Narrative:

During taxi out for our third leg, we all again discussed how tired we were. It was again the captain's leg. We took off to the east and climb out was normal. During climb out all altitude assignments from ATC appeared normal. Our final altitude assignment came as the captain was leveling off at 14000 ft, the previously assigned altitude. We had been cleared to FL290. I read back FL290 and reset the altitude alerter. After 6 mins at FL290 ATC asked us what our altitude was. I answered FL290, then the captain said, 'ask them what we were assigned.' ATC's response was that we were assigned FL260, but it was okay, since there was no other traffic and ZLA would take us at FL290. There was no further discussion with ATC about the situation and there was never any conflict with other air traffic as far as we know. Further discussion among crew members revealed that neither the captain nor the so could recall the communications with ATC assigning us any altitude above 5000 ft. Our cockpit resource management procedures call for the PF to repeat the altitude assigned and check the altitude alerter. To the best of my recollection this was done, but I can't be sure. The effects of fatigue were becoming more noticeable. My concern is that there was potential for a disaster. For at least 6 mins our flight was not at the altitude ATC thought we were and no communication was made to us concerning the apparent discrepancy. Whether we or ATC were in error is not known at this time. Due to the departure delay and reduced time at the intermediate stops, we were all feeling the effects of fatigue. In retrospect, I can say that normal cockpit resource management procedures were beginning to erode. I believe that the two major factors that led to this situation are as follows. The system that is supposed to provide separation between IFR aircraft somehow failed to detect an apparent altitude discrepancy (between ATC and the crew) of 3000 ft for 6 mins. Current far's allow airlines that operate night flts to schedule crew members for extended duty periods that have no consideration for the effects of circadian rhythm upset. In our case, we were within the letter of our labor agreement and all far's regarding flight and duty time. Though we felt fatigued, we pressed on because there exists no legal way for crew members to stop a flight short of a scheduled destination with the current regulations. Several pilots at our company have been threatened with their jobs if they refused to take a flight they feel too tired to take. Less than 1 week before this event took place, one of my crew members on our flight was threatened for this very reason. I always understood that the current ATC computer system would provide a warning to air traffic controllers whenever an aircraft deviated 300 ft from the assigned altitude. If such a system does not exist for all airspace that ATC controls, it should. ATC personnel are equally subject to the effects of circadian rhythm upsets. The FAA needs to strongly consider updating the regulations concerning on duty limits for crew members, particularly where overnight operations are involved. Considerations must be given to the effects of over-night scheduling on flight crew members' circadian rhythm. On duty times should be further limited for operations that are conducted during normal sleep times. I cannot stress the importance of these issues enough. In today's competitive business market it, companies are not willing to bear the costs of hiring more workers to promote a safer environment. Pilots are threatened with their jobs for taking steps on their own to protect themselves and their certificates. Labor agreements are ineffective when employers find loopholes to gain more productivity from fewer workers. I hope the FAA will change the current regulations to make night air freight operations safer for us and communities we fly over.

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Original NASA ASRS Text

Title: ALT BUST IN A NIGHT OP.

Narrative: DURING TAXI OUT FOR OUR THIRD LEG, WE ALL AGAIN DISCUSSED HOW TIRED WE WERE. IT WAS AGAIN THE CAPT'S LEG. WE TOOK OFF TO THE E AND CLB OUT WAS NORMAL. DURING CLB OUT ALL ALT ASSIGNMENTS FROM ATC APPEARED NORMAL. OUR FINAL ALT ASSIGNMENT CAME AS THE CAPT WAS LEVELING OFF AT 14000 FT, THE PREVIOUSLY ASSIGNED ALT. WE HAD BEEN CLRED TO FL290. I READ BACK FL290 AND RESET THE ALT ALERTER. AFTER 6 MINS AT FL290 ATC ASKED US WHAT OUR ALT WAS. I ANSWERED FL290, THEN THE CAPT SAID, 'ASK THEM WHAT WE WERE ASSIGNED.' ATC'S RESPONSE WAS THAT WE WERE ASSIGNED FL260, BUT IT WAS OKAY, SINCE THERE WAS NO OTHER TFC AND ZLA WOULD TAKE US AT FL290. THERE WAS NO FURTHER DISCUSSION WITH ATC ABOUT THE SIT AND THERE WAS NEVER ANY CONFLICT WITH OTHER AIR TFC AS FAR AS WE KNOW. FURTHER DISCUSSION AMONG CREW MEMBERS REVEALED THAT NEITHER THE CAPT NOR THE SO COULD RECALL THE COMS WITH ATC ASSIGNING US ANY ALT ABOVE 5000 FT. OUR COCKPIT RESOURCE MGMNT PROCS CALL FOR THE PF TO REPEAT THE ALT ASSIGNED AND CHK THE ALT ALERTER. TO THE BEST OF MY RECOLLECTION THIS WAS DONE, BUT I CAN'T BE SURE. THE EFFECTS OF FATIGUE WERE BECOMING MORE NOTICEABLE. MY CONCERN IS THAT THERE WAS POTENTIAL FOR A DISASTER. FOR AT LEAST 6 MINS OUR FLT WAS NOT AT THE ALT ATC THOUGHT WE WERE AND NO COM WAS MADE TO US CONCERNING THE APPARENT DISCREPANCY. WHETHER WE OR ATC WERE IN ERROR IS NOT KNOWN AT THIS TIME. DUE TO THE DEP DELAY AND REDUCED TIME AT THE INTERMEDIATE STOPS, WE WERE ALL FEELING THE EFFECTS OF FATIGUE. IN RETROSPECT, I CAN SAY THAT NORMAL COCKPIT RESOURCE MGMNT PROCS WERE BEGINNING TO ERODE. I BELIEVE THAT THE TWO MAJOR FACTORS THAT LED TO THIS SIT ARE AS FOLLOWS. THE SYS THAT IS SUPPOSED TO PROVIDE SEPARATION BTWN IFR ACFT SOMEHOW FAILED TO DETECT AN APPARENT ALT DISCREPANCY (BTWN ATC AND THE CREW) OF 3000 FT FOR 6 MINS. CURRENT FAR'S ALLOW AIRLINES THAT OPERATE NIGHT FLTS TO SCHEDULE CREW MEMBERS FOR EXTENDED DUTY PERIODS THAT HAVE NO CONSIDERATION FOR THE EFFECTS OF CIRCADIAN RHYTHM UPSET. IN OUR CASE, WE WERE WITHIN THE LETTER OF OUR LABOR AGREEMENT AND ALL FAR'S REGARDING FLT AND DUTY TIME. THOUGH WE FELT FATIGUED, WE PRESSED ON BECAUSE THERE EXISTS NO LEGAL WAY FOR CREW MEMBERS TO STOP A FLT SHORT OF A SCHEDULED DEST WITH THE CURRENT REGS. SEVERAL PLTS AT OUR COMPANY HAVE BEEN THREATENED WITH THEIR JOBS IF THEY REFUSED TO TAKE A FLT THEY FEEL TOO TIRED TO TAKE. LESS THAN 1 WK BEFORE THIS EVENT TOOK PLACE, ONE OF MY CREW MEMBERS ON OUR FLT WAS THREATENED FOR THIS VERY REASON. I ALWAYS UNDERSTOOD THAT THE CURRENT ATC COMPUTER SYS WOULD PROVIDE A WARNING TO AIR TFC CTLRS WHENEVER AN ACFT DEVIATED 300 FT FROM THE ASSIGNED ALT. IF SUCH A SYS DOES NOT EXIST FOR ALL AIRSPACE THAT ATC CTLS, IT SHOULD. ATC PERSONNEL ARE EQUALLY SUBJECT TO THE EFFECTS OF CIRCADIAN RHYTHM UPSETS. THE FAA NEEDS TO STRONGLY CONSIDER UPDATING THE REGS CONCERNING ON DUTY LIMITS FOR CREW MEMBERS, PARTICULARLY WHERE OVERNIGHT OPS ARE INVOLVED. CONSIDERATIONS MUST BE GIVEN TO THE EFFECTS OF OVER-NIGHT SCHEDULING ON FLC MEMBERS' CIRCADIAN RHYTHM. ON DUTY TIMES SHOULD BE FURTHER LIMITED FOR OPS THAT ARE CONDUCTED DURING NORMAL SLEEP TIMES. I CANNOT STRESS THE IMPORTANCE OF THESE ISSUES ENOUGH. IN TODAY'S COMPETITIVE BUSINESS MARKET IT, COMPANIES ARE NOT WILLING TO BEAR THE COSTS OF HIRING MORE WORKERS TO PROMOTE A SAFER ENVIRONMENT. PLTS ARE THREATENED WITH THEIR JOBS FOR TAKING STEPS ON THEIR OWN TO PROTECT THEMSELVES AND THEIR CERTIFICATES. LABOR AGREEMENTS ARE INEFFECTIVE WHEN EMPLOYERS FIND LOOPHOLES TO GAIN MORE PRODUCTIVITY FROM FEWER WORKERS. I HOPE THE FAA WILL CHANGE THE CURRENT REGS TO MAKE NIGHT AIR FREIGHT OPS SAFER FOR US AND COMMUNITIES WE FLY OVER.

Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.