The runway incursion of a Beech Baron aircraft onto an occupied runway at Bankstown Airport highlights the potential effect of expectation bias and the importance of pilots focusing on specific instructions given by air traffic controllers, a new Australian Transport Safety Bureau investigation report says.
On the morning of 26 October 2021, the Baron aircraft, registered VH-NSK, and operated by Little Wings, was conducting a post-maintenance flight to test its stall warning system, the investigation report details. Prior to this flight the pilot had not conducted a VFR flight from the airport for some considerable time and had only departed Bankstown from runway 29C for flights over the last previous 18 months.
Following pre-flight checks, the aircraft was cleared to taxi to holding point A8 for a departure from runway 29R. Once there, the pilot contacted air traffic control (ATC) and advised they were holding short of runway 29R for departure and were advised to hold position. Just prior to this, an Embraer 190 received clearance to enter runway 29C at holding point A2, for high-power engine runs.
Moments later ATC instructed VH-NSK to line-up and wait for runway 29R. The pilot read back their instruction and seeing VH-NSK commence taxiing the Tower controller began assisting two helicopters operating north of the airport. During this time VH-NSK crossed runway 29R and entered and lined up on runway 29C.
Turning back to VH-NSK, the Tower controller issued an instruction for take-off. When VH-NSK was detected on runway 29C, the Tower Controller immediately called for VH-NSK to ‘hold position, hold position you are lined up on Centre, hold position’ and issued repeated instructions to stop. At the same time, the pilot of VH-NSK saw the Embraer conducting high-power engine runs on runway 29C and did not commence the take-off.
ATSB Transport Safety Director Stuart Macleod said this incident highlights the importance of pilots focusing on the specific instructions given by air traffic controllers and how expectation bias can affect how they receive and understand verbal instructions
“As the pilot of the Baron aircraft had only conducted IFR flights departing from Bankstown’s runway 29 centre for the last 18 months it is likely their focus had narrowed to the actions for the unfamiliar VFR departure and despite confirming their instructions back to ATC they reverted to what they had done previously.
“When issued instructions by air traffic control, pilots need to focus on listening and then repeat what was said in your head and then actively apply that information,” said Mr Macleod.
For more information on runway safety and avoiding errors that lead to runway incursions go to Airservices Australia’s A pilot’s guide to Runway Safety and their specific publications for Bankstown, Moorabbin, Parafield, Jandakot and Archerfield airports.
Read the report: Runway incursion involving Beech Aircraft Corp. 58, VH-NSK, Bankstown Airport, New South Wales, on 26 October 2021