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Charkhi Dadri Mid-Air Collision (Event Sequence (KZA1907 reported 8…
Charkhi Dadri Mid-Air Collision
Management
SVA763
Captain Khalid Al Shubaily, First Officer Nazir Khan and Flight Engineer Edris Arabia
Veteran Captain with more than 9,800 hours flying time
KZA1907
Pilot Gennadi Cherepanov and Radio Operator Igor Repp
Captain with more than 9,200 hours flying time
Controller VK Dutta
Indira Gandhi International Airport
Event Sequence
KZA1907 reported 8 minutes later at 14,500 feet, still descending
SVA763 traveling in opposite direction at 14,000 feet
KZA1907 cleared to descend 15,000 feet
Dutta advised KZA1907 of SVA763
Dutta did not receive a reply after repeating the warning
The two aircraft had collided, the tail of KZA1907 cut through SVA763's left wing and horizontal stabilizer
KZA1907 exploded mid-air and SVA763 spiraled downward before crashing into a field
Captain Timothy J. Place, United States Air Force pilot reported he saw that “a large cloud lit up with an orange glow”.
Co-Pilot only heard 14,000ft from Repp's translation and moved accordingly
KZA1907 Radio operator, Igor Repp repeated Dutta's directions to the crew
Repp noticed their altitude just before SVA763 was in view
KZA1907 Captain gave the order to ascend
System Parts
Soviet Union use metric system to calibrate altitude and distance
Only the radio operator onboard the KZA1907 spoke English
Communication gap
No secondary surveillance radar (aircraft identity and altitude readings)
Limited airspace, surrounded by Indian Air Force
Workplace
Kazakhstan Airlines Ilyushin Il-76TD
Registration UN-76435
37 People
Departed New Delhi 18:32 local time
Flight KZA1907
Due to land in Dhahran
Saudi Arabian Airlines Boeing 747-168B
Registration HZ-AIH
312 People
Due to arrive in New Delhi
Flight SVA763
Human and System Investigation
Co-Pilot not clarifying instructions and acting on his own
So what?
This communication error led to the disaster
Human and System Investigation Tools
Situation Present Assessment Method (SPAM)
Situation Awareness Global Assessment Technique (SAGAT)
Crew Situational Awareness
Situation Awareness Verification and Analysis Tool (SAVANT)
Secondary Task Monitoring
Knowledge Elicitation Investigation
No secondary surveillance radar (SSR)
So what?
ATC Controller VK Dutta could not verify their altitude via radar
This technology would have prevented this accident from happening
Knowledge Elicitation Tools
Link Analysis