part II:

1.1.1.8 When the runway is wholly or partly contaminated by

standing water, snow, slush, ice or frost, or is wet asso-

ciated with the clearing or treatment of snow, slush,

ice or frost, the runway condition report should be

disseminated through the AIS and ATS services. When

the runway is wet, not associated with the presence of

standing water, snow, slush, ice or frost, the assessed

information should be disseminated using the runway

condition report through the ATS only.

1.1.3.19 Where available, the pilot reports of runway braking

action should be taken into consideration as part of

the ongoing monitoring process, using the following

principle:

• a pilot report of runway braking action is taken

into consideration for downgrading purposes;

and

•

a pilot report of runway braking action can be

used for upgrading purposes only if it is used in

combination with other information qualifying

for upgrading.

Note 1. The procedures for making special air- reports

regarding runway braking action are contained in the

Procedures for Air Navigation Services — Air Trac

Management (PANS-ATM, Doc 4444), Chapter 4, and

Appendix 1, Instructions for air- reporting by voice

communication.

1.1.3.20 Two consecutive pilot reports of runway braking action

of POOR shall trigger an assessment if an RWYCC of 2

or better has been reported.

54 Appendix B — Air Navigation Service Providers

1.1.3.21 When one pilot has reported a runway braking ac-

tion of LESS THAN POOR, the information shall be

disseminated, a new assessment shall be made and

the suspension of operations on that runway shall be

considered.

According to provision 6.6.1 of ICAO Doc 4444 – PANS ATM,

ATC shall transmit to an arriving aircraft current runway surface

conditions, in case of precipitants or other temporary hazards

as early as practicable after the aircraft has established com-

munication with the approach control unit, unless it is known

that the aircraft has already received this information. Further-

more, according to provision 6.6.5 of PANS ATM, signicant

changes in runway surface conditions shall be transmitted

without delay during nal approach.

According to provision 11.4.3.4.1 of PANS ATM, information

on aerodrome conditions shall be provided in a clear and

concise manner so as to facilitate appreciation by the pilot of

the situation described. It shall be issued whenever deemed

necessary by the ATCO/AFISO on duty in the interest of safety,

or when requested by an aircraft. If the information is provid-

ed on the initiative of the ATCO/AFISO, it shall be transmitted

to each aircraft concerned in sucient time to enable the

pilot to make proper use of the information.

Phraseology. The following phraseology provided in Doc

4444 PANS ATM shall be used for provision of aerodrome

information:

a) [(location)] RUNWAY (number) SURFACE CONDITION [CODE

(three-digit number)], followed as necessary by:

1) ISSUED AT (date and time UTC);

2) DRY, or WET ICE, or WATER ON TOP OF COMPACTED

SNOW, or DRY SNOW, or DRY SNOW ON TOP OF ICE, or

WET SNOW ON TOP OF ICE, or ICE, or SLUSH, or STAND-

ING WATER, or COMPACTED SNOW, or WET SNOW, or DRY

SNOW ON TOP OF COMPACTED SNOW, or WET SNOW ON

TOP OF COMPACTED SNOW, or WET, or SLIPPERY WET or

SPECIALLY PREPARED WINTER RUNWAY or FROST;

3) DEPTH ((depth of deposit) MILLIMETRES or NOT

REPORTED);

4) COVERAGE ((number) PER CENT or NOT REPORTED);

5) ESTIMATED SURFACE FRICTION (GOOD, or GOOD TO

MEDIUM, or MEDIUM, or MEDIUM TO POOR, or POOR, or

LESS THAN POOR);

6) AVAILABLE WIDTH (number) METRES;

7) LENGTH REDUCED TO (number) METRES;

8) DRIFTING SNOW;

9) LOOSE SAND;

10) CHEMICALLY TREATED;

11) SNOWBANK (number) METRES [LEFT, or RIGHT, or LEFT

AND RIGHT] [OF or FROM] CENTRELINE;

12) TAXIWAY (identication of taxiway) SNOWBANK (num-

ber) METRES [LEFT, or RIGHT, or LEFT AND RIGHT] [OF or

FROM] CENTRELINE;

13) ADJACENT SNOWBANKS;

14) TAXIWAY (identication of taxiway) POOR;

15) APRON (identication of apron) POOR;

16) Plain language remarks.

b) [(location)] RUNWAY SURFACE CONDITION RUNWAY (num-

ber) NOT CURRENT;

c) LANDING SURFACE (condition);

d) CAUTION CONSTRUCTION WORK (location);

e) CAUTION (specify reasons) RIGHT (or LEFT), (or BOTH SIDES)

OF RUNWAY [(number)];

f) CAUTION WORK IN PROGRESS (or OBSTRUCTION) (position

and any necessary advice);

g) BRAKING ACTION REPORTED BY (aircraft type) AT (time)

GOOD (or GOOD TO MEDIUM, or MEDIUM, or MEDIUM TO

POOR, or POOR);

h) TAXIWAY (identication of taxiway) WET [or STANDING

WATER, or SNOW REMOVED (length and width as applicable),

or CHEMICALLY TREATED, or COVERED WITH PATCHES OF DRY

SNOW (or WET SNOW, or COMPACTED SNOW, or SLUSH, or

FROZEN SLUSH, or ICE, or WET ICE, or ICE UNDERNEATH, or ICE

AND SNOW, or SNOWDRIFTS, or FROZEN RUTS AND RIDGES

or LOOSE SAND)];

i) TOWER OBSERVES (weather information);

j) PILOT REPORTS (weather information).

Note: The terms SLIPPERY WET and SPECIALLY PREPARED WIN-

TER RUNWAY are used in the EU.

Pilot report of runway braking action. The braking action

observed by the pilot depends on the type of aircraft, aircraft

weight, runway portion used for braking and other factors.

Pilots will use the terms GOOD, GOOD TO MEDIUM, MEDIUM,

MEDIUM TO POOR, POOR and LESS THAN POOR.

When receiving a routine pilot report of in-ight weather

conditions (AIREP), the ATCO/AFISO should consider that

these terms rarely apply to the full length of the runway and

are limited to the specic sections of the runway surface

in which sucient wheel braking is applied. Since AIREPs

are subjective and contaminated runways may aect the

performance of dierent aircraft types in dierent ways, the

reported braking action may not be directly transferable to

another aircraft.

If an ATS unit (e.g., ATC tower) receives an AIREP by voice

communications concerning braking action that is found

not to be as good as that reported, ATCO/AFISO shall forward

the AIREP without delay to the aerodrome operator. This is a

prerequisite for using the AIREP for downgrading purposes

when assessing the RWYCC.

Global Action Plan for the Prevention of Runway Excursions 55

ANSPs and aerodrome operators shall have coordinated (e.g.,

by means of an SLA) operating procedures for the distribution

of AIREPs to aerodrome operators.

Radio Telephony. Time-critical aerodrome information (such

as weather, surface conditions, wind, etc.) that may aect

runway operations shall be provided to pilots in ‘real time’

using radiotelephony communication.

Use of ‘non-essential’ information. ATCOs/AFISOs should

understand that some well-intentioned actions, clearances

and instructions, or information passed to ight crews to

improve the ow of air trac may not always have the

planned consequences. For instance, using phrases such as

‘landing long available’ might induce pilots to touchdown

further down the runway than they had originally intended/

calculated. Furthermore, depending on ight crew experience

and constraints, the surface conditions and the time/

position in the landing sequence where the manoeuvre is

executed, the use of ‘expedite vacate’ may trigger pilots to

travel too fast for the conditions and/or aerodrome layout.

Of course, in many situations, the use of these phrases may

be perfectly legitimate (and safe). Nevertheless, to lessen

the risk of runway excursion, controllers should use them

with care. The timing of the messages is a key consideration,

and they should be used only in circumstances that are

appropriate to the prevailing runway surface conditions and/

or aerodrome layout.

Declared distances. ICAO Annex 14, Aerodromes, §2.8

requires that distances shall be calculated to the nearest

metre or foot for a runway intended for use by international

commercial air transport. These ‘declared distances’ include:

takeo run available (TORA); takeo distance available

(TODA); accelerate-stop distance available (ASDA); and

landing distance available (LDA).

Note: Guidance on calculation of declared distances is given

in Attachment A, Section of ICAO Annex 14 and in local rules,

where available.

TORA and LDA for a particular runway may vary from those

published for a variety of reasons (e.g., construction work

or snow clearing operations, which may reduce the takeo

and landing distances available). This ‘essential information’

must be made available to ight crews via an appropriate

mechanism and format, in accordance with ICAO Annex 15,

Aeronautical Information Services, ICAO Doc 4444 PANS ATM

and ICAO Doc 10066 PANS AIM. In addition, the temporary

reduction of the ‘declared distances’ should be included in the

ATIS messages. Nonetheless, ATS may also consider it appro

priate to provide this information in ‘real-time,’ even when the

changes have been notied in aeronautical publications and/

or ATIS/D-ATIS. At aerodromes, where ATIS is not available,

ATS should proactively inform the ight crew by means of a

radiotelephony (R/T) exchange of the reduced takeo and

landing distances available.

Intersection departures. Flight crews may opt for, or ATS

may suggest, a departure from a runway intersection that

eectively reduces the runway length available for ight

operations. Intersection departures should be appropriate

to the aircraft type and take into account work in progress

and other relevant factors limiting operations.

ATS should provide alternative runway(s) to the assigned

intersection runway in case the ight crew report not able to

perform a takeo from the assigned intersection.

The ultimate decision regarding intersection departure

rests with the ight crew; however, ATC actions assist in the

decision-making process. To ensure that the intersection

TORA distances are known, ATS should inform pilots of the

takeo run available (in metres) from the runway intersection

position if this diers from the signage.

According to ICAO Doc 7030, European Regional Supplemen-

tary (EUR SUPPs) § 6.5.2.4, ‘Runway declared distances for an

intersection take-o position shall be published in the relevant

AIP, clearly distinguishable from full runway declared distances’.

Best practice exists concerning the associated phraseology

to be used by ATS, which is in line with the guidance in the

ICAO EUR SUPPs, namely:

■

‘TORA’ (to be pronounced as ‘TOR-AH’) replaces the words

‘TAKEOFF’ in the R/T message.

■

Thus, an example ATC R/T message to advise of the takeo

run available from an intersection will be: ‘Call sign, Tora

runway 09, from intersection alpha, 2800 metres’.

When an ANSP plans for intersection departure procedures,

the development of these procedures should be coordinat-

ed with the aerodrome operators. This is to ensure that the

procedures of both organisations do not contain inconsist-

encies or discrepancies and that they take into account op-

erational needs and limitations, especially with regard to

the interfaces of the two organisations, irrespective of how

they are organised internally. In the EU, from an ATM point

of view, this recommendation is based on the requirement

ATS.OR.110 contained in Reg. (EU) 2017/373 (as amended

by 2020/469). It says, ‘An air trac services provider shall

establish arrangements with the operator of the aerodrome

at which it provides air trac services to ensure adequate

coordination of activities and services provided as well as

exchange of relevant data and information’.

Example case study

https://www.skybrary.aero/index.php/

B772,_St_Kitts_West_Indies,_2009

To supplement the oral message, ICAO Annex 14, Aero-

dromes, recommends that an intersection takeo sign should

be provided when there is an operational need to indicate

the remaining TORA for an intersection takeo. In addition,

according to provision 5.4.3.29 of Annex 14, Volume I, ‘the

inscription on an intersection take-o sign shall consist of a nu-

merical message indicating the remaining take-o run available

56 Appendix B — Air Navigation Service Providers

in metres plus an arrow, appropriately located and oriented,

indicating the direction of take-o…’.

The GAPPRE recommendation ADR4 takes the above Annex

14 provision further by recommending provision of takeo

run available (TORA) signs at all runway holding positions

from which intersection takeos are conducted.

In the EU, the installation of an intersection takeo sign, indi-

cating the remaining takeo run available (TORA), is consid-

ered a prerequisite wherever intersection takeos are allowed

ANSPs should cooperate with aerodrome operators to clarify

the signage requirements on individual aerodromes.

Construction/Work in Progress. The runway length available

for takeo or landing may change during construction or

other work in progress. If the revised runway lengths available

(TORA/LDA) dier from published data, the revised TORA/LDA

should be made available by the aerodrome operator to ight

crews via changes to the AIP and/or NOTAM. ATIS/D-ATIS (data

link ATIS) should also be used to re-enforce the message.

For short-notice reductions when the necessary aeronautical

information amendments have not been promulgated, it is

important to clearly state that the TORA/LDA is dierent from

published and it will be necessary for ATS to broadcast the

essential information via R/T and/or ATIS/D-ATIS. In addition,

ATS may also consider it appropriate to provide this informa-

tion in ‘real-time’ even when the changes have been notied

in aeronautical publications and/or ATIS/D-ATIS.

ICAO Doc 4444, PANS ATM, Phraseologies § 12.3.1.10 provides

the phraseology to be used by ATCO to notify the ight crew

of on-going construction work:

■

CAUTION CONSTRUCTION WORK (location);

■

CAUTION (specify reasons) RIGHT (or LEFT), (or BOTH SIDES

OF RUNWAY [Number]); and,

■

CAUTION WORK IN PROGRESS (or OBSTRUCTION) (position

and any necessary advice).

Example case study

https://www.skybrary.aero/index.php/

B738,_Manchester_UK,_2003

https://www.skybrary.aero/index.php/

DH8D,_Chania_Greece,_2010

Landing distances. With regard to reduced landing distances

(displaced threshold), Annex 14, Attachment A, §3.5 states:

‘Where a runway has a displaced threshold, then the LDA will be

reduced by the distance the threshold is displaced. … A displaced

threshold aects only the LDA for the approaches made to that

threshold; all declared distances for operations in the reciprocal

direction are unaected.’

Reference materials

ICAO Annex 3, Meteorological Services for International Air

Navigation.

ICAO Annex 11, Air Trac Services.

ICAO Annex 14, Aerodromes.

ICAO Annex 15, Aeronautical Information Services.

ICAO Doc 4444 – PANS ATM.

ICAO Doc 10066 – PANS AIM.

ICAO Doc 9981 – PANS Aerodromes.

ICAO Doc 7030, Regional Supplementary Procedures

(Europe).

ICAO Doc 9432, Manual of Radiotelephony.

ICAO Circular 355 - Assessment, Measurement and Report-

ing of Runway Surface Conditions.

European Commission Regulation No 923/2012 on Standard-

ised European Rules of the Air – SERA, and associated Accept-

able Means of Compliance and Guidance Material.

European Commission Regulation 2017/373 on ATM/ANS

Common Requirements and associated Acceptable Means of

Compliance and Guidance Material.

European Commission Regulation (EU) No 139/2014 – Aer-

odromes, and associated Acceptable Means of Compliance,

Certication Specications and Guidance Material.

EASA SIB No 2018-02: Runway Surface Condition Reporting,

18 January 2018.

EASA SIB No 2015-25: Publication of declared distances for

runways where intersection take-os take place, 18 Novem-

ber 2015.

FAA AC 150/5200-30D: Airport Field Condition Assessments

and Winter Operations Safety, of 29 October 2020.

RCAM Braking Action Codes and Denitions for Pilots, AC 91-

79A CHG1 Appendix 1, April 2016.

Flight Safety Foundation (FSF) ALAR Toolkit, brieng notes:

8.1, 8.3, 8.5, 8.6 and 8.7.

Global Action Plan for the Prevention of Runway Excursions 57

Correct alignment on the runway

Why should ANSPs follow the recommendations?

The runway edge lights provide an overall perspective to

both landing and taking o aircraft. This is enhanced by the

centreline lights that provide information to the ight crew

by supporting better alignment on the runway centreline

and by providing information about the remaining runway

distance by means of alternate red and white lights, where

implemented.

The runway centreline lights could help prevent aircraft from

lining up for departure with the edge lights, while they pro-

vide valuable visual cues for landing aircraft, too.

What can ANSPs do to implement the

recommendation?

Runway centreline lights are usually installed on precision

CAT II/III approach runways to facilitate landing under ad-

verse visibility conditions. They are located along the runway

centreline and are normally spaced at approximately 15 m

(50-foot) intervals. When viewed from the landing threshold,

the runway centreline lights are white until the last 3,000 feet

(900 m) of the runway. The white lights begin to alternate with

red for the next 2,000 feet (600 m), and for the last 1,000 feet

(300 m) of the runway, all centreline lights are red.

ICAO Annex 14, § 5.3.12.2 recommends also that ‘Runway

centre line lights should be provided on a precision approach

runway category I, particularly when the runway is used by air-

craft with high landing speeds or where the width between the

runway edge lights is greater than 50 m.’ In addition, Annex 14

§ 5.3.12.4 recommends that ‘Runway centre line lights should

be provided on a runway intended to be used for takeo with an

operating minimum of an RVR of the order of 400 m or higher

when used by aeroplanes with a very high takeo speed, par-

ticularly where the width between the runway edge lights is

greater than 50 m.’

Typically, all lights are controlled by the ATC tower, a ight

service station or another designated authority. This also

avoids the cost of having the lighting system on for extended

periods.

Use of the runway centreline lights along with the runway

edge lights will, on the one hand, support the correct runway

visual acquisition and positioning by ight crew and reduce

the likelihood of wrong aircraft alignment on the runway or

on the wrong runway or on a taxiway; and on the other hand,

it will provide for better alignment with the runway centreline

during landing operations.

Important note: Recommendation ANSP7 and the guidance

notes provided above are closely linked to the following rec-

ommendation for aerodrome operators. ANSP should also re-

view the relevant guidance material provided in Appendix B,

which contains additional information and advice that can help

achieve the objectives of recommendation ANSP7.

Recommendation ADR10. If installed, runway

centreline lights should also be used together with

the runway edge lights whenever runway edge lights

are switched on and when the runway is in use.

References

ICAO Annex14, Volume 1 ‘Aerodrome Design and Operations’.

ICAO Doc 9157 ‘Aerodrome Design Manual Part 4, Visual Aids‘,

chapter 16.

ICAO Doc 4444 PANS-ATM, Chapter 7.

UK CAA, CAP 637 Visual Aids Handbook (2007).

ICAO Runway Excursion Risk Reduction Toolkit - Aerodrome

Best Practice (2nd edition).

ACRP Report 148: LED Aireld Lighting System Operation and

Maintenance, J. Burns et al., Transportation Research Board

(U.S.), 2015.

https://www.skybrary.aero/index.php/Runway_Lighting.

European Commission Regulation 2017/373 on ATM/ANS

Common Requirements and associated Acceptable Means of

Compliance and Guidance Material.

European Commission Regulation (EU) No 139/2014 – Aer-

odromes, and associated Acceptable Means of Compliance,

Certication Specications and Guidance Material.

Recommendation ANSP7: If installed, runway centreline lights should also be used together with

the runway edge lights whenever runway edge lights are switched on and when the runway is in use.

Left intentionally blank

Global Action Plan for the Prevention of Runway Excursions 59

APPENDIX C

GUIDANCE AND EXPLANATORY MATERIAL

FOR AIRCRAFT OPERATORS

1 General considerations for aircraft operators 61

1.1 Collaboration with other industry stakeholders/safety information sharing (OPS 1) 61

1.2 Aircraft operator’s safety culture (OPS 29) 62

1.3 Training ight crews in preventing runway excursions (OPS 3) 63

1.4 Dealing safely with challenging ATC clearances (OPS 6) 64

1.5 Dealing safely with (late) runway changes (OPS 8) 66

1.6 Safety reasons for ight crews requesting runway changes (OPS 9) 68

1.7 Understanding wind limitations (OPS 11) 68

1.8 Flight technique in crosswind operations (OPS 12) 69

1.9 Technical solutions helping to prevent runway excursions (OPS 4) 71

1.10 Flight data monitoring (FDM) and other means of detecting runway excursion risks

(OPS 2, 31, 33, 35)

1.11 The use of data-link systems (OPS 5) 74

1.12 Check of current conditions versus planned conditions (OPS 10) 75

2 Special considerations for the departure phase 77

2.1 Takeo performance and the use of EFB (OPS 13, 34) 77

2.2 The rejected takeo decision process (OPS 14) 80

2.3 Correct line-up for departure (OPS 27, 28) 82

3 Special considerations for the arrival phase 84

3.1 Safe descent, approach, landing and go-around policies (OPS 7) 84

3.2 Landing performance — correct assessment and implications for aircraft stopping

(OPS 15, 23, 24, 30)

3.3 Runway and approach type selection (OPS 17) 93

3.4 Autoland without protection of ILS critical/sensitive areas (OPS 20) 94

3.5 Stabilised approach and landing (OPS 18, 19, 32) 96

3.6 Go-around policy, decision-making and pilot monitoring duties (OPS 16) 101

3.7 Where and how should ight crews touchdown? (OPS 21, 22) 105

3.8 Bounced landing recovery (OPS 25) 108

3.9 Change of controls during landing and taxi-in (OPS 26) 109

4 References 110

60 Appendix C — Aircraft Operators

1 Glossary

ASIAS Aviation Safety Information Analysis and Sharing

ATC Air trac control

ATCO Air trac controller

ANSP Air navigation service provider

CDO Continuous descent operation

EASA European Aviation Safety Agency

EBAA European Business Aviation Association

ERA European Regions Airlines Association

EOFDM European Operators Flight Data Monitoring Forum

EOSID Engine-out standard instrument departure

EVAIR EUROCONTROL voluntary ATM incident reporting

FAA Federal Aviation Administration

FMC Flight management computer

FSF Flight Safety Foundation

GRF Global Reporting Format

IATA International Air Transport Association

ICAO International Civil Aviation Organization

IDX Incident Data eXchange (IATA)

ILS Instrument landing system

LDA Landing distance available

LDA Low drag approach

LOFT Line-oriented ight training

LOSA Line Operations Safety Audit

LPV Localiser performance with vertical guidance

MRVA Minimum Radar Vectoring Altitude

MTOW Maximum takeo weight

OAT Outside air temperature

OPC Operator prociency check

RAAS Runway Awareness and Advisory System

RCC Runway condition code

RNP Required navigation performance

ROAAS Runway Overrun Awareness and Alerting System

RTO Rejected takeo

PF Pilot ying

PIREP Pilot report

PM Pilot monitoring

PIC Pilot in command

SIC Second in command (Copilot)

SID Standard instrument departure

SMS Safety management system

SOP Standard operating procedure

STAR Standard arrival route

TEM Threat and error management

TOW Takeo weight

Global Action Plan for the Prevention of Runway Excursions 61

2 General considerations for aircraft operators

Each aircraft operator is invited to review and prioritise the

proposed recommendations. The following guidance mate-

rial is provided to assist with implementation.

2.1 Collaboration with other industry

stakeholders/safety information

sharing (OPS 1)

Why should aircraft operators follow this

recommendation?

In order to eectively prevent runway safety events, it is nec-

essary that all stakeholders in aviation work together and

exchange safety-relevant information. This allows aircraft

operators and other stakeholders to learn from each other,

understand dierent perspectives and create a shared mental

picture of the threats and hazards that ight crews and air

trac controllers have to cope with in daily operation.

Aircraft operators have the best source of information avail-

able to gain knowledge about what works well and what

needs improvement in order to mitigate runway excursion

risks in daily operation — the ight crews. Aircraft operators

can actively encourage ight crews to report not only occur-

rences but also their experiences in routine operation, both

positives and negatives (e.g., on approach path management,

trac spacing or actual braking action at an airport during

wet runway operation).

By exchanging safety reports and information about their

safety risk areas with other aircraft operators, airports and

air navigation service providers (ANSPs), aircraft operators

might even be able to receive additional relevant information

on top of what their ight crews experience, making them

aware of hazards which would otherwise be hidden to them.

Being proactive in safety information sharing can help the

whole industry to become preventative in runway excursion

risk reduction.

What can aircraft operators do to implement the

recommendation?

In order to build or receive the required level of trust needed

to establish a safety information exchange with other aircraft

operators or other industry stakeholders, aircraft operators

should consider the following steps:

■

Aircraft operators should be proactive in establishing pro-

fessional contacts between the safety, ight operations

and training departments of their organisation and those

of other industry stakeholders such as ANSPs and other

aircraft operators. Professional contacts and direct coop-

eration will help to build trust and will enable the ow of

safety-relevant information.

■

Aircraft operators should include their senior and board

management as well as communication departments in

the process of setting up safety information-sharing net-

works in order to increase their understanding of how the

benets of such exchange outweighs the manageable

risks of reputational problems, especially as safety informa-

tion exchange does not only include negative events but

positive ones as well. If necessary, consider setting up for-

mal agreements for the exchange of sensitive information.

■

Aircraft operators should make it as easy as possible to

allow external stakeholders direct safety reporting of rel-

evant safety events or safety risk areas into their safety

management systems (SMS) (e.g., by proactively promul-

gating the relevant email address or website information),

while at the same time requesting the relevant addresses

from the others to enable communication between the

SMS on specic issues without losing precious time and

to get rst-hand information on relevant safety topics.

(See OPS 6.)

■

Aircraft operators should consider proactively distribut-

ing their safety newsletter or magazine to other industry

stakeholders and promulgating relevant information re-

ceived via safety information-sharing networks to their

ight crews to enhance their awareness on industry safety

issues and encourage their own safety reporting.

■

Aircraft operators should consider registering or joining

existing safety information-sharing networks or relevant

organisations, which are currently the following:

›

European Union Aviation Safety Agency (EASA)

Data4Safety;

› European Operators Flight Data Monitoring (EOFDM);

›

U.S. Federal Aviation Administration (FAA) Aviation

Safety Information Analysis and Sharing (ASIAS);

› SKYbrary;

› Flight Safety Foundation;

› European Regions Airline Association;

›

International Air Transport Association (IATA) (Flight, In-

cident and Accident Data eXchange (FDX, IDX and ADX);

› Local runway safety teams (LRST);

›

Eurocontrol Voluntary Air Trac Management (ATM)

Incident Reporting (EVAIR); and,

› European Business Aviation Association (EBAA).

Recommendation OPS 1: Aircraft operators

should participate in safety information shar-

ing networks with all relevant stakeholders.

This should facilitate the free exchange of

relevant runway safety information includ-

ing identied risks, safety trends and good

practices.

62 Appendix C — Aircraft Operators

2.2 Aircraft operator’s safety culture

(OPS 29)

Why should aircraft operators follow this

recommendation?

Many runway excursion events happen in normal operation,

meaning with technically fully operational aircraft and without

any (impending) abnormal or emergency situation, and are

caused by ight crews’ mismanagement of threats. However,

these human failures often originate from organizational and

operational pressures ight crews face in their daily operation. It

is therefore of utmost importance that ight crews feel psycho-

logically safe to always behave in a risk-averse (i.e., defensive/

conservative) manner with regard to their safety-relevant deci-

sion-making. This includes feeling free to intervene, for exam-

ple, within their ight crew or toward their operations control

and air trac control (ATC), if required. For this, ight crews need

the backing of their aircraft operator as an employer, which

should make clear to them that such risk-averse behaviour is

not only tolerated but explicitly expected and encouraged.

Always prioritising safety over eciency, and thereby being

risk-averse, is the ultimate tool which ight crews have in daily

operation to prevent complex and error-prone situations, to

always work as intended and to deal safely with all threats

on their ights. Especially for the prevention of runway ex-

cursions, this includes, but is not limited to:

■

Taking the time needed to perform aircraft performance

calculations and doing pre-departure or approach set-

up/briengs in a calm and thorough manner, even if this

causes delay or holding; and,

■

Performing a missed approach whenever not stabilised on

approach or reduce wind limits (see OPS 11), depending

on the ight crew’s experience, prociency or fatigue level,

even if this leads to a diversion.

There are many more examples reecting the need for a psy-

chologically safe environment which ight crews need to en-

sure safe ights. Because individual pilots may have diering

risk perceptions and risk appetites, there is an additional need

to clarify that eective prevention of unsafe events requires

safe (team) decision-making, meaning that the more risk-

averse (that is, the more defensive or conservative) option

will always be preferred as demanded by any of the pilots in

a ight crew, irrespective of rank or experience.

What can aircraft operators do to implement the

recommendation?

As set out by the structure of an aircraft operator’s SMS,

the safety policy, whether standing alone or incorporated

into other policy texts, is the highest-ranking policy in the

organisation, governing all of their activities and those of

their employees. Writing and formulating this policy in such

a way as to leave no doubt to anyone that aircraft operators

expect everyone in their organisation to always prioritise

safety over eciency, even if this means accepting nancial

losses or delay, will create a common baseline for their oper-

ations. Although a SMS looks for a balance between safety

and eciency using risk management principles, it has to be

made clear, especially to the frontline sta, that their duty is

to always prioritize safety over eciency in order to ensure

safety and, in this context, to prevent runway excursions.

The following passages might serve as a guideline for a word-

ing of such a policy:

‘Safety is our most important business function as (airline/

organisation) highly depends on safe and reliable oper-

ation. All levels of management and all employees are

responsible for the delivery of the highest level of safety

performance, starting with me, the (accountable man-

ager/CEO). The adherence to these standards is more im-

portant than economic or other matters. To achieve these

standards, I (accountable manager/CEO) will support the

management of safety through the implementation of

all necessary measures and the provision of all nancial,

material and human resources which are required for safe

day-to-day operation. This will result in an organisation-

al culture that fosters safe practices and encourages or

even rewards open and eective safety reporting and

communication.’

‘Our mutual goal shall be to apply our “Safety First” princi-

ple in our strategic and day-to-day decision-making and

to manage safety in a proactive and systematic manner

in order to ensure an always ecient, reliable and resilient

operation of (airline/organisation) and its related activi-

ties. You and I can contribute to this by learning from our

mistakes; sharing best practices; reporting hazardous or

unsafe situations or problems; applying critical thinking

with regard to our policies, standards and procedures;

and reporting any possibility for improvement via our

established reporting systems.’

Writing policies alone will be insucient to foster the re-

quired culture. However, by exemplifying these values and

educating and training their ight crews on how to meet

this common standard, aircraft operators will create the

work environment required to make it easy for their ight

crews to deal safely with all everyday threats and eectively

prevent runway excursions. Furthermore, aircraft operators

can convey a positive message to foster safe behaviour by

presenting good examples of safe decision-making in their

safety promotion (e.g., the eective intervention by a pilot

monitoring (PM) on an unstable approach leading to a go-

around. Aircraft operators can even choose to reward pilots

directly for positive safety behaviour.

Recommendation OPS 29: Aircraft oper-

ators should foster a culture that stimulates

safe behaviour, which in turn encourages

risk-averse decision-making by ight crews.

Global Action Plan for the Prevention of Runway Excursions 63

2.3 Training ight crews in preventing

runway excursions (OPS 3)

Why should aircraft operators follow this

recommendation?

Runway excursions can happen during takeo or landing.

There can be overruns or veer-os, on both takeo or landing,

after or during a non-normal situation (e.g., a takeo abort

or a brake failure upon landing). They can also happen in

normal operation owing to ight crews’ mismanagement of

ight-related threats. The prevention of runway excursions

requires a holistic approach towards pilot training covering

both pilot’s technical and non-technical competencies as

well as the promotion of a safety-oriented company culture

throughout the training. In order to eectively prevent run-

way excursions, ight crews need training which increases

their condence in handling their aircraft safely, even in de-

manding and complex situations (e.g., in gusty crosswinds).

It is also important that they require training in how to safely

manage threats and hazards as a team without using up their

own and their team members’ safety margins. Runway excur-

sion prevention training therefore requires special emphasis

on team decision-making and eective monitoring and in-

tervention, including safely taking away control by the PM in

complex situations, if required, irrespective of considerations

of rank or experience.

What can aircraft operators do to implement the

recommendation?

Flight operations, crew training and safety departments

should develop common strategies to address the issue of

runway excursion prevention. The aircraft operator’s SMS

can deliver case studies and insights from investigations.

The training department can use those for building eec-

tive lesson plans both for their simulator and crew resource

management/threat and error management (CRM/TEM) and

accident prevention trainings. This should also bear in mind

the necessity for appropriate presentation of the cases in

order to avoid negative training. The ight operations de-

partment can use the training feedback to critically reassess

their policies and standard operating procedures (SOPs).

Additionally, the safety promotion part of the SMS can be

used to distribute data and raise ight crews’ awareness of

the prevention of runway excursions. Lessons learned from

past incidents or accidents can easily be distributed using

safety promotion tools (e.g., internal safety journals, email

briengs, memos).

Flight crew training for runway excursion prevention should

include, among other things:

■

Train ight crews in takeo and landing performance cal-

culation and assessment (See OPS 29 and OPS 13);

■

Expose ight crews to changing weather situations in

simulator missions which require recalculations and/or

changes to previous decisions (e.g., increasing tailwind

requiring a change of runway direction);

■

Train ight crews in takeo decision-making, including

simulator scenarios which help to establish resilience to

startle during takeo (e.g., when dealing with loud tyre

bursts, engine stalls) (See OPS 14);

■

Train ight crews in recovering the descent prole safely

(e.g., resulting from late descent clearances);

■

Train ight crews in ways to increase the descent distance

with ATC (e.g., by using intervention wordings like ‘una-

ble’ or requesting appropriate mileage) (See OPS 9, OPS 7,

OPS 19);

■

Train ight crews in go-around decision-making and ex-

ecution in various situations, including early or late go-

arounds on approach or landing (even during are and

touchdown) (See OPS 16);

■

Train ight crews in eective monitoring and intervention,

including safely taking away control from the pilot ying

(PF) by the PM, if required, irrespective of rank or experi-

ence (See OPS 19);

■

Brief ight crews on how simulator representativeness

regarding aircraft behaviour, fault generation or environ-

mental conditions may restrict or inuence the training

objective with regard to runway excursion prevention (e.g.,

diering simulator crosswind behaviour, restrictions in

simulating brake failures or dierent runway contamina-

tion or slipperiness) in order to avoid negative training; and

■

Highlight the availability of aircraft arresting systems

such as engineered materials arresting systems (EMAS),

if available.

In the event that aircraft operators outsource such training to

a training provider, they should make sure that the training

methods and scenarios used full their needs with regard

to runway excursion prevention training. In general, aircraft

operators should rethink the amount and structure of their

ight crew training for preventing runway excursions. Com-

plying only with the minimum legal requirements in terms

Recommendation OPS 3: Aircraft operators

and training providers should include realis-

tic, evidence- and competency-based scenar-

ios in their training programmes requiring

threat and error management for runway

excursion prevention during both takeo

and landing. This should include evidence-

and competency-based recurrent simulator

training programmes which are represent-

ative in terms of environmental conditions,

including crosswinds, landing on contami-

nated/slippery runways and poor visibility

adapted with simulator representativeness.

Representativeness of simulators should be

assessed and their limitations communicated

(in order to avoid negative training).

64 Appendix C — Aircraft Operators

of the amount and frequency of simulator events for ight

crews might not be sucient to compensate for a possi-

ble reduction in ight crews’ manual ying skills owing to

today’s increased use of automation. Training ight crews

regularly and thoroughly in ying stabilised approaches and

landings in demanding weather situations such as chang-

ing or gusty (cross)winds, low ceiling/visibility or turbulence

conditions and using dierent levels of automation (with or

without ight director guidance), including manually own

go-arounds, might be worth considering for maintaining and

possibly improving ight crews’ ability to eectively prevent

runway excursions.

2.4 Dealing safely with challenging ATC

clearances (OPS 6)

Why should aircraft operators follow this

recommendation?

The aviation industry is a complex sociotechnical system

of which aircraft operators and ANSPs are equal parts. Both

entities, and thereby, their management and sta, have the

primary duty to ensure safe ights. This mutual goal, and

especially the eective prevention of runway excursions,

can only be achieved if ight crews and air trac controllers

(ATCOs) prioritise safety over eciency in their daily opera-

tion, meaning that they are always TETO

-minded and aim to

operate with adequate safety margins.

However, there might be situations in which ight crews

and ATCOs have dierent perspectives on the safety margin

TETO – Thoroughness Eciency Trade O (the opposite of ETTO – Eciency Thoroughness Trade O) – see https://www.skybrary.aero/index.php/

Toolkit:Systems_Thinking_for_Safety/Principle_7._Trade-os

actually needed, leading to a dierent perception of what is

safe and what is not. While ight crews cannot have a global

picture of the collision risk with other trac, especially in

crowded airspace, ATCOs cannot have the full picture of the

threats which ight crews have to cope with on the ight

deck. For instance, applying minimum separation only or

vectoring an aircraft along a regularly used descent prole

does not necessarily guarantee that this separation or this

vectoring is always safe. There may be individual threats to

a ight which are invisible to ATCOs but visible to the ight

crews, who might therefore require more safety margins than

the ATCOs would expect. This could be ight crew fatigue, lack

of prociency or training, changing winds aloft leading to a

reduced speed-reduction capability, or aircraft-type-related

threats, like gross weight or performance limitations. There-

by, ight crews are often confronted with ATC clearances or

instructions which they are not comfortable with. Examples

of this are:

■

A tight base-turn;

■

An instruction to keep the speed up;

■

Late descent clearance;

■

Requests to expedite vacating the runway;

■

Requests for immediate/rolling takeos;

■

Late runway changes, on both takeo or landing;

■

Late handing over from approach to tower (<9 nm nal);

■

Instructions to increase the rate of descent and reduce the

speed at the same time; and,

■

Instructions for an early level-o, on both takeo or

go-around.

These clearances are often well intentioned but do not always

take into consideration the high workload and complexity

they pose to the ight crew during the last minutes of the

ight. They might even lead ight crews to accept a clearance

which will make the safe operation of the aircraft a challenge.

Flight crews should be encouraged to intervene and reject

such challenging clearances (e.g., by using the wording ‘un-

able’). Nevertheless saying ‘no’ or ‘unable’ might be a highly

dicult and demanding task for ight crews, if they do not

feel psychologically safe to do so. There are many dierent

reasons for this:

■

Flight crews do not know that they are ‘allowed’ to refuse

an instruction;

■

Flight crews might not realise which situation they are

being pushed into;

■

Flight crews do not want to oend the controller by re-

fusing the instruction;

■

Flight crews fear reprisal either from aircraft operators

or ATC;

Recommendation OPS 6: Aircraft operators

should implement policies for ight crews

not to accept ATC procedures and clearances

which have the potential to decrease safety

margins to an unacceptable level for the ight

crew thereby increasing the risk of runway ex-

cursions. This includes such procedures and

clearances which increase the likelihood of

having an unsafe approach path manage-

ment with consequences for safe landing, e.g.

which bear the risk of being unstabilised at

the landing gate or high-energy approaches.

These policies should be further supplement-

ed by the implementation of eective SOPs

and ight crew training.

Flight crews should be required to report

such risks within their operator’s SMS and the

aircraft operator should further report such

risks to the ANSPs via established reporting

systems (see Recommendation OPS 1).

Global Action Plan for the Prevention of Runway Excursions 65

■

Cultural issues might give the ATC instruction the status

of an ‘order’;

■

There may be felt or real commercial pressure to accept

‘shortcuts’;

■

The deviation has become the standard;

■

Status hierarchy eects on the ight deck; and,

■

Lack of intervention/assertiveness training.

The same applies, of course, to ATCOs, who should also have

the possibility and backing by their management to always

reject any unacceptable request by ight crews and even

challenge and intervene in ight crews’ ight path manage-

ment if it is deemed too risky by the ATCO. This mutual inter-

vention and concept of ‘prevention by intervention’ needs to

be accepted by the ANSPs and the aircraft operators. There

should be consensus in our industry that the more defensive

and conservative (i.e,. more risk-averse) option should always

be that preferred in a given situation, irrespective of whether

demanded by ight crews or ATCOs.

Especially for ATC, it is important to understand that air-

craft operators expect their ight crews to always adhere to

stabilised approach criteria or be risk-averse in their safety-

relevant behaviour, which might require them to refuse ATC

clearances. Having a written ocial policy and related SOPs

in their documentation gives ight crews and the persons

in contact with the ANSPs (e.g., safety sta during meetings

with local runway safety teams) sucient arguments and

backing to promote a common risk perception of ight crews

and ATCOs in daily operation. Furthermore, such interchange

of arguments might even provide aircraft operators with the

opportunity to critically reassess their own ight procedures

and learn from others.

Meetings with the ANSP (e.g., those attended by your

safety department sta in local runway safety teams) are a

proactive way of increasing understanding of each other.

The knowledge gained during these meetings should be

disseminated to all crews to raise their awareness of the

matters discussed. This will enable crews to know about

safety issues at dierent locations and thus be prepared for

the ‘unexpected’. Furthermore, aircraft operators can put in

place an exchange programme between ANSPs and aircraft

operators. This means that controllers will be allowed to

conduct familiarisation ights in the ight deck or in a ight

simulator and that ight crews will visit the ANSP facilities.

This will help to improve their understanding of each other’s

work constraints.

In the scope of their respective SMS, it is important that ight

crews and ATCOs understand the importance of reporting any

issue with challenging clearances or requests which reduce

or eliminate required safety margins in daily practice. Safety

https://www.iata.org/contentassets/7a5cd514de9c4c63ba0a7ac21547477a/iata-guidance-unstable-approaches.pdf

https://runwayexcursions.faa.gov/docs/Avoiding%20Unstable%20Approaches%20-%20Important%20Tips.pdf

departments will need data in order to be able to address

such issues so that both groups can mutually learn from each

other and so that hazards or negative trends can be identied

and acted on early.

What can aircraft operators do to implement the

recommendation?

An aircraft operator’s duty is to make clear to all their ight

crews via policies, SOPs and training that they are allowed

to reject any ATC instruction which may create an unsafe

situation. Their ight crews need to understand that they are

ultimately responsible for the safe operation of their aircraft

in its entirety, while ATCOs are only responsible for the safe

separation of trac in their individual airspace. The following

should be considered when establishing such policies, SOPs

and training practices:

■

Aircraft operators should provide their ight crews with

documented tools (e.g., procedures describing when and

how to use wordings like ‘unable’), which may help them

to overcome psychological barriers for intervention, as

mentioned above. When formulating procedures, make

it clear that the decision to refuse a clearance should be

communicated as soon as possible to allow the ATCO to

review his/her trac sequencing. Reference for such tools

can be taken from already established best practices (e.g.,

as outlined in the Civil Air Navigation Services Organi

sation (CANSO) paper with important tips for pilots and

ATCOs, or IATA’s paper on unstable approaches.)

■

Aircraft operators should consider restricting high speed

ying (>250 kts) below Flight Level (FL) 100, except for

non-normal or emergency situations.

■

Aircraft operators should incorporate ATC intervention

scenarios in their simulator programme and during CRM/

TEM/accident prevention courses.

■

Aircraft operators should require their ight crews to pro-

actively provide hazard reports about potentially unsafe

departure or approach procedures as well as challenging

ATC clearances in order to gain knowledge about aected

airports in their route network. These reports should also

be used to inform all of their ight crews about issues with

challenging ATC clearances via their airport briengs or

similar means. Additionally, aircraft operators should get

in contact with other stakeholders (e.g., EVAIR, IATA-IDX,

ANSPs or other aircraft operators directly) in the scope

of safety information exchange programmes in order to

obtain information on challenging clearances at specic

airports.

■

Aircraft operators should explore how they can improve

the mutual awareness between their ight crews and air

trac controllers through coordinated publications, meet-

ings, familiarisation ights or visits to ATC facilities.

66 Appendix C — Aircraft Operators

2.5 Dealing safely with (late) runway

changes (OPS 8)

Why should aircraft operators follow this

recommendation?

ATCOs may try to keep the runways which are optimal for their

capacity planning in use for as long as possible. Moreover,

they are often not aware of the tasks involved and consid-

erations required to safely prepare an aircraft for takeo or

landing in case of a runway or departure/approach change.

These tasks include a new TEM review and brieng, new

navigation and ight management computer (FMC) set-up

and performance calculation. Consequently, if not previous-

ly anticipated and prepared by the ight crew, late runway

changes (including intersection changes for departure or

changes in the type of standard instrument departure [SID]

or approach) can easily become a safety problem as they may

lead to increased workload on the ight deck. The problems

which might arise from this are in Table 1.

What can aircraft operators do to implement the

recommendation?

In order to help ight crews dealing safely with the threat

of (late) changes such as runway, intersection, departure or

approach changes, an aircraft operator’s duty is to provide

their ight crews with adequate policies, SOPs, tools and

training. The following should be considered when estab-

lishing these:

■

Aircraft operators should communicate proactively to the

ANSPs (e.g., via local runway safety teams and/or via their

commercial contacts) that they expect their ight crews

and the ANSP to always prioritise safety over eciency.

Aircraft operators should make clear to the ANSP that

capacity and eciency is not their primary concern but

rather the safe conduct of their ights. They should also

explain that delay vectoring to achieve better descent

management or time for runway/approach changes is

preferred rather than tight-and-high approach vectoring

or late runway changes for capacity reasons.

■

Aircraft operators should support their ight crews in an-

ticipating runway, intersection, SID or approach changes

by implementing the following via their policies, SOPs

and training:

Recommendation OPS 8: Aircraft operators

should implement policies or SOPs for ight

crews not to conduct takeo or approach fol-

lowing any runway change until the appropri-

ate set-up, planning, performance calculations

(for multi-pilot operations this includes inde-

pendent calculations and cross-checks by at

least two pilots) and re-briengs are complet-

ed. When a takeo runway change is received

whilst taxiing, the above should be performed

by the ight crew without rushing and when

the aircraft is stationary. Runway-excursion

related TEM should be addressed in the brief-

ing every time a runway change is expected,

probable or actually occurs.

Table 1.

Takeo Landing

Runway excursion–related:

• Errors in takeo performance calculations (e.g., using the

wrong runway, a wrong intersection or incorrect wind status);

• Errors during entry of performance data into the FMC and

in V-speed/N1/EPR settings (settings for specic aircraft

congurations);

• Line-up via the wrong intersection; and,

• Procedural shortcuts (e.g., not waiting for both engines to

stabilize symmetrically before applying takeo power when

being rushed).

Non-Runway excursion–related:

• Crews following the wrong taxi route;

• Runway incursions; and,

• Crew confusion or SID violations due to discrepancies in the

stored SID in the FMC.

Runway excursion–related:

• Rushed and unstabilised approaches;

• Errors in landing performance calculations which might lead

to runway excursions;

• Unawareness of actual runway status and resulting stopping

margin;

• Unawareness of optimum runway exit, leading to taxi-o with

inappropriate taxi speed; and,

• Flying the wrong approach or to the wrong runway.

Non-Runway excursion –related:

• Wrong radio and navigation settings for approach;

• Preparing or ying the wrong go-around route;

• Discrepancies in the stored FMC data leading to crew

confusion; and,

• Not intercepting the cleared approach in time – this is

especially critical at airports with parallel runway operations.

Global Action Plan for the Prevention of Runway Excursions 67

›

Flight crews should be advised to gain awareness of

the wind prole (e.g., by means of information from

the operational ight plan, outside cues or pilot reports

[PIREPs] from other crew) in order to prepare for a prob-

able runway change. This can already be done during

pre-ight preparation even in regard to the landing

(e.g., by viewing the wind prole in the last 5,000 feet

shown in the operational ight plan, if available).

› Flight crews should be provided with any relevant in-

formation regarding which runway, SID or approach

they can usually expect at an airport (e.g., by means of

specic airport brieng/information provided by the

aircraft operator).

› Flight crews should be required to consider a possible

runway, intersection, SID or approach change already

in their TEM brieng for every departure and approach

brieng. Actively asking ATC about any planned change

of runway, SID or approach should be encouraged, if

deemed useful.

› Flight crews should be required in their taxi and take-

o brieng to identify the correct runway intersection

and line-up point also by visual cues, if available (e.g.,

wind socks, ramps, re station). During complex taxiway

arrangements, a step-by-step taxi route conrmation

should be used in order to line-up the runway using

the correct intersection or line-up point.

■

Aircraft operators should support their ight crews in

dealing safely with (late or sudden) runway, intersection

or approach changes by implementing the following via

their policies, SOPs and training:

›

Flight crews should refrain from accepting approach

or line-up clearance for a runway until the appropriate

set-up, planning, performance calculations and re-brief-

ings are completed. Encourage ight crews to request

delay vectors, or even holding or other time-generating

means, if required, instead of rushing for departure or

approach and landing.

› Passenger cabin-secure readiness should also be a re-

quirement for acceptance to line up and for nal ap-

proach completion.

› Accept departure and arrival delays, especially in the

event of late changes. Support ight crews to withstand

the operational pressure to go o-block or land with-

out having prepared the runway, intersection, SID or

approach change properly, just to avoid delay.

›

Consider providing ight crews with a ‘Late change

– checklist’ covering items for the FMC and NAV set-

up, performance considerations and a re-brieng (see

Figure 6).

›

Require each pilot of the active ight crew to in-

dependently verify performance calculations and

cross-checks.

›

On ground: During taxi, ight crews should direct their

full attention to the position and movement of the air-

craft at the airport. If the runway, intersection or SID

change for takeo was not anticipated by the ight

crew, this might require them to do relevant work like

performance calculations, new FMC and NAV set-up and

re-brieng when the aircraft is stationary. Therefore, the

aircraft operator’s policies and SOPs should clarify that

adhering to this SOP takes precedence over any time

pressure like airport slots, night curfews or ight duty

time restrictions in order to allow their ight crew to ac

complish the necessary tasks without rushing, thereby

eectively mitigating runway excursion risks.

›

In ight: Managing and monitoring the aircraft and

its ight path is of utmost importance for accident

prevention. If not anticipated by the crew, a late run-

way or approach change (e.g., below FL100), requires

a concerted set of tasks accomplished by the PF and

PM. In normal operation, there is no need to accept or

even request rushed approaches. Building a shared

mental model, especially with regard to the approach

and go-around, weather, trac and other threats, is

more important than on-time performance. Ideally,

ATC should not issue runway changes to aircraft below

FL100 and crews should avoid accepting them, unless

required for safety reasons. If a runway change is ac-

cepted below FL100, the crew should enter a holding

Figure 6. Example late change checklist

DEPARTURE

FMS

FMS RWY/SID change?

FMS vs IAC WYPT x-check?

SID PDG change

(able?)

New ALT / SPD constraints

Setup

SID/RTN NAV-SET change?

MCP CRS SELECTORS change?

RWY HDG change?

1. STOP ALT change?

MEOAA change?

(eosid?)

Performance

OPTIMYM FLAPS? (tora?)

V-SPEEDS change?

T/O N1?

(correct bleed setting?)

EOSID special? (e/o holding?)

Brieng

New CHART X-CHECK required?

New SID/EOSID Brieng?

New TAXI Route?

New Threats/Hazards?

APPROACH

FMS

FMS RWY/APP change?

FMS vs IAC WYPT x-check?

FMS STAR/TRANS. change

(able?)

New ALT / SPD constraints

Setup

APPG/A NAV-SET change?

MCP CRS SELECTORS change?

RWY HDG change?

G/A ALT change?

MDA/DA change?

(vdp/callouts?)

Performance

OPTIMUM FLAPS? (reverse/a/b?)

V-REF SPEED change?

A/B CHANGE?

(optimym rwy exit?)

EO-G/A special? (eosid/vis.escape?)

Brieng

New CHART X-CHECK required?

New APP/G/A Brieng?

New TAXI Route?

New Threats/Hazards?

(Late) CHANGE - CHECKLIST

68 Appendix C — Aircraft Operators

pattern (if necessary) and not commence the approach

until the set-up, briengs and checklists are completed.

›

If their aircraft are equipped with a ight management

system (FMS) capable of storing two ight plans, ight

crews should consider using this feature when prepar-

ing for a departure or arrival and there is a possibility for

one of two dierent runways to be assigned for takeo

or landing. The ight plan ‘on standby’ can be easily

activated without a signicant increase in workload.

2.6 Safety reasons for ight crews

requesting runway changes (OPS 9)

Why should aircraft operators follow this

recommendation?

ATCOs often try to keep runways which are optimal for capac-

ity planning and/or for adherence to local noise abatement

restrictions in use for as long as possible. This may lead to

signicant tail wind and/or crosswind operation or operation

on shorter, slipperier or more performance-limited runways,

despite better options being available at an airport. All of these

risks can be contributing factors to runway excursion events.

In order to proactively prevent safety-critical events, there

should be consensus in the industry that ight crews are

allowed to request a more favourable runway for any reason

which may aect the safety of their ight, even if granting

such requests might lead to departure or landing delays.

Safety reasons which might lead ight crews to request an-

other runway providing them with a greater safety margin for

their departure or arrival may include, among other things:

■

Wind proles leading to reduced safety margins (e.g., a tail

wind, crosswind or variable winds). It is important to un-

derstand that while the surface wind might still be within

the limits, the winds at altitude are often well beyond these

limitations, making it harder for ight crews to stabilise

their aircraft until touchdown;

■

A runway condition status estimated by the ight crew to

be worse than reported (e.g., the ight crew expects the

runway to be slippery wet, when only reported to be wet);

■

Technical or special performance reasons (e.g., when op-

erating with minimum equipment list [MEL] items like a

locked reverser);

■

Human factors reasons (e.g., fatigue when operating in a

pilot’s window of circadian low or a lack of prociency);

■

Approach and runway lighting considerations (e.g., at

night and in marginal weather conditions);

■

Engine-out or go-around climb considerations (e.g.,

weather, crosswind or trac on engine-out SIDs (EOSID)

or go-around);

■

Crosswind limitations (e.g., in gusty winds or when using

reduced crosswind limits);

■

Sun-blinding at the approach minimum or during go-

around and initial EO tracking; and,

■

Bird concentration or signicant visual ight rules (VFR)

trac.

In these cases, ight crew should not be reluctant to ask for

a more appropriate runway, clearly stating that this is for

safety reasons, even if this means delaying the departure

or approach.

What can aircraft operators do to implement the

recommendation?

An aircraft operator’s duty is to provide their ight crews with

adequate policies, SOPs and training, especially in safety rel-

evant decision-making, to support them in always choosing

the most appropriate runway for takeo and landing. The

following should be considered when establishing these:

■

Aircraft operators should communicate actively to the

ANSPs (e.g., during meetings with local runway safety

teams) that they expect their ight crews and the ANSP

to always prioritise safety over eciency.

■

Aircraft operators should require their ight crews to

make their performance calculations also taking into ac-

count the maximum foreseeable tailwind for the takeo

or landing runway in order to gain awareness of resulting

stopping margin in the event that a runway change is not

possible or the weather creates variable winds (e.g., during

thunderstorms).

■

Aircraft operators should require their ight crews to use

a conservative strategy when assessing the need for a

runway change request in their TEM brieng.

■

Aircraft operators should consider informing ANSPs in ad-

vance via their operations control if certain ights need to

take o in the opposite direction or in a dierent direction

than usual (e.g., due to performance limitations). This will

give ATCOs and ight crews the chance to plan ahead and

coordinate the best departure time or runway allocation.

(See also OPS 6.)

2.7 Understanding wind limitations

(OPS 11)

Why should aircraft operators follow this

recommendation?

Environmental threats like crosswind and tail wind compo-

nents need to be safely managed by ight crews in order to

prevent runway excursions. Operations in tail wind and cross-

wind conditions require not only specic handling techniques

Recommendation OPS 9: Aircraft operators

should implement policies or SOPs for ight

crews to request a more favourable runway

for takeo or landing for any reason, which

may aect the safety of the ight and to ad-

vise the safety reasons to ATC.

Global Action Plan for the Prevention of Runway Excursions 69

but also good knowledge of and strict adherence to the ap-

plicable cross- and tail wind limitations, depending on run-

way status. Aircraft manufacturers publish only an aircraft’s

maximum demonstrated crosswind capability as shown in

the certication process. Using such values as actual aircraft

limitations in routine operation may pose additional threats

to the operation for the following reasons:

■

The conditions prevailing or used during the ight tests

from which such values result may be dierent from the

conditions that ight crews may experience in daily prac-

tice (e.g., values have been achieved by test pilots).

■

Only providing ight crews with recommended instead of

denite crosswind or tail wind limits may put additional

operational pressure on ight crews to accept and try to

cope with challenging environmental conditions, despite

being unable to safely do so.

■

In the absence of denite company crosswind or tail wind

limitations, there is an increased need for the ight opera-

tions and safety departments to conduct risk assessments

of all airports in the route network and to publish limits

with regard to maximum wind limits individually, irrespec-

tive of airport classication.

What can aircraft operators do to implement the

recommendation?

Aircraft operators should support ight crews in safely man-

aging threats from crosswinds and tail winds by considering

at least the following when determining policies, SOPs and

training regarding wind limitations:

■

Aircraft operators should provide their ight crews with

denite wind limitations, taking into account dierent

runway states. These should include any gusts. These lim-

itations should be aligned with the aircraft ight manual

(AFM), ight crew training manual (FCTM) and manufac-

turers’ guidance and include any further restrictions or

guidance on wind limitations given by the manufacturers.

Implementing specic drift limits for touchdown should

be considered (see OPS 21).

■

Aircraft operators should provide their ight crews with

the freedom to reduce these limits whenever they deem

necessary in actual ight operations (e.g., due to fatigue,

prociency issues or other safety reasons) in order to en-

sure safe takeos and landings.

■

Aircraft operators should highlight in their CRM/TEM

that xed wind limits may have the potential to develop

a normative goal eect, which means that ight crews

think they always have to be able to take o or land up

to this given wind-limit, irrespective of their actual crew

performance in terms of prociency, fatigue or other safety

reasons. Training, including simulator training, should be

provided to enable and encourage ight crews to consider

reducing the wind limits when necessary.

■

Aircraft operators should request recommendations and

non-technical objections from the manufacturer when

developing policy and procedures concerning wind limits

in the event that no manufacturer’s guidance on wind

limitations is published.

■

Aircraft operators should consider imposing further re-

strictive limitations for specic airports or situations based

on the operator’s risk assessments (e.g., imposing limits

based on crew experience, crew composition or training).

Communicating their crosswind limits for specic airports

to aerodrome operators and ANSPs (e.g., via participation

in local runway safety teams or via their commercial con-

tacts) may help to achieve a common risk picture of their

ight crews and ATCOs in daily operation, making it easier

for both groups to deal safely with environmental threats.

2.8 Flight technique in crosswind

operations (OPS 12)

Why should aircraft operators follow this

recommendation?

Crosswinds not only contribute to runway veer-os, on both

takeo and landing, but they can also contribute to runway

overruns because the actual are distance will be inuenced

by the crosswind technique used by the ight crew, thereby

eventually leading to signicantly reduced stopping margins.

Moreover, crosswinds can also inuence controllability after

touchdown so that the ight crew is required to reduce their

Recommendation OPS 12: Aircraft oper-

ators should publish specic guidance and

training for their ight crews on crosswind

takeo and landing techniques, especially

in wet, slippery or contaminated runway

conditions. This should include the correct

touchdown and stopping techniques, which

incorporate all available control and decel-

eration devices as well as TEM topics and

methods for eective monitoring and inter-

vention by the PM. Aircraft manufacturer’s

advice should be incorporated, if available.

Recommendation OPS 11: Aircraft opera-

tors should dene company cross- and tail-

wind limits which are specic to each type

of aircraft operated. Moreover, specic guid-

ance on the runway conditions and the gust

components should be claried. Aircraft op-

erators should establish clear policies to allow

their ight crew to reduce the established

limits whenever deemed necessary for safety

reasons in actual ight operation.

70 Appendix C — Aircraft Operators

reverse thrust, which also may lead to signicantly reduced

stopping margins, especially in cases when performance cal-

culations assumed uninterrupted and full use of maximum

reverse thrust.

Although crosswind landings and engine-out recoveries in

crosswinds on takeo might be highly complex manoeu-

vres, it should be ensured that the PM is always eective in

cross-checking the PF and ready to intervene with callouts or

even by taking over control, if necessary, irrespective of rank

and experience. This needs to be trained not only via class-

room training but also via appropriate simulator intervention

sessions, and appropriate documentation on the intervention

SOP should be provided.

What can aircraft operators do to implement the

recommendation?

Owing to dierences in ight technique between y-by-wire

and conventional aircraft, only general guidance is presented.

Aircraft manufacturers publish specic guidance on cross-

wind techniques in their respective ight crew training man-

uals, which take precedence. The following considerations

may supplement existing recommendations:

Crosswind during takeo:

■

Initial runway alignment and smooth symmetrical thrust ap-

plication result in good crosswind control capability during

takeo. For some types of aircraft, a rolling takeo procedure

may even be advised in certain crosswind or tail wind con-

ditions to avoid engine surge. To support their ight crews,

it might be helpful to inform ANSPs (e.g., via participation

in local runway safety teams) about such a necessity, order

to allow appropriate trac spacing in such conditions and

increase awareness and knowledge among ATCOs of specics

in aircraft operation.

■

Especially in wet or slippery runway conditions, special

attention should be paid to ensure the engines are spool-

ing up symmetrically before advancing the thrust levers

further for takeo. Light forward pressure on the yoke or

side stick increases nosewheel steering eectiveness. Any

deviation from the centreline during thrust application

should be countered with immediate smooth and posi-

tive control inputs. Aircraft operators’ documentation and

training should therefore also cover the use of nosewheel

steering, especially with regard to whether and to what

extent the use of a tiller is recommended during the initial

takeo run.

■

Aircraft operators’ SOPs and training should ensure that

their ight crews’ TEM brieng for departure covers cross-

wind considerations for both normal and non-normal sit-

uations. Flight crews can set their own crosswind limits for

their takeo, depending on other threats like their pro-

ciency, experience, fatigue or runway state and can also

gain awareness of the expected wind correction angle

after lifto or options for aircraft position in the event of

a rejected takeo associated with re or smoke situations.

Crosswind during approach:

■

Depending on the orographic or weather situation on

approach, high crosswind situations may be accompanied

by a changing wind prole from the start of the approach

until landing. Aircraft operators’ SOPs and training should

therefore incorporate guidance for their ight crews to

establish nal landing conguration early on. This ena-

bles them to concentrate on their tracking, consciously

perceive wind information and gain awareness of their

margin for possible wind limits without being distracted

by conguration changes or checklist reading.

■

Aircraft manufacturers consider several factors such as

aircraft geometry, aileron and rudder authority when rec-

ommending a crosswind approach technique. This can be

the wings-level or crabbed approach, the steady sideslip

approach or a combination of both in strong crosswind

conditions. Aircraft operators’ documentation should in-

clude SOPs on disconnecting the autopilot at an appro-

priate altitude to allow their ight crews sucient time

to establish manual control of the aircraft well before the

de-crab phase and are.

Crosswind during landing:

■

Aircraft operators’ SOPs and training should highlight

that on wet or contaminated runways in particular, a

rm touchdown is recommended to minimise the risk

of aquaplaning and ensure a positive touchdown. When

touching down with a residual crab angle on a dry runway,

the aircraft automatically realigns with the direction of

travel down the runway. This does not happen on a wet

or contaminated runway.

■

A residual crab angle on the runway also has some impli-

cations when reverse is selected. In the event that a lateral

control problem occurs in high crosswind landings, ight

crews might have to reduce reverse thrust to reverse idle

and release the brakes to correct back on the centreline. This

will minimise the reverse thrust side force component and

provide the total tyre cornering forces for realignment with

the runway centreline. Aircraft operators’ documentation

and training should also cover the use of nosewheel steering,

especially with regard to whether and to what extent the

use of a tiller is recommended during the nal landing run.

■

Stable approach criteria have to be met throughout the

stable gate until touchdown. As crosswind situations, es-

pecially in combination with gusts and turbulence, may

easily lead to lateral or vertical path deviations, it is of ut-

most importance that aircraft operators’ SOPs and training

for the PM lead to eective monitoring and intervention

behaviour, irrespective of rank and experience. Their SOPs

and training should also highlight that a go-around is always

the favoured option instead of taking over control (e.g., by

the pilot-in-command [PIC]) in order to force a landing. Their

classroom and simulator intervention training should cover

various situations during approach and landing requiring

intervention by the PM. This should include mandatory call-

outs, go-arounds from various stages of the approach and

Global Action Plan for the Prevention of Runway Excursions 71

landing — even during touchdown (as long as reversers are

not deployed) — as well as taking over control by the PM

in order to perform a go-around, if necessary.

2.9 Technical solutions helping to

prevent runway excursions (OPS 4)

Why should aircraft operators follow this

recommendation?

There are generally two types of runway excursion events:

those that happen in non-normal operation (e.g., due to an

aircraft malfunction like a brake or gear failure), and those

that happen in normal operation, meaning with technically

fully operational aircraft and no (impending) abnormal or

emergency situation. Abnormal events are sometimes almost

impossible for ight crews to foresee and prevent, making

additional technical solutions barely eective. However, those

events which occur in normal operation could be to a large

extent eectively prevented by appropriate safety-relevant

decision-making on the part of the ight crew. In normal op-

eration, ight crews always have the option to make more risk-

averse decisions (e.g., delay their takeo, go around or divert).

Additional supporting systems like an airport moving map

(AMM), industry solutions such as the runway awareness and

advisory system (RAAS), runway overrun awareness and alert-

ing system (ROAAS), or a head-up guidance system (HGS) can

have a positive inuence on ight crews’ situational aware-

ness and risk perception, thereby improving their safety-

relevant decision-making (see Figure 7).

Some automated systems such as RAAS provide aural and/

or visual alerts when approaching a runway, when a runway

is too short or when stabilised approach criteria are being

violated (e.g., too fast, too high). Some systems like ROAAS

are recognised safety nets (now mandated in Europe begin-

ning in January 2025 for new aircraft) providing an alert in

ight and on the ground when there is a risk of not being

able to stop within the available landing distance, thus ad-

vising to either go around when still possible, or to deploy

on the ground all deceleration means. The use of a head-up

Recommendation OPS 4: The aircraft op-

erator should incorporate appropriate tech-

nical solutions to reduce runway excursion

risks, where available (including ROASS,

and runway veer-o awareness and alerting

systems, when and if available). If technical

solutions are not available, operators should

implement appropriate SOPs and TEM strate-

gies which support ight crews in eectively

preventing runway excursions.

Figure 7. Example synthetic vision system

Courtesy of Honeywell

72 Appendix C — Aircraft Operators

guidance system for all approaches may help the ight crews

in their decision-making as well because most HGS provide

for a 3-degree slope indication, indicate the ight path and

have a guidance line for the touchdown point. Using HGS for

all approaches may assist the ight crews in ying stabilised

approaches. This is especially true for visual approaches when

no vertical guidance (e.g., instrument landing system [ILS],

precision approach path indicator [PAPI], visual approach

slope indicator [VASI]) is available. Most HGS systems also

have the feature showing the runway remaining after touch-

down. Note also th at some synthetic visions systems (SVS)

also incorporate similar energy management cues on head-

down displays such as the primary ight display (PFD) (e.g.,

ight path vector, acceleration and speed cues, ight path

reference line, runway distance remaining).

What can aircraft operators do to implement the

recommendation?

As not all aircraft are already tted with such systems in their

basic conguration, aircraft operators will have to make joint

business and safety cases to decide on additional investment.

When considering the topic of technical solutions for the

prevention of runway excursions, the following may support

the decision-making process:

Aircraft operators should make themselves aware of the tech-

nical solutions currently available or which might become

available in the near future. The active involvement of their

pilot workforce will help to determine which technical solu-

tions might be helpful in daily practice. Aspects to be con-

sidered are the experience and prociency level of the pilot

workforce, the number of complex and challenging airports

(e.g., with short or multiple runways, steep approaches) and

the amount of operational pressure on the ight crews (e.g.,

during high/frequent/tight schedule operations) in the route

network which may suggest a benet of additional safety

investments.

■

When installingadditional technical solutions,their use

should be clearly documented in the company procedures.

The documentation should also contain any useful back-

ground information to enable ight crews to understand

the limitations of such systems. In addition, provisions

for appropriate pilot training for the introduction of new

technical solutions will need to be addressed.

■

Irrespective of the technical solution, and especially if no

such technical solutions are available for a particular air-

craft to aid ight crews in preventing runway excursions,

the most important measure to ensure runway excursion

prevention is to support the ight crews in the defensive

management of threats by means of appropriate policies,

SOPs and training. Therefore, operators’ SOPs and brieng

procedures should focus on making it easy for ight crews

to gain complete awareness of threats to their operation

and provide them with the power and freedom to take

defensive decisionswithout operational pressure. Further

information can be found throughout the document. An

example of a threat/hazard awareness checklist to in-

crease ight crews’ awareness of threats can be found

on Figure 8 (p. 73).

2.10 Flight data monitoring (FDM) and

other means of detecting runway

excursion risks (OPS 2, 31, 33, 35)

Why should aircraft operators follow this

recommendation?

Flight data monitoring (FDM) can be a very helpful and eec-

tive tool for enhancing safety. Especially in regard to runway

Recommendation OPS 2: Aircraft operators

should include and monitor aircraft param-

eters related to potential runway excur-

sions in their Flight Data Monitoring (FDM)

programme. Whenever standardised FDM

markers are provided by the industry, aircraft

operators should use them with priority to

ensure the eectiveness of risk mitigation

and safety assurance associated with runway

excursion barriers and to allow comparability

on an industry level.

Recommendation OPS 31: Aircraft opera-

tors should monitor go-around policy com-

pliance through their FDM programmes and

establish go-around safety performance in-

dicators (SPIs) for monitoring through their

SMS. In addition to monitoring go-arounds,

aircraft operators should also monitor discon-

tinued approaches.

Recommendation OPS 33: Aircraft oper-

ators, for aircraft equipped with EFBs and

when technically feasible, should systemat-

ically compare the EFB takeo performance

loggings with the relative FDM data to iden-

tify the takeo runway excursion risks.

Recommendation OPS 35: Aircraft oper-

ators should consider observational proce-

dures (e.g. Line Operations Safety Audits) to

identify runway excursion safety risks pre-

cursors and best practices which cannot be

captured by the traditional reporting or FDM.

Global Action Plan for the Prevention of Runway Excursions 73

excursion prevention, aircraft operators can use it to track rel-

evant safety performance indicators (SPI) such as go-around

rates from unstable or discontinued approaches or precursors

leading to unstable approaches. Setting runway excursion–

related SPIs for both takeo and landing helps operator’s

management to ensure safety performance.

Another option providing useful data to assess an aircraft

operator’s runway excursion risk is the use of line operations

safety audits (LOSA). As with FDM, data collection depends

heavily on ight crews’ trust in and buy-in to the tool. To

help them introduce and carry out a LOSA project, aircraft

operators may choose to use International Civil Aviation Or-

ganization (ICAO) Doc 9803 as guidance material.

What can aircraft operators do to implement the

recommendation?

The main objective when using FDM, LOSA or other tools in

the context of runway excursion prevention is to gain aware-

ness of precursors for runway excursion risks in aircraft op-

erators’ operations. The focus of attention should therefore

be on nding safety issues associated with takeo, approach

and landing operations. The following proposals may help to

set up the tools properly:

Figure 8. Example threat/hazard awareness checklist

THREAT / HAZARD AWARENESS TOOL

Departure Threat/Hazard Awareness

DEP AIRPORT

CAT: A B C

GROUND OPS & TIME

WEATHER

 p / LARGE SCA LE WX?

TOPERF / SID & HUMAN FACTORS

RWY / SID / TO PERF CHAN GE?

EO / EMERGENCY RETURN

FACILITIES

GND HANDLING

WIND

RWY: INT:



N/A MATOW:



MTOW

EO SI D



NCF / OPS HRS RESTRICTED

 NO ILS / RNP APP (lighting?)

 NO D-ATIS / NO MRC

 RCFF< 7 / PCN restricted

 LOWEST T/O MINIMA > 400m

 AOI / CCI RELEVANT



NOTAM RELEVANT



T/A < 50min / LATE CREW ARR

 SECURI TY SEARCH r equi r ed

 STAFF / EQPMT. missing (s hi ft?)

 PUSHBACK DELAY pr oba bl e

 RAMP / TWY CONGESTION

 DE-/ANTI -I CI NG requi red



APU-LI M:

 N/A min (gnd ai r?)



VARIABLE / CALM WINDS

 CWC / TWC (a c t. limit ? trend ?)



WI N D >1 5k t

(ops restrictions?)

 GUSTS (orography or roll cloud?)

 WI ND-SHEAR / LLWS (sa fe t/o?)



LAND / SEA WIND EFFECTS



W.-CHANGE ALOFT

(twc? wca?)



INTSCT. T/O

(line-up / tora / view?)

 RWY - TORA<2500m (oppos. td z?)



RWY - WET / DAMP (realist.ba?)

 RWY - SLIPPERY / CONTAMIN.

 RWY - SLOP E (uneven rwy ? bi rds?)

 RWY - WIDTH <40m (cwc? loa d?)



W/S TOPERF REQ. (

wx / rwy / g w?)



HEAVY / LOW GW

(rotat io n / eo?)

 A/C - SYS. MALF. / MEL-OPS



A/C - DIFFERENCES (1F MC? CB N?)

 BLEED / FLAP SETTING special

 NADP 1 OR SPEC. /  V1/R > 4 kts

 STO P MARGIN < 200m (line-u p? )



CWC / TWC

LIM:  25 / 0



EOSID - SID DEV. PRIOR 400’

 EOSID - COMPLEX (wca? navs?)

 EOSID - EARLY TURN (mrva? )

 EOSI D - OPPO SI TE TO SID

 EOSID - LATE ACCEL. (msa? turn? )

 EOSID - WX / TFC / TERR critical



EOSID - EO ON SID CRITICAL

ATC / NOISE

TAXI -OUT

CLOUDS / VISIBILITY

SID: RNAV: B P RNP: 1 2

EMERGENCY RETURN

 CHALLENGI NG / DIFFICULT ATC

 HI RO / MRO T / RR S M

 PARALLEL / X-ING RWYs

 SI NGLE RWY / CONGEST. OPS

 SINGLE / REM O TE / NO ATC

 HIGH TA / LATE HANDOVER



NADP / COMFAIL special

 SHORT / LONG TAXI-ROUTE

 BACKTRACK required

 RWY CROSSI NG req ui r ed

 SLIPPERY POS / APN / TWY

 MARKINGS / LIGHTING / LOVIS

 HOTSPOTS / WI P / VEHICLE TFC



INBOUND TFC / T/O QUEUE

 DARKNESS SR/SS:  n/a

 SUN POSITION (sid turns?)

 VISIBILITY < 5000m (trend?)

 LOW SP R EAD (mist / fog?)

 LOW CLOUDS (<1000’? / rtn app?)

 PRECIPITATION (wiper? c ontam.?)



CB / TCU / THERM. (t/o / sid / cl b?)

 RTE 2 REQ (rwy / si d / sfx c hange? )

 NO IMM. T/O (atc-unable info!)

 T/O NEAR MINTOF (t/o queue?)

 UNEVEN RWY / NO RCLL

 SPACING / WAKES / LLTURB.



BIRDS / VFR / DRONE (360view?)



F/D OFF / R. DATA

/ M.T H R .

 S I D-COM P LEX (early a/p? exp. wca?)

 SID-EARLY TURN (sun pos.? m rva?)

 SID-EARLY LVL-OFF (ea rly a/ p? )

 SID-PDG > 3,3%

(able? nad p?)

 SID-OPPOS. TFC (early a/p / v/s?)

 SID-WX c ri tical (cb, tcu ts, w/s, ice?)



WX-RADAR / WIPER REQ.

 RTN - RWY  DEP RW Y

 RTN - NO VIS RTN / OPP. LDG

 RTN - OVERWT (max t/d v/s? ldr?)



RTN - LDA < 2500m

 RTN - WX / TFC / TERR critical

 RTN - NO ILS/RNP (exp. app?)



RTN - APP: EO G/A special

ENVIRONMENT

RESTRICTIONS

ADVERSE WX

HUMAN FACTORS

T/O ALTERNATE



N/A

 TERRAI N cri tical (high. obs tacle?)

 HI GH ELEVATION (toperf?)

 LOCAL WIND / WX PHENOM.

 WATER IN VC (ponds / sea?)

 BIRDS (flocks? mig rat io n tim e? )

 VFR / DRONE TFC (contro lle d?)



PEAK / HUB TFC (wk/time of day?)

 DELAY / EET ≥ PL.BT / ACSCHED.

 HOT BRAKES / SHORT T/A

 DEP-NCF / RTD (outbound tfc?)

 DEST-NCF / RTA / DBC-DLY

 FDT / RT MARGIN < 2h

 SNOW REMOVAL proba bl e



H.O.T LIMITED (precipitat. tren d?)

 INCOMING WX (remain. time?)

 WX TREND DETERIORATING

 TURBULENCE ON SID / CLB

 THUNDERSTORM (vc? embd?)

 ICING / HAIL / +SN / VA / SA



OAT <10° (cold wx ops? )



OAT >30° / TEMP INVERSION

 FATIGUE / FITNESS (crew?)

 AWAKE > 10h (time in wocl?)

 EMOTIONAL / STRESSED

 PERCEIVED TIME PRESSURE

 PROFICIENCY (self o r cre w)



COMPLACENCY / ROUTINE



IDLE TIME / DISTRACTION

 NEAR LIMIT OPERATION



UNFAMI LIAR AIRPORT / VARI ANT

 WORK-ERROR(S) > 2

 WORK ATMOSPHERE



SPORTY / SLOPPY ATTITUDE

 LOW ROLE / TYPE EXPERIENCE



TRAINING / CHECK / OBS FLT



ALT - NO ILS/RNP (exp. app?)



ALT - LDA < 2500m

 ALT - WX / TFC / TERR cri tical

 ALT - NOTAM rel evant

 DI V - RTE WX / ICE / TERR (mfa?)

 DIV - RTE TFC / VFR / SUA



DI V - EET > 30mi n

Arrival Threat/Hazard Awareness

DEST. AIRPORT

CAT: A B C

ARRIVAL & TIME

WIND-PROFILE?

WEATHER

 p / LARGE SCA LE WX?

LANDPERF / APP / LDG & HUMAN FACTORS

RW Y / APP CHAN GE?

GO-ARO UND / DIVERSI O N

FACILITIES DESCENT WIND RWY: W.ADD:  +5 MALW:  MLW OLD:  < 20000m GO-AROUND



NCF / OPS HRS RESTRICTED

 NO ILS/RNP APP (light ing?)

 NO D-ATIS / NO MRC

 RCFF< 7 / PCN restricted

 LOWEST APP MINIMA > 550m

 AOI / CCI RELEVANT



NOTAM RELEVANT



DES - EARLY / STEP-WISE

 DES - TFC (belo w / s low / op pos ite?)

 DES - TWC / WIND CHANGE

 DES - TURB / WX (cat / cb/tcu / ice )

 CABIN NOT READY YET

 TRANSITION / HOLDING



SNOW REMOVAL probabl e

 VARIABLE / CALM WINDS

 CWC / TWC (act. limit? trend?)

 WI ND >1 5k t

(ops res t ri ct ions? )

 GUSTS (orog rap hy or ro ll clou d? )

 WI ND-SHEAR / LLWS (safe ldg?)



LAND / SEA WIND EFFECTS



W.-CHANGE ALOFT

(twc? Wca?)

 DISPLACED THRHLD (lda? vis.ill.? )

 RWY - LDA < 2500m (tpl? mgn?)



RWY - WET / DAMP (realist.ba?)

 RWY - SLIPPERY / CONTAMIN.

 RWY - SLOP E (uneven rwy? flare?)



RWY - WIDTH < 40m (cwc? )



RWY - FL15 LDG DIST. LIMITED



HEAVY / LO W GW (config timing?)

 A/C - SYS. MALF. / MEL-OPS



A/C - DIFFERENCES (1F MC? CB N?)

 BLEED / FLAP SETTING special

 REVERSE / MAX MANUAL BRK

 STO P MARGIN < 200m (tpl req.?)



CWC / TWC

LIM :  33 / 15

 G/A - EARLY TURN (wx / sun?)

 G/A - EARLY LVL OFF (tfc?)

 G/A - WX / TFC / TERR critical



G/A - PROFICIENCY / RAW DATA

 G/A - GRADIENT > 2,5%

 G/A - SPEC. EO G/A REQ.



BALKED LDG SPECIAL

(eosid?)

ATC / NOISE

TAXI-IN

CLOUDS / VISIBILITY

APP: RNAV: B P RNP: 2 1 .3

DI VER SION

 CHALLENGI NG / DIFFICULT ATC

 HI RO / MRO T / RR S M

 PARALLEL / X-ING RWYs

 SI NGLE RWY / CONGEST. OPS

 SINGLE / REM O TE / NO ATC

 HI GH TL / LATE HANDOVER

 NADP / COMFAIL special

 SHORT / LONG TAXI-ROUTE

 BACKTRACK required

 RWY CROSSI NG req ui r ed

 SLIPPERY HST / TWY / APN/POS

 MARKINGS / LIGHTING / LOVIS

 HOTSPOTS / WI P / VEHICLE TFC

 SMALL / CROWDED APRON

 DARKNESS SR/SS:  n/a

 SUN POSITION (app / g/a / turns?)

 VISIBILITY < 5000m (trend?)

 LOW SP R EAD (mist / fog?)

 LOW CLOUDS (<1000’?)

 PRECIPITATION (wiper? c ontam.?)



CB / TCU / THERM (des / app / ga?)

 RTE 2 REQ (rwy / ap p / sfx c hange?)

 FMC  IAC / NO FMC DATA

 G/P INTCPT: < > 9NM FINAL

 G/P > 3° (v/s >1000?, ea rly conf.?)



TWC ON FINAL (wind-cha nge?)

 I AN / L/V-NAV (g/s-off? gps? rnp?)



F/D OFF / RAW DATA (wca? p/ p?)

 NO FULL LIGHTI NG / BLACKHOLE

 PAPI  G/P / IMPAIR. or NO PAPI

 BARO  RA (rising / falling terrain?)



VISUAL ILLUSION / SUN-BLI ND.

 TURBULENCE < 1 000’ / W AKES

 TDZ LOW DENS. / C/O CONGEST.



WX-RADAR / WIPER REQ.

 EXTRA FUEL < 10 MIN



NO 2. G/A OPTION

 NO OPTION TO STAY



DIV RTE - WX / ICE / TERR (mfa?)

 DIV RTE - TFC / VFR / SUA

 DIV RTE - NO DIRECTS AVAIL.



DIV RTE - EET < 15 MIN

ENVIRONMENT

RESTRICTIONS

ADVERSE WX

HUMAN FACTORS

DEST. ALTERNATE(S)

 TERRAI N cri tical (high. obs tacle?)

 HI GH ELEVATION:

 LOCAL WIND / WX PHENOM.

 WATER IN VC (ponds / sea?)

 BIRDS (flocks? mig rat io n tim e? )

 VFR / DRONE TFC (contro lle d?)

 PEAK / HUB TFC (wk/time of day?)



DELAY / POS OCCUP / ACSCHED.

 NEXT T/A < 50min / AC CHANGE

 DEST-NCF / RTA / DBC-DLY

 DEP-NCF / RTD (outbo un d tfc?)

 FDT / RT MARGIN < 2h

 APU-LIM:

 N/A min (gnd ai r?)



PROCEED. AFT / IMM / CUSTOM

 INCOMING WX (remain. time?)

 WX TREND DETERIORATING

 TURBULENCE IN DES / APP

 THUNDERSTORM (vc? embd?)

 ICING / HAIL / +SN / VA / SA



OAT <10° (cold wx ops? )

 OAT >30° / TEMP INVERSION

 FATIGUE / FITNESS (crew?)

 AWAKE > 10h (time in wocl?)

 EMOTIONAL / STRESSED

 PERCEIVED TIME PRESSURE

 PROFICIENCY (self o r cre w)



COMPLACENCY / ROUTINE



IDLE TIME / DISTRACTION



NEAR LIMIT OPERATION



UNFAMILIAR DEST / D.ALT

 WORK-ERROR(S) > 2

 WORK ATMOSPHERE



SPORTY / SLOPPY ATTITUDE

 LOW ROLE / TYPE EXPERIENCE

 TRAINING / CHECK / OBS FLT

 D. ALT - NO ILS/RNP (exp. app?)



D. ALT - LDA < 2500m

 D. ALT - WX / TFC / TERR cri tical

 D. ALT - NOTAM relevant

 D. ALT - MIN. FUEL ON APP

 D. ALT - NCF / PARKING limited

 D. ALT - OPS / HOTAC limited

74 Appendix C — Aircraft Operators

■

Aircraft operators should target a 100 percent coverage

of ights by their FDM programme. Precursors for run-

way excursion events might be relatively rare and missing

some may easily distort the understanding of an aircraft

operator’s actual risk.

■

Aircraft operators should consider using industry best prac-

tices on FDM (e.g., as described by the EOFDM forum, a

voluntary and independent safety initiative). Aircraft op-

erators thus have the option to obtain precursors which

have already been subject to a risk-based analysis, receive

additional information on their implementation, or com-

pare their operation with that of others in order to share

lessons learned and mutually improve their operations. The

EOFDM’s work

provides a list of precursor factors for several

types of runway excursion accidents and several ight data

measurements. In total, the report lists 34 precursors for

runway excursion and more for other high-risk events which

can be used to develop safety performance indicators.

■

Aircraft operators should be transparent and promulgate

among their pilot workforce relevant material on FDM,

LOSA or other data collection tools. They should explain

and make clear which precursors and methods aircraft

operators use and what their targets are. This enhances

trust in aircraft operators and their FDM. In a healthy and

positive safety culture, FDM can then even serve as an

individual feedback tool for their ight crews. Insights

gained can be used for simulator and classroom CRM/

TEM/accident prevention training as well.

2.11 The use of data-link systems (OPS 5)

Why should aircraft operators follow this

recommendation?

Preventing runway excursions is primarily a matter of ight

crews’ safety-relevant decision-making. This, in turn, requires

that all pilots on the ight deck possess a shared and realistic

mental picture of the actual and expected environmental

conditions for takeo and/or landing, such as weather and

runway conditions. In order to enable ight crews to receive

https://www.easa.europa.eu/domains/safety-management/safety-promotion/european-operators-ight-data-monitoring-eofdm-forum#group-easa-

downloads

this information on time for use in their briengs and result-

ing decision-making (e.g., in the event of an (impending)

runway change), it should be made as easy as possible for

them to obtain and understand such information. Voice

only methods (e.g., VHF-ATIS or meteorological information

for aircraft in ight [VOLMET]) can be time-consuming and

error-prone due to impaired VHF-reception and dierences

in handwriting quality. This method should therefore only

be used as a backup solution. Using digital means (e.g., via

ACARS or the Internet) simplies the process of information

gathering and ensures that the information documented is

not outdated, misunderstood, wrong or illegible.

Moreover, the use of data-link systems allows the ight crew

to obtain current weather information without a single pilot

losing situational awareness. It also allows for an improved

follow-up in a rapidly changing weather environment, there-

by again enhancing the ight crew’s awareness and deci-

sion-making. By requiring all ight crew members on a ight

deck (e.g., on enlarged ights) to familiarise themselves with

the actual and expected conditions, their potential to detect

and correct unsafe situations (e.g., failing to go around if re-

quired) can be increased as additional ight crew members

(e.g., supernumerary or enlarged crew) are able to monitor

the active ight crew’s decision-making with regard to the

actual conditions and can also intervene, if required.

What can aircraft operators do to implement the

recommendation?

■

If not already implemented, aircraft operators should con-

sider a business case for the investment in digital means

for weather information reception on the ight deck. This

should be underpinned by a realistic safety case or risk as-

sessment taking into account aspects such as route prole,

age structure of the pilot workforce, etc.

■

When installing data-link systems, their use should be

clearly documented in the company procedures. The pro-

cedures should also contain limitations on phases of ight

during which data-link systems should not be used by the

active ight crew (e.g., during the nal approach phase).

■

In general, procedures or policies may require the active

ight crew to share safety-relevant information with observ-

ers or additional crew members on the ight deck, provided

they are judged as qualied, and invite them to support and

monitor the active ight crew’s decision-making. Digital

means may facilitate that ight crews use this option.

■

In the event that aircraft operators consider not provid-

ing the technical means to print the digitally obtained

weather/airport information, specic procedures should

be implemented ensuring continuous monitoring of the

aircraft and its ight path by at least one pilot, while the

other familiarises him/herself with the information, espe-

cially if the presentation format of the weather information

on the display unit makes it hard to read or understand

Recommendation OPS 5: If technically fea-

sible, aircraft operators should equip their air-

craft eet with data-link systems (e.g. ACARS)

enabling them to digitally obtain the latest

weather information (e.g. D-ATIS or METAR).

The use of this technical means has to be sup-

ported by adequate SOPs enabling all pilots

on the ight deck to familiarise themselves

with the latest weather conditions without

impeding aircraft and ight path monitoring.

Global Action Plan for the Prevention of Runway Excursions 75

(e.g., ATIS information being meshed or covering several

pages on an FMS control display unit [CDU]).

2.12 Check of current conditions versus

planned conditions (OPS 10)

Why should aircraft operators follow this

recommendation?

Runway excursions, and runway overruns in particular, are of-

ten caused by more than one factor.

These include, among

others, tail winds, long landings, high touchdown speeds, late

or inappropriate use of reverse thrust or speed brakes, and

reduced runway friction or contamination. For the prevention

of runway excursions, it is therefore of utmost importance that

the environmental conditions and aircraft conguration used

during the takeo and landing performance calculations are the

same as the actual conditions during takeo and landing. Oth-

erwise, the actual takeo or landing might be conducted with

signicantly reduced or even no safety margins (e.g., if there is

a tail wind instead of no wind or a head wind, runway status is

worse than calculated, autobrake is used instead of maximum

manual braking or idle reverse is used instead of maximum

reverse thrust as assumed in the performance calculations).

What can aircraft operators do to implement the

recommendation?

■

Make sure (e.g., by means of appropriate training and easy-

to-use and understandable documentation) that ight

crews and operations sta (when doing performance

calculations) know exactly what they are calculating with

regard to the safety factors used and assumptions made

by the performance calculation program or tables.

■

Allow ight crews and operations sta to make conservative

calculations based on their knowledge and experience (e.g.

incorporating changes in wind, temperature, QNH, runway

status), even if this might lead to operational restrictions

(e.g., diversions, reaching ight duty time limits). At the

actual time of departure or arrival, weather conditions can

https://www.iata.org/en/publications/safety-report/

be dierent from those at the time of dispatch or even

from those at the time of the approach brieng. Although

it might be commercially sound to use exact environmental

parameters at the time of calculation, this might, in reali-

ty, lead to takeos or landings with reduced or no safety

margins. The following list may be used as a guideline to

cope with this threat. Implementation will make it easier

for ight crews to assess their actual safety margin shortly

before takeo and landing, thereby avoiding time consum-

ing re-calculations, unnecessary go-arounds or diversions:

›

In headwind situations, ight crews may be allowed

to do performance calculations based on zero wind.

›

In calm or variable wind situations, ight crews may

use a minimum of 5 kts tailwind for their calculations.

›

If a variable range of wind direction is given (e.g., 330/5

300V360), ight crews should use the most negative

value for the given runway direction.

›

In tail wind situations, ight crews may consider eects

causing increasing tail winds (e.g., by incoming weather

or land/sea wind eects).

› For every takeo, ight crews may search for cues (e.g.,

operational ight plan wind information at SID way-

points, trails of smoke or clouds, PIREPs) to estimate the

wind aloft to get an idea of possible wind shifts (e.g., to-

wards tail wind) aecting the takeo path or their EOSID.

›

Gross weight and temperature values used for calcu-

lation should reect actual or realistic numbers at the

time of break-release or touchdown (e.g., actual takeo

weight [TOW] higher than load-sheet value due to short

taxi-out or higher landing weight [LW] due to shortcuts

on approach).

■

During their TEM brieng, ight crews should pay special

attention to signicant changes or trends in wind direction

and/or runway surface conditions (e.g., due to incoming

or deteriorating weather situations). They should try to

anticipate relevant changes as early and as comprehen-

sively as possible. Options which might help to gain the

necessary awareness may include, in addition to ATIS or

METAR information, to ask for PIREPs or ATC information,

or even to use certain smartphone weather apps providing

more detailed weather information (if approved by the

operator). If it is foreseeable that operational limits will be

reached (e.g., wind or runway contamination limits) they

should discuss alternatives for their departure or landing

as well as dening their acceptable limits, if dierent from

published limits. (see OPS 11).

■

When approaching the runway, either before takeo or

before landing, ight crews should mention any updates

to their takeo or approach brieng focussing on possible

dierences to the planned versus actual conditions.

■

Ensure through SOPs and training that ight crews always

verify (and possibly call out) before line-up that they have

Recommendation OPS 10: Aircraft oper-

ators should implement policies or SOPs

requiring ight crews to conrm prior to com-

mencing the takeo or landing phase that

the actual conditions (weather and aircraft

conguration) are better or at least corre-

spond to the values used for performance cal-

culations. When conditions are predicted to

approach operational limitations, ight crews

should be required to identify the limiting

parameters and incorporate this information

into their TEM brieng.

76 Appendix C — Aircraft Operators

identied and are using the correct runway, the correct

intersection and the correct line-up procedure, as used in

their takeo performance calculations (see recommenda-

tion OPS 27, OPS 28)

■

Ensure through SOPs and training that ight crews are

aware of the wind and runway conditions given with the

takeo or landing clearance and that they check that these

conditions are consistent with those used for the perfor-

mance calculations.

■

Flight crews should check the latest weather information

before their in-ight landing distance assessment is con-

ducted. If sucient time remains and cockpit duties allow

it, crews should always try to get the latest available weather

information just prior to starting the approach. If during

the approach, the crews feel that the weather conditions

have changed, they may seek clarication on the actual

conditions with the ATCO.

Global Action Plan for the Prevention of Runway Excursions 77

Recommendation OPS 13 a: Aircraft op-

erators should ensure their policies or SOPs

require ight crews to perform independent

performance calculations. This should also

include independent cross-checks of the load

and trim sheet and the actual TORA/TODA

from the AIS (e.g. if reduced by NOTAM) with

TORA/TODA used to calculate the takeo

performance. This independent calculation

should also be applied following a runway

change.

Recommendation OPS 13 b: Aircraft op-

erators should ensure their policies or SOPs

include ight crew gross error checks and

crew cross-checks prior to any data input and

prior to executing any data input in the FMS.

Recommendation OPS 34: Aircraft oper-

ators, for aircraft equipped with EFBs and

when technically feasible, should visualise

on the EFB the FULL RWY with its planned T/O

RWY holding position to increase the situa-

tional awareness of the crew for the intended

T/O position.

3 Special considerations for the departure phase

Nudges are interventions that preserve the freedom of choice but that nonetheless inuence people’s decisions.

3.1 Takeo performance and the use of

EFB (OPS 13, 34)

Why should aircraft operators follow this

recommendation?

Many runway safety events stem from erroneous or inade-

quate takeo performance calculations and errors made dur-

ing transfer and input of data into the FMC. Such errors are all

preventable if ight crews are supported by customised SOPs,

appropriate training and a safety-focussed work environment.

Load and trim sheet as well as takeo performance calcu-

lations are usually performed just before departure when

the ight crew is exposed to various distractions. Therefore,

the eective prevention of errors in takeo performance

calculations very much depends on the ability and freedom

of the ight crew to safely manage external threats like time

pressure, distraction or fatigue.

A rst step in preventing runway excursion is a critical check

of the load and trim sheet data, irrespective of whether it

is provided by a third party or generated in the cockpit by

the ight crew. Only if a check is carried out to ensure that

the load and trim sheet values match reality in terms of

passenger/baggage/cargo weights, seating and load distri-

bution, including a check of the pre-dened values such as

dry operating weight/index and takeo, trip and taxi fuel, and

all resulting values are within the allowed limits, can this data

serve as the basis for takeo performance calculations. This

check should always be done independently by all active crew

members on the ight deck. For the following calculation of

takeo performance either using electronic means such as

EFB solutions or paper versions, it is again highly recommend-

ed that all active crew members on the ight deck verify their

own performance calculations independently and then cross-

check them with each other, even if this is time-consuming.

EFB solutions incorporating navigational charts and ap-

plications for ight planning such as takeo and landing

performance calculation programs are already widely used

in the industry as they not only save costs but also can sim-

plify processes for ight crews (e.g., by making performance

calculations easier and faster). However, their use requires

up-to-date and accurate databases as well as an adequate

user interface. If threats like runway shortenings, intersection

closures, etc., are not incorporated in time into the database

used for performance calculations, the probability of the

ight crew failing to detect such errors is high, especially

as current NOTAM format and presentation in aviation in

combination with fatigue, time pressure or complacency

may lead to ight crews sometimes not reading or checking

NOTAM information properly.

In order to make it as easy as possible for ight crews to pre-

vent input errors (e.g., environmental or aircraft conguration

data) and as easy as possible to understand the calculation

results in terms of the safety margin provided for their take-

o, the EFB solution should incorporate nudges

(that may

be reminders such as pop-ups and triggers) and means of

visualisation. Visualisation in particular is a great tool to en-

able ight crews to easily build a correct risk picture for their

takeo in terms of runway excursion prevention. Being aware

of the additional stop margin resulting from their calculation

and being able to easily cross-check that the takeo position

and line-up procedure used for the calculation matches the

one expected or used is key for ight crews’ safety-relevant

decision-making (e.g., deciding on a re-calculation or accept-

ing or rejecting line-up clearances). If technically feasible,

visualisation of this information should therefore combine

results of performance calculations and airport layouts.

Regardless of whether an FMC or non-FMC equipped air-

craft is used, the subsequent process of setting the takeo

speeds (V

, Vr, V2) and respective engine parameters (e.g., N1,

Derate, Flex/AssTemp) or bug setting needs to be done in a

coordinated manner to reduce input error and allow eective

cross-checking. Again, these steps require an environment

78 Appendix C — Aircraft Operators

which allows safe management of distraction and time pres-

sure by the ight crew. There should be consensus in the

industry that safety considerations always take precedence

over time or eciency considerations. As correct takeo per-

formance calculations are one of the top priorities for runway

excursion prevention, ight crews should be encouraged by

aircraft operators to accept a departure delay, if required, in

order to always perform these tasks properly.

What can aircraft operators do to implement the

recommendation?

To enable awless and time-saving processes with load sheet

and takeo performance calculations in daily operation, air-

craft operators should put in place customised SOPs support-

ing their ight crews in eectively preventing or detecting

errors during calculation, cross-checks and data-input.

Below is some guidance on how this could be achieved:

■

In general aircraft operators should:

› Provide special guidance to cabin crew and handling

agents stipulating that they should not disturb ight

crews while they are performing load sheet perfor-

mance calculations, data insertions or briengs. This

could be achieved by incorporating relevant guidance

or regulations into service contracts with ground han-

dling companies and by making this matter a topic in

CRM training for cabin crews. Aircraft operators’ ight

crew CRM/TEM training should provide guidance on

how to mitigate the risks posed by distraction and time

pressure before departure.

›

Consider promoting safety reporting on frequent errors

by ight crews with regard to performance calculations

and use line check or LOSA data to detect aws in the

input design of EFB or EFB SOP. They should also use

their pilot workforce actively to nd the best SOP set

for their EFB solution in their operation.

› Ensure that EFB back-end processes are able to cover

safety-relevant changes to performance databases in

order to provide safe and valid data to the front-end

at all times.

› Use company NOTAMs or equivalent means to inform

ight crews and dispatch sta about short-term chang-

es to runway and performance data.

›

Use ‘highlighting or marking’ of relevant NOTAM in-

formation in ight preparation tools to make it easy

for their ight crews to detect safety-relevant changes

to runway data and ultimately detect errors in perfor-

mance databases more easily.

› Provide ight crews with sucient time for pre-ight

preparation in order to enable them to read and analyse

NOTAM information properly (consider establishing a

delay code for extended ight preparation).

■

Load and trim sheet

When designing the SOPs for preparing and cross- checking

the load and trim sheet, aircraft operators should consider

the following:

› All information which ight crews relay or use for pre-

paring the load and trim sheet (e.g., trip or load sheet

data information such as takeo, trip and taxi fuel, dry

operating weight/dry operating index [DOW/DOI])

should be cross-checked by the pilot who did not ll

in the form in question.

› Before the aircraft doors are closed, ground handling

sta, or equivalent, should be required to report to the

ight crew the nal number of passengers who went

through the departure gate (or nal load data in the

case of cargo ights) and the nal load distribution

as per information provided by the gate and loading

personnel (by intentionally not referring to the latest

edition of the load sheet) in order to make it possible to

detect any load sheet errors before departure. Timing

of ground processes and setting of turn-around times

should incorporate margin for error detection and clar-

ication in case of deviations.

›

At least the nal version of the load and trim sheet

should be checked independently by all active crew

members on the ight deck.

■

Performance calculation

When designing the SOPs for calculating safe takeo per-

formance, aircraft operators should consider the following:

›

Irrespective of the source of the performance data pro-

vided to aircraft operators, aircraft operators should en

sure that these data are correct and safe for use. This can

be ensured by eective auditing processes. However, if

aircraft operators are not using active ight crews which

have direct experience with the use of the audited EFB

solution as auditors, it is important to incorporate feed-

back and experience from line operation into the audit

checklists and brieng for the auditors. Otherwise, they

will not be able to detect aws in the use nor ensure

the unambiguity, clarity, validity and preciseness of the

performance data and EFB processes.

›

To allow ight crews to consider dierent scenarios

already in the takeo/TEM brieng, the aircraft oper-

ators’ SOP should require the ight crew to calculate

preliminary takeo performance prior to the brieng

using the most realistic and expectable values in terms

of gross weight and environmental conditions. In some

cases, it might also be necessary to consider assessing

the landing performance in case of immediate return or

to consider a takeo alternate. SOPs should require that

takeo performance calculations be performed prior to

the brieng with most realistic and expectable values.

›

In case of enlarged crews, aircraft operators should

consider how to incorporate the additional ight

crew members in the process of takeo performance

Global Action Plan for the Prevention of Runway Excursions 79

calculation, too, in order to ensure a best use of all re-

sources available.

›

Aircraft operators should ensure that the performance

calculation, its cross-check and the following steps for

preparing the aircraft for departure can be accom-

plished by the ight crew without rushing. Therefore,

timing of processes, denition of departure delay and

turn-around times should incorporate sucient mar-

gin to mitigate time pressure and hurry-up syndrome,

especially in cases when the nal load and trim sheet

is received only shortly before scheduled/planned de-

parture times.

›

The SOP for cross-checking the results of the calculation

should allow ight crews to carry out the cross-check

intuitively and easily. It should require ight crews to

check not only the results but also the input data, such

as aircraft tail sign, runway, intersection and environ-

mental and aircraft conguration data. The scan pattern

should be prescribed and follow an intuitively recog-

nizable reason.

› However, the use of cross-checks alone is often a weak

risk control measure to ensure that ight crews correctly

insert all relevant environmental and aircraft congu-

ration data. The inuences of fatigue, lack of procien-

cy, good SOPs or training, distraction or time pressure

may lead to inadequate cross-checks by ight crew.

Little nudges or triggers throughout the input process

are helpful and eective in ensuring that ight crews

make the correct inputs right away (e.g., a pop-up if

wet runway was selected together with a low outside

air temperature [OAT], but without engine anti-ice).

The following list of nudges/triggers might be useful:

• Pop-up for engine anti-ice;

• Pop-up for wind limits;

• Pop-up for weight limits;

• Pop-up for information on remaining stop margin;

and,

•

Pop-up for minimum equipment list (MEL) items

and considerations.

›

In cases where a class 1 EFB is used for the performance

calculation, each crew member should be provided

with an EFB to ensure proper independence of calcu-

lation and cross-check.

›

When using paper-based takeo performance cal-

culations, special considerations should be given

to readability of tables and charts and the need for

interpolation.

› In any case, the actual TORA/TODA, especially if being

altered by NOTAM, should be checked against the val-

ue used in the takeo performance program or table/

chart individually and independently by each ight

crew member. If it is not technically feasible to combine

the results of takeo performance calculations and

airport/runway layout in one visualisation, at least the

EFB solution should make it possible to visualise the

available stop margin in relation to the TORA. The SOP

should then require the ight crew to visually conrm

the runway and takeo position used during the cal-

culation on the airport layout chart and estimate the

available stop margin.

■

Data entry into the FMC

In order to ensure an error-proof SOP for transferring or

entering data into the FMC, aircraft operators should con-

sider the following:

› This data insertion is usually done just before departure

when the ight crew is exposed to various distractions.

Aircraft operators should encourage ight crews to be

assertive in not allowing themselves to be distracted or

feel time pressure when accomplishing this task.

›

The load and trim sheet data and the takeo perfor-

mance data can be entered via a single process or a

split process. In any case, the data input should be

performed by the pilots together in a concerted man-

ner to avoid errors like entering the zero fuel weight

(ZFW) as takeo weight/gross weight (TOW/GW), or

entering the wrong aps setting or takeo parameters.

Therefore, it is suggested that one pilot states the value

to be entered rst before the other pilot enters it into

the FMC. This allows for initial gross error checks for

plausibility (e.g., the ZFW, the TOW and fuel loaded).

Before executing the entry, the pilot who gave the value

should again conrm that it has been entered correctly

in terms of value and box/position in the FMC before

giving the execution command or signalling agreement

for execution.

›

SOPs which allow one pilot to enter nal weight or

performance values without supervision and cross-

checking should be avoided, even if single cross-checks

are used and the values to be entered are given by the

other pilot in any later step. Mutual entry and cross-

checks are more eective and thereby safer. They may

even save more time, especially in cases when errors are

made and new calculations/entries have to be made.

› In any case, each pilot should also be required to crit-

ically check the ‘reasonableness’ of the combination

of aps settings, takeo reference speeds and thrust

settings by using their experience and intuition. ‘Doubt

is a fact’ — if any pilot feels unsure about the values,

they should be recalculated, even if it takes time. Air-

craft operators should give special consideration to

this when operating mixed eets and should consider

providing their ight crews with guidelines or standard

values to make checking the reasonableness of takeo

data simpler.

› Wherever technically possible, cross-checks should be

performed between independently calculated values

80 Appendix C — Aircraft Operators

by the FMC and performance calculation tools, EFB or

paper-based (e.g., characteristic minimum manoeu-

vring speeds such as minimum clean speed).

› As a backup, aircraft operators should consider invest-

ing in safety by using technology that automatically

checks the data entered into the FMC for consistency

between the takeo parameters (e.g., takeo securing

(TOS) by Airbus).

Additional material is provided in the IATA “FMS Data Entry

Prevention Errors – Best Practices”.

■

(Late) changes

The same precautions and thoroughness in safe takeo

performance calculations as mentioned above are valid

in the event of any (late) changes. The following list pro-

vides an overview of situations requiring the ight crew

to recalculate and reinsert takeo performance data:

› Runway and/or intersection changes;

› Obvious environmental changes (e.g., wind, tempera-

ture, runway status);

› Unplanned selection of performance-inuencing sys-

tems (e.g.. anti-ice);

›

Prolonged idle time (e.g., in case of waiting time for

de-icing, slot, etc.);

›

Reasonable doubt of either pilot regarding the correct-

ness of the data;

› Load and trim sheet changes; and,

› Aircraft defects (e.g., MEL items).

■

Additional considerations

Flight crew training is based on monitoring and respond-

ing to the attainment of takeo reference speeds. How-

ever, crews have few options of detecting reduced or

degraded takeo acceleration until approaching the end

of the runway. Technology providers have an important

role to play in developing systems that provide alerts to

the ight crew when the actual acceleration is too low

in order to enable a safe takeo (e.g., takeo monitor-

ing (TOM) by Airbus. Furthermore, the FDM programme

should be used to identify issues in relation to perfor-

mance calculations, slow acceleration, etc. In the scope

of the SMS promotion, any issues discovered relating to

takeo performance calculations should be fed back to

the crews to raise their awareness and share the lessons

learned (e.g., study insights about increased passenger

weights, study insights on erroneous takeo performance

calculations or incident/accident examples).

(See OPS 8.)

https://www.iata.org/contentassets/b6eb2adc248c484192101edd1ed36015/fms-data-entry-error-prevention-ed-1-2015.pdf

3.2 The rejected takeo decision

process (OPS 14)

Why should aircraft operators follow this

recommendation?

Flight crews can prevent runway excursions during takeo

through proper takeo decision-making. This includes the

decision-making involved in both initiating and rejecting

a takeo.

Runway veer-os typically occur at low speed owing to a

ight crew’s mismanagement of the beginning of the takeo

roll (e.g., if ight crews mishandle the transfer of directional

control from tiller to rudder or between either pilots or if they

do not ensure symmetrical engine spool up before applying

takeo power.) This frequently happens during rolling take-

os, when ight crews are under actual or perceived time

pressure for reasons including actual time constraints such

as night curfews or slots or from perceived time pressure

resulting from ATC’s spacing.

Runway overruns are often the result of attempts to reject

a takeo above V1 (the maximum speed at which the pilot

must take the rst action to reject a takeo [e.g., apply brakes,

reduce thrust, deploy speed brakes]), errors in takeo perfor-

mance calculations or aircraft being aerodynamically unable

to y owing to loading errors or ice build-up. To guarantee

safe aircraft stopping within the calculated accelerate-stop

distance during a rejected takeo (RTO), it is of utmost im-

portance that the takeo performance calculations are made

using a conservative strategy or that they at least reect the

actual conditions during takeo in terms of aircraft weight

and runway status. Therefore, not only are the takeo speeds

key elements for a safe takeo, but also the ight crew’s

awareness of additional threats inuencing the available

stop margin in case of an abort, too. Factors like fatigue, lack

of prociency or possible distractions during the takeo run

(e.g., by radio/telephony [R/T] trac, emotional stress owing

to time pressure, pressure from ATC or a negative work at-

mosphere in the cockpit) may lead to incorrect recognition

of failures or delayed abort initiation.

The most important speed range for failure management and

takeo abort decision-making is the high-speed segment of

the takeo run, which is typically between 80 kts and 100 kts

(depending on the operator and aircraft type) and just before

V1. When rejecting a takeo near V1, a pilot’s reaction time to

Recommendation OPS 14: Aircraft opera-

tors should publish SOPs and guidance which

incorporate runway excursion mitigation

associated with rejected takeo decision-

making and rejected takeo manoeuvres.

Appropriate training should be provided.

Global Action Plan for the Prevention of Runway Excursions 81

initiate the stop is critical. Considering a typical medium to

large turbofan aircraft’s V1 is to150 kts, this would mean using

up the available stopping margin by a minimum of 80 m per

second of delayed abort initiation. Given the fact that today

many takeos are calculated as balanced eld takeos, giving

no or only around 150 m additional stopping margin, and that

factors like rudder deposit in the opposite touchdown zone

(especially on short runways) may signicantly reduce run-

way friction, policies or SOPs requiring conservative takeo

performance calculations are needed.

What can aircraft operators do to implement the

recommendation?

Ensuring that takeos and (RTOs) do not lead to runway ex-

cursions is also a matter of aircraft operators’ policies and

SOPs on takeo performance calculations and takeo and

reject initiation, as well as the associated pilot training. The

following should be considered when establishing such SOPs

and training practices:

■

Aircraft operators should provide SOPs requiring that

ground sta and ight crews cross-check actual passen-

ger, baggage or cargo loading arrangements before the

closure of aircraft doors in order to guarantee that the

aircraft is loaded as stated on the load and trim sheet used

by the ight crews for takeo performance calculation.

■

Aircraft operators should provide SOPs for ight crews de-

ning under which conditions rolling takeos are allowed.

This should include considerations regarding runway sta-

tus, crosswinds and requirements for handover of control,

as well as dierences in engine spool up behaviour (e.g.,

after an engine change). These SOPs should require ight

crews to use a conservative strategy when considering roll-

ing takeos and should encourage them not to accept any

time pressure (e.g., from schedule considerations or ATC).

■

Aircraft operators should provide clear and robust SOPs for

RTOs, in particular based on clearly documented criteria for

mandatory RTO up to 80/100 knots and from there to V1.

The SOPs should specify who may call out a stop decision

in both ranges and explicitly require that an RTO attempt

above V1 should only be made when it is impossible to get

airborne (e.g., owing to signicant centre of gravity load-

ing issues). RTO actions for the high-speed case should be

unequivocally stated, including maximum braking unless

there is a very clear indication that this would cause other

control problems. If using the terms “unsafe or unable to y”

as a criterion to reject a takeo, aircraft operators should

consider dierentiating or explaining them further in their

procedures and training, as this may include inuences such

as aircraft icing, load issues, errors in takeo performance

calculations, large negative speed trends due to tire failures

or go-around trac above. This will help to reduce psy-

chological barriers which might be stopping ight crews

from rejecting a takeo because of possible self-induced

mistakes, thus helping to avoid unsafe takeo attempts.

https://www.easa.europa.eu/sites/default/les/dfu/EASA_Research_Startle_Eect_Managements_Final_Report.pdf

■

Although the PIC has the nal responsibility for the safety

of a ight, that does not necessarily mean that the PIC has

to make the decision to abort a takeo. Both pilots on a

ight deck have to be trained in safe RTO decision-making

and RTO execution to ensure proper reaction in the event

of obvious or subtle incapacitation or a delayed failure rec-

ognition by either pilot at any stage during the takeo run,

including the high-speed portion up to V1. For the sake

of runway excursion prevention, it is more important that

the allocation of the reject decision, the reject execution

and the task sharing between the PF and PM guarantee

safe takeo decisions and a minimum failure recognition

and reaction time on every ight.

■

The RTO manoeuvre is a mandatory item in the operator’s

prociency check (OPC). Flight crews are therefore trained

in and assessed on the manoeuvre on a regular basis. How-

ever, this assessment is mostly focussed on the correct ex-

ecution of the manoeuvre and not on the decision-making

process. Therefore, aircraft operators should consider the

following concerning ight crew’s RTO training:

›

It is strongly recommended that recurrent training and

checking, as well as initial pilot training (e.g., operator

conversion courses, type ratings and command up-

grading courses) also include simulator exercises that

require the ight crew to detect and identify abnormal

situations that are not the result of a clear and distinct

loss of thrust, such as tyre burst close to V1, nose gear

vibrations, engine stalls, bird strikes at high speed, wind

shear or uneven aircraft acceleration, opening of side

window, instrument failures, or ight control issues.

These exercises can also be used to provide training

in dealing safely with startle eects.

In all cases, both

pilot roles (PIC or second-in-command [SIC]) should

be equally trained in deciding on and making RTOs at

various stages throughout the takeo, including dier

ent scenarios (e.g., low speed/high weight, high speed/

high weight, wind shear induced, incapacitation at low

speed and at high speed) in order to guarantee safe

takeo decisions.

› The training goal should be to make ight crews con-

dent in taking the right decision (to reject or not to

reject) in every case. Therefore, specic training on the

topic of RTO with regard to TEM awareness and brief-

ings is also recommended. Items like the additional

stop margin available on takeo, taking into account

specic hazards aecting an RTO (e.g., strong cross

winds, low speed aborts in high thrust/low weight sit-

uations), should be part of every ight crew’s departure

brieng. This should not only be documented but also

taught both in classroom CRM/TEM training and sim-

ulator training.

›

Irrespective of to whom the decision and task of an

RTO is allocated, the essential supporting and monitor-

ing task of the other pilot should be emphasised. This

82 Appendix C — Aircraft Operators

includes monitoring of thrust parameters, monitoring

the speed trend, performing timely standard callouts,

detecting and identifying abnormal conditions, moni-

toring the use of all braking and stopping devices, and

verifying maximum braking is applied continuously

unless control issues dictate otherwise.

3.3 Correct line-up for departure

(OPS 27, 28)

Why should aircraft operators follow this

recommendation?

Unclear markings/lighting of runways and taxiways are haz-

ards which may be encountered in operation, and ight crews

can make unintended errors. Either combination of imper-

fections can result in misjudgement or failures, leading ight

crews to take the wrong runway or intersection, lining up

using a dierent line-up technique than calculated, thereby

losing or reducing their additional stopping margin, or lining

up for takeo despite not actually being ready for departure,

both procedure-wise and mentally.

Maintaining good situational awareness is one of the most

important ways that ight crews can operate safely and pre-

vent incidents and accidents. In order to enable ight crews

to do so, they need good policies, SOPs or technical solutions

as well as good training. Otherwise, common threats like

schedule or ATC pressure, impaired teamwork on the ight

deck due to steep cockpit authority gradients, mismanaged

distractions, confusing or ambiguous airport/chart layouts or

missing runway markings/lighting/signing may contribute to

runway excursion events in their operation.

What can aircraft operators do to implement the

recommendation?

In order to make it easy for their ight crews to avoid line-up

errors, aircraft operators have the following options:

■

Technical solutions: Modern EFB solutions provide airport

moving map (AMM) functions allowing ight crews to

monitor their position at all times. This increases situational

awareness and might help prevent errors during taxi and

takeo briengs, and reduces the risk of taking wrong run-

way intersections for takeo. Other tools like the runway

advisory and awareness system or takeo securing func-

tion (e.g., TOS by Airbus) may provide additional support

for ight crews by using aural advisories on runway entry

or FMS messages by issue alerts if discrepancies on runway

usage are detected. The proper use of such tools should

be documented and trained, including hints on how to

use marking or highlighting of taxi routes, hotspots or

intersections.

■

Airport briengs: Complex airports and layouts leading

to long and complicated taxi routes and several options

when selecting dierent runway intersections may pose

more runway excursion risks to ight operation than air-

ports with only one runway and no intersections availa-

ble. By providing comprehensive airport briengs, aircraft

operators can ensure that all their ight crews, including

those which have not visited a specic airport before, are

suciently aware of any hotspots or runway excursion

risks like taking the wrong runway or intersection. Good

airline processes to implement or maintain airport brief-

ings include the proactive involvement of the aircraft op-

erator’s and airport’s safety departments, which may add

valuable information on frequent errors or occurrences

reported by ight crews, ATCOs or airport sta.

■

SOPs: A rst step in preventing runway excursion is the

pre-ight procedure. Therefore, the following should be

included as a minimum for runway excursion prevention

in aircraft operators’ SOP:

› During their TEM brieng, the ight crew should posi-

tively identify the aircraft’s parking position in relation

to the expected runway and/or intersection for take-

o, considering possible late runway or intersection

changes in order to avoid any taxi and line-up errors.

Especially in cases of very short taxi times, ight crews

should consider planning their o-block, start of taxi

as well as the taxi speed to allow all necessary duties

and reports (e.g., cabin secure) to be accomplished

without rushing.

›

Flight crews should be required to consider the line-up

procedure available or expected by ATC for the respec-

tive runway or intersection and to include this in their

takeo performance calculations. Especially in cases

when ATC expects, and the ight crew accepts, a roll-

ing takeo, this may signicantly use up the stopping

margin and therefore needs to be considered in the

Recommendation OPS 27: Aircraft opera-

tors should implement policy, technical solu-

tions or SOPs which conrm that the aircraft

is lining up on the planned runway, its centre-

line and via the correct intersection.

Recommendation OPS 28: Aircraft opera-

tors should publish SOPs and guidance for

their ight crew not to accept line-up, back-

track or takeo clearances until pre-takeo

preparation (including cabin secure), proce-

dures and checklists are completed to the

appropriate point which permits the ac-

complishment of the associated manoeuvre

without delay and until they have reported

“ready for departure” to ATC. Aircraft opera-

tors should publish an explicit SOP for “rolling

takeos”.

Global Action Plan for the Prevention of Runway Excursions 83

calculations. In any case, ight crews must be aware of

which line-up technique is incorporated in their take-

o performance calculations (e.g., 90 or 180 degrees,

rolling via the taxi line, backtrack).

›

As there are dierent interpretations by manufacturers,

ight crews and ATCOs of what a rolling takeo means,

aircraft operators should clarify this in their documen-

tation and with the ANSPs of their route network, if

required (e.g., via participation in local runway safety

teams or via their commercial contacts). As a rolling

takeo may not always leave sucient time for the

ight crew on the runway to identify correct line-up,

this type of line-up requires special considerations by

the ight crew. These could be to identify the correct

line-up position, to review the RTO case or to gain ad-

ditional awareness of the actual runway/wind status or

the weather/trac in the departure sector. Additional

threats like night or low visibility operation, no or bad

taxi or runway markings/lighting may contribute to

errors in correct line-up and should be dealt with in

the TEM brieng and considered before accepting or

requesting a rolling takeo. ANSPs should also be ad-

vised that time for engine spool up may vary according

to aircraft type. Therefore, they should bear in mind in

their sequence planning that departing aircraft might

need up to 30 seconds on the runway before starting

to move. This time span may be even longer in winter

operation if engine checks or run-ups are needed.

› The SOP for a rolling takeo should therefore ensure

that ight crews accept or plan such a manoeuvre only

if they are certain that they do not need additional

time on the runway (e.g., for weather radar scanning,

adjusting sun visors, waiting for winds to be in limits

or reviewing RTO or engine out procedures). This SOP

should help to prevent any active pilot in the ight

crew from being mentally distracted when starting the

takeo run and any procedural task in the pre-take-

o procedure from being missed (e.g. switching on

a trac-alert and collision avoidance system (TCAS),

weather radar, receiving cabin secure report)

›

Make sure via the SOP that ight crews report ‘ready for

departure’ to ATC only if all required tasks, including the

‘cabin secure’, if applicable, have been accomplished.

Frequently used alternatives like ‘ready upon reaching’

should be explicitly avoided. Consider making ‘cabin

secure’ an item for ight crew’s pre-takeo checklist

or allow reading of the pre-takeo checklist only after

the cabin secure information has been received. Allow

and encourage ight crews to reject any request or

instruction by ATC for an immediate line-up or takeo

if not all pilots on the ight deck are actually ready for

such a procedure, both mentally and procedure-wise.

› To prevent or detect any line-up errors, aircraft opera-

tors’ SOP should ensure that ight crews have to posi-

tively identify and call out the runway and intersection

before line-up (e.g., the PF or PM calls out: ‘RWY 08R,

Intersection A4 – identied’). Consider adding a trig-

ger or nudge for ight crews to mentally recheck the

takeo performance calculation by the latest at this

stage as well, if this was not already required during

review of the takeo brieng when approaching the

takeo runway.

›

Aircraft operators’ SOP should also give guidance for

ight crews on how to deal with cases requiring long

backtracks (e.g., half the runway or more). Such situa-

tions are connected with time pressure due to incoming

trac and can pose additional threats to their ights

(e.g., forgetting procedural items due to distraction

or even missing turn-around taxi guidance at turning

bays or runway beginnings). They can even contribute

directly to runway excursions.

■

Training: Preventing runway excursions is not only a mat-

ter of pilots’ technical competencies in dealing with threats

like crosswinds, slippery runways or technical failures but

also, more often, it is a matter of pilots’ non-technical com

petencies like safety-relevant decision-making, situational

awareness and clear communication within the ight crew

and ATC. Therefore, ight crew training and checking with

regard to runway excursion prevention should focus on

the following elements:

›

Encouraging and rewarding assertive behaviour (e.g.,

being reluctant to accept challenging ATC clearances like

immediate takeos and being persistent when having

doubts — for example, when unsure about the wind

information in a takeo clearance or when unsure about

the status of cabin preparation — “doubt is a fact”.)

› Training in anticipative behaviour and thorough TEM

briengs

› Training in dierent line-up techniques

(See OPS 4, OPS 8.)

84 Appendix C — Aircraft Operators

4 Special considerations for the arrival phase

This includes ights with dispatched MEL items

4.1 Safe descent, approach, landing and

go-around policies (OPS 7)

Why should aircraft operators follow this

recommendation?

According to the 2018 Boeing statistical summary, 60 percent

of all fatal accidents between 2008 and 2017 happened in the

arrival phase of a ight, which includes the descent, initial

approach, nal approach and landing. Even the numbers

of the 2019 EASA annual safety review show that runway

excursions are still one of the two top key risk areas in the risk

portfolio for commercial air transport (CAT) airlines, air taxi

and non-commercial complex businesses based on accident

data from 2014–2018. Although the rst version of our action

plan for the prevention of runway excursions (EAPPRE 2013)

might have already had some positive impact, as shown by

the analysis by the NLR (Figure 9), we still need to make fur-

ther eorts to improve our industry’s safety performance,

especially with regard to the prevention of runway excursions.

In terms of runway excursion prevention on landing, all meas-

ures taken by aircraft operators, ANSPs, airport operators,

manufacturers and regulators should have one primary and

common goal which is to enable ight crews/unmanned

aircraft to land on a runway safely and leave it safely via a

taxiway. The role of an aircraft operator is to provide its ight

crews (including remote operators) with appropriate policies,

SOPs and training to achieve this common goal. Its policies,

SOPs and training determine to a very large extent whether

ight crews can eectively prevent runway excursions on

landing.

What can aircraft operators do to implement the

recommendation?

Aircraft operators’ policies, SOPs and training should provide

a holistic and practical set of guidelines and actions for their

ight crews which make it as easy as possible for them to cre-

ate the required safety margins throughout the arrival ight

phase, including the sub-ight phases of descent, approach,

landing and go-around. The following should be considered

when establishing such SOPs and training practices:

General

■

First of all, the aircraft operator’s safety policy and there-

by their SOPs should aim to eliminate any operational

pressure on ight crews which could encourage them to

rush briengs or performance calculations, land from an

unstable approach or take unnecessary risks in challenging

weather conditions.

This is especially important for the prevention of runway

excursions in normal operation (i.e., with technically fully

operational aircraft

and no (impending) non-normal or

emergency situation). In normal operation, ight crews

always have the option to handle all relevant threats to

their ights (e.g., weather, trac, fatigue, distractions) in

a defensive/conservative (i.e., risk-averse) manner, and

can thus reduce complexity in given situations and work

as intended by their SOPs. In non-normal operation, this

freedom may be limited, depending on the nature of the

non-normal or emergency situation (e.g., during land-

ing with known or unknown tyre failure, a re or medical

emergency on board).

■

For ight crews, the work of ensuring a safe descent, ap-

proach, landing and taxi-in begins during their pre-ight

preparation when considering and anticipating the threats

to be managed during the arrival phase of their ight.

Aircraft operators’ policy for determining the block fuel

should therefore require that ight crews consider specic

threats (which increase the risks of runway excursions) in

their fuel decision before departure in order to ensure that

they always have sucient options to take safe decisions

during arrival and approach (e.g., delay the approach, hold

or go-around). At least the following common threats

which increase the risk of runway excursions should be

considered in the fuel decision:

Figure 9. Worldwide RE occurrence rate,

commercial ights

Rate per million ights

3.5

2.5

1.5

0.5

Year

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Acccidents and incidents

data 2019 preliminary

Source: NLR

Recommendation OPS 7: Aircraft oper-

ators should implement policies for safe

descent and approach planning, stabilised

approach, safe landing and go-around and

should ensure that these are implemented

in their training. Aircraft operators should de-

ne which elements of these policies have

to be included and highlighted during the

approach briengs by ight crews.

Global Action Plan for the Prevention of Runway Excursions 85

› Destination and/or destination alternate have perfor-

mance-limiting runways in combination with unfavour-

able weather conditions;

›

Destination and/or destination alternate have no 3D

(e.g,. ILS, required navigation performance [RNP] and

localizer performance with vertical guidance [LPV]) ap-

proach) available, which increases the risk of unstable

approaches;

› Destination and/or destination alternate have ATC en-

vironments which tend to lead to ‘hot and high’ vec-

toring or tight spacing, increasing the risk of unstable

approaches and landings; and,

› Destination and/or destination alternate operate with

tailwind components TWC or may impose (late) runway

changes.

■

The aircraft operator’s policy for determining the land-

ing performance limits during dispatch should require

dispatch personnel and ight crews to use conservative

values (e.g., for wind components and runway conditions

according to the latest weather report and forecast availa-

ble) in order to dispatch a ight legally, even if this results

in reducing the allowed trac load, ight diversions or

cancellations. (See also 4.2 for a detailed explanation.)

Safe arrival planning and descent

■

Aircraft operators should require their ight crews to

prepare each approach and landing thoroughly, even if

they y into an airport frequently or within short intervals.

The structure of this preparation, especially in terms of

a thorough TEM analysis, should be the same for every

approach and landing attempt, although the time needed

for this may vary, depending on the structure used for

the approach brieng (e.g., when using the T-P-C brieng

method

). Therefore, ight crews should be required to

start the approach preparation suciently early during

cruise ight in order to be nished with the approach

brieng before the top of descent, considering also early

or step descents or increased ATC communication when

nearing the destination. On ights with longer cruise seg-

ments, the ight crews should be required to agree on an

approximate time when the approach brieng will start

so that every ight crew member can manage his/her

other duties and tasks in time to be fully attentive for the

approach brieng. In order to guarantee thoroughness of

approach preparation and reduce distractions to aircraft

operation and monitoring, especially on short ights, the

ight crew might need to do parts of the approach plan-

ning and brieng already on the ground or incorporate the

TEM analysis for the approach into their pre-ight prepa-

ration. Aircraft operators’ processes should incorporate

such circumstances (e.g., by adapting reporting times or

allowing the ight crews to make or accept departure

delays). In any case, aircraft operators’ policies or SOPs

should provide an option for their ight crews to enter

Threat – Plans – Considerations: A threat-based brieng method see: https://ightsafety.org/asw-article/rethinking-the-brieng/

holdings or take delay vectoring if not able to complete

the approach preparation before starting an approach

(e.g., in case of last-minute runway changes or on ights

with only little or even no cruise time).

In order to eectively mitigate any runway excursion risks,

the approach preparation and brieng should cover at

least the following:

› A thorough threat analysis for the descent, approach,

landing, go-around and taxi-in, including the aircraft

status, human factors, weather and trac situation,

approach and runway/taxiway specics (see more de-

tails and a list of common threats leading to runway

excursions in Figure 10 (p. 86). Flight crew brieng

should focus especially on revising conditions that

would require a go-around and/or rejected landing

instead of focussing mainly on approach, landing and

rollout procedure.

› A joint landing performance assessment by the ight

crew based on individual (by each ight crew member)

and conservative calculations, especially with regard

to runway status and wind components, in order to

determine the additional stop margin and go-around

performance available (see OPS 15).

›

A joint ight crew decision on when to start the descent

or plan for alternatives, if dierent from the FMC top of

descent (e.g., due to trac or weather).

› A joint ight crew decision on the runway, the touch-

down point limit and conguration used for landing

(See OPS 21).

›

A joint ight crew decision on the type of approach and

methods used (e.g., use of automatic modes or from

which point in the approach manual ight is planned).

›

A joint ight crew decision on whether and to what

extent operational limits such as crosswind limits have

to be reduced (e.g., due to fatigue, prociency and ex-

perience) and whether and which additional gates have

to be set throughout the approach (e.g., for approach

continuation regarding wind limits, runway friction val-

ues, visibility). This should include canned decisions in

marginal conditions.

› A review of those items which have to be rehearsed in

the approach brieng (e.g., the go-around procedure

to achieve psychological priming for go-around or the

point of rst conguration change, gear selection or

nal conguration).

■

Aircraft operators should require ight crews to perform

the descent with a conservative strategy, especially with

regard to energy management and thus distance needed

for losing altitude. Although air trac controllers have a

basic understanding of aircraft performance, they might

not be aware of aircraft–type-specic or environmental

threats which can reduce the descent and speed reduction

86 Appendix C — Aircraft Operators

capability of an aircraft (e.g., ineective speed brakes, a

high aircraft gross weight and changing wind proles or

thermals). Therefore, ight crews should be encouraged

by policy or SOPs to reject any challenging clearances

(e.g., by using the wording ‘unable’, and to request or plan

more mileage for descent instead. Aircraft operators’ SOPs

should specify that high speed ying (>250 kts) below

10,000 ft, early gear extension or interception of the ap-

proach glide path from above in order to match an ATC

given or planned descent path should not be used, if not

required for non-normal or emergency procedures.

■

Although continuous descent operations (CDO) and low

drag approaches (LDA) may be favourable for economic,

ecological and noise reasons, their safe conduct requires

many optimal conditions to be present, which might not

always be the case in reality. Inuences of changing wind

proles during descent, intermediate level-os due to

airspace structure, aircraft-related factors or human fac-

tors on the ight deck, like fatigue or prociency, may

unnecessarily increase complexity for a ight crew dur-

ing CDO or LDA. In order to always ensure safe approach

path management by ight crews, aircraft operators may

wish to consider establishing further mileage/altitude/

speed gates as a baseline for a safe approach path to sup-

port ight crews in achieving stable approaches, thereby

preventing runway excursion events. The following values

for medium to large aircraft (e.g., A320/B737) may serve as

an example (adaptions for dierent operations or aircraft

type may be needed) (see OPS 18):

■

Last 18–15 nm from touchdown: speed reduction (de-

pending on aircraft gross weight, wind, aircraft’s speed-

reduction capabilities) from 250 kts to 210 kts or minimum

clean speed should be initiated;

■

Last 12 NM from touchdown: the aircraft should be ying

at a maximum speed of 210 kts. A ‘12 miles to touchdown’

callout by the PM could be a helpful tool to raise aware-

ness for the PF, especially on approaches without a direct

indication of mileage to the runway. Flight crews should

be required to plan a level segment for further speed re-

duction and start of initial conguration.

■

Last 9 NM from touchdown/3,000 ft above aerodrome level

(AAL): the aircraft should be ying at a maximum speed

of 180 kts and an initial ap setting;

■

Last 6 NM from touchdown/2,000 ft AAL: the gear should

be lowered and an intermediate ap setting selected; air-

speed should be around 150 kts;

■

Last 3 NM from touchdown/1,000 ft AAL: nal aps should

have been selected, landing checklist completed and the

aircraft should have reached nal approach speed.

Figure 10. Example safe arrival planning (based on medium to large turbofan aircraft (e.g., A320/B737),

adaptions for dierent aircraft type may be needed

REV.TPL

TDZ

Last 400m

Last 200m

REV.TPL

TDZ

Last 400m

Last 200m

WEATHER Threats

• Variable/calm winds

• CWC/TWC

• Wind>15kts/Gusts

• Wind-shear

• Wind change aloft

• Darkness/Sun Position

• Visibility <5000m

• Low Clouds

• CB/TCU/Thermals

• PRECIPITATION

• Incoming WX/Det. trend

• TS/HAIL/ +SN

• OAT < 10°C/OAT > 30°C

• TEMP. INVERSION

APPROACH Threats

• APP/RWY Change

• FMA ≠ IAC

• NON-PRECISION APP

• TWC/Windshift on nal

• G/P INCPT ≠ 9NM

• G/P > 3°

• PAPI ≠ G/P

• NO FULL APP/RWY LTS

• VISUAL ILLUSIONS

• TURBULENCE < 1000'

• TDZ low density

• Wakes

• WX RADAR/WIPER REQ.

• BARO ≠ RA

• F/D OFF / RAW DATA

DESCENT/ARRIVAL Threats

• SIGNIFICANT TWC

• CHANGING WIND PROFILE

• RESTRICTING TFC below

• TERRAIN/AIRSPACE Restrictions

• Weather/Turbulence/Updrafts

• HIGH SPEED DESCENT

• HOT & HIGH VECTORING

• TRANSITION/HOLDING

• STAND. APP/LOVIS

• WX RADAR/ required

LDG Threats

• DSPLCD THRHLD

• RWY – LDA < 2700m

• RWY – WET/DAMP

• RWY – SLIPP. WET

• RWY – SLIPP/CONT.

• RWY – SLOPE

• RWY – WIDTH

• CWC/TWC

• STOP MGN < 200m

GO-AROUND Threats

• G/A – EARLY TURN

• G/A – EARLY LVL-OFF

• G/A – WX/TFC/TERR critical

• G/A – GRAD. > 2.5%

• G/A – PROFICIENCY

• BALKED LDG special

AIRPORT Threats

• NO ILS/RNP APP

• GPS outage predicted

• NOTAM relevant

• SPECIAL A/P INFO

• CHALLENGING ATC

• HIRO/MROT

• NO/REMOTE ATC

• LOCAL WIND/WX Phen.

• HIGH ELEVATION

DIVERSION Threats

• EXTRA-FUEL < 10 min

• NO OPTION TO STAY

• DIV. RTE – NO DIRECTS

• DIV. RTE – WX/ICING

• DIV. RTE – TFC/SUA/VFR

• DIV. RTE – TERR/MFA

• DIV. RTE – EET < 15 min

D.ALTN Threats

• D.ALTN – LDA < 2700m

• D.ALTN – WX/TFC critical

• D.ALTN – NOTAM relevant

• D.ALTN – NCF/PARK. limited

• D.ALTN – OPS/HOTAC limited

• D.ALTN – NO ILS/RNP APP

• D.ALTN – MIN. FUEL on APP

Human Factor threats

• Fitness/Fatigue

• Prociency

• Complacency

• Distractions

• Emotions

• Unfamiliarity

• Work Atmosphere

• Low Role/Type Experience

• Training/Check Flight

PIC

PF/PM

SIC

PF/PM

INTERVENTION

INTER-

VENTION

ATC

Best Destination Alternative

Planned Destination

Approach Preparation, incl. Brieng (T – P – C*) completed

before T.O.D. (*Threats – Plan – Considerations)

G/A

AAL – NOT TO SCALE

T.O.D.

MUST

GATE

10,000' 250kts

210kts/

Min. Clean

190–180kts

160–150kts

Final App Speed

3,000'

2,000'

1,000'

18–15NM

Start Speed

Reduction

to Min. Clean

210kts/

Up-Speed

Min. Clean

Green Dot

190–180kts

Init. Flaps

G/P INTCPT

160–150kts

Gear Down

Intmed. Flaps

On Final Speed

LDG Flaps Set

LDG CKL done

Arrival

Descent

9NM 6NM 3NMDistance to Touchdown: 12NM

Final Approach

Approach/

LVL-DECEL

STAR/TRANSITION/

HOLDING?

MDA

DA/DH

Global Action Plan for the Prevention of Runway Excursions 87

Recommendation OPS 15: Aircraft oper-

ators should develop SOPs which include

an assessment, possibly prior to the top of

descent, of landing performance based on

the latest and best-available weather infor-

mation. This calculation should not be per-

formed using dispatch weather information.

Flight crews should be informed of the type

of landing distance data available (factored

or unfactored) and of which correlating safe-

ty factors are used. When possible, the crew

should complete descent, approach, landing

planning, set-up and briengs prior to the

top-of-descent.

Recommendation OPS 23: Aircraft opera-

tors should publish SOPs for their ight crews

when runway conditions are uncertain or

actual or anticipated slippery wet, slippery

or contaminated, to fully use all decelera-

tion means, including speed brakes, wheel

braking and reverse thrust irrespective of

noise-related restrictions, until a safe stop

is assured, unless this causes controllability

issues.

Recommendation OPS 24: Aircraft opera-

tors should publish SOPs and guidance and

provide training highlighting the importance

of active monitoring, including monitoring

of the activation of the stopping devices on

landing, and eective intervention during

landing associated with pilot monitoring du-

ties and performance. Appropriate training

should be provided.

Safe approach, landing and go-around

■

Aircraft operators should require ight crews to always

choose the type of approach which best suits the indi-

vidual crew composition in terms of the tness, abilities

and prociency of the PF and the tness and assertiveness

of the PM. This may lead to choosing a complex manual

own circling or visual approach by a very t and pro-

cient crew which collaborates well or opting for a standard

ILS approach using automation if the ight crew’s team

performance may be degraded. It is important that air-

craft operators’ policy for approach selection does not

only cover external factors like weather or facilities, but

also human factors in the cockpit, like fatigue, procien-

cy or work atmosphere. Furthermore, aircraft operators

should consider classifying 2D non-precision approaches

as non-normal manoeuvres and require special consider-

ations for such approaches (e.g., early nal conguration,

autopilot coupling (see also OPS 17).

■

Aircraft operators should require ight crews to actively

observe and highlight signicant wind changes below

10,000 ft until touchdown in order to anticipate possible

inuences on the descent path and speed reduction capa-

bility (e.g., strong tail winds on base leg or nal or positive

wind on nal which requires an earlier conguration).

■

Aircraft operators should require ight crews to take

into account the weather and trac situation along the

missed-approach routing in their decision to start or con-

tinue an approach. Such policies or SOP should ensure that

ight crews always retain an option for a safe go-around,

even if this means not starting an approach or discon-

tinuing it early. Low-level turns below minimum radar

vectoring altitude (MRVA), even in visual conditions, often

considered as an alternative option (e.g., to avoid nearby

thunderstorms or trac) should be avoided.

Safe taxi-in

Aircraft operators should require ight crews to include the

taxi-in brieng in the approach brieng, considering especially

the surface condition and maximum speeds when leaving the

runway (e.g., when using slippery wet high-speed turno).

Special considerations should be given to a change of control,

if necessary, during landing rollout (see also OPS 26).

Flight crew training

Aircraft operators should consider critically reviewing their

training philosophy on a recurrent basis to ensure that it

clearly prioritises safety in all its components and incor-

porates the items mentioned above. An aircraft operators’

ight crew training personnel, such as line training pilots,

type rating instructors or examiners, should be required

to always act as role models for line pilots, focussing on a

defensive and conservative approach to ight operations

and thoroughness in SOP adherence. Moreover, their role

and status may inhibit cockpit team members from be-

having assertively. In general, ight crew training should

incorporate intervention training, both in the simulator and

classroom CRM/TEM training, using scenarios which require

ight crews to practice assertive behaviour, both in the cock-

pit within the ight deck team and outside the cockpit (e.g.,

towards ATC or towards their operations control) in order

to always guarantee safe team decision-making by ight

crews in daily practice.

4.2 Landing performance — correct

assessment and implications for

aircraft stopping (OPS 15, 23, 24, 30)

88 Appendix C — Aircraft Operators

Why should aircraft operators follow this

recommendation?

Aircraft operators’ main duty in the aviation system is to

ensure safe transport. Ensuring Guaranteeing safe ights is

not only a goal, but an obligation for everybody working in

this high-risk environment to always put safety in front of

other objectives like on-time performance, trac capacity,

fuel eciency, noise or passenger comfort. This is especially

important with regard to the industry’s approach to landing

performance, its calculation and its assessment. There should

be consensus in our industry that a defensive and conserva-

tive (i.e., risk-averse) approach to landing performance should

be promoted and applied even if this leads to an increase in

go-arounds, diversions or ight cancellations.

In practice, even the landing performance on a relatively long

runway (e.g., >2,500 m/>8200 ft) can easily be limited for a

ight crew by the aircraft type, the actual status of the runway

and other factors like wind, touchdown point, aircraft system

degradations or human performance variations. Although

dispatch and some operational landing distance values in-

clude certain safety factors to absorb some deviations, the

dispatch as well as any operational landing distance or actual

runway available may not be adequate when more than one

deviation from the reference conditions come together. The

shorter the runway, the more safety-critical these deviation

eects may become.

The following data show the eect of relatively minor devi-

ations from a baseline calculation of landing distance for a

wet runway. The reference condition is a reasonably attain-

able performance level following normal operational prac-

tices on a nominal wet runway surface. The Quick Reference

Handbook (QRH) data on the bar chart below is based on:

1,500-foot touchdown, VAPP=VREF+5, 5 knot speed bleed-

o to touchdown, sea level, standard day (15°C), no wind,

no slope, recommended all engine reverse thrust, braking

action – good, consistent with FAA wheel braking denition

of a wet non-grooved runway.

The vertical line in Figure 11 and Figure 12 represents the

dispatch requirement that is 1.92 times the dry runway ca-

pability of the aeroplane. Each downward bar demonstrates

the cumulative eect of the operational variation listed. In

overrun incidents, there are usually a number of factors that

contribute to using up the margin available, especially if the

runway has poorer wet runway friction capability.

Figure 11 shows that, in general, the dispatch landing dis

tance is conservative enough to absorb some deviation from

the expected conditions. However, when enough deviations

from the reference conditions occur, the dispatch landing

distance or actual runway available may not be adequate.

For example, wheel braking may be reduced on the wet run-

way because of questionable runway conditions caused by

rubber build-up, polishing, or puddling due to heavy rain or

poor drainage. The following charts show the same infor-

mation as above, but assuming a ‘braking action – medium’

runway, which is consistent with data that has been seen in

some overrun accidents and incidents where the runway’s

maintenance condition is in question.

Figure 12 shows that if there is a possibility of a runway be-

ing wet, one can very quickly use up the entire margin in

the dispatch wet runway calculation. Therefore, dispatchers

and ight crews should perform dispatch landing perfor-

mance calculations using conservative values (e.g., for wind

components and runway conditions, according to the latest

weather report and forecast available) in order to dispatch

a ight legally, even if this results in reducing the allowed

trac load for a ight.

Time of landing/in-ight assessment of landing performance

Taking a conservative approach to ight operations becomes

an even more valuable tool for preventing runway excursions

when determining, while still in ight, the landing perfor-

mance. Flight crews need to be able to know what weather

conditions they can accept for the landing to be performed

Figure 12. Wet landing distance – BA: Medium

Reference QHR

landing distance slippery

Landing distance

Temperature increased by 15C

5 knots above planned V

APP

10 knot tailwind

Touchdown at 2500'

Dispatch wet

required

eld length =

1.92 x actual

dry eld length

Figure 11. Wet landing distance – BA: Good

Reference QHR

landing distance wet

Landing distance

Temperature

increased by 15C

5 knots above

planned V

APP

10 knot tailwind

Touchdown at 2500'

Dispatch wet

required

eld length =

1.92 x actual

dry eld length

Recommendation OPS 30: Aircraft oper-

ators should, when determining their TEM

strategies and SOPs, identify runways with

a remaining safety margin of less than 400

m/1,200 ft after application of all required

safety factors as safety critical.

Global Action Plan for the Prevention of Runway Excursions 89

safely, so that they can decide in time on possible holdings,

diversions or go-arounds.

With the introduction of the ICAO Global Reporting Format

(GRF), an at-time-of-landing assessment of landing perfor-

mance is becoming mandatory or already is mandatory (e.g.,

in the European region; see EC965/2012 CAT.OP.MPA 303

303 — check of landing distance at time of arrival). There

are good reasons to comply with this requirement for every

approach and landing:

■

The dispatch calculation usually yields results in weight

limitation only and not the runway length required, mak-

ing it hard for ight crews to estimate the additional stop

margin available in relation to runway length available.

Landing an aircraft without knowing its exact perfor-

mance and safety margin reduces situational awareness

of ight crews and may lead to inappropriate ight crew

decision-making. (Providing results in runway length re-

quired for dispatch calculations would have two advantag-

es: It requires the crew to be aware of the runway length

available at the destination airport, and it is possible to

compare it with the in-ight landing performance that

gives results in length also.)

■

Weather forecasts are not describing precisely the actual

weather at the time of arrival. Especially in demanding

weather situations, ight crews need an assessment of

landing performance (e.g., during the approach prepara-

tion, which is based on latest weather information and not

on that used for dispatch calculations) in order to make

informed decisions such as which landing ap congura-

tion or which type of braking (e.g., autobrake or manual

braking) or which amount of reverse thrust is needed to

land safely.

■

Some approaches require special go-around considera-

tions in case of engine failure upon initiation or during

the go-around (e.g., due to bird strike), and landing perfor-

mance does not only cover landing distance assessment

but also go-around climb gradient assessment.

■

If an in-ight landing performance assessment is not

required, landing-performance-relevant information

(e.g., a locked reverser or a failed autobrake) may not be

considered or may be inappropriately considered by a

ight crew during their approach preparation or follow-

ing a late runway change (e.g., due to fatigue, distraction,

complacency).

■

Weather situations and/or runway status can change,

sometimes more quickly than expected by ight crews and

air trac controllers, leading to the landing performance

being limited on a runway, even if previous calculations

did not show this. Consequently, ight crews might risk

landing on a runway which does not provide an adequate

stopping margin if they did not assess in advance what

their actual limits for landing on a specic runway are, as

the following example highlights:

The ATIS states ‘runway in use 33 RWY dry, wind 250/10

gusting 25, visibility 9999 Vicinity RaSh, cloud sct 2500 sct

3000 Cb, temperature 32/25, QNH 1009’.

The crew has two options: Either they take into account

the actual weather (i.e., runway dry, no wind component)

or they consider the possibility of a shower passing on

the runway when they will be landing (i.e., runway wet,

or contaminated) and a wind component of 5 to 10 kts

tail wind.

The rst option is the more favourable case (in terms of

short-time economic considerations) but does not pre-

pare the crew for the decision to be taken in the event of

weather deterioration on short nal. The second option

will allow the crew to assess whether the landing can be

conducted safely in the worst case (e.g., what is the maxi-

mum tail wind and the worst runway condition that they

can accept). Thus, if on nal, ATC says the conditions are

‘runway wet and 230/15 gusting 20 clear to land runway

33’, the decision to land or not will be based on a sound

performance calculation in the case of the second option

and on guesswork only in the case of the rst option.

While most ight crews are familiar with the dispatch re-

quirements on landing performance which are based on

unfactored actual landing distances (ALD), multiplied with a

regulatory factor, it is important that ight crews are aware of

when manufacturers are basing their in-ight landing perfor-

mance on unfactored or factored operational landing distanc-

es (OLD), and that they know and understand which safety

factors their operator has implemented, both for normal and

for non-normal conditions. This is especially important for

ight crews when landing on a short (e.g., £ 2500 m/£ 8200

ft), slippery wet or contaminated runway.

Considerations regarding the correct use of stopping devices

On top of the considerations above, there are further threats

which could contribute to a reduction or disappearance of

the safety margin leading to runway excursions. Figure 13

(p. 90) gives an overview of frequent contributing factors to

runway overruns. It shows that especially after touchdown,

some specic factors inuencing the stopping margin (e.g., a

late or inadequate use of stopping devices) may signicantly

aggravate the risk of a runway overrun.

The other reasons behind such ight crew errors are very often

not aircraft system malfunctions but systemic deciencies like

improper ight crew training, improper or missing SOPs or TEM

guidance, or even complacency by ight crews. Organizational

pressure driven by economic reasoning may inuence a ight

crew’s decision-making not only on approach (e.g., to land in-

stead of going around) but also during the landing roll. The use

of reverse thrust above idle or heavy braking in the high-speed

portion of the landing run might have become a less common

practice among ight crews (e.g., due to considerations on

fuel savings and brake wear, noise abatement requirements at

airports or passenger comfort reasons). Consequently, there

is currently a risk in the industry that ight crews may feel

90 Appendix C — Aircraft Operators

inhibited or reluctant to make full use of all deceleration means

upon landing. The resulting runway excursion risk can be mit-

igated if ight crews know and understand the assumptions

which underlie the results of their landing performance calcu

lations (e.g., if any reverse thrust or maximum manual breaking

is required to achieve the calculated stopping performance).

Additionally, aircraft operators should encourage and provide

ight crews with the freedom to ignore any noise, economic or

ATC requirements whenever they deem it necessary to main-

tain their safety margin.

In order to ensure that the incorporated safety factors can

provide the expected stopping margin, ight crews need to

understand that they must apply the necessary procedural

steps (e.g., brake application, spoiler and reverser activation)

in the assumed time and to the expected extent in order to

keep deviations from the reference conditions as small as

possible — especially in situations when operating near or

at the calculated landing performance limit. Moreover, with

regard to the safety factors used, it is important for ight

crews to know that in some cases, the results of landing per-

formance calculations are advisory only (e.g., contaminated

landing performance on some aircraft). This means they are

calculated only and not ight-tested, so that it depends on

the manufacturer or company policy which additional mar-

gin, if any, is or has to be applied to provide an additional

safety margin in practice.

Incident and accident reports often reveal that ight crews,

controllers and airport operators tend to overestimate the

actual runway friction capability and underestimate the

inuence and presence of factors which could lead to reduced

stopping performance (e.g., rubber build-up; polishing or

puddling due to heavy rain or poor drainage; prolonged are

due to crosswinds; the need to reduce reverse in crosswinds,

etc.). Although the new ICAO GRF will introduce an improved

set of measures for determining runway status, its applica-

tion still relies on human assessment and continuous critical

review by operations personnel or AIREPs/PIREPs by landing

ight crews. (AIREPs are dened by Eurocontrol as reports

from aircraft in ight that are prepared in conformity with

requirements for position, and operational and/or meteoro-

logical reporting.) As this might not always be a given in prac-

tice, especially in challenging and rapidly changing weather

situations, and not all runways provide good braking action

when not dry, it should be obvious that ight crews should

be required to always assess the weather using a conservative

strategy. This applies in particular to the runway condition

and the wind component as well as to the crews’ making full

use of all deceleration means when landing on a slippery wet,

slippery or contaminated runway, irrespective of any noise

or other restrictions unless they cause controllability issues.

What can aircraft operators do to implement the

recommendation?

Whether ight crews can eectively prevent runway excur-

sions in their ight operation or not depends largely on air-

craft operators’ policies, SOPs and training with regard to

landing performance. The following should be considered

when establishing such SOPs and training practices:

Figure 13. Overrun characteristics

No approved

in-ight

realistic

operational

landing distance

Overruns often are

caused by more than

one factor!

Decision height

Unstable approach

(too high, too fast)

Tailwind

Long landing

High

touchdown speed

Reverser level too low/reduced too soon

Reversers late/

not deployed

Speedbrakes

late/not

deployed

Friction limited/

runway contamination

too low

Preparation Stability “Floating” Conguration

Source: International Coordinating Council of Aerospace Industries Associations

Global Action Plan for the Prevention of Runway Excursions 91

Aircraft operators might choose to categorise their landings by analogy with the remaining stop margin available (e.g., orange landings if the dierence

required between LDA and OLD is less than 400 m/1,200 ft, or red landings if the dierence is only 200 m or less) in order to simplify ight crews’ risk aware-

ness when landing on performance critical runways. These values may of course change depending on the aircraft type used.

■

Aircraft operators’ policies and SOPs should clearly high-

light that landing at the originally planned destination is

not the default option for a ight, but that go-arounds,

diversions or even ight cancellations are encouraged if

ight crews do not consider it safe to start an approach or

to land at the destination airport. Aircraft operators can

do this by requiring ight crews and dispatchers to always

base their assessment of landing performance on a con-

servative strategy, in particular concerning the assessment

of the runway condition and wind components, even if

this leads to go-arounds, diversions or ight cancellations.

This operational conservatism should incorporate policies

or SOPs which allow a ight crew to further reduce oper-

ational limits (e.g., crosswind, tail wind or weight limits),

whenever they deem it necessary. (See OPS 11 and OPS 29.)

■

Performance calculation at the time of landing preferably

should be performed during the approach preparation in

cruise ight before reaching the top of descent. It should

take into account the actual aircraft status (e.g., MEL items

like an inoperative thrust reverser, failure of autobrakes or

auto-spoiler), the most realistic landing weight and the

latest weather and runway information available. Flight

crews should be required to always assess the weather

using a conservative strategy, in particular with regard to

the runway condition and the wind component. In order

to cover deteriorating weather trends or sudden runway

changes, ight crews should be required to conduct a

worst-case analysis to dene the performance limits for a

landing (e.g., in terms of maximum crosswinds or lowest

braking action value allowed [canned decisions]), as well

as a calculation for realistically expectable conditions (e.g.,

for planning the expected runway exit).

■

In order to support ight crews in assessing the landing

performance correctly, aircraft operators should provide

unambiguous landing performance information. At least

the following information concerning the landing perfor-

mance data should be provided to ight crews:

› What level of reverse thrust was assumed;

› The assumption of the wheel braking;

› Whether the data was factored or not;

› If the data was factored, then by what amount; and,

› What the air distance allowance in the data was.

■

Aircraft operators’ TEM guidance with regard to runway

excursion prevention should require ight crews to always

brief and agree on at least the following seven items:

›

The type of braking intended to be used (e.g., autobrake

setting, manual or no braking);

› The amount of reverse thrust to be used (e.g., idle, in-

termediate or full);

›

The additional stop margin available* (after application

of all safety factors) and those limits resulting from the

in-ight assessment of the landing performance (e.g.,

maximum tail wind or crosswind limits which are below

the ight crew operating manual’s[ FCOM’s] values);

› The limits set by the crew, if dierent from given oper-

ational limits or if airport/aircraft specic;

› The touchdown point limits (see OPS 21);

› The planned runway exit and expected taxi-in, includ-

ing the expected surface condition; and,

› Factors which may lead to a reduction in the stop mar-

gin (e.g., crosswinds, single reverse only, high Vref wind

increments, thermal eects).

Brieng these items will not only lead to improved team

decision-making prior to and during the approach and

landing but also enable the PM to eectively monitor and

provide timely advice or intervene if he/she observes any

changes in environmental conditions or a lack of activation

of the required stopping devices upon touchdown (e.g., no

automatic ground spoiler activation or no or insucient

reverse thrust). Furthermore, using the method of ‘canned

decisions’ (i.e., what will we do if this or that happens, set-

ting clear decision gates) makes it possible to determine

up to what level of deterioration a landing can still be

safely accomplished and enables the ight crew to agree

on denite limits and clear gates for the continuation of

the approach or landing (e.g., maximum crosswind or tail

wind limits, minimum visibility or runway friction values).

This makes it easier for the PM to eectively monitor and

intervene, irrespective of rank and experience.

■

Aircraft operators should consider incorporating a policy

or SOP clearly stating that ight crews are allowed, and

are encouraged, to disregard any noise abatement restric-

tions or to refuse any ATC instructions when they deem it

necessary for safety reasons. This should incorporate the

requirement to make full use of all deceleration means

when landing performance is limited, both on actual or

assumed slippery wet, slippery or contaminated runways,

unless this causes controllability issues.

■

Aircraft operators’ philosophy and policies with regard to

the role of the PM should clearly specify that the function

of the PM includes monitoring, providing directive assis-

tance and both passive and active intervention. Passive

intervention requires the PM to make callouts, including

callouts on items missed by the PF upon touchdown.

However, in the event that the PF does not react in time,

the PM is required to actively intervene, for example, by

taking over control. With regard to landing performance

and runway excursion prevention, the following items

should be monitored by the PM, specically:

92 Appendix C — Aircraft Operators

›

Stabilised approach criteria to be maintained until

touchdown, with a special focus on airspeed;

›

Touchdown within and before the dened lateral

touchdown limit;

› Immediate or timely brake application, depending on

the selected braking method;

› Immediate deployment of ground spoilers;

›

Immediate and symmetrical application of thrust re-

verse, if required; and,

›

Centreline adherence and remaining stopping margin.

On top of monitoring the technical tasks of the PF, it

is critical for the prevention of runway excursions that

the PM also monitors, assists and intervenes in the PF’s

safety- relevant decision-making, irrespective of rank or

experience. Preventing runway excursions requires clearly

safety-oriented team decision-making, which means that

it should always be based on a conservative strategy, in

particular when assessing the runway condition, wind

components and the ight crew’s ability to land safely.

Therefore, aircraft operators’ policies and SOPs should, in

normal operation, require the PIC to always choose the

more conservative option as deemed necessary by any

ight crew member (including enlarged crew) and to ac-

cept any interventions by the SIC which provide a greater

safety margin for the approach and landing. This should

include all decisions regarding the approach and landing

but should not aect the PIC’s emergency authority in the

event of (impending) abnormal or emergency situations.

■

Aircraft operators’ ight crew training is crucial for the

eective prevention of runway excursions in their ight

operation because it fosters the implementation of their

policies and SOPs and can support their ight crews in

understanding the sensitivity of the topic of landing per-

formance and its associated safety aspects. While ensuring

that ight crews have adequate knowledge and under-

standing of how to prevent runway excursions, their train-

ing should strive to make them condent in dealing with

complex or challenging weather and landing situations. It

should also, however, promote the required conservative

mind-set, enabling ight crews to easily decide on go-

arounds or diversions, if required. This can be trained by

means of line-oriented ight training (LOFT) sessions as

well as specic runway excursion prevention lessons in the

recurrent simulator and CRM/TEM trainings. These should

include the following topics:

›

Team decision-making based on a conservative assess-

ment of landing performance calculation results;

›

Go-arounds from various situations (e.g., due to unsta-

ble approaches below the approach minimum, due to

changing weather leading to approaching or exceeding

limits);

›

Intervention scenarios, including taking over control

before and after touchdown; and,

›

Landing and braking on dierent runway surface

conditions.

Training ight crews should be reminded of the impor-

tance of showing conservative behaviour in practice in

order to be good role models for runway excursion pre-

vention. Furthermore, aircraft operators’ theoretical and

recurrent training for runway excursion prevention should

focus on at least the following topics:

■

The use of ground spoilers/speed brakes

Ground spoilers primarily reduce lift and increase drag.

Reducing lift increases the weight on the wheels, and thus

improves braking performance. The eect of the ground

spoilers is even greater on wet or contaminated runways,

where brake performance is already lower, and the risk

of aquaplaning is increased. Ground spoilers are usually

automatically extended, and their automatic extension

should be monitored by ight crews. If they do not extend,

a callout should be made by the PM and where possible,

they should be extended manually without delay, either

by the PF or PM.

■

The use of reverse thrust

The deceleration eect of thrust reversers is more eective

at high speed, so the selection should be made as soon as

possible, generally at main landing gear touchdown. The

reverse thrust should be maintained until a safe taxi speed

is achieved or the stop is assured, all the while considering

the controllability eects of crosswinds and the possible

reduction in visibility if snow is blown up in front of the

aircraft. It is also important to understand that if the reverser

is stowed early, the reapplication of reverse thrust from

forward idle can take up to 10–15 seconds to reach eec-

tive reverse thrust level (depending on the aircraft type);

however, the reapplication from reverse idle will take only

3–5 seconds to reach an eective reverse thrust level. Similar

to ground spoiler extension, the immediate, correct and

symmetric application of reverse thrust should also be mon-

itored by the PM. The importance of monitoring symmetric

deployment should be emphasised, especially during ight

crew training. If dispatch with a thrust reverser locked out

is permitted and use of a single reverser is permitted, then

an explicit SOP for its use should be provided.

■

The use of brakes/autobrake

Selecting an autobrake level means selecting a deceler-

ation rate rather than a braking eort. Selecting reverse

thrust with an autobrake level will not increase the decel-

eration eort on a dry runway, assuming ground spoilers/

speed brakes are extended; it will simply reduce the energy

applied to the brakes. Selecting reverse thrust on a dry

runway provides minimal additional deceleration with

maximum manual braking and no additional deceleration

with autobrakes. On slippery runways, the target decelera-

tion associated with the selected autobrake level may not

be achievable with braking alone, in which case reverse

thrust use is essential for stopping the aircraft even with

autobrake.

Global Action Plan for the Prevention of Runway Excursions 93

Figure 14. Additive thrust reversers

Poor runway

No reverse thrust

With reverse thrust

Stop

Drag

Brakes

Reverse thrust

Less More

Deceleration

Braking applied Max manual braking (advisory) POOR RUNWAY

Recommendation OPS 17: Aircraft op-

erators should require the ight crew to

carefully evaluate operational safety before

selecting/accepting an approach and land-

ing runway including the following: weather

conditions (in particular cross- and tailwinds),

runway condition (dry, wet or contaminated/

slippery), inoperable equipment, and aircraft

and ight crew performance in order to re-

duce runway excursion risks.

Special considerations for landings on runways with a braking action

of less than medium

Many runway excursion incidents and accidents happen on

runways providing only medium or even less breaking action

(e.g., GRF RCC 2 or 3). Landing on runways with a braking

action of less than medium should therefore be treated with

reluctance both by aircraft operators and ight crews.

Flight crews are confronted with adverse weather (e.g., heavy

rain showers or severe winter operation), leading to runway

conditions providing less than medium braking action. Air-

craft operators should consider individual risk assessments

for the use of these airports as destination or destination-

alternate airports and provide valuable information in their

airport briengs or operational ight plans for their ight

crews — e.g., with regard to PIREPs or frequently made mis-

takes, special (orographic) factors which inuence speed

control on short nal, general weight limitations based on

the risk assessment.

In such special cases, the need cannot be overemphasised for

an immediate, symmetrical and full use of reverse until reach-

ing a safe taxi speed or full stop is assured. As Figure 14 shows,

when using maximum manual braking, thrust reversers are

additive. While deceleration due to drag does not change for

all runway conditions, the deceleration eects from reverse

thrust increase signicantly; brake eciency decreases due

to slippery runway conditions.

(See R&D3.)

4.3 Runway and approach type

selection (OPS 17)

Why should aircraft operators follow this

recommendation?

The type of operation (normal or non-normal) may inuence

a ight crew’s safety-relevant decision-making. Being opera-

tionally conservative (e.g., by requesting another approach, a

longer runway or a runway oering better wind conditions)

is often easier for ight crews in non-normal operation (e.g.,

in cases when an aircraft has a technical failure or an emer-

gency) than in normal operation, because the need for the

request is obvious and thereby easier to justify to air trac

controllers as well as to the aircraft operator’s management.

Nevertheless, threats like tail winds or crosswinds, fatigue,

reduced or lack of approach/runway lighting, a non- precision

approach, lack of prociency, etc. may lead to the same critical

94 Appendix C — Aircraft Operators

reduction in the safety margin for a ight as a major technical

failure would. Therefore, there should be consensus in the

industry that ight crews, who have nal authority over the

safe operation of their aircraft, should have the freedom to

always choose the type of approach and landing runway

which provide the highest level of safety and operational

assurances for their ight, especially with regard to runway

excursion prevention. The risk appetite for a given situation

may dier according to individual ight crews and their air-

craft and its performance, equipment or technical status, as

well as the individual human and team factors on the ight

deck, such as the pilot’s prociency, airport familiarity, fatigue

levels or type of ight (e.g., training, check or maintenance

test ight). Consequently, some ight crews may be able to

accept a specic approach or landing runway whereas others

may not. There should be no pressure on ight crews (e.g.,

due to trac, capacity, schedule, noise or other reasons) to y

approaches and attempt landings which expose them to run-

way excursion risks which they are not able to control safely.

What can aircraft operators do to implement the

recommendation?

Aircraft operators can support their ight crews in preventing

runway excursions by providing them with policies or SOPs that

encourage and embolden them to withstand any economic

or other peer pressure which could lead to unsafe decision-

making. This is especially important when selecting the landing

runway and the associated approach. The following should be

considered when establishing such policies or SOPs:

■

Aircraft operators should require ight crews to critically

assess during their approach preparation and continu-

ously during their arrival whether the landing runway and

associated approach in use can still assure a landing with

sucient safety margin to prevent a runway excursion (op-

erational safety). This assessment should be accomplished

jointly by the ight crew using a conservative strategy and

be based on at least the following ve items:

›

The runway length, width and surface condition, includ-

ing deteriorating trends (e.g., during winter operation

or in heavy rain showers);

›

The weather at the time of arrival, especially with regard

to wind components, precipitation and icing, consid-

ering also deteriorating trends;

›

The aircraft status, including the landing performance in

relation to the gross weight at the expected touchdown

time, the functionality of deceleration devices and the

equipment available for approach (e.g., area navigation/

required navigation performance [RNAV/RNP]);

›

The ight crew’s status in relation to tness, prociency,

airport and aircraft/variant familiarity as well as the

individual work atmosphere; and,

›

The alternative options available at the airport in terms

of approaches and landing runways available.

■

Aircraft operators should allow and encourage ight crews

to choose the approach and runway which provide the

highest level of safety and operational assurances based

on their own individual local rationality, even if this leads

to delay, increased fuel consumption or the violation of

noise restrictions. Flight crews should be allowed and

encouraged to cater for such circumstances if they are

able to anticipate such threats (e.g., by taking extra fuel or

accepting delay on approach). Policies should make clear

that decisions concerning approach and runway selection

should always be joint ight crew decisions based on the

most conservative option as preferred by either ight crew

member, unless a non-normal or emergency situation may

require the PIC to decide otherwise.

■

Aircraft operators should require ight crews to generally

prefer 3D approaches over 2D approaches and, where

deemed applicable, to always use the highest level of auto-

mation in order to reduce crew workload and increase the

ight crew’s situational awareness. However, aircraft oper-

ators’ policies and SOPs should provide guidance for their

crews on the circumstances and accompanying precau-

tionary measures under which deviations from the above

are allowed (e.g., to maintain the prociency of manual

ying skills for ight crews). This may include restrictions

like the necessity to brief and agree on the use of manual

ight in the approach brieng, imposing requirements

to also use partial automation (e.g., auto thrust) and to

require reversion to automatic ight as soon as request-

ed by the PM to safely cope with complex situations and

avoid task overloading (e.g., during nal approach or base

turns with simultaneous conguration changes, checklist

reading and ATC calls).

■

Aircraft operators should support ight crews by proac-

tively exchanging information with ANSPs and airport

operators on airports in their route network where tail

wind/crosswind operation is prevalent (e.g., in combina-

tion with relatively short runways) or to explain why ight

crews might need to request approach and/or runway

changes (e.g., during local runway safety team meetings

or via their commercial contacts).

4.4 Autoland without protection of ILS

critical/sensitive areas (OPS 20)

Why should aircraft operators follow this

recommendation?

Although use of the autoland capability of an aircraft, if in-

stalled and approved, can aid a crew in landing safely under

protected conditions (e.g., during low visibility operation),

this method may pose signicant threats to a ight when

used without protected ILS critical/sensitive areas. The reason

for this is that rapid and unpredictable signal deections

from localiser or glideslope antennas may be induced by

any aircraft or vehicle which is positioned in or crossing the

critical and sensitive areas, leading to unpredictable autopilot

behaviour, which may be catastrophic at very low altitudes

Global Action Plan for the Prevention of Runway Excursions 95

Recommendation OPS 20: Aircraft op-

erators should publish SOPs and guidance

their ight crews not to conduct auto-land

approach manoeuvres at airports when low

visibility procedures (LVP) are not in force,

unless:

■

the ILS critical and sensitive areas are

protected,

■ ATC had been informed and reassurance

of ILS sensitive area protection had been

received

■ specic precautions have been taken and

risk analysis has been performed.

■

the aircraft is demonstrated as robust to

non-protection of ILS sensitive area.

and during landing rollout. The best-known example of such

an event was an accident in Munich in 2011 when a Boeing

777 veered o the runway. Although manufacturers generally

allow the practice of autoland approaches without protected

critical and sensitive areas under the assumption that ight

crews could take over manually in case of ight path devia-

tions, this option should be used with the greatest reluctance

and only under very special and risk-assessed conditions.

Depending on the aircraft type and the point of reversion

to manual ight, the aircraft may be inadequately trimmed

for manual ight, the ight crew might not be aware of the

actual aircraft status and its go-around capability, the ight

crew’s cognitive performance may be reduced by fatigue or

surprise/startle, or there may be a risk of approach instability

by large and abrupt control inputs, which may, in turn, lead

to unnecessarily complex situations in close proximity to

the ground.

The autoland function of an aircraft is a safety feature which

allows the ight crew to ensure safe landings either in de-

graded weather situations or in the event of degraded ight

crew abilities to safely y the airplane manually, (e.g., due to

fatigue, lack of prociency or incapacitation of a crew mem-

ber). However, this requires certain conditions to be met,

including proper ground protection, a certain wind envelop

or other aircraft-type-specic restrictions.

What can aircraft operators do to implement the

recommendation?

Flight crews need proper training and safe policies/SOPs

enabling them to ensure safe autolands. When establishing

such SOPs and training practices, aircraft operators should

consider at least the following:

■

Aircraft operators should restrict the use of autoland to

conditions when the ILS critical/sensitive areas are pro-

tected. This should apply to both routine line ights and

training ights.

■

Aircraft operators should require ight crews to consider

during their pre-ight preparation whether an autoland

may be required or desired for landing (e.g., due to weath-

er or human performance limitations). In such cases, the

ight crew should ensure that the airplane carries su-

cient fuel for possible delay/holding in case protection of

the ILS critical/sensitive areas cannot be guaranteed by

ATC at the estimated arrival time.

■

Aircraft operators should require ight crews to advise ATC

as early as possible of the need for protected ILS critical/

sensitive areas during approach and landing, as the neces-

sary trac spacing and system setup may take some time.

Before starting the autoland approach, the ight crew

should have received acknowledgement by ATC that the

protection has actually been given during their landing.

The protection of ILS critical/sensitive areas is currently the

most eective measure to mitigate the risk of signal disrup-

tions during autolands. If aircraft operators consider using

the autoland function in their operation without any ground

protection (e.g., during certication processes or in marginal

weather conditions), they need to prove to their regulator

in a safety case or formal risk assessment that any proposed

alternative guarantees at least the same level of safety as the

ground protection. At least the following should be consid-

ered for such a risk assessment:

■

The aircraft operator should check that the ILS beam

quality and the eect of terrain prole before the runway

have no adverse eect on autopilot/ight director (AP/

FD) guidance. In particular, the eect of terrain disconti-

nuities within 300 m before the runway threshold have

to be evaluated.

■

The aircraft operator should consider the amount and

scope of training needed to train ight crews in safe

aircraft recovery in the event of autopilot misbehaviour

and osets due to signal disruption, especially at low lev-

el and during touchdown and landing rollout. Therein,

ight crews should be made aware that localizer (LOC)

or glideslope (GS) beam uctuations, independent of air-

craft systems, may occur, and the PF must be prepared

to immediately disconnect the AP and take appropriate

action should unsatisfactory guidance occur. This should

also include establishing proper intervention SOPs (e.g.,

go-around call) and initiation by the pilot detecting signal

disruptions rst (this may be the PM or PF) and the provi-

sion of practical training in the simulator.

■

The aircraft operator should consider the simulator rep-

resentativeness (i.e., whether such failures or disruptions

can be realistically simulated.

■

The aircraft operator should specify clear limits and re-

strictions for the use of autoland without protected areas

(e.g., with regard to weather, daylight, aircraft systems or

96 Appendix C — Aircraft Operators

information from ATC about the intended landing using

autoland without protected areas). As an example: On an

Airbus aircraft, at least CAT2 capability should be displayed

on the ight mode annunciator, and CATII/III procedures

should be used. Visual references should be obtained at

an altitude appropriate to the performed CAT I approach;

otherwise go-around should be initiated.

■

The aircraft operator should seek guidance from the air-

craft manufacturer regarding possible tools to make the

aircraft robust to non-protection of ILS sensitive areas by

technical means (e.g., the Airbus Exact Landing Interfer-

ence Simulation Environment (ELISE) software for airports

and ANSPs), which can eectively eliminate interference to

an ILS due to aircraft, vehicles, buildings and other objects

in close proximity to the runway.

4.5 Stabilised approach and landing

(OPS 18, 19, 32)

Why should aircraft operators follow this

recommendation?

It is well accepted throughout the industry that a prerequi-

site for a safe landing is a stabilised approach. All worldwide

applicable regulations like ICAO Procedures for Air Naviga-

tion Services – Aircraft Operations (PANS OPS), Doc 8168, or

IATA Operational Safety Audit (IOSA) standards, as well as

national regulations, clearly demand stable approach policies

and implemented the criteria for a stable approach concept

as sparked by the Flight Safety Foundation Approach and

Landing Accident Reduction (ALAR) Tool Kit more than 20

years ago.

Nevertheless, there are still ight crews in today’s worldwide

ight operation taking the risk of continuing to land from an

unstabilised approach. Flight crews need to be made aware of

the risks associated with unstabilised approaches, especially

in regard to runway excursion prevention. Continuing to land

from an unstabilised approach, even though the landing

might be perceived as uneventful, is a safety-critical event.

According to a safety study by IATA on accidents in the pe-

riod from 2012 to 2016, an average of six accidents per year

were preceded by an unstable approach. The analysis also

revealed that unstable approaches were cited as one of the

contributing factors in 50 percent of hard landings, 27 per-

cent of runway/taxiway excursions, 9 percent of tail strikes,

6 percent of undershoots, and 3 percent of loss of control, of

in-ight damage or of controlled ight into terrain. As run-

way excursions are still one of the key risk areas in aviation,

and as shown by the preliminary gures regarding the latest

accidents in 2019 and 2020, there is still a strong need across

the industry to support ight crews in complying with stable

approach policies in daily practice.

Although the criteria which dene a stable approach may

dier among aircraft operators, depending on their type of

operation, their route network or type of aircraft used, the

common key element is the requirement for a go-around if

an approach or landing becomes destabilised at or below

the stable approach gate. The problem, faced in particular by

commercial aviation today, is that there might still be barriers

in the aviation system which lead to a reluctance among some

ight crews to call for or to execute go-arounds (see recom-

mendation OPS 16). At the same time, capacity and approach

Recommendation OPS 18: Aircraft opera-

tors should clearly dene stabilised approach,

landing and go-around policies in their op-

erations manual. These policies have to be

aligned with regulations requirements and

manufacturers guidance. Supplementing

SOPs should include the requirement for

completion of the landing checklist and y-

ing with the nal approach speed latest at

the dened approach/landing gate. These

SOPs should include appropriate means

for the pilot monitoring (PM) to eectively

monitor and, if needed, intervene. To properly

implement the dened policies and SOPs,

aircraft operators have to deliver appropriate

training.

Recommendation OPS 19: Aircraft opera-

tors should publish SOPs and guidance and

provide training highlighting the importance

of active monitoring and eective interven-

tion by the pilot monitoring (PM) during de-

scent, approach, approach path management

and landing. Actions to be taken by the PM

and required reactions by the PF should be

clearly documented in the ocial publication

(e.g. SOPs or Operations Manual, FCOM, etc.).

These publications should include guidance

how to achieve eective PM performance,

independent of rank and experience.

Recommendation OPS 32: Aircraft opera-

tors should:

1) Dene an unstable approach followed by

landing as a mandatory reporting event

by the ight crew and

2) Minimise the need to report a go-around

due to an unstable approach unless there

is another signicant event in relation to

the go-around, e.g. ap overspeed.

Global Action Plan for the Prevention of Runway Excursions 97

Table 2

Nudges between the PM and PF Nudges between the ight crew and ATC

Asking/advising the PF on the use of speed brakes;

Asking/advising the PF on the estimated shortest distance to go

(even at regular intervals);

Stating out loud actual wind or gross weight and its inuence on

the descent path; and,

Calling out anticipation of an unstable approach.

Pilot: asking ATC for the planned track miles to go;

Pilot: advising ATC on the required track miles to go;

ATCO: stating the planned track miles to ight crews on initial

contact or asking for the required track miles; and,

ATCO: asking/challenging ight crews if their approach path or

approach speed appear higher than usual.

management is sometimes eciency-oriented instead of

safety-oriented. Therefore, the strategy for the industry to

cope with the problem of ‘unstable approaches – landed’

should be twofold:

■

It should be made as easy as possible for ight crews to

achieve stable approaches; and,

■

It should be made as easy as possible for ight crews to ex-

ecute a go-around if their approach becomes destabilised.

Achieving stable approaches as well as go-arounds from un-

stable approaches requires a joint eort and collaboration

throughout our industry. While regulators, aircraft manufac-

turers, ANSPs, aircraft operators and training organisations

can inuence ight crews’ stable approach performance by

providing useful policies, approach procedures, SOPs and

training, frontline personnel like ight crews and ATCOs can

achieve stable approaches by applying a defensive/conserv-

ative strategy in their energy and trac management and by

strictly adhering to SOPs and limitations, as well as through

early mutual intervention, if required.

(Early) intervention in particular is a key to achieving stable

approaches and to preventing ‘unstable approaches – landed’,

thus reducing the risk of runway excursions signicantly. An

unstable approach often largely originates prior to starting

the approach (e.g,. due to hot and high approach vectoring

by ATC, energy mismanagement by the PF or the ight crew’s

lack of or inappropriate threat analysis with regard to relevant

threats like signicant tail wind components or restrictions

associated with weather, terrain or trac during descent.

Many runway excursion events involve the aircraft ying

higher or lower than the desired vertical ight path and/

or faster or slower than the desired airspeed. Therefore, the

role of the PM (and other qualied ight crew members on

the ight deck, if available, like supernumerary or enlarged

crew) is not only of paramount importance throughout the

approach phase but also during the descent.

Contrary to hard intervention measures on nal approach,

like calling for a go-around or taking over control from the

PF (which may require tremendous psychological eort for

the PM, depending on the cross-cockpit authority gradient,

the cockpit’s work atmosphere or the airline’s culture and

its training quality), the PM has various opportunities in the

descent, arrival and initial approach to use soft intervention

measures, like deviation callouts, rejecting shortcuts by ATC

or using nudges vis-à-vis the PF. Nudges are interventions

that preserve the freedom of choice but that nonetheless

inuence people’s decisions. Human decisions are often

heavily inuenced by cognitive and behavioural biases. We

tend to favour default options, to make contextual instead

of objective decisions and we are deeply aected by social

norms. Therefore, nudging is an elegant and useful tool which

can be used either within the ight deck team or in the team

formed by the ight crew and the relevant ATCO.

Achieving a stable approach is a collaborative eort by the PF,

PM(s) and ATCO(s) which requires that mutual intervention

between ight crews and ATCOs, as well as mutual inter-

vention within the ight deck team, is accepted by all team

members. The old notion of ‘my leg, your leg’ (single-pilot at-

titude on the ight deck whereby the PM is viewed merely as

an assistant to the PF) or the idea that ATC is not responsible

for an aircraft’s energy management are counterproductive to

achieving safe descents, approaches and landings, and thus

to preventing runway excursions. In order to provide appro-

priate intervention throughout the descent and approach,

the following nudges could help to ensure that neither the

PM, nor the PF or ATCO, feel uncomfortable or lacking in

condence when it comes to the safe operation of the aircraft

(Table 2).

With regard to achieving stable approaches, it is worth noting

that there might still be signicant dierences between ight

crews’ and ATCO’s perspectives on safe aircraft operation.

As ATCOs handle many dierent types of aircraft which are

operated by many dierent aircraft operators, it is sometimes

hard for them to understand why some ight crews require

more mileage or declare ‘unable’, while others seem to be able

to follow their instructions, especially if dealing with aircraft

types belonging to the same approach category (e.g, A320

and B737). If ATCOs could see that ight crews sometimes

undertake unsafe practices, such as ying near or at the edge

of their operational speed and ap envelope, diving for the

required descent path with high nose down pitch, extending

the gear early just to be able to reduce their speed below aps

extension speed or risk ying high speed in low level, only

to heed ATC instructions, ATCOs would maybe refrain from

providing challenging clearances. Moreover, the inuences of

varying descent and speed reduction capabilities of dierent

aircraft types and the inuences of dierent gross weights or

tailwind components also need to be considered. Therefore,

98 Appendix C — Aircraft Operators

there should be consensus in the industry that ight crews,

who are ultimately responsible for the safe operation of their

ights, have the right to intervene in ATC instructions, and

that ATCOs have the right to intervene in ight crews’ air-

craft handling if they believe there to be any threat to a safe

approach and landing (e.g., when ight crews intercept an

approach path exceptionally high or fast).

In order to achieve acceptance of intervention among team

members and to avoid this having a negative impact on the

work atmosphere on the ight deck or damaging the repu-

tation of aircraft operators among ANSPs, it is important that

intervention methods and their associated expected and

permitted reactions are documented and standardised. For

nudges or soft interventions like deviation callouts, common

wordings such as ‘Checked’, ‘Roger’ or ‘Thank you’ might be

sucient. However, for hard interventions like expressing

concerns, calling for a go-around or taking away aircraft con-

trol, clear procedural guidance and training for ight crews is

required. There are tools already in use by some aircraft oper-

ators like intervention cascades (e.g., ‘I feel uncomfortable, I

feel concerned, I feel unsafe’, or the ‘CUS’ method which uses

callouts like ‘Concerned – Uncomfortable – Safety’. These have

in common the fact that they are usable during all phases

of ight. With regard to the descent, approach and landing

phase, they can most certainly help assure stable approaches,

too, but there are circumstances when only a go-around call

or taking away control from the PF is the best option for the

PM to prevent an accident.

The Foundation safety study on go-around decision-making

reports that more than 50 percent of runway excursions follow

a stable approach which becomes unstable after threshold

crossing. This may happen due to wind shear, thermals, the

PF’s lack of prociency, overcontrolling, fatigue, etc. In such

cases, it is important that ight crews initiate a go-around,

even during are and touchdown (until the selection of reverse

thrust) instead of forcing a landing. Eective intervention by

the PM in such situations by calling for a go-around or even

by taking away controls from the PF in order to initiate the

go-around may be necessary. According to a joint paper on

stable approaches by IATA and the International Federation of

Air Line Pilots’ Associations (IFALPA), the idea that either pilot

can call for a go-around is an essential part of CRM, which is

the core concept of TEM, and in fact should be an important

element in an aircraft operator’s TEM training (IATA, 2016). The

circumstances for such intervention by the PM should be clear-

ly stated in the SOP, and appropriate guidance and training

should be provided which also highlights possible dierential

risk perception of the PF/PM, depending on whether the role of

the PF is fullled by the PIC or the SIC. Training for taking over

control from the PF safely (e.g., in case of macho behaviour (not

accepting a go-around call) or (subtle) incapacitation, possibly

by fatigue, startle or tunnel vision of the PF, should be included

already in the initial pilot and type rating training and should

also be a standing topic of recurrent simulator training for all

ight crews, irrespective of rank and experience.

https://www.iata.org/contentassets/7a5cd514de9c4c63ba0a7ac21547477a/iata-guidance-unstable-approaches.pdf

What can aircraft operators do to implement the

recommendation?

Aircraft operators should provide ight crews with policies,

procedures and training which make it as easy as possible for

them to conduct stable approaches and as easy as possible

to decide for a go-around in the event that the approach

or landing becomes unstabilised. The following should be

considered when establishing the associated policies, SOPs

and training practices:

Aircraft operators should dene a combined stable approach

and landing policy, making clear that certain stable criteria

must be met until touchdown. The guidelines and limitations

should make operational sense for both ight crews and

management, resulting in greater acceptance of the policy.

The nal report of the FSF Go-Around Decision-Making and

Execution Project (FSF, 2017) or the third edition of IATA’s

unstable approach paper (IATA, 2017)

may include useful

hints and ideas. If aircraft operators are considering chang-

ing their stable approach SOP, it may be advisable to run an

awareness campaign to explain the philosophy behind the

new SOP. Examples of incidents or accidents that could have

been prevented with the SOP would certainly strengthen its

case. In general, at least the following items for dening a

stable approach SOP should be considered:

■

Denition of approach gates

In order to always achieve a stable approach, the following

gates could provide helpful guidance for ight crews. The

following values for medium to large aircraft (e.g., A320/

B737) may serve as an example (adaptions for dierent

operations or aircraft type may be needed):

›

Last 18–15 nm from touchdown (depending on aircraft

gross weight, wind, aircraft’s speed reduction capabil-

ities): reduction from 250 kts to 210 kts or minimum

clean speed should be initiated;

›

Last 12 nm from touchdown: the aircraft should be

ying at a maximum speed of 210 kts. A “12 miles to

touchdown” callout by the PM could be a helpful tool

to raise awareness for the PF, especially on approaches

without a direct indication of mileage to the runway.

Flight crews should be required to plan a level seg-

ment for further speed reduction and start of initial

conguration;

›

Last 9 nm from touchdown/3,000 ft AAL: the aircraft

should be ying at a maximum speed of 180 kts and

on an initial ap setting;

›

Last 6 nm from touchdown/2,000 ft AAL: the gear

should be lowered, and an intermediate ap setting

selected, airspeed should be around 150 kts; and,

›

Last 3 nm from touchdown/1,000 ft AAL: nal aps

should have been selected, landing checklist complet-

ed and the aircraft should have reached nal approach

speed.

Global Action Plan for the Prevention of Runway Excursions 99

Further check heights to help ight crew in their deci-

sion management are the outer marker/ xed distance

check, the stabilisation height, and 100 above/approach-

ing minimum or minimum. Compliance with all required

ight parameters within tolerance at one ‘gate’ means the

ight can continue until the next ‘gate’, where again an

assessment will be made. It should be emphasised that

the ight crew should not become complacent when a

‘gate’ is passed successfully. In fact, they should be con-

tinuously prepared for a go-around until the ‘point of no

return’: the selection of reverse thrust. Aircraft operators

of aircraft without reverse thrust should dene their own

specic policy.

■

Criteria of a stabilised approach

These must be clearly dened and easily assessable by

the ight crew and should be reached by the latest at the

stabilisation height. Examples could be:

1. Aircraft is on the correct prole (lateral and vertical

ight path):

• CAT I ILS: aircraft within +/− 1 dot vertical path and

localiser.

• RNAV: within ½ -scale deection of vertical and lat-

eral scales and within RNP requirements.

•

Localiser/VHS omnidirectional radio (LOC/VOR):

within 1 dot lateral deviation.

• Visual: within the ‘slightly high’ and ‘slightly low’ in-

dications visual approach path indicators and lined

up with the runway centreline not later than 300 ft.

2. Aircraft is properly congured to land:

•

The aircraft is in the landing conguration (gear and

aps set, speed brakes retracted).

• No more changes to a dierent ap setting due to

unexpected wind change in approach.

3. Aircraft is at the correct speed:

•

Airspeed is stabilised within Vref + 10 kts to Vref

(without wind adjustments).

• Thrust is stabilised to maintain the target approach

airspeed.

Note that the use of an auto thrust system (ATS)

for approach and landing can modify the previous

recommendations. Aircraft operators should also

specify whether it is possible to use the ATS without

autopilot for approach and landing. If it is possible,

they should promote the use of ATS in manual y-

ing as it may reduce the pilot workload in monitor-

ing speed and adjusting thrust, therefore freeing

mental capacity for situational awareness. This may

also prevent aircraft carrying excess speed over the

threshold.

• Sink rate is no greater than 1,000 fpm.

4. Checklists completed:

•

The landing checklist is completed. This will allow

the PF to fully focus on ying duties and the PM to

fully focus on monitoring duties.

› General:

• The stabilised approach gates should be observed,

and the stabilisation height must be complied with.

•

Normal bracketing corrections in maintaining sta-

bilised conditions occasionally involve momentary

overshoots made necessary by atmospheric condi-

tions; such overshoots are acceptable. Frequent or

sustained overshoots are not.

•

Unique approach procedures or abnormal condi-

tions requiring a deviation from the above elements

require a special brieng.

› Denition of stabilisation height

Stabilisation heights are limits and ‘must’ gates where

all of the stable criteria must be fullled at the latest.

Flight crews should not view the stabilised height as a

target as this may result in some overrun of the height.

Common stabilisation heights used throughout the

industry are 500 ft above the aireld elevation in visual

meteorological conditions (VMC) and 1,000 ft in instru-

ment meteorological conditions (IMC). Note that some

operators use only the 1,000 ft requirement whatever

the weather conditions. This not only simplies the

operating procedures but also simplies the process

for verifying compliance (e.g., by FDM) and is recom-

mended to provide a better safety margin.

› Actions at stabilisation height

When passing the stabilisation height, the PM performs

the compliance check and calls out the result (for in-

stance, ‘stable’/’not-stable’/’go-around’); the PF only

has the choice between two possibilities: continue

the approach or discontinue it, using the appropriate

call out (i.e., ‘continue’ or ‘go-around’. In the event that

the approach is not stabilised, the PF must initiate a

go-around manoeuvre. If the PF does not perform it,

the PM has to take over control and perform the go-

around. In such cases, SOPs should be provided for the

PM to call all go-around–related memory items once

actioned and include the required response/action if

not performed by the other pilot.

› Actions in the event of destabilisation below stabi-

lisation height

While the criteria and SOP mentioned before protect

against high-energy or rushed approaches, this SOP

concerns destabilisation after passing the stabilisation

height. Usually this is a transient condition often caused

by changing wind velocity or direction, thermals, lack

of PF’s prociency, overcontrolling or fatigue. Provided

100 Appendix C — Aircraft Operators

the PF can regain the stabilised approach criteria, the

approach may continue. During the later stages of the

approach, the PF’s focus usually shifts from inside the

ight deck to outside. Depending on the level of auto-

mation used and the philosophy of the airline, either

the PF or PM will start looking for the visual references

needed to continue the approach beyond the decision

height (DH). Monitoring for possible excessive devia-

tions from path, speed, vertical speed, pitch or bank is

crucial in this phase of transition from approach to land-

ing as well as during are and touchdown. Timely and

eective callouts by the PM are necessary to guide and

support the PF, who can easily become task saturated

at this time and may not have the required capacity to

exercise complex judgement. Especially in this phase,

the PM should be ready to intervene hard by calling for

a go-around or taking away control from the PF in order

to go around in case deviations are excessive or the

PF does not correct the deviations appropriately. This

philosophy has consequences for the decision-making

process and CRM; training is needed to enable the PM

to consistently judge the situation and take the proper

decision on short nal.

■

Aircraft operators should consider installing stable ap-

proach and energy management monitoring and alerting

systems when available for the type of aircraft.

■

Aircraft operators should implement an open policy on

go-arounds, making a go-around a normal procedure and

not an abnormal issue (see OPS 16).

■

Aircraft operators’ safety policies and commitments should

contain a general requirement for frontline personnel

to always use a defensive/conservative strategy in their

safety-relevant decision-making. The role descriptions for

the PIC and SIC should specically contain the requirement

for these roles to always use a defensive/conservative strat-

egy in their ying and safety-relevant decision-making.

This will foster a general safety-oriented ight operation

which, in turn, will support their ight crews in achieving

stable approaches while at the same time reducing the

need for interventions and go-arounds.

■

Aircraft operators should implement standardised inter-

vention methods to be used by the ight crew both for

mutual intervention within the cockpit team and towards

ATC. These methods should be incorporated as SOPs in

the aircraft operators’ published operations manuals and

should clearly describe when and how the PM should

intervene, depending on the situation, including taking

away control from the PF, and the permitted reactions by

the PF. On the one hand, this will help to reduce barriers

preventing the PM from using interventions appropriately

without fear of jeopardising the cockpit work atmosphere

(‘nit-picking’ or status considerations). It will also ensure

timely and eective intervention which otherwise could

CUS – method based on the approach of “TeamSTEPPS” (Team Strategies and Tools to Enhance Performance and Patient Safety), a healthcare solution for

improving patient safety

CANSO, IFATCA, IFALPA paper: https://runwayexcursions.faa.gov/docs/Avoiding%20Unstable%20Approaches%20-%20Important%20Tips.pdf

be inhibited by the PM possibly worrying about perform-

ing an intervention too early (e.g., if the PM wants to give

the PF time to correct, which may be inadequate in some

situations. On the other hand, this will ensure that the

reactions by the PF are appropriate (e.g., by correcting

eectively, going around or handing over the controls

without reluctance). An example of intervention cascades

on top of the usual deviation callouts are the use of ‘CUS’

wordings by the PM like ‘I’m concerned’, ‘I’m uncomforta-

ble’, ‘This is a safety issue’ or ‘Stop the line’.

Other wordings

might be useful, depending on the culture and maturity

of the pilot workforce. The role description in the opera-

tions manual for the SIC and PM roles should include the

authority for eective intervention, including taking away

controls from the PF, if required, irrespective of rank and

experience. Any intervention policy should incorporate

additional crew members on the ight deck like qualied

supernumerary, enlarged crew or training sta. The scope

of intervention towards ATC should include the wording

‘unable’ as promoted by CANSO, the International Feder-

ation of Air Trac Controllers’ Associations (IFATCA) and

IFALPA.

The topic of mutual intervention to guarantee

stable approaches should be discussed jointly by aircraft

operators and ANSPs (e.g., during local runway safety team

meetings, or by inviting ATC personnel to attend the oper-

ator’s CRM/TEM/accident prevention trainings.

■

Aircraft operators’ automation and checklist philosophy

should require ight crews to plan conguration changes

and checklist reading in such a way that the PM’s tasks

will not be impaired by task overloading, also taking into

account requirements for ATC communication.

■

Aircraft operators should dene an ‘unstable approach –

landed’ as an incident which must be reported by ight

crews and which should be dealt with under just culture

principles. The mandate to report go-arounds from unsta-

ble approaches should be restricted to those events where

another reportable incident component was present (e.g.,

a aps overspeed) in order to foster the attitude that the

go-around itself is a normal procedure and is encouraged

by the aircraft operator in all cases.

■

Aircraft operators should use their safety promotion tools

to continuously promote the stabilised approach principle

and the need for defensive/conservative ying, as well as

the need for early intervention and go-arounds, to their

ight crews and management personnel in order to im-

prove the buy-in of both groups to these concepts and

to foster a mature safety culture. Compliance with the

relevant policies and SOPs should be veried using means

such as an FDM system which is guarded by a gatekeeper

and air safety reports in line with just culture practices.

An open reporting culture in the scope of the SMS will

help to identify precursors to unsafe practices or design

aws in SOPs or approach procedures. Flight crews and

Global Action Plan for the Prevention of Runway Excursions 101

Recommendation OPS 16: Aircraft opera-

tors should develop a clear go-around policy

which should be further supplemented by

a set of SOPs and guidance materials to put

this policy into action. This go-around policy

should enable every ight crew member on

the ight deck to call for a go-around at any

time unless an emergency situation dictates

otherwise. In all cases, the SOPs should re-

quire both pilots to have and retain the re-

quired visual reference below DA/MDA with a

go-around call mandatory if either pilot loses

it. A go-around should also be mandatory if

the approach becomes unstabilised below

the specied approach/landing gate.

Recurrent simulator training should be provid-

ed on the competencies of safe go-around in

various stages during the approach and land-

ing, including shortly prior or during touch-

down (before activation of thrust reversers).

management should receive feedback on analytics and

investigation results at regular intervals (e.g., bi-monthly).

■

Aircraft operators’ training on stabilised approaches should

be provided in the simulator and in the classroom. Crews

should not be allowed to y unstabilised approaches dur-

ing their simulator training. Instead training ight crews

should encourage and reward defensive/conservative

ying and decision-making. During simulator training,

instructors should put the same emphasis on following the

go-around procedures as in the real world. Their simulator

training should contain intervention trainings covering

various situations requiring soft and hard interventions by

the PM, which should include various situations requiring

go-around calls and taking away control from the PF. Such

training should be given to every pilot irrespective of rank

and experience. De-identied incidents from their airline

or airline group should be used as examples during recur-

rent training to highlight the need for compliance with

the stable approach policy and eective intervention, if

required. This helps to show that incidents/accidents do

not only happen to others. Using other real case studies

may help to further increase understanding of the po-

tential risk of a runway excursion after an unstabilised

approach. The SKYbrary accident and incident database,

among others, may serve as a library for such case studies.

(See OPS 31 to include go-around/discontinued approach

observation via FDM.)

4.6 Go-around policy, decision-making

and pilot monitoring duties (OPS 16)

Why should aircraft operators follow this

recommendation?

A go-around is a normal ight procedure. It is one of the most

eective tools in aviation to prevent approach and landing

accidents. A Flight Safety Foundation study of 16 years of run-

way excursions determined that 83 percent could have been

avoided with a decision to go around. As approach and landing

accidents account annually for approximately 65 percent of all

accidents, as much as 54 percent of all accidents could poten-

tially be prevented by going around (FSF, 2017).

For each aircraft, there are distinct procedures in place

for performing a go-around safely, and at least each pub

lished instrument approach provides a predetermined

and safety-risk-assessed go-around path and routing for

approaching aircraft. Like other normal ight manoeu-

vres such as takeo, approach or landing, go-arounds are

mandatory manoeuvres in any pilot’s initial and recurrent

training/ checking. Nevertheless, this safety tool may still,

even in today’s aviation, be stigmatised as being dangerous

or undesired, when in fact the opposite is true.

It is even in the economic interest of airlines that their ight

crews execute go-arounds, if required. Promoting of go-

arounds will not only invest in the airline’s safety culture

but may prevent incidents and accidents in the long run

(e.g., if a go-around prevents a hard landing which results

in damage that could contribute to a landing gear event

some years later, for example). Even in the short term, it is

economically more desirable for an airline to use some fuel

for a go-around instead of having to deal with the costs

and negative outcomes of mishaps during landing (e.g., a

hard landing, a runway excursion or an abnormal runway

contact), which may not only have a signicant impact on

an operator’s schedule but also may create huge follow-on

costs, negative brand reputation or regulatory restrictions.

Go-around compliance rates are therefore not only a key

safety performance indicator for an aircraft operator’s safety

management but also a key performance indicator for air-

craft operator’s general management.

Go-arounds are even of benet to the ATM system because

they may reveal system and procedure design deciencies

such as hot and high approach vectoring, excessively tight

spacing or inappropriate approach design. Possible separa-

tion issues arising due to go-arounds (e.g., during simultane-

ous landing and departure operation or during unsegregated

parallel runway operation) will reveal where the ATM system

is working at or above its safe capacity limits. They can even

be anticipated and their risks mitigated in advance.

While the go-around manoeuvre is not hazardous in itself, it

becomes hazardous when executed improperly (IATA, 2016).

As this applies to other ight manoeuvres like takeo, ap-

proach or landing as well, it is obvious that go-arounds need

the same attention and focus in terms of pilot training. There-

fore, go-around training should not only include training in

the technical competencies required by a pilot to perform

102 Appendix C — Aircraft Operators

the go-around manoeuvre correctly but should also incor-

porate training in non-technical competencies associated

with the go-around manoeuvre like situational awareness,

communication and decision-making.

Flight crews have to be made aware of adverse eects on

decision-making and cross-monitoring of several cognitive

biases like anchoring bias, attentional tunnelling (tunnel vi-

sion), conrmation bias and plan continuation bias. Moreover,

disorientation or startle eects may cause human performance

to deteriorate further during go-arounds if unexpected air-

craft or system behaviour occurs. Expectancy and conrmation

biases strongly inuence individuals’ mental models of their

current situation. The rst step in countering cognitive biases

is to identify them. For example, ight crews might be trained

in ‘de-biasing’ techniques, such as imaging how a planned

course of action might fail, before committing to that plan.

Critical thinking and a willingness to search for information

that is contrary to one’s mental model and other methods

for de-biasing like mutual cross-monitoring and early chal-

lenging/intervention (noticing/alerting/taking over control),

pattern matching as well as mental priming for go-around can

be lifesaving. The decision-making process associated with

go-arounds starts during pre-ight preparation and should

be reviewed by the ight crew continuously during the ight

as shown in Figure 15.

In a recent safety study, more than 65 percent of the ight

crews reported that they had experienced a situation in their

career in which neither pilot on the ight deck called for a go-

around even though it was required, which might explain why

a go-around, although being a normal procedure, is still not

a frequent occurrence. Even today, there may still be barriers

within the aviation system which prevent ight crews from

initiating go-arounds, despite being required to perform one

(e.g., individual pilot’s risk perception that landing is the safer

option, schedule or fuel consumption considerations, author

ity gradient on the ight deck, non-acceptance of stabilised

approach policies, lack of training/go-around prociency or

“get-there-itis”). Get-there-itis or plan continuation bias is a

proclivity to continue a planned or habitual course of action

past the point when changing conditions require altering the

plan. This is the strong unconscious tendency to forge ahead

with the original plan in spite of changing conditions. This

bias grows stronger near the end of the mission as the crew

anticipates landing the aircraft and completing the ight. Plan

continuation bias may have the eect of obscuring subtle

cues which indicate that original conditions and assumptions

have changed. In addition, numerous incidents and human

factors studies have revealed that once an individual has se-

lected a particular course of action, it takes very compelling

cues to alert them to the advisability of changing their plan.

Figure 15. The decision-making process associated with go-arounds

Training

Awareness

Bulletins

Discussions

Familiarity

with SOPs

Briefing

potential of

go-around

and

contingency

Update

arrival

information

Discuss

approach,

go-around

and

diversion

Brief STAR,

instrument

approach,

go-around/

missed

approach,

diversion

and

contingency

Update

arrival

information

improve

situational

awareness

Brief

specifics

including,

monitoring,

task sharing,

call outs for

go-around

Monitor,

cross-check,

update

situational

awareness

Prepare for

decisions

From this

point until

touchdown,

decide to

continue or

go-around

Decide to

continue or

go-around

Decide to

continue or

go-around

Pre-flight Pre-depart Cruise Top of

descent

Descent Pre-

approach

Approach Stabilised

Gate

DH/DA Below

DH/DA

Decisions can be planned and

rehearsed and relative merits tested for

benefit in a variety of situations

Decision making is dynamic,

and relies on situational

information, policies, and

procedures

Decision making is

dynamic and relies

on procedures and

previously briefed

options

Decision

Auto-

reactive

Cognitive activity Motor programme activity

Time available for decision making

Mental capacity available

Ability to handle change

Global Action Plan for the Prevention of Runway Excursions 103

This is why the role of the PM and other qualied crew mem-

bers on the ight deck (supernumerary or enlarged crew) is

so important, especially for the prevention of approach and

landing accidents such as runway excursions. In contrast to

the PF, who may easily become task saturated, especially in

manual ight, the PM (and the other crew members on the

ight deck, if applicable) may have more mental capacity and

thus better situational awareness to detect trends and ight

path deviations. If the PM or the other qualied ight crew

members are feeling uncomfortable or not condent with

the safe outcome of the approach and landing, they should

intervene (e.g., by speaking up and nally calling for a go-

around, if required). With regard to the prevention of runway

excursions in particular, it is important to promote that any

ight crew member may call for a go-around at any time and at

any stage during the approach and landing (until the selection of

reverse thrust), unless abnormal or emergency situations dictate

otherwise. There should be consensus in the industry that at

least the following apply to go-arounds in normal operation:

■

A go-around must be performed as soon as any ight

crew member calls for it, irrespective of the caller’s rank

or experience;

■

Go-around execution should neither be delayed nor

discussed; the go-around should be applied without

hesitation;

■

A go-around can be initiated at any time during approach

and landing until the selection of reverse thrust;

■

Once initiated, a go-around must be completed; and,

■

A pilot should never have to justify a go-around decision.

The philosophy that either pilot can call for a go-around is

vital and should be an important item in aircraft operators’

role descriptions and ight crews’ initial and recurrent train-

ings. Status hierarchy and status generalisation eects (e.g.,

attributing a general low status to copilots or thinking that a

pilot without a PIC rating is a less competent pilot than a pilot

with a PIC rating) might still be present in today’s aviation and

act as a barrier to eective and safe team decision-making.

Aircraft operators’ culture, policies, SOPs and training should

ensure that it is not more dicult for a less experienced co-

pilot to call for a go-around than for an experienced com-

mander, and that both pilots are equally open to accepting

intervention from each other when working together. Indeed,

especially the cockpit role of the PM is more that of a super-

visor for the PF than of an assistant, irrespective of rank or

experience of the pilot fullling this role.

What can aircraft operators do to implement the

recommendation?

Aircraft operators should have a go-around policy which is

separate from other policies such as their stable approach

policy. The rst reason for this is that go-arounds might be

necessary for various reasons besides an unstable approach.

The second reason is that the go-around decision is one of

the most important decisions for the prevention of runway

excursions and requires clear and unambiguous SOPs, guid-

ance and training. The policy underlying these SOPs, guidance

and training should therefore be comprehensive. The follow-

ing should be considered when establishing the policy, SOPs

and training practices:

■

Aircraft operators’ go-around policy should dene the go-

around as a normal procedure which should, as soon as

the need is identied by any of the ight crew members,

neither be delayed nor discussed, and which should be

applied without hesitation. Once the go-around decision

has been initiated, it must be completed.

■

Aircraft operators’ SOPs should not contain any restrictions

for the PM and/or the SIC(s) to call for a go-around at any

time during approach and landing, until the selection of

reverse thrust. This should not aect the emergency au-

thority of the PIC. The role descriptions for the PM and

for the copilot roles (e.g., second/rst/senior rst ocer)

should contain a formulation providing unrestricted au-

thority for mandating go-arounds. Overruling a SIC’s go-

around call by the PIC should only be allowed in the event

of previously briefed abnormal situations or (impending)

emergencies. The denitions and regulations for super-

numerary and enlarged ight crew members should also

specify the means by which they can intervene eectively,

if required, depending on their qualication and possibil-

ities on the type-specic ight deck.

■

Aircraft operators’ go-around policy should explicitly ex-

press the senior management’s commitment that ight

crews are always free in their decision to go around and

divert without having to justify the decision, even if this

leads to operational impacts such as delay, missing night

curfews, additional fuel consumption, diversion, etc. In-

stead, go-arounds should be promoted and rewarded by

management in order to encourage the ethos of go-around

as a safety manoeuvre. The operator’s fuel policy should

ensure that ight crews have the freedom to uplift sucient

extra fuel if they foresee that a go-around may be needed at

the destination or destination alternate. Nevertheless, the

go-around compliance rate should be monitored by safety

management. Aircraft operators should consider, based on

the maturity of their safety culture, whether ight crews

should generally report go-arounds or reasons for them,

according to whether this would have an inhibiting eect

on ight crews’ go-around decision-making.

■

Aircraft operators’ go-around policy should require their

ight crews to always be go-around-prepared and go-

around-minded. In order to always be suciently prepared

for a go-around and to cope with complex missed approach

procedures or demanding environmental conditions (e.g.,

weather, terrain and trac), which can easily result in high

workload, mental overload and task saturation, especially if

the ight crew’s mental capacity has already been reduced

(e.g., by fatigue, distraction or lack of prociency), the fol-

lowing should be considered when determining the policy

and SOPs associated with go-arounds:

104 Appendix C — Aircraft Operators

› The go-around policy should contain a list of possible

scenarios which may mandate ight crews to discon-

tinue or go around from an approach or a landing (until

the selection of reverse thrust) and include, at least,

the following:

•

Go around, if the visibility or ceiling is below the

minimum required for the type of approach at the

specied gates (e.g., outer marker, 1,000’ AAL or

minimum);

• Go around, if the appropriate visual references are

not obtained or are lost at or below MDA (or min-

imum descent height)/DA (or decision height) by

either pilot. This includes the are and touchdown;

• Go around, if prior to touchdown the wind is above

the operational or pre-determined wind limit or the

runway status is below the limit determined by the

ight crew’s landing performance assessment;

• Go around, if the criteria for a stable approach are

not met at the relevant approach gate(s) or can no

longer be maintained until touchdown;

•

Go around, if technical defects or failures occur dur-

ing approach which might inhibit a safe continua-

tion of approach, landing or go-around;

• Go around, if doubts by either pilot exist about the

aircraft’s geographic or spatial position;

• Go around, if confusion by either pilot exists about

the use or behaviour of the automation;

•

Go around, if it is foreseeable that the go-around

routing and path will not be suciently clear of ad-

verse weather or restricting trac;

• Go around, if instructed to do so by ATC;

•

Go around, if required by type-specic reasons as

outlined in the respective FCOM; and,

• Go around, if required by special considerations as-

sociated with CATII/III operation.

›

Flight crews should be required to check in advance the

missed approach in the FMC to match the published or

expected missed approach procedure on the approach

chart for the approach to be own.

› Flight crews should be required to include an assess-

ment of the expected fuel status at go-around initia-

tion, the expected threats during the go-around (e.g.,

expected weather and winds on the go-around route,

eects of aircraft weight, complexity of the missed

approach procedure, go-around prociency and expe-

rience, trac in the missed approach area) and the re-

maining options after the go-around in their approach

brieng, highlighting in particular circumstances that

PICMA – PIC monitored approach; see www.picma.info

One-team-cockpit-concept, see Schmidt,T. A.; Nixon, J.; Kourdali, H. K.; Kemény,C.; and Popp, C. “OneTeamCockpit — Enhancing the Flexibility of Flight Deck

Procedures during the Go-around.”

might require them to adapt the go-around proce-

dure (e.g., to avoid altitude busts or speed exceedances

in case of early level os). If deemed necessary (e.g.,

for prociency reasons), the sequence of actions, the

task-sharing and callouts can be rehearsed in the ap-

proach brieng as well.

■

Flight crews should be provided with guidance on how

to proceed after two consecutive approaches to the same

runway at one airport and on the requirements for an

exceptional third attempt or the necessity for a diversion.

■

Flight crews must acquire the visual reference at the latest

at the minima and maintain it until landing. If at any time

after passing the minima, one of the ight crew members

loses sight of the required visual references or is not sure

about the safe outcome of the landing, a go-around must

be initiated or called for. It should be highlighted that this

option remains available until the aeroplane touches the

ground and up to the selection of reverse thrust.

■

Aircraft operators should consider using a concept ight

crew’s role assignment and task-sharing supporting stable

approaches and smooth and coordinated go-arounds (e.g.,

as promoted by the PICMA

approach and go-around

concept or the one-team-cockpit concept).

■

When operating into special/challenging airports (e.g.,

CAT C airports) or airports with specic restrictions (e.g.,

PIC landings only), aircraft operators should consider re-

quiring special monitoring and intervention training for

SIC/copilots operating those ights, in order to guarantee

qualied and eective monitoring of such approaches and

landings in all cases.

■

Aircraft operators’ ight crew training should consider

that ight crews are traditionally trained to perform a

go-around at the approach minima. However, most go-

arounds do not happen at the approach minima. It is thus

important that the training and checking in the simulator

includes dierent go-around scenarios, both prepared

and unprepared, during dierent stages of the approach,

including go-arounds during are and touchdown (before

activation of the thrust reversers). While conducting the

go-around, adherence to the dened PF/PM task sharing

and the optimum use of crew resource management (e.g.,

for monitoring ight parameters and calling any excessive

ight parameter deviations or any change in expected

conditions) are of paramount importance and should be

a focus in the training. Nevertheless, ight crew training

should also incorporate intervention training on how the

PM can take over control from the PF, if required, in or-

der to perform the go-around. For such cases, the SOP

should require the PM to call out all go-around-related

memory items once actioned and include the required

PM action if a required memory call involved in initiating

a go-around has not been made at the appropriate time

by the previous PF.

Global Action Plan for the Prevention of Runway Excursions 105

Recommendation OPS 22: Aircraft opera-

tors should publish SOPs and guidance for

landing techniques that are aligned with the

ICAO Global Reporting Format and manu-

facturer’s guidance for all runway states and

environmental conditions. Aircraft operators

should require their ight crews to always

favour a go-around or diversion rather than

to attempt a landing when approaching wet,

slippery/contaminated runways without ap-

propriate stopping margin and/or in limiting

wind situations. Appropriate training should

be provided including training in the ICAO

Global Reporting Format.

Recommendation OPS 21: Aircraft oper-

ators should clearly dene their policy for

a safe landing and publish it in their SOPs

and operations manuals. This policy should

clearly dene acceptable touchdown limits

and prohibit intentional long and short land-

ings, e.g. to minimise runway occupancy or

minimise taxi time to the gate. The supple-

menting SOPs and guidance should include

means, methods and responsibilities with

regard to how a crew will identify and act

on such limits. Appropriate classroom and

simulator training should be provided.

■

Aircraft operators should establish internal go-around

compliance rate measures, targets and goals (safety per-

formance indicators and targets (SPI and SPT). Where nec-

essary, ight crew associations and operator management

should establish a basis and/ or process in which FDM can

be used to assist in eectively managing go-around com-

pliance targets. Depending on the actual number of go-

arounds in the operation and thereby on the availability of

sucient data to analyse, it could be helpful to investigate

every go-around in order to check the correct implemen-

tation of go-around procedures. Regular feedback on the

results of such analytics should be presented to the pilot

workforce and accountable safety boards/committees.

4.7 Where and how should ight crews

touchdown? (OPS 21, 22)

Why should aircraft operators follow this

recommendation?

Landing excursions are of two types: overruns, in which air-

craft run o the end of the runway surface, and veer-os, in

which aircraft exit the side of the runway surface. Findings of

the FSF Go-Around Decision-Making and Execution Project

(2017) show that collective situational awareness is low during

the landing phase. Although most operators have policies

dening where the touchdown should occur, very few have

guidance or SOPs explaining how to determine where the

touchdown should occur, or how and when to determine

whether a go-around should be executed. For example, most

operators specify that the aircraft should touch down in the

touchdown zone (TDZ), on the centreline; however, they do

not train or specify how to determine if the aircraft has passed

the TDZ, who should make the determination, or how much of

a deviation from the runway centreline is permissible before a

go-around should be conducted. Most ight crews say either a

gut feeling or experience helps them to judge when an aircraft

has passed the acceptable limit, even though they readily state

that their experience does not include go-arounds from the

landing phase. The impact of improving collective situational

awareness in the landing phase could be signicant.

The landing phase is complex and therefore does not leave

crews many opportunities to make complex instantaneous

calculations. However, it is very important for the ight crew

to get the aeroplane on the ground at the right point and at

the right speed to ensure that there is the greatest amount of

distance remaining to absorb factors the pilot does not have

control over, such as unreported tail wind, late wind shifts from

crosswind to tail wind, worse-than-expected runway friction

capability, etc. While still in IMC conditions, ight crews are

expected to follow the localiser and glide slope or equivalent

indications for their approach. During an ILS approach, it would

be best to continue exactly on the localiser and glideslope, like

during an autoland, even in VMC. However, signal bending

or disruptions (e.g., due to departing aircraft, or the lack of

exact electronic guidance to the touchdown point during non-

precision approaches) require the PF, when transitioning to

VMC conditions, to gradually shift his/her attention to the visual

approach indicator or to the runway and the touchdown point

while still using the instruments as a backup. Once stabilised on

the prole and if the runway is in sight, ight crews can already

project where their ight path will intersect with the runway;

this projected visual touchdown point should be the aiming

point marking, normally resulting in the main landing gear

touching down on the second touchdown marker, 300 m from

the runway threshold. This technique ensures that the landing

complies with the assumptions made by the performance cal-

culations: stabilised 3-degree prole, appropriate threshold

crossing height (TCH, usually calculated with 50 ft) and ying

at no more than the approach speed which was used for the

calculation. The position of the runway and the touchdown

point on the windshield are important and should become a

‘reference value’ for the pilot. Any deviation from the approach

prole should be recognised by the pilot and corrections made.

However, visual illusions may result in diculties for ight

crews to judge the correct position of the aircraft on nal ap-

proach when the runway is in sight. A non-standard runway,

and dierent terrain and weather perceptions than ight crews

106 Appendix C — Aircraft Operators

are used to may create visual illusions which may increase the

risk of missing the optimum touchdown point, thus increasing

the risk of runway excursions, if not accounted for by the ight

crew. Table 3 provides a list of typical visual/optical illusions

and their eect on runway sight and prole management.

Additionally, visual aim point versus gear touchdown point

dierences increase as the glide path angle decreases as in a

at approach. For a particular visual approach, the dierence

between gear path and eye level path must be accounted for

by the pilot. Systematically making long landings or steep

approaches would mean dierent positions of the landing

runway on the windshield and dilute the value of this visual

reference as a backup for prole deviations.

If installed at the runway, a PAPI may aid the ight crew by

providing visual descent guidance information during the ap-

proach (Remark: According to ICAO Annex 14, Part 5, dated

1.1.2020, the operation of T/AT-VASIS should be discontinued).

The PAPI on-slope signal should usually coincide with that of

the ILS to provide guidance down to are initiation. However,

even this aid does not come without restrictions. Flight crews

may have to deal with dierences between the angle of the

approach glide path and the angle of PAPI guidance, or the

PAPI may be calibrated for a certain eye-to-aerial height lead-

ing to deviation indication (e.g., one white – three red) on the

PAPI although ying exactly on the ILS glide if not using the

largest type of aircraft regularly approaching the runway. Al-

though “one white – three red” should clear all obstacles in the

approach by a safe margin, this margin may provide a wheel

clearance of as low as 1.5 m, depending on the installations

made by the airport. Therefore, diving below the nominal PAPI

glideslope in order to shorten the touchdown, as often used

on short runways or those with displaced thresholds, is not

advisable. Additionally, eects by condensation, snow, ice,

dirt or bad illumination may impair the use of this generally

This may vary based on factors affecting visual approach slope obstacle clearance and PAPI positioning

useful support system for ight crews. Additional risk factors

for oating into the runway like tail wind components, excess

airspeed above the threshold, aircraft-specic ground eects

or extended ares because of crosswinds may increase the

likelihood of not touching down in the touchdown zone.

In general, touchdown zones vary in length, with a determining

factor being the total runway length. Runways of 7,990 ft and

longer have touchdown zones of 3,000 ft long (FAA), and run-

ways of 2,400 m and longer have touchdown zones of 900 m

long (ICAO). Relative positioning markings are present within

the TDZ and are clearly identiable on a non-contaminated

runway. The aiming point is the widest marking located at a

distance of 1,000 ft from the threshold (FAA), and 400 m from

the threshold (ICAO

), with the end of the TDZ being identied

by the last marking at 3,000 ft (FAA) and 900 m (ICAO) on run-

ways greater than 7,990 ft or 2400 m. Aiming point markings

are 150-ft-long white rectangular stripes, one on each side of

the runway centreline, which begin at the distances indicated

below. The width of the aim point markings varies according

to the width of the runway. ICAO also denes touchdown aim

points in reference to the available landing area in Table 4.

Approach alerting and monitoring systems such as Smart-

Landing provide aural alerts when an aircraft has passed a

company-dened touchdown area. When an aircraft passes

this area without touching down, an aural alert such as ‘long

landing, long landing’ is given (Honeywell International, 2019).

SOPs may then dictate a go-around. This objective warning

immediately enhances crew awareness and leads to better

decision-making. In the absence of such a system, the PM,

through SOPs, can be directed to monitor the passing of the

touchdown limit and make an active call such as ‘TL’ [touch-

down limit], ‘deep landing’ or ‘end of zone’ after passing the last

marking indicating the passage of the TDZ. In cases in which the

runway is contaminated and markings are not visible, a couple

Table 4.

Available landing area < 800 m 800-1,200 m 1,200-2,400 m >2,400 m

Touchdown aim point 150 m 250 m 300 m

400 m

Table 3.

Visual illusion of being too HIGH on ap-

proach à may lead the PF to increase de-

scent à higher risk of short/hard landings

Visual illusion of being too LOW on ap-

proach à may lead the PF to reduce de-

scent à higher risk of long landings

Visual illusion of being too FAR AWAY from

the runway à may lead the PF to reduce

descent à higher risk of long landings

Long(er) runway than used to;

Narrow(er) runway than used to;

Bright illuminated ALS/RLS;

Upslope of runway/terrain;

Entering MIFG (shallow fog); and,

FG/BR, RA, DU (fog/mist, rain, widespread).

Wide(er) runway than used to;

Short(er) runway than used to; and,

Downslope of runway/terrain

Low intensity ALS/RLS; and,

Flying in haze.

Global Action Plan for the Prevention of Runway Excursions 107

of options exist. If available, runway remaining markers or ap-

parent geographic references (e.g., crossing taxiway/ runway)

can be used, or, using the landing distance ‘rule of thumb’, ight

crews can calculate that for an aircraft traveling 250 ft/76 m per

second, the normal touchdown area of 1,000 to 2,000 ft (300 to

600 m) will be passed within four to eight seconds — 250 fps x

4–8 seconds = 1,000 to 2,000 ft. Calculations also will show that

the end of the 3,000-ft-long TDZ will pass within approximately

12 seconds — 3,000 ft/250 fps = 12 seconds.

Most operators specify that the touchdown should occur on

the runway centreline, but do not say how this should happen

or who determines when the aircraft is drifting. As important

as it is to have situational awareness regarding a longitudinal

limit, it is equally important to understand lateral limits. Man-

ufacturers often provide cockpit visual cues and techniques

for determining where the main landing gear is in relation to

the aircraft centreline. As an example, Boeing says that for the

787, the view through ‘the lower outboard corner of the pilot’s

forward window to the ground is a good visual reference for

the outboard side of the main landing gear wheels on the same

side. The lower inboard corner of the pilot’s forward window is

also a good reference for the opposite side main gear wheels’

(The Boeing Company, 2013). In the absence of other lateral

limits, maintaining the most outboard main landing gears on

either side of the centreline (straddling) is a reasonable limit.

Using visual cues, as in the example above, can help determine

the positioning of the main landing gear. This is considered a

rough operational guideline with its own limitations; however,

there are no known alternatives other than relying on ‘gut

sense’. The monitoring of this positioning can be performed by

the PM during the landing, and if he/she sees that the position

of the aircraft is incorrect, he/she can make an appropriate

call: ‘Drift limit.’ In this case, SOPs would dictate a go-around.

What can aircraft operators do to implement the

recommendation?

In order to support their ight crews in preventing runway

overruns and veer os, aircraft operators can publish safe land-

ing and touchdown policies and SOPs and provide appropriate

training. At least the following should be considered when es-

tablishing the associated policies, SOPs and training practices:

■

Aircraft operators should establish safe landing guidelines

for their ight crews which should consider at least the

following:

› Fly a stabilised approach down to the runway.

›

Height at threshold crossing should be 50 ft (otherwise

landing performance may not be achieved).

› Speed at threshold crossing should be in accordance

with manufacturer’s guidance. Bleeding o additional

airspeed by wind/gust increments, added as per guid-

ance, should be started accordingly.)

›

Tailwind for a non-contaminated runway is generally

no more than 10 kts, or less if landing performance or

the ight crew requires lower operational limits, and no

more than 0 kts for a contaminated runway.

›

Touch down just beyond the touchdown aim point

following a normal are, and not beyond the touch

down limit (typically the end of the TDZ). If not touched

down within the TDZ (or revised touchdown point lim-

it), go around.

› Touch down on the runway centreline with the main

landing gear on both sides of (straddling) the runway

centreline. If all main landing gear are on one side of

the centreline, go around.

›

After touchdown, promptly transition to the desired de-

celeration conguration: brakes, spoilers/speed brakes

and thrust reversers or equivalent (e.g., lift dump). Note:

Once thrust reversers have been activated, a go-around

is no longer an option.

›

Monitor both aircraft speed and runway distance re-

maining during landing roll. (Aircraft operators should

direct specic actions for the PF and PM at appropriate

distances — 900m, 600m, 300m remaining — in case

speed is higher than normally expected).

■

Aircraft operators should prohibit intentional short or long

(deep) landings (e.g., to minimise runway occupancy time

for ATC reasons or to minimise taxi time to the gate for

economic or schedule considerations). Flight crews should

be required to always land within a runway’s touchdown

zone or within the revised touchdown point limit (e.g.,

in case the TDZ of a runway cannot fully be used due to

critical landing performance).

■

Aircraft operators should dene procedures describing

how ight crews can jointly determine a revised touch-

down point limit (TPL; e.g,. during approach brieng). A

revised touchdown point can be determined by citing

a known distance point along the runway (e.g., taxiway

marking, runway distance marker or time period from the

time the aircraft crosses the threshold — one second ap-

proximates 250 ft (76 m) in distance.)

■

Aircraft operators should establish callouts to be used

during landing which alert the PF to the fact that the

touchdown point limit or the lateral drift limit has been

reached (e.g., PM: ‘End of zone’ and/or ‘Drift limit’. Both

callouts require an immediate go-around. If the PF does

not comply with the go-around command, the PM shall

take over control in order to perform the go-around.

■

Aircraft operators’ training should make their ight crews

aware of the dierent existing touchdown zone mark-

ings and dierent runway layouts during their initial and

recurrent training. They should also emphasise the im-

portance of good practice on all runways, long and short,

to provide a standard are and landing technique. This

training, as well as airport briengs, should include special

or unusual operational requirements at specic airports

in the company’s network (e.g., downdrafts/updrafts due

to terrain, shifting winds, and visual illusion induced by

narrow/wide runway or night operations). Training on the

use of the head-up guidance system, if installed, should

108 Appendix C — Aircraft Operators

be conducted during ground courses to ensure landing

within the appropriate touchdown zone, with practical

training conducted during simulator sessions.

■

Aircraft operators should provide SOPs and training for

their ight crews, supporting them with the correct touch-

down techniques. These SOPs must follow corresponding

FCOM/FCTM content unless the case for alternatives or

amplication is formally documented for reference and

explicit post holder approval has been given. Clear SOPs

are required for all runway braking action circumstances

which may be encountered. Operation manuals should

cover interpretation of all runway surface condition re-

porting methods likely to be encountered (GRF and oth-

ers) and the use of ‘pilot reports’ in any format likely to be

encountered should be subject to an SOP as well.

4.8 Bounced landing recovery (OPS 25)

Why should aircraft operators follow this

recommendation?

A bounced landing is when an aircraft touches down and be-

comes airborne again. This may easily contribute to a runway

excursion event because the remaining runway for another

touchdown, pilot’s sight or the aircraft’s controllability may

become limited. Bouncing at landing is usually the result of

one, or a combination, of the following factors:

■

Excessive sink rate;

■

Late are initiation;

■

Power-on touchdown;

■

Wind shear or thermal activity; and,

■

Lack of pilot prociency or training of manual ying skills.

Most threats which may lead to possible bouncing can be

anticipated and identied well before starting the approach

and landing, and should be considered in ight crew’s TEM

brieng (e.g., special wind eects due to orography or weath-

er, training ights, high temperature/low density overhead

the TDZ, non-ILS/RNP approaches, especially with steep PAPI

or approach glide path). These considerations could also be

taken into account during pre-ight preparation when con-

sidering extra fuel for possible go-arounds.

When a bounced landing occurs, ight crews have dierent

options, depending on the aircraft manufacturer’s and aircraft

operator’s guidance and SOPs. As there may be dierent inten-

sities of bounced landings, manufacturers and aircraft oper-

ators might dierentiate their recovery techniques between

‘light’ (<1.5 m/5 ft) and ‘high’ bounces (>1.5 m/5 ft)*. In general,

the most eective method to safely recover from a bounced

landing is to initiate a go-around while considering the aircraft’s

body angle and closure to the surface in order to avoid a tail

strike and controllability issues. (Sometimes this manoeuvre

of initiating a go-around after a touchdown is called ‘rejected

landing’ which must not be confused with the actions needed

during a takeo reject, like retarding the throttles.)

What can aircraft operators do to implement the

recommendation?

In order to support their ight crews in dealing with bounced

landings safely, aircraft operators should provide good SOPs

and training. The following should be considered when es-

tablishing such SOPs and training practices.

■

Aircraft operators should make sure that their SOPs include

techniques for bounce recovery which are aligned with

aircraft manufacturers’ guidance or have been established

in coordination with the manufacturer of the aircraft used.

When operating mixed eets, their documentation and

training should clearly show dierences in bounce recov-

ery between aircraft types.

■

Bounced landing recovery training should be included in

initial and recurrent training, including various scenarios

with light and high bounces. This training should high-

light that safe go-around initiation and execution are the

priority, rather than trying to land, especially from a high

bounce. It should also include scenarios requiring the PM

to actively monitor and intervene in mismanaged recov-

eries, including taking over control in order to go around

safely. Emphasis should be placed on the correct reaction

of the PF to hand over controls and instantly switch to the

PM role without negative feelings.

■

The SOP and training should make clear that in all cases,

a go-around after touchdown (rejected landing) can still

be initiated until the selection of reverse thrust. However,

once a rejected landing is initiated, the ight crew must

be committed to proceeding and not retard the thrust

levers in an ultimate decision to complete the landing.

Runway excursions, impact with obstructions and major

aircraft damage are often the consequence of reversing

an already initiated rejected landing.

■

Training ights require special considerations. Training

for the instructors should focus on bounce prevention

during training ights (e.g., anticipating threats which

could lead to bounced landings and incorporating this

into their TEM briengs with the trainee). There should be

no dierence in bounce recovery techniques and training

for line ight crews and instructors in order to ensure that

a common philosophy is practiced during ight operation.

Instructors should strive to show role model behaviour (i.e.,

favouring a go-around rather than trying to land, especial-

ly from a high bounce. In order to detect possible areas

Recommendation OPS 25: Aircraft opera-

tors should dene policies and procedures to

address bounced landings. Whenever avail-

able, aircraft operators should take into ac-

count and include manufacturers’ guidance.

Moreover, aircraft-specic and appropriate

training, including simulator training, should

be provided for ight crews.

Global Action Plan for the Prevention of Runway Excursions 109

Recommendation OPS 26: Aircraft oper-

ators should develop guidance on whether

and when a change of control during land-

ing rollout has to take place and require their

ight crews to brief and agree on the planned

runway exit, taking into account the friction

status of both runway and runway exit, when-

ever available. When a change of control is

necessary during rollout, this should be per-

formed below taxi speed and when the air-

craft trajectory is stable.

for improvement in the training system, aircraft operators

should consider using FDM to detect negative trends with-

in training and line operation.

Dierent recovery techniques

In the event of a light bounce, a typical technique for recovery

would require the pilot to maintain the pitch attitude (any

increase could cause a tail strike) and allow the aircraft to land

again. Special attention should be paid to the increased land-

ing distance. If the remaining runway length is not sucient,

a rejected landing can still be initiated until the selection of

reverse thrust.

In the event of a high bounce, a landing should not be

attempted as the remaining runway length might not be

sucient to stop the aircraft. A rejected landing initiated

from this position would typically require the pilot to apply

takeo/go-around (TOGA) thrust and maintain the pitch atti-

tude and conguration until the risk of a tail strike or second

touchdown has disappeared. Then the normal go-around

technique can be used.

4.9 Change of controls during landing

and taxi-in (OPS 26)

Why should aircraft operators follow this

recommendation?

Still today, many companies and some aircraft designs do

not allow the second-in-command (SIC)/copilot to taxi the

airplane. Consequently, when the SIC is PF, control must be

transferred at some point. This situation presents a great deal

of potential for the two crew members to have dierent per-

ceptions or expectations about which exit to take, when to

take over and in which aircraft conguration. Resulting inap-

propriate braking or high taxi speeds during or before turning

o the runway may lead to runway and taxiway excursions.

Remark: The need for change of control during a landing roll,

which continues to cause lateral runway excursions, can be

reduced and eventually eliminated either by the buyers of

new aircraft not selecting the cost-saving option of a left side

only steering tiller or (preferably) by aircraft manufacturers

ceasing to oer this option altogether.

What can aircraft operators do to implement the

recommendation?

Aircraft operators should provide ight crews with SOPs that

allow continuous deceleration upon landing, a safe change-

over of controls and a safe taxi-in. The following should be

considered when establishing such SOPs and associated

training practices:

■

A safe landing and taxi-out starts during the approach

brieng. Aircraft operators’ SOPs should therefore require

the ight crew to agree on the optimum runway exit and

possible alternatives based on their landing performance

calculations. The more defensive/conservative (i.e., risk

averse) option as preferred by either pilot should always be

chosen by the ight crew, irrespective of eciency consid-

erations (e.g., taxi time, break wear or ATC requirements).

In their TEM brieng and resulting autobrake selection,

ight crews should consider not only the runway status

but also the taxiway status in terms of contamination and

slipperiness (especially during wet and winter operation),

provided such information is available or can be estimated.

■

Aircraft operators should consider providing ight crews

with limitations and guidelines for maximum taxi speeds

when turning o the runway, depending on the kind of

taxiway used (e.g., high-speed or 90-degree turnos) high-

lighting the inuences of dierent runway/taxi surfacing

(e.g., grooved or not, de-iced or not, rubber debris, etc.).

■

If using a single tiller aircraft type, aircraft operators

should consider retrotting a right seat tiller, or, if they

are in the process of purchasing new aircraft, ordering a

conguration including tillers for both pilot seats. In the

event that a retrot is not possible, an explicit SOP for

changeover must be provided for ight crews considering

rudder pedal steering angles and rudder eectiveness at

low speeds. Transfer of aircraft control during the landing

rollout should be reviewed as part of the approach brief-

ing. Ideally, the handover of controls, if required, should

be accomplished after decelerating into the low speed

regime, prior to vacating the runway, even if this leads to

passing a planned exit. The control change should nor-

mally be initiated by the PF (e.g., by the call ‘You have

control’. If the rate of deceleration is not appropriate for

the runway distance remaining, the PM should take control

of the aircraft and apply maximum deceleration devices.

■

In order to ensure safe team decision-making with regard to

runway excursion prevention, it is useful to train and allow

SICs to taxi the airplane as well. A taxi-trained pilot will be

able to better assess eects of dierent runway and taxi-

way friction levels, be more condent in assessing delayed

or slowed breaking during landing roll (e.g., on slippery/

contaminated runways) and will be a more eective back-up

in the event of incapacitation events. Furthermore, it might

be a positive investment in safety to stop using aircraft with

only one tiller. In any case, copilots should be trained to slow

the airplane safely until below taxi speed, including taxiing

safely into runway high-speed turnos.

110 Appendix C — Aircraft Operators

5 References

Airbus: Flight Crew Training Manual (FCTM)

Airbus: Flight Crew Operations Manual (FCOM)

Airbus: Getting to grips with aircraft performance

Airbus: Flight Operations Brieng Notes: Flying Stabilised Approaches

Airbus: Flight Operations Brieng Notes: Bounce Recovery — Rejected Landing

Australian Transport Safety Bureau: Tail strike and runway overrun Melbourne Airport, Victoria 2009

Transportation Safety Board of Canada: Runway Overrun and Fire Toronto 2005.

Joint industry/FAA Takeo Safety Training Aid

BOEING: Flight Crew Training Manual (FCTM)

IFALPA / BOEING: Brieng leaet: Certied versus advisory landing data on Boeing aircraft.

JAR/EASA Flight Crew Licensing

Flight Safety Foundation: Approach and Landing Accident Reduction (ALAR) tool kit

Flight Safety Foundation: Go-Around Decision-Making and Execution (GADM&E) Project Report

EUROCONTROL: A study of runway excursion from a European perspective

IATA: Runway Excursion Case Studies; Threat and Error Management Framework

J. O’Callaghan. Slippery When Wet: The Case for More Conservative Wet Runway Braking Coecient Models, National

Transportation Safety Board, AIAA AVIATION Forum, 2016.

Global Action Plan for the Prevention of Runway Excursions 111

APPENDIX D

GUIDANCE AND EXPLANATORY MATERIAL

FOR AIRCRAFT MANUFACTURERS

GEM Recommendation MAN1 112

GEM Recommendation MAN2 112

GEM Recommendation MAN3 113

GEM Recommendation MAN4 113

GEM Recommendation MAN5 114

GEM Recommendation MAN6 115

GEM Recommendation MAN7 115

GEM Recommendation MAN8 115

GEM Recommendation MAN9 116

GEM Recommendation MAN10 117

GEM Recommendation MAN11 118

GEM Recommendation MAN12 119

GEM Recommendation MAN13 119

GEM Recommendation MAN14 120

GEM Recommendation MAN15 121

GEM Recommendation MAN16 121

112 Appendix D — Aircraft Manufacturers

Signicant progress and agreement as to terminology and

standards was accomplished during the work of the U.S.

Federal Aviation Administration (FAA) Takeo and Landing

Performance Assessment (TALPA) Aviation Rulemaking Com-

mittee (ARC) activity that occurred in 2008 and 2009. In this

activity, six of the major manufacturers worked with the FAA,

aircraft operators, business jet operators, airport operators

and other industry interest groups to recommend a standard

terminology for reporting and evaluating runway conditions

and criteria for manufacturers to use when computing the

aeroplane’s performance information for takeo and landing.

TALPA ARC recommendations pertaining to aircraft perfor-

mance data for non-dry runways have been issued by the

FAA in two Advisory Circulars, AC 25-31 for takeo and AC

25-32 for landing, as rulemaking activities were not possible

at the time. This allows exibility for manufacturers regarding

whether or how to implement this new performance infor-

mation. Some manufacturers have created operational data

using terminology and standards consistent with the TALPA

ARC recommendations.

In parallel and as part of the overall implementation of

the TALPA recommendations, the International Civil Avia-

tion Organization (ICAO) has developed Document 10064

“ Aeroplane Performance Manual” to combine guidelines on

certication and operational requirements regarding aero-

plane performance. It was developed in the context of the

Friction Task Force of the Aerodrome Operations and Services

Working Group on the basis of existing and proposed national

regulations and the TALPA ARC proposals. This new harmo-

nisation of the runway surface condition assessment and

reporting throughout the world is named Global Reporting

Format (GRF).

To translate the ICAO standards into European regulation,

the European Union Aviation Safety Agency (EASA) launched

Rulemaking Task RMT.0296, which resulted in the publication

in 2016 of NPA (Notice for Proposed Amendment) 2016-11,

proposing appropriate amendments to the operational reg-

ulation, revised airworthiness standards for takeo perfor-

mance on contaminated runways and new in-ight landing

performance computation at time of arrival. The proposed

changes are expected to increase the current level of safety in

relation to aeroplane performance, to improve harmonisation

with FAA rules and to ensure alignment with ICAO Opin-

ion 02/2019 containing the proposed new EASA regulation

adopted by the European Commission.

In 2019, FAA tasked the Aviation Rulemaking Advisory Com-

mittee (ARAC) with a review on implementing TALPA ARC

recommendations as a new airworthiness standard instead

of advisory material, in order to incentivise manufacturers to

implement this new performance information. This proposal

is currently being discussed by the FAA Flight Test Harmoni-

zation Working Group (FTHWG).

Those new physics-based time-of-arrival assumptions com-

plement the existing landing distances assumptions at time

of dispatch, which are not harmonized among all runway

states. A proposal to harmonise landing distance assumptions

at time of dispatch on all runway states is also being discussed

in the context of the FAA FTHWG.

It is recommended that all certication agencies keep work-

ing to ensure that takeo and landing performance informa-

tion are proposed in similar standards.

In the meantime, for existing designs, the data provided by

manufacturers should allow ight crew to determine takeo

and landing performance for any runway surface condition as

reportable via a runway condition report (RCR) standardized

by ICAO Annex 15. The use of standard terminology facilitates

the mapping of the data to the reported condition.

While the standards for deriving the performance data are not

retroactive, it should be ensured that a minimum compliance

with the above mentioned ACs is established, in particular for

the landing distances at time of arrival (LDTA), there should be:

■

Data available for all six reportable braking action

categories;

■

Accountability for temperature and runway slope; and,

■

Accountability for recommended approach speeds.

It is recognised that it may not be reasonably achievable to

produce updated performance data. European operational

regulation sets minimum requirements for the availability of

performance data based on the aircraft performance class

and the type of operations. Manufacturers should ensure

that they meet or exceed these minimum requirements in

the data they provide to the operators, and that this data is

made available in a timely manner before these new rules

come into force on 12 Aug 2021.

Recommendation MAN1: Aircraft manu-

facturers should present takeo and landing

performance information for dispatch and

time-of-arrival for the full range of report-

able runway conditions, using common and

shared terminology and to agreed standards,

set out in FAA ACs 25-31 and 25-32.

Recommendation MAN2: Training mate-

rial promulgated by aircraft manufacturers

and aircraft training providers should em-

phasise the necessity of making best use of

deceleration means, including speed brakes,

wheel braking and reverse thrust, in a timely

manner, until a safe stop is assured, and in

particular when conditions are uncertain or

when runways are wet or contaminated by

applying full braking devices, including re-

verse thrust, until a safe stop is assured.

Global Action Plan for the Prevention of Runway Excursions 113

This type of information is often included in the manufac-

turer’s ight crew operating manuals or ight crew training

manuals with supplemental information, possibly in bulletins

or magazine articles.

An example of a manufacturer’s guidance on operating on wet

or contaminated runways is provided later in this appendix.

Delayed application of deceleration devices has been con-

tributory in numerous runway excursions (12% per Interna-

tional Air Transport Association [IATA] Safety Trend Evaluation,

Analysis Data Exchange System [STEADES] analysis, 2019).

Reference

STEADES Incident and Accident Data 2008Q1 to 2018Q2,

International Air Transport Association, 2019.

Contributors to longitudinal runway excursions at landing

can occur during both the air phase and ground phase. These

include:

■

Air phase: Unstable approach, wind shift at low altitude,

long are, long de-rotation. Without actual information

on the risk of a consequent runway overrun, the crew may

be tempted to continue an approach in the belief that

they may recover the situation, or that they have sucient

landing distance margins.

■

Ground phase: Late selection of engine thrust reversers,

too early cancellation of reverser, runway friction coe-

cient lower than expected, late or delayed manual braking.

One of the major enhancements recognized for longitudinal

excursion prevention is on-board technology to help the

pilot to decide to land or go around (air phase), or to pro-

vide alerting on the need to apply all deceleration devic-

es to their maximum utilisation during the ground phase.

Dierent systems are currently available or in development

to provide the ight crew information to assist with these

decisions for which references are provided below. Guidance

material can be found in — ED-250, Minimum Operational

Performance Standard for a Runway Overrun Awareness and

Alerting System.

The European Union agreed in mid-2020 to mandate instal-

lation of such functionality, termed ROAAS(Runway Overrun

Awareness and Alerting System) for future large aeroplanes,

excluding retrot.In addition to this mandate, manufactur-

ers should consider proposing solutions adapted to retrot

scenarios, when feasible. Manufacturers should also consider

implementations that provide protection for all runway con-

ditions as dened by the GRF.

References

Airbus Safety First #08 – July 2009 [https://safetyrst.airbus.

com/app/themes/mh_newsdesk/documents/archives/

the-runway-overrun-prevention-system.pdf]

and FAST

[https://www.airbus.com/content/dam/corporate-topics/

publications/fast/Airbus-FAST55.pdf]

Konrad G, et al. Development of a Predictive Runway Over-

run Awareness and Alerting System, Aviation Electronics

Europe (AEE) Conference & Exhibition, Munich, June 2018.

[https://embraer.com/global/en/news?slug=1206700-em-

braers-new-enhanced-phenom-300e-receives-anac-ea-

sa-and-faa-approval-achieving-triple-certication]

The aviation industry has changed greatly in the past decade

as to how the calculation of performance in general, and in

landing distances in particular, is done. Landing distance

assumptions have become much more complex with the

implementation of physics-based time-of-arrival dry, wet

and contaminated landing distances (assumptions detailed

in FAA AC 25-32 and EASA CS 25.1592) on top of the already

existing various landing distances assumptions at time of

dispatch (see recommendation MAN1). New assumptions

for steep approach landings or shortened wet runway land-

ing distance associated with grooved/porous friction course

surfaces have also been implemented.

Recommendation MAN3: On-board real

time performance monitoring and alerting

systems that will assist the ight crew with

the land/go-around decision and alert when

more deceleration force is needed during the

landing roll should be made widely available.

Recommendation MAN4: The aviation

industry should develop systems and ight

crew manuals to help ight crews calculate

landing distances easily and reliably in nor-

mal and non-normal conditions. Systems

should have a method to apply recommend-

ed assumptions. All landing distance com-

puting tools available for the aircraft (e.g.,

ight management system [FMS], electronic

ight bag [EFB]) and on-board real time per-

formance monitoring and alerting systems

(e.g., ROAAS) should be consistent with the

overall harmonized set of data used for land-

ing performance assessment. Whenever con-

sistency between on-board alert-triggering

thresholds and landing distance computa-

tion methods available to the crew cannot

be entirely achieved, means to determine

these thresholds for the planned conditions

and guidance to the ight crew on a recom-

mended course of action should be provided.

114 Appendix D — Aircraft Manufacturers

This diversity of landing assumptions can make the overall

set of data for landing performance assessment dicult to

understand for some operators. And those operators also

have to cope with various operational landing factors to be

applied according to the type of operations.

From the late 1990s, aircraft communications, addressing

and reporting systems (ACARS) sand laptops have started

showing up in the cockpit, and on-board avionics capabili-

ties have continuously improved. The information the ight

crew obtains from these systems is computed based on crew

input such as airport/runway, weather conditions, wind, run-

way conditions, approach type, etc. These systems replace

the need for crew to do multiple hand calculations, ipping

through paper charts and adding/subtracting/ interpolating

in cumbersome tables and charts. Often because of the num-

ber of computations required, ight crew relied on quick

checks of the numbers or didn’t do the appropriate perfor-

mance checks at all. It is now much easier for the ight crew

to get an appropriate answer with less exposure to error. It is

also easier for the crew to look at multiple scenarios so they

can have a plan in the event they obtain additional informa-

tion late in the approach that the runway has deteriorated.

Manufacturers of these devices and methods are continually

searching for better ways to do this, and in this very com-

petitive business there is no doubt that improvement will

continue.

The availability of such interactive systems, however, does not

excuse aircraft manufacturers and operators from presenting

the performance information in an intuitive format that is

error-tolerant to use. This becomes even more important

when the performance tables are only used very occasionally

as a backup to an electronic system.

It is also recommended that aircraft manufacturers provide

cross-check capabilities between landing distance computa-

tion tools available if those tools are not approved. This cross-

check can be done manually through appropriate operational

methods or automatically through direct communication

links between systems.

In the past decade, on-board real-time performance moni-

toring and alerting systems (e.g., ROAAS) have also started

being implemented in some aircraft to assist ight crew dur-

ing landing.

It is recommended that aircraft manufacturers make all land-

ing distance computing tools available for the aircraft (FMS,

EFB) and on-board real-time performance monitoring and

alerting systems consistent with the overall harmonized set

of data used for landing performance assessment (see rec-

ommendation MAN1).

However, on-board monitoring and alerting functions must

comply with specic requirements in line with ED-250, which

may necessitate the adaptation of landing distance compu-

tations to ensure that alerts are always pertinent and system-

atically triggered early enough for the crew to react.

Furthermore, real-time constraints and data availability in the

avionics environment may not permit the use of the same

performance models, input and runway data as in operational

tools (e.g., EFBs). Regulators consider that no approach should

be initiated when it can be anticipated that alerts will be

triggered because available runway length is not compatible

with triggering thresholds. Sucient margins may exist based

on the sole result of the LDTA used by the ight crew in plan-

ning the approach. There is thus a need to make available to

the pilots the criteria used by the on-board function, or to

implement automatic cross-checks of the LDTA data available

to the crew against these triggering criteria.

All providers of tools for digital takeo and landing data de-

termination are encouraged to implement safeguards for

erroneous data insertions and cross-checks between various

data sources. This is to ensure calculations are performed with

correct data inputs and that the results are appropriately

inserted in aircraft systems.

Any means should be taken to reduce the risk of input errors.

This includes the prevention of data inputs which violate air-

craft or operator limitations (e.g., maximum weights, tail wind

and crosswind limits in combination with dierent runway

states, congurations required for a certain non-normal situa-

tion). Any human factors aspects of the concerned interfaces

should be considered, along with how they integrate into

the specic cockpit environment in which they are meant

to be used.

Standard operating procedures (SOPs) should be dened for

data inputs in the calculation tools as well as for the inser-

tion of the results in the avionics. This includes independent

calculations followed by cross-checks between the crew

members and comparison of values from dierent sources

Recommendation MAN5: EFB manufac-

turers and providers should develop user

interfaces for the calculation and data entry

of takeo and landing performance data, de-

signed to minimise the possibility of errors

introduced by the pilot.

EFB systems should enable the ight crew to

perform an independent determination of

takeo and landing data and to implement,

where possible, an automatic cross-check of

inputs and to ensure correct insertion of the

data in the avionics.

EFB systems should use terminology and

presentation of data consistent with aircraft

systems and aircraft documentation to the

extent practical.

Standard operating procedures should be

developed to support a cross-check of per-

formance data by both pilots.

Global Action Plan for the Prevention of Runway Excursions 115

(e.g., manoeuvring speeds from the EFB and the ight man-

agement computer).

If technically possible (e.g., through suitable databases), such

gross-error checks between dierent sources and systems

should be performed automatically.

Example guidance material may be found in FAA AC 120-

76, “Authorization for Use of Electronic Flight Bags”; EASA

AMC 20-25, “Airworthiness and operational consideration for

electronic Flight Bags (EFBs)”; and in the work from EUROCAE

WG-106, which at the time of publication was in the approval

stage with ED-273, “Minimum Operational Performance Stand-

ard for Electronic Flight Bag (EFB) Software Applications”.

The reporting and investigation of aircraft accidents and in-

cidents is regulated by ICAO Annex 13. The results of such

investigations are sometimes shared publicly. However, due

to their much higher rate of occurrence, much more can be

learned from precursor events if they are identied as such

and acted upon.

Some manufacturers review yearly or bi-yearly the signicant

accidents and incidents as well as the causal factors and issues

highlighted by these events. This can be done at meetings

and conferences attended by operators, and in manufacturer

publications like bulletins, changes in procedures or other

information.

Updates to this recommendation reect the reality that not

all overruns can be investigated. Not all overruns are possibly

known, especially less severe ones and/or overruns involving

older aircraft models in certain regions of the world. Also

there are possibly geo-political or conict limitations.

The eectiveness of vision enhancement technologies such as

cameras that operate outside the visible light spectrum, and

other imaging technologies used in low visibility takeos or

landings may be aected by strong crosswinds due to the nar-

row eld-of-view that may be available. Loss of this enhanced

capability and situational awareness in low visibility conditions

may adversely aect the touchdown point, either laterally or

longitudinally, and could contribute to a runway excursion.

■

An accurate knowledge of the runway condition is key for

the validity of landing performance computations, and

a clear case can be made for the need to improve pilot

awareness of runway surface conditions. However, today,

generating accurate, consistent and timely updated runway

conditions reports on the aerodrome side, and accurate

PIREPs on the pilot side is challenging, and there is a risk of

having runway conditions information transmitted by air

trac control (ATC) with a lack of real time and accuracy.

■

Methods used to evaluate the runway surface conditions

have limitations that illustrate this challenge:

›

Runway contaminant type and depth observations

conducted by airport personnel are based on a com-

bination of visual observations and spot-checks. It is

a generally dicult task to consolidate what may be

diering conditions across the entire width and length

of the runway into a succinct runway condition report.

In addition, during active precipitation and/or freezing/

melting conditions, the validity of the information may

become outdated soon after it is issued.

›

Runway friction measurements along certain points on

a runway provide a more quantitative approach and are

useful for identifying trends in runway surface condi-

tion but are not recommended for use in predicting

aircraft stopping performance.

› Braking action reports from pilots:

• ICAO (Annex 6 Part I 4.4.2.1) mandates pilot report-

ing of braking action that is worse than previously

reported. When receiving the information, ATC is

mandated to transmit this information to the airport.

•

However, PIREPs of braking action are highly subjec-

tive: It is sometimes dicult for the pilot to identify

which portion of the deceleration is coming from

the wheel braking eect on the runway and which

part is due to other aircraft deceleration contributors

(aerodynamic drag forces, reverse thrust) which are

not linked to the surface condition. This is especially

true with the use of autobrake, often recommended

on contaminated runways.

Recommendation MAN6: Manufacturers

should monitor and analyse (worldwide)

runway excursions involving the aeroplanes

they support and share the lessons learned

— where feasible.

Recommendation MAN7: Manufacturers

should provide information about eective

crosswind landing and takeo techniques,

including in low visibility, when required.

Recommendation MAN8: Manufacturers

should consider a function able to:

■ Use aircraft data to compute braking ac-

tion (i.e., maximum achievable tire-runway

friction when braking is friction-limited);

■

Display it to the crew to assist pilot’s

braking action report to air trac control

(PIREP),

■ Convey it, just after landing, to airport op-

erators and to the aircraft operator(s).

116 Appendix D — Aircraft Manufacturers

■

Thus, this guidance refers to a function, complementary to

the above regulatorily dened methods of runway surface

condition assessment, able to use aircraft data to compute

maximum achievable braking action. This can typically be

measured when the aircraft is braking, by determining

the component of the overall aircraft deceleration force

generated by the brakes. This allows the determination

of an observed friction coecient characteristic that can

be compared to a scale (DRY, GOOD, GOOD TO MEDIUM,

MEDIUM, MEDIUM TO POOR, POOR) standardized in ac-

cordance with the ICAO GRF.

■

There are systems currently available or in development to

report runway braking action to partnering airports and

airlines based on the information measured by the aircraft

during landing, for which references are provided below.

■

In conjunction with 3.5.3 recommendation: Knowing the

accurate runway state, together with the possibility to con-

gure (at least manually) this state in the ROAAS alerting

settings, will allow for a more timely and accurate ROAAS

alerting when runway conditions are degraded.

Guidance material available: ASTM E17.26workgroup has

been launched to produce a standard for the aircraft braking

action report generating system, which should then feed the

EUROCAE WG-109 standard covering airport runway weather

information system, using the data of such a function as an

input.

It should also be noted that development of such solutions

will depend on multiple factors, including the avionics archi-

tecture of a specic aircraft. Not all aircraft will necessarily be

able to support this function.

Reference

Airbus Safety First [https://safetyrst.airbus.com/

using-aircraft-as-a-sensor-on-contaminated-runways/]

An accurate 3D trajectory, including an accurate touchdown

point, is desirable, and dierent solutions can be used to

achieve it (e.g., expanded automatic landing capabilities) or as

an aid to better reach this objective (e.g., functions that pro-

vide additional ight crew information to improve positional

awareness of the aircraftrelative to the landing runway).

Other solutions not discussed here may be permissible as

well. The intent here is not to support means to lower landing

minima.

It is to be highlighted that intrinsic dierences between large

aircraft and bizjets exist (inertia, distance between the centre

of gravity and the cockpit, etc.) which may lead to very dif-

ferent considerations in terms of solutions to be developed

to address this intended function.

Guidance on expanded automatic landing

solutions

Some aircraft types include auto ight guidance system

functions that allow automatic landing in low visibility con-

ditions typically designed for CAT 3 operations. For these

challenging operations, usage of the auto ight guidance

system is mandatory. This system has to demonstrate ade-

quate performance in a wide range of operational conditions

(e.g., aircraft weight, airport altitude, wind) regardless of the

visibility conditions. Today, this system is rarely used outside

the intended original use (CAT 3 operations) mainly because

it is dependent on ground instrument landing system (ILS)

navigation technology that is known to be sensitive to traf-

c around the antennas. New navigation means are now

available (for example, global navigation satellite systems)

and some aircraft manufacturers have certied autoland ca-

pacities based on these navigation means. Modern systems

may include means to detect and/or compensate known

navigation means anomalies (e.g., ILS), in addition to crew

monitoring that can generally detect these behaviours.

When landings are performed in degraded visibility condi-

tions (better than CAT 2/3 minima) the usage of an automatic

landing system will support the are manoeuvre and guid-

ance during roll out and ensure appropriate management

of the aircraft lateral trajectory prior to or after touchdown.

Being in the position to monitor the aircraft trajectory, the

crew is supported in their tasks. In addition, for a crew trained

for CAT 2/3 operation, usage of the automatic landing sys-

tem outside of the CAT 2/3 operation should not require

additional training.

Therefore development of extended automatic landing sys-

tem capabilities, that can be used in degraded visibilities

condition, in particular when CAT2 or CAT 3 operations are

not required or not available (typically CAT2 or 3 runway

operated in CAT 1 or better conditions, or CAT 2 or 3 runway

with degraded light conguration, or CAT 1 runways), is one

possible way to meet the intent of this recommendation,

and to achieve an accurate nal approach trajectory and

touchdown point in such conditions.

Recommendation MAN9: Manufacturers

should consider making available ight deck

functionality enabling an accuracy of the 3D

aircraft trajectory with regards to the runway

(including the touchdown point), especially

for degraded visibility landings.

For example, in order to satisfy this recom-

mendation, manufacturers could consider

making available:

■

Expanded automatic landing capabilities; or,

■

Functions that provide additional informa-

tion to the ight crew to improve position-

al awareness of the aircraftrelative to the

landing runway.

Global Action Plan for the Prevention of Runway Excursions 117

Guidance on “enhancing ight crew position

awareness relative to the landing runway during

approach” solutions

This guidance is focused on an alternative or complemen-

tary solution (i.e., enhancing ight crew position awareness

relative to the landing runway during approach). It is appar-

ent that technology maturity may vary by aircraft type (e.g.,

business and corporate operators, mainline carriers) and a

given solution may not t the needs of all operators and

manufacturers. Some solutions are already in operational

service. It also needs to be taken into account that in some

cases, the solution will be suitable only for forward-t due to

the technology and system architecture needs, whereas other

simpler solutions may also be available for retrot purposes.

The purpose here is to provide a high-level outline of the

breadth of position awareness solutions that are available,

and where they are not available, manufacturers should con-

sider maturing technology to the point where such solutions

can benet the entire eet.

Position awareness systems fall into one of two ight deck

functions:

■

Strategic awareness (e.g., navigation display, EFB moving

maps), and;

■

Tactical cues (e.g., primary ight display [PFD], synthetic vi-

sion system [SVS], head-up display [HUD]). Among tactical

cues, head-up functions can be used as an aid throughout

the approach and landing.

Examples are given below, and each solution needs to be

weighed against the current state-of-the-art and architectural

limits of a specic aircraft type or aircraft family.

Improved tactical position awareness during approach can

be provided by one of more of the following:

■

HUD and/or SVS that provide cues such as conformal

runway symbols, extended runway centrelines, distance-

to-go markers, conformal lateral deviation scales, ight

path symbol (FPS), and runway distance remaining upon

touchdown. Among these solutions, only head-up func-

tions should be used as an aid in the nal stages of the

approach down to the landing. Cues such as the FPS and

runway symbology provide enhanced situational aware-

ness down to the touchdown point, including during

crosswind conditions.

■

Systems such as enhanced vision systems can be fused

with HUD and/or SVS imagery to provide additional situ-

ational awareness.

Figure 16 shows a notional SVS with an FPS, FMS selected run-

way and airport (cyan rectangles), conformal lateral deviation

and extended centreline to the runway. All enhance position

awareness with respect to the landing runway.

Note that EUROCAE – ED-249 (Minimum Aviation System

Performance for Aircraft State Awareness Synthetic Vision

Systems) provides high-level requirements for continuous

awareness of attitude, altitude, topography and energy state

(speed, acceleration and altitude) related to the ight path

and perceived motion of the aircraft.

FDA (also designated as ight data monitoring or ight opera-

tional quality assurance) is the routine collection and analysis

of ight data to develop objective and predictive information

for advancing safety. It includes the systematic monitoring

of exceedances such as excessive vertical speed or long are,

as a means to identify operational risks and feed observa-

tions back to the concerned ight crew and evidence-based

training and may support an operator’s safety management

system. An FDA programme is prescribed by ICAO Annex 6

Part I, for commercial operators of aeroplanes with a maxi-

mum certied takeo mass of more than 27,000 kg.

Figure 16. Notional SVS depiction on approach

Courtesy Honeywell

Recommendation MAN10: Aircraft manu-

facturers and ight data analysis (FDA) service

providers should provide adequate interfaces

and consider developing additional services

for FDA, to help operators identify precursors

to runway excursions.

For example, this could include services to

identify:

■

Discrepancies on runway surface condi-

tions (comparing experienced conditions

with ATC reported conditions); and,

■ Reduced aircraft performance margins at

landing or takeo, by comparing actual

data (such as deceleration and distances)

with the expected aircraft performance

according to manufacturer models.

118 Appendix D — Aircraft Manufacturers

There is existing guidance for the implementation of ight

data monitoring precursors published by European Op-

erators Flight Data Monitoring forum, which contains 34

precursors that can be implemented by an FDA programme

to monitor the risk of runway excursion. It allows aircraft

manufacturers and FDA service providers to identify the

necessary ight parameters and FDA algorithms to monitor

this risk.

On-board alerting systems such as ROAAS recognize that, de-

spite such digressions from the expected pilot performance,

there may not be an operational risk while some operations

are inherently more exposed due to systemic issues. For ex-

ample, when operating from a long runway in good condi-

tions, a ROAAS type system may be very tolerant of reduced

braking eectiveness due to aircraft systemic issues. If a crew

were to take those conditions to a short runway, they may

nd themselves using up any safety margin. Another example

would be if an aircraft had an issue where it was not able to

produce full takeo thrust. On a longer runway, this might

not be noticed; with sucient data and models to support

an accurate prediction of aircraft performance, the issue can

be identied. The goal of this recommendation is to provide

sucient aircraft data and expected results so that degrad-

ed capabilities, such as in these examples, can be identied

during post-ight data analysis.

Technology is now available to perform more integrated

analysis of ight data and to compare the observed aircraft

performance to aircraft performance models and analyse the

results to identify operations that have objectively a higher

exposure to events such as runway excursions.

Two possible applications can directly be derived from exist-

ing on-board systems:

■

Energy-based ight path analysis to identify occurrences,

even momentary during the approach, of reduced margin

to stopping before the runway end (post-ight ROAAS);

and,

■

Identication of reduced available runway braking action

(post ight ABAR – aircraft braking action report).

While ROAAS is designed to prevent a runway excursion on

a given ight, a statistical analysis can highlight approach

procedure design, or ATC practices, that more frequently put

the aircraft in a high-energy state during the approach that

is critical in terms of its performance capability. This allows

adapting procedures in an informed and objective way.

ABAR-generating systems are becoming available for some

aircraft types but may not be compatible with all eets. For

post-ight analysis, these compatibility issues typically do

not exist. Statistical analysis of deferred ABARs can identify

deciencies of the runway surface that create slippery con-

ditions when wet, or instances where the airport report was

not accurate as to the eect on aircraft performance. Such

information can be used for crew brieng and performance

planning, as well as fed back to the airport, which can inform

users accordingly and plan maintenance action.

These two types of observations could be combined to iden-

tify instances where performance capability would have been

marginal with regards to the available runway length for the

observed runway condition.

It should be noted that should the additional data needed

to support this recommendation be added in conjunction

with the initial design of the aircraft, or in concert with other

planned updates, the commercial impact should be minimal.

There have been several takeo performance-related events

over this last decade. Even though sucient margins were

available in most of them, these are high risk situations po-

tentially leading to a tail strike or a runway overrun.

Erroneous parameters, when used for the performance cal-

culation, can lead to incorrect takeo speeds or thrust com-

putations. On other occasions, takeo data wrongly inserted

in the ight management system or not updated following a

late runway change can lead to takeo without the correct

performance data.

In-service experience shows a number of events where air-

craft have started takeo from a taxiway intersection when

the computed performance was for the entire runway length,

where takeos have started from the opposite QFU (the op-

posite end of the assigned departure runway), from a dierent

runway than the planned runway, or even from a taxiway.

Finally, a few cases of residual braking leading to an abnormal

aircraft acceleration were reported during the takeo roll.

Most of these events can be avoided by complying with the

SOPs. Indeed, several cross-checks enable the ight crew to

identify discrepancies. These examples, however, show that

errors can still be made, typically in stressful situations, with

high crew workload, last minute changes or demanding ATC

requests.

Therefore, manufacturers should consider developing takeo

performance monitoring functions aiming at reducing the

risk of runway overrun.

These functions should timely warn the crew in case the con-

sidered takeo performance parameters (e.g., mass, speeds,

thrust, aps and runway) do not allow a safe takeo. Such

a function should consider the aircraft real-time position

within the airport at takeo initiation, in order to cover sce-

narios such as a takeo attempt from a wrong runway, a

wrong intersection or even a taxiway. These functions should

also monitor the evolution of the real measured takeo roll

against the expected one.

Recommendation MAN11: Manufactur-

ers should consider a real-time takeo per-

formance monitoring function in order to

reduce the risk of runway excursion during

takeo, including aircraft performance-re-

lated or wrong-position scenarios.

Global Action Plan for the Prevention of Runway Excursions 119

Note that airport moving maps provide additional crew aware-

ness of position relative to runways and taxiways, and these

systems have the potential to mitigate errors associated with

incorrect runway, incorrect intersection, or inadvertent taxiway

takeos. Other systems (if equipped) can provide an alert if the

aircraft attempts a departure from a runway other than that

programmed in the FMS (FMS runway disagree) or attempts a

taxiway takeo (e.g., runway awareness and advisory system).

References

TakeoSurveillance &MonitoringFunctions — Safety

First | October 2019 — Airbus S.A.S. (https://safetyrst.

airbus.com/takeo-surveillance-and-monitoring-functions/)

Improving Runway Safety with Flight Deck Enhancements,

Boeing Aero Magazine, Quarter 1, 2011. (https://www.

boeing.com/commercial/aeromagazine/articles/2011_q1/

pdfs/AERO_2011_Q1_article2.pdf)

The objective is to enhance ight crew awareness of ight

path and aircraft energy state during approach and reduce

the need for late go-arounds.

Current systems such as head-up guidance systems (HGS) can

have a positive inuence on a ight crew’s situational aware-

ness and risk perception, thereby improving decision-making.

The use of a HGS for all approaches may help the pilots in

their decision-making as well, because most HGS provide

for a 3-degree slope indication, indicate the ight path and

have a guidance line for the touchdown point. Using HGS

for all approaches may assist the pilots in ying stabilised

approaches. This is especially true for visual approaches when

no vertical guidance (e.g., ILS, precision approach path indica-

tor [PAPI], visual approach slope indicator [VASI]) is available.

Some HGS systems also have a feature that shows show the

runway remaining after touchdown.

Note also that many SVS incorporate very similar ight path

and energy cues on head-down displays such as the PFD

(e.g., FPS, acceleration and speed cues, ight path reference

line, runway distance remaining) and that such symbols may

also be present on PFDs without SVS terrain functionalities

The HUD and many SVS systems present information that is

ight path-based, and the inuence of factors such as cross-

winds, drag and power is reected in the information shown.

For example, during a crosswind condition, the FPS should

be pointing to the runway, irrespective of the current aircraft

heading during a crab (i.e., the direction the aircraft’s nose is

pointing). For FMS-coupled approaches, the HUD and/or SVS

information is an eective way to monitor the approach. HUD

and SVS energy information is typically depicted in reference

to the FPS, and both a speed error tape and acceleration cues

are presented.

The above display cues provide enhanced ight path and

speed awareness and aid the crew in maintaining a stable

approach.

Where such systems are not already available or the technol-

ogy has not matured to the required technology readiness

level, such systems should be considered and made available

to operators when benecial for aircraft operations. Evalua-

tions of the benets of such functions should be performed

based on in-service data and experience shared when and

where available. It is understood that the provision of such

technologies is inuenced by multiple factors (technology

maturity, architectural limitations, forward-t versus retrot

needs, etc.), and the necessary trade-os to provide such

capabilities will need to be made.

Figure 17 (p. 120) provides an example of SVS that provides

enhanced path and energy awareness cues.

References

EUROCAE – ED-249 (Minimum Aviation System Performance

for Aircraft State Awareness Synthetic Vision Systems).

Commercial Aviation Safety Team (CAST) identied Safety

Enhancement SE 200.

When landing on wet or contaminated runways, the ight

crew has to focus on multiple actions to ensure that landing

can be performed safely. One priority is to make the best use

of runway length available by targeting an accurate touch-

down point (both longitudinal and lateral) and keeping the

aircraft as close as possible to the centreline to avoid any

lateral deviation on these low-friction runway states. Flight

crew must also ensure that braking and reverse applications

are performed with minimal delays.

The use of automatic braking allows the release of constraints

on ight crew for minimising delays in brake application. It

also provides symmetrical braking during the landing roll.

It is recommended that aircraft manufacturers provide rec-

ommendations in their airplane ight manual or operational

documentation for the use of automatic braking when land-

ing on wet or contaminated runways.

Recommendation MAN12: Manufacturers

should consider making available systems

that provide ight path and energy state

awareness in order to aid the ight crew

to better anticipate and maintain stability

throughout the approach.

Recommendation MAN13: Manufacturers

should provide recommendations in their

operational documentation for the use of

automatic braking when landing on wet or

contaminated runways, when appropriate, to

minimize delays in brake application.

120 Appendix D — Aircraft Manufacturers

Stabilised approach is a key element for safe approach and

landings. Failing to establish and maintain a stabilised ap-

proach may potentially result in abnormal runway contact,

controlled ight into terrain (CFIT), in-ight damage, loss

of control in–ight (LOC-I), runway excursion, tail strike or

undershoot. During the 2009–2018 period, 49 percent of

fatal accidents in commercial aviation occurred during nal

approach and landing phases, resulting in 903 on-board fa-

talities [reference below, Boeing Statistical Summary].

An approach is stabilised only if all the criteria in company

SOPs are met before or when reaching the applicable min-

imum stabilization height. The recommended minimum

stabilization heights are 1,000 ft above airport elevation in

instrument meteorological conditions (IMC), or 500 ft above

airport elevation in visual meteorological conditions (VMC).

The stabilised approach monitoring system is intended to

increase situational awareness by monitoring stabilised ap-

proach criteria and providing timely awareness for the crew,

in order to minimize unstabilised approach occurrences.

■

The system should consider monitoring the approach ele-

ments presented by FSF ALAR Toolkit — Brieng note 7.1

— Stabilized Approach, as practical;

■

The system should automatically check elements and pro-

vide timely feedback for the crew;

■

The system should inform the crew which stabilised ap-

proach element is not being met during an unstabilised

approach;

■

The system should be harmonized with other systems

used in the same phase, in terms of alerts, pilot inputs

and procedures. Other systems examples may be list

ed, but not limited to: terrain awareness and warning

system (TAWS), ROAAS and landing gear alerts, among

others; and,

■

The system should not be intrusive (i.e., to preserve the

crew’s attention to ATC clearance/messages) and not

lead to unnecessary go-arounds (e.g., too frequent alerts

when not fully justied) that could risk to overcome ATC

Recommendation MAN14: Manufacturers

should consider making available on-board

real-time stabilised approach monitoring

systems that provide alerts when there is a

deviation from stable approach criteria. In

those cases where other alerting systems

are used in combination (e.g., ROAAS), the

alerting systems must be consistent to avoid

unnecessary go-arounds.

Figure 17. Example SVS with enhanced path and energy awareness

Courtesy of Honeywell

Global Action Plan for the Prevention of Runway Excursions 121

capability, and should t with existing SOPs, recommen-

dations and callouts.

References

BOEING: Statistical Summary 2018.

Flight Safety Foundation: ALAR Brieng Note 7.1 — Stabi-

lized Approach.

IATA et. al: Unstable Approaches — Risk Mitigation Policies,

Procedures and Best Practices, 2nd ed 2016.

NTSB, Safety Alert 077 — Stabilized Approaches Lead to

Safe Landings, 2019.

Improving Runway Safety with Flight Deck Enhancements,

Boeing Aero Magazine, Quartet 1, 2011. (https://www.

boeing.com/commercial/aeromagazine/articles/2011_q1/

pdfs/AERO_2011_Q1_article2.pdf

Selection of the wrong runway for takeo or landing can

invalidate any performance computations done to ensure

a safe takeo or landing. Providing the crew with improved

position awareness, or awareness when the available runway

surface appears to be atypically short, can help a crew avoid

beginning a takeo or approach to a runway that was not

planned.

Airport moving maps provide additional crew awareness

of position relative to runways and taxiways. These systems

have the potential to mitigate errors associated with incorrect

runway, incorrect intersection or inadvertent taxiway takeos.

The systems are typically part of an EFB or installed avionics

(e.g., on the navigation display).

Other ight deck systems (if equipped) provide an alert if the

aircraft attempts departure from a runway other than that

programmed in the FMS or attempts a takeo or landing

on the taxiway (e.g., runway awareness and advisory system

[RAAS]).

References

Improving Runway Safety with Flight Deck Enhancements,

Boeing Aero Magazine, Quarter 1, 2011. (https://www.

boeing.com/commercial/aeromagazine/articles/2011_q1/

pdfs/AERO_2011_Q1_article2.pdf

Runway Awareness and Advisory Sys-

tem https://www.skybrary.aero/index.php/

Runway_Awareness_and_Advisory_System_(RAAS)

New aircraft technology that is not covered by existing regu-

lations is often certied via standards that are not published

and made available to the rest of the aviation community.

This situation can make wider adoption of similar technolo-

gy more dicult for other manufacturers and can produce

products with related functionality but dissimilar operating

characteristics, including displays, controls and even basic

operating capabilities.

By collaborating with other industry organizations and reg-

ulators, common rules can be established and made known,

which permits other adopters of similar technology to have

validated requirements for design and can create a standard

level of performance for all implementations. There are many

organizations that help facilitate development of this type

of standard for aviation technology, such as the European

Organisation for Civil Aviation Equipment (EUROCAE); RTCA,

formerly known as the Radio Technical Commission for Aer-

onautics; and SAE International.

Recommendation MAN15: Manufacturers

should provide on-board real-time means to

enhance position awareness with respect to

runways on nal approach and ground oper-

ations to address risks of aircraft lining up on:

■

The incorrect runway for landing or

departure;

■ A taxiway for landing or departure; or,

■ The incorrect intersection for departure.

Recommendation MAN16: Whenever new

functionality is created that is not supported

by existing regulatory guidance, that func-

tionality should be preferably supported by

development of minimum operations per-

formance standards (MOPS) by a standards

organization.

122

Left intentionally blank

Global Action Plan for the Prevention of Runway Excursions 123

APPENDIX E

GUIDANCE AND EXPLANATORY MATERIAL

FOR REGULATORS AND ICAO

Eective oversight of runway, aerodrome and ight oper-

ations should continue to form an important part of the

safety management system of the aerodrome operator, air

navigation service provider (ANSP), aircraft operator, other

stakeholders and of the state safety program activities.

Under the Convention on International Civil Aviation, States

are responsible to ensure safety, regularity and eciency of

aircraft operations, air navigation services and operations at

aerodromes under their jurisdiction. Therefore, it is essential

that the State exercises its safety oversight responsibilities

and ensures that aircraft operators, ANSPs and aerodrome

operators comply with the applicable national/regional regula-

tions, which are built on the relevant International Civil Aviation

Organization (ICAO) Standards and Recommended Practices.

The regulatory authority responsible for safety oversight

should conduct regulatory oversight and inspections on

aircraft and aerodrome operators as well as ANSPs in order

to monitor the safe provision of these operations and to verify

compliance with the regulatory requirements.

The oversight of aircraft operators, ANSPs and aerodrome

operators by their regulator should include at least the

following:

■

Ensuring that aircraft operators, ANSPs and aerodrome

operators have developed, implemented and continue

to maintain an eective runway excursion prevention

programme that meets national/regional requirements;

■

Conducting audits and inspections to examine the in-

terfaces between the aerodrome operators and other

stakeholders involved in runway excursion prevention

(e.g., communication of safety-signicant information re-

garding changing surface conditions in real time to the

appropriate air trac services providers);

■

Reviewing and continuously improving the training pro-

gram for pilots, air trac controllers, aerodrome ight in-

formation service ocers and aerodrome personnel on

runway excursion prevention measures;

■

Reviewing operators’ incident prevention programs, in-

cluding occurrence reporting relating to runway excur-

sions; for aircraft operators, this should include monitoring

aircraft parameters related to potential runway excursions

from their ight data monitoring program;

■

Reviewing the training programs for air trac controllers

to ensure that the subject of ‘stabilised approaches’ and

aircraft energy management is included;

■

Reviewing runway maintenance programs, including re-

moval of contaminants, refurbishing programs, and the

assessment of runway contamination and friction levels in

line with the latest, national/regional requirements; and,

■

Reviewing the noise mitigation measures through hazard

identication and risk assessment for aerodromes ensur-

ing coordination between the organisation managing the

change and other stakeholders.

In addition to the regulatory oversight, it is benecial that

a regulator keeps a high level, national focus on the risk of

runway excursions. This can be achieved by establishing a na-

tional runway safety forum. Membership in the forum should

include representatives from aerodromes, aircraft operators’

ight operations, air trac services, industry safety groups,

local runway safety teams and the regulatory authority.

Terms of reference for such a group should be to:

■

Address specic hazards identied nationally, coordinating

this through sub-groups or external agencies as required;

■

Promote good practices and information sharing, raise

awareness through publicity and educate the industry;

■

Actively enhance work continuing in industry and act as

a point of coordination for industry;

■

Identify and investigate which technologies are available that

may reduce runway excursion risks and promote their use;

■

Review current aerodrome, air trac control and aircraft

operational procedures and, if necessary, make recom-

mendations on future policy, guidance and advisory

material for all stakeholders to reduce the risk of runway

excursions; and,

■

Oversee the reporting of runway excursion incidents and

utilise the data to highlight issues and trends.

Regulators should continue to actively support and promote

the Global Action Plan for the Prevention of Runway Excur-

sions (GAPPRE) as part of state safety program activities. Al-

though GAPPRE contains recommendations only, regulators

should ensure that it is given appropriate consideration in

oversight activities by:

■

Promoting awareness of GAPPRE;

■

Conducting an operators gap analysis to ensure that all

recommendations are implemented;

■

Ensuring that runway safety and the prevention of runway

excursions are addressed in regular audit inspections;

124 Appendix E — Regulators and ICAO

■

Ensuring that the ndings and recommendations arising

from audits are implemented; and,

■

Working collaboratively with other regulators and ICAO

to ensure that the signs, markings and lighting systems

of the runway environment and associated procedures

are appropriate for all day, night and reduced visibility

operations and, where necessary, develop improvements

and enhancements as required.

ICAO should support and promote GAPPRE as part of the

ICAO Runway Safety Programme, its regional activities and

the work of the respective panels and working groups. This

should include but should not be restricted to:

■

Investigating measures to support ight crew to enable

dierentiation between the runway centreline lights and

the runway edge lights. This may include, for example,

dierentiation by colour, luminosity or pattern;

■

Considering provisions in Annex 14 that de-couple the

provision of taxiway centreline lights from trac density.

This is currently foreseen in recommended practice 5.3.17

of ICAO Annex 14. In practice, the taxiway centreline lights

are also used for the guidance of the individual aircraft (ir-

respective of the trac density) and not just for their con-

trol in the context of an aerodrome’s surface movement

guidance and control systems. Moreover, this should take

into account that occurrences of misaligned takeos have

taken place at aerodromes where the taxiway leading to

the runway entry was not equipped with taxiway centre-

line lights, and that the investigation of these occurrences

has shown that the misaligned aircraft (they were aligned

with the runway edge lights during their takeo) were

operating alone with no other trac present;

■

Investigating measures to enhance ight crew positional

awareness in the runway touchdown zone during ap-

proach and landing. Specically, the improvement of the

visual aids may include, for example, lighting systems indi-

cating the end of the touchdown zone. This will help ight

crew, especially in conditions where runway markings are

dicult to observe, to have an optimal are and to decide

whether to go around, when the timeliness of the decision

is a critical parameter aecting the runway excursion risk;

■

Investigating the possibility of upgrading to a standard

the use of simple touchdown zone lighting. This may en-

hance ight crew awareness of the touchdown zone and

will increase touchdown point accuracy, which is a critical

risk factor for the runway overrun risk.

■

Investigating the possibility of increasing the use of run-

way centreline lights to include more operations. This is

because there have been numerous runway excursions

(either high speed overruns or veer-os), during both the

landing and the takeo phase, whose investigation has

identied the existence of a runway centreline lighting

system as a measure that could have prevented the events.

■

Investigating potential regulatory measures to devel-

op detailed rules for the maintenance of manoeuvring

area signs.

Specic rationale and explanatory material related to recom-

mendation REG16: Support the development of approved

signal-in-space SBAS models to allow certication of auto-

matic landing on LPV 200 procedures as part of a wider initi-

ative to promote and encourage the development of LPV 200

instrument ight rules procedures on a wider set of runways.

States and/or regions developing SBAS systems capable of

supporting LPV 200 (localizer performance with vertical guid-

ance) approach procedures should support with data and/

or detailed specication the creation, validation and publi-

cation of signal-in-space models to enable the certication

of automatic landing with LPV 200. These signal-in-space

models shall include nominal performances (e.g., includ-

ing all nominal variability of the signals), and failures case

denitions. Certication authorities should recognise these

signal-in-space models as acceptable means to demonstrate

adequate automatic landing performances based on SBAS.

The rational includes:

■

The certication of aircraft automatic landing systems as

per all weather operation regulations requires demon-

stration of acceptable landing performance. To perform

this demonstration, acceptable means of compliance is

to rely on simulation and ight tests. The simulation re-

quires a signal-in-space model representative of nominal

distribution of errors and failure cases of the navigation

means used to support the operation.

■

The allowed minimums of an LPV 200 procedure are not

intended to be changed by the use of an automatic land-

ing system.

■

LPV 200 procedures are expected to be rapidly deployed

in regions where SBAS systems supporting LPV oper-

ations have been developed. Observed performance of

SBAS-in-space in regions where it is deployed has been

fully compatible with existing certied automatic landing

systems. However, we are currently lacking approved sig-

nal-in-space models to certify automatic landing capacity

based on SBAS. Such capacity would support the R&D rec-

ommendation R&D1, and Aircraft MAN9. Eorts to develop

such models have been constrained by the lack of data

availability and an approved methodology. In particular,

details on normal distribution of errors and ground-based

monitoring thresholds are dicult to obtain, and only the

specications may be known. Lack of a failure case model

prevents the failure case assessment from being performed

at the aircraft level (for example for ILS case and GBAS case,

the monitoring thresholds are published in standards).

As dierent SBAS systems are being deployed worldwide, it

is expected that performance of these systems might slightly

dier and that each system would require a specic signal-

in-space model.

Global Action Plan for the Prevention of Runway Excursions 125

APPENDIX F

GUIDANCE AND EXPLANATORY MATERIAL ABOUT

GEM RECOMMENDATION R&D RECOMMENDATIONS

GEM Recommendation R&D1 126

GEM Recommendation R&D2 126

GEM Recommendation R&D3 127

GEM Recommendation R&D4 127

GEM Recommendation R&D5 128

GEM Recommendation R&D6 128

GEM Recommendation R&D7 128

GEM Recommendation R&D8 129

126 Appendix F — R&D

The main reason for including recommended R&D topics

in the GAPPRE document is that the dierent experts who

participated in the development of GAPPRE felt that some

technologies needed more research and development before

they could be used in operations. Also, some technologies

must still mature for real-world systems development to en-

sure that they meet the intended function of reducing runway

excursions. The list of recommended R&D topics can help to

dene research projects in the future.

This appendix contains background information on the rec-

ommended R&D topics.

Occurrence data have shown that in a number of veer-os

during the landing phase, the aircraft had started to deviate

from the lateral track before touchdown. An example of such

cases is shown Figure 18. This shows the start of the lateral

deviation as function of time to touchdown. In most of these

runway excursions, the deviation started around or just after

passing the runway threshold. The lateral deviation was often

caused by some crosswind which was not compensated for

by the pilots or by incorrect control inputs by the pilots, often

in combination with a lack of outside visual references (e.g.,

due to sudden heavy rain, when passing the threshold). An

awareness and alerting system that informs or warns pilots

of the lateral deviation before touchdown could help reduce

these types of runway excursions.

One challenge is that such an awareness/alerting system

would need to be triggered suciently ahead of the touch-

down to allow appropriate time delay for crew action (oth-

erwise it may add confusion without allowing the required

time for trajectory correction or go-around). Expected crew

procedures for this alert would have to be dened. Nuisance

alerts should be minimised to avoid alerting if crew ade-

quately manoeuvre the aircraft to correct wind variations that

may occur in the late nal approach. Finally, the awareness/

alerting system will have to rely on navigation means to ade-

quately estimate risk of lateral excursion; this would require a

high level of navigation mean accuracy and integrity in order

to minimise the nuisance rate. Details of such a system should

be developed and the system should be evaluated (e.g., in

a simulator) to determine the actual benets. Development

of this system has not yet started.

The system would mainly benet commercial transport air-

craft that do not have automatic landing capabilities or have a

head-up display installed to help to provide lateral guidance.

It is unclear at this moment if it could be introduced as a

retrot or only for new designs.

References

D3.16 – Flight Data Monitoring Workshop: Runway Veer-

o Risk Monitoring Tools, Future Sky Safety, https://www.

futuresky-safety.eu/download/

H. Nelson, A Review of Runway Excursion, Airbus, 2015.

Lateral control of aircraft during the landing roll-out phase is

a complex interaction of rudder input and lateral forces acting

on the airframe (with crosswind) and tires. In particular, the

lateral friction forces on the aircraft tires are complex when-

ever there is a combination of cornering and brake applica-

tion (e.g., during landing in crosswind). Dierent engineering

models are used to capture these characteristics for a variety

of runway conditions. Only part of the directional control

characteristics envelope can be safely examined and vali-

dated in ight testing that is mostly limited to dry runways.

The idea is to dene standard models for lateral friction on

degraded runway states and acceptable means of compliance

to demonstrate roll-out performance for dierent runway

states and crosswind conditions. Currently, aircraft manu-

facturers use their own developed models for lateral friction

forces on tires. They do not have approved lateral friction

models for degraded runway state or sometimes even for a

dry runway. Lack of such standard models prevents automatic

landing performance demonstrations from being done by

simulation. Similar to standards for wheel braking friction

(see, e.g., EASA CS 25.109, and EASA AMC 25.1591), standard

models for the lateral friction forces should be developed for

R&D1: Investigate an awareness and alert-

ing system when an aircraft experiences ab-

normal/signicant lateral deviation during

nal stages of the landing.

R&D2: Conduct research on transport-cat-

egory aircraft, to extend automatic landing

capacity to any runway state.

Figure 18. Start of lateral deviation as function of

time to touchdown in runway veer-o accidents,

01/01/2012 to 07/07/2014

160

140

120

100

–25 –20 –15

Time to touchdown (seconds)

Height above runway (feet)

–10 –5 0

Source: H. Nelson, A Review of Runway Excursion, Airbus, 2015

Global Action Plan for the Prevention of Runway Excursions 127

dierent runway states (dry, wet and contaminated). These

models should account for the eect of brake application.

References

D3.2 – Shortcomings in current modelling for modern

aircraft, https://www.futuresky-safety.eu/wp-content/

uploads/2016/02/FSS_P3_NLR_D3.2_ES_v2.0.pdf

Expansion of ight simulator capability for study and solu-

tion of aircraft directional control problems on runways,

NASA CR-145084, 1978.

Enhancement of Aircraft Ground Handling Simulation

Capability, Advisory Group for Aerospace Research and

Development, AGARDograph-333, 1998.

Over the years, a number of runway overrun accidents and

incidents have occurred after the aircraft landed on a wet

runway. An analysis of the aircraft stopping performance in

these events indicates that the wheel braking friction coef-

cient achieved during the landing roll was signicantly less

than the coecient predicted by industry-accepted models,

and less than assumed in the wet-runway landing distance

advisory data provided in the manufacturers’ airplane ight

manuals. The wheel braking friction coecient that can be as

sumed on a wet runway during an aborted takeo is specied

by 14 CFR 25.109 or EASA CS 25.109. The 25.109 model has

been proposed and used for computing landing distances on

a wet runway as well. In a number of runway overruns, there

were no clear indications that the runway would be slippery

when wet. It is believed that deciencies in the runway micro

texture have resulted in the lower wheel braking friction lev-

els. The wheel braking friction coecients specied in FAR/CS

25.109 are based on generalized curves originally developed

by engineering design organization ESDU. These ESDU curves

were based on data for runways having a sharp micro texture.

For wet runway surfaces having a smooth micro texture, the

standard curves of 25.109 overestimate the braking friction

capabilities of aircraft tires. An example of such an overesti-

mation is shown in Figure 19. In this example, a slippery wet

condition (RCR = 3) matches the achieved braking friction

levels much better. At this moment, there are no acceptable

methods for assessing the runway micro texture. Research is

therefore needed on methods that airports can use to assess

the runway micro texture. Whenever the micro texture level

is below a dened threshold, the runway could be declared

‘Slippery wet’ (e.g., RCR = 3). This could also initiate runway

resurfacing. Explorative research has shown that high res-

olution laser scanners can help to assess the micro texture

characteristics of a hard surface. However, further research is

needed to validate this technique for runways and to dene

thresholds that can be used by airports. Correlation of laser

scanner results with full-scale ight test data is also needed as

part of the validation process. Aircraft full braking tests on wet

runways with dierent micro textures should be conducted

and compared to results obtained with high resolution laser

scanners.

References

J. O’Callaghan. Slippery When Wet: The Case for More Con-

servative Wet Runway Braking Coecient Models, National

Transportation Safety Board, AIAA AVIATION Forum, 2016.

Topic 9 Wet Runway Stopping, FAA Aviation Rulemaking Ad-

visory Committee FTHWG Phase 2, 2018.

EASA Research Agenda 2020 https://www.easa.europa.eu/

sites/default/les/dfu/easa_research_agenda_2020-2022.pdf

Airports often struggle to give accurate information regard-

ing the wetness of their runways during operations. Simple

empirical models have been developed over the years that

predict the water lm depth on a surface as a function of

rainfall, location and runway topography (slopes and texture).

Some of the empirical models that are currently used do not

always agree well with experimental data (other than those

data used to develop the equations) and cannot account for

surface wind. The empirical water depth models are often

developed using data obtained for road surfaces. Research

is needed to further improve the models for runway surfaces,

including grooved surfaces. Also, the concept of operations of

R&D3: Improve methods for assessing run-

way micro texture. Make pilots and aero-

drome operators aware of the impact of a

poor micro texture and of the shortfalls of

current industry practice.

R&D4: Develop models for assessing runway

wetness, particularly the depth.

Figure 19. Example of low braking friction on a wet

grooved runway

0.5

0.4

0.3

0.2

0.1

0.0

20 40

Ground speed (knots)

Minimum friction level regulation (RCR = 5)

B737-700 overrun at KMDW

Slippery wet

RCR = 3

Braking friction coefficient

60 80 100 120 140 160

Source: NTSB, NLR

128 Appendix F — R&D

such models in an airport environment need to be developed.

The use of water lm models have been tested at airports

with some success.

References

Gallaway, B. M., Pavement and geometric design criteria for

minimizing hydroplaning, U.S. Federal Highway Adminis-

tration; its R&D report no. S-0929, 1979.

Gallaway, B.M., Schiller, R.E., Jr. and Rose, J.G., The Eects of

Rainfall Intensity, Pavement Cross Slope, Surface Texture

and Drainage Length on Pavement Water Depths, Texas

Transportation Institute Report 138-5, 1971.

D3.11 – Assessment of the impact of new concepts

reducing the risk of runway excursions, Future Sky Safe-

ty Project, https://www.futuresky-safety.eu/wp-content/

uploads/2019/04/FSS_P3_TR6_D3.11_v2.0.pdf

Accumulation of water on runway, ESDU Data Item 19005,

May 2019.

With the introduction of the Runway Condition Assessment

Matrix (RCAM) as part of the Global Reporting Format, the

need to assess contaminants on a runway has become more

critical. Many airports are looking for systems that can auto-

matically detect the runway condition (e.g., type of contam-

inant and its depth). Mobile, as well as static, monitoring

systems are currently available. However, their accuracy is

sometimes questionable and the operational limitations

are often unclear. Research is needed into the accuracy and

working of these systems. There is also a need for design spec-

ications that manufacturers can use when developing the

surface monitoring systems. Work on drafting specications

has been started by EUROCAE.

References

Guilhem Blanchard, Antoine Dejean de La Batie, Sébastien

Belon, Caractérisation automatisée de l’état de surface des

pistes aéroportuaires - État de l’art et perspectives, DGAC-

STAC, 2019.

Minimum Aviation System Performance Standards (MASPS)

for Runway Weather Information Systems, EUROCAE WG-

109 (to be published in 2021).

A function of the graded area of a runway strip is to reduce

the risk of damage to an aircraft running o the runway. For

this reason, airports have to comply with International Civil

Aviation Organization (ICAO) standards that dene the limits

of how much an aircraft’s landing gear can sink into the soil

in the graded area. The runway strip and graded area must

meet specic longitudinal and transverse slopes, and bearing

strength requirements. Because the graded portion of a strip

is provided to minimise the hazard to an aircraft running o

the runway, it should be graded in such a manner as to prevent

the collapse of the landing gear of the aircraft. The surface

should be prepared in such a manner as to provide drag to

an aircraft, and it should have sucient bearing strength to

avoid damage to the aircraft. To meet these divergent needs,

the following guidelines are provided for preparing the strip.

Aircraft manufacturers consider that a depth of 15 cm is the

maximum depth to which the nose gear may sink without col-

lapsing. Therefore, it is recommended by ICAO that the soil at

a depth of 15 cm below the nished strip surface be prepared

to have a bearing strength of a California Bearing Ratio (CBR)

value of 15 to 20. The intention of this underlying prepared

surface is to prevent the landing gear from sinking more than

15 cm. This requirement is tested under dry surface conditions.

Aircraft veer-o accidents have shown that in many cases,

the gear collapsed when running over the graded area of the

runway strip when it was wet from rainfall. The relatively low

shear strength of unpaved runway surfaces when wet limits

aircraft loads imposed on the runway. There could be a need

to develop graded areas which do not have this shortcoming.

Research in this area is therefore recommended.

References

M. Crispino et Al. “Soil Improvement of Runway STRIP and

Runway End Safety Area (RESA) through an Innovative

Methodology.” Proceedings of the First Congress of Trans-

portation and Development Institute, 2011.

Aerodrome Design Manual, ICAO Doc 9157.

The objective is to enhance ight crew awareness of the air-

craft energy state during approach and reduce the need for

late go-arounds.

Current systems such as head-up guidance systems (HGS) can

have a positive inuence on a ight crew’s situational aware-

ness and risk perception, thereby improving decision-making.

The use of an HGS for all approaches may help the pilots in

their decision-making as well because most HGS provide

R&D6: Research ways to improve graded

area of wet runway strips to mitigate the

damage to aircraft when veering o a runway.

R&D7: Research and develop functions that

provide additional ight path and energy in-

formation (such as ight path vector symbol-

ogy) in order to help the ight crew to better

anticipate and maintain stability at the gate

and below.

R&D5: Explore the accuracy of and develop

new automatic runway condition monitoring

systems.

Global Action Plan for the Prevention of Runway Excursions 129

for a 3-degree slope indication, indicate the ight path and

have a guidance line for the touchdown point. Using HGS

for all approaches may assist the pilots in ying stabilised

approaches. This is especially true for visual approaches when

no vertical guidance (e.g., instrument landing system, preci-

sion approach path indicator, visual approach slope indicator)

is available. Most HGS systems also have a feature that shows

the runway remaining after touchdown.

Note also that some synthetic visions systems incorporate

similar energy management cues on head-down displays

such as the primary ight display (e.g., ight path vector, ac-

celeration and speed cues, ight path reference line, runway

distance remaining).

Where such systems are not already available or the technol-

ogy has not matured to the required technology readiness

level, such systems should be developed and made available

to operators. Evaluations of the benets of such functions

should be performed based on in-service data and experience

when/where available.

Numerous runway excursions are related to unstable ap-

proaches. Some ight deck systems such as the runway

awareness and advisory system (RAAS) already provide aural

and/or visual alerts when stabilised approach criteria are be-

ing violated (e.g., too fast, too high). Other systems such as

the runway overrun awareness and alerting system (ROAAS)

provide instantaneous information, such as predicted stop-

ping points, to the pilots. These systems typically function

at altitudes below 1,500 ft. Earlier awareness of such con-

ditions beginning at the start of the descent would lower

the number of unstable approaches. The objective is to

reduce the risk of unexpected energy/trajectory conditions

(leading to possible go-arounds) when approaching landing

decision gates. R&D eorts should be conducted to develop

a real-time strategic awareness and alerting function to

enable appropriate energy management throughout the

descent (from top of descent) and approach, upstream of

the ROAAS/RAAS protection domain. This function should

ideally account for current and predicted energy conditions,

air trac control (ATC) change requests, winds conditions,

etc., and provide path adaptation and conguration man-

agement cues, and alerting when unsafe landing conditions

are predicted.

The system should assist in timely planning and predicting

an optimized trajectory, taking into account the current en-

ergy and trajectory state and the ATC change requests, and

giving guidance to the crew to anticipate future sequence of

actions for energy dissipation on this optimized prole (e.g.,

conguration change).

R&D8: R&D eorts should be conducted to

develop on-board real time stabilised approach

monitoring (upstream of ROAAS function at

higher altitudes e.g., Flight Level 200). Such sys-

tems should ensure that they are harmonized

with other systems such as ROAAS and the

runway awareness and advisory system (RAAS).

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that EUROCONTROL is mentioned as the source and it is not used for commercial purposes (i.e. for nancial gain).

The information in this document may not be modied without prior written permission from EUROCONTROL.

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