<< >> NASA ASRS Report 268763, April 1994

Widebody transport cargo aircraft mistakes an intersection name for another, heading deviation. Language barrier part of problem.

Attributes
ACN	268763
Time
Date	199404
Day	Mon
Local Time Of Day	1801 To 2400
Place
Locale Reference	atc facility : fue
State Reference	FO
Altitude	msl bound lower : 39000 msl bound upper : 39000
Environment
Flight Conditions	VMC
Light	Night
Aircraft 1
Operator	common carrier : air carrier
Make Model Name	Commercial Fixed Wing
Operating Under FAR Part	Part 121
Navigation In Use	Other
Flight Phase	cruise other
Route In Use	enroute : direct enroute airway : rjtg
Flight Plan	IFR
Person 1
Affiliation	company : air carrier
Function	flight crew : captain oversight : pic
Qualification	pilot : atp
Experience	flight time last 90 days : 200 flight time total : 15000
ASRS Report	268763
Person 2
Affiliation	company : air carrier
Function	flight crew : first officer
Qualification	pilot : commercial pilot : atp pilot : instrument
Events
Anomaly	non adherence : clearance other anomaly other other spatial deviation
Independent Detector	other other : unspecified
Resolutory Action	flight crew : returned to intended course or assigned course other
Consequence	faa : reviewed incident with flight crew
Supplementary
Primary Problem	Flight Crew Human Performance
Air Traffic Incident	Pilot Deviation

Narrative:

When we were near foe swbound fukuoka control (japan) cleared us from esbis direct bulan direct anpu. Our flight plan was esbis - mikes - bolod - salmi - APU. We misheard bolod for bulan and read back esbis direct bolod direct APU. ATC acknowledged readback. We started to fly the wrong heading over esbis and another carrier advised us we had misunderstood the clearance. We were about 5 mi off course at that time. We then proceeded direct bulan and called naha control and phonetically spelled bulan to make sure of the clearance. The fact that bolod was on our flight plan and bulan was not, contributed to this mistake. Japanese accented english makes bulan and bolod sound the same. Suggestions: 1) change similar sounding fixes in same area. 2) when reclring a flight, spell phonetically and use A-1 (alpha 1) airway designator instead of direct bulan direct APU.

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Original NASA ASRS Text

Title: WDB CARGO ACFT MISTAKES AN INTXN NAME FOR ANOTHER, HDG DEV. LANGUAGE BARRIER PART OF PROB.

Narrative: WHEN WE WERE NEAR FOE SWBOUND FUKUOKA CTL (JAPAN) CLRED US FROM ESBIS DIRECT BULAN DIRECT ANPU. OUR FLT PLAN WAS ESBIS - MIKES - BOLOD - SALMI - APU. WE MISHEARD BOLOD FOR BULAN AND READ BACK ESBIS DIRECT BOLOD DIRECT APU. ATC ACKNOWLEDGED READBACK. WE STARTED TO FLY THE WRONG HDG OVER ESBIS AND ANOTHER CARRIER ADVISED US WE HAD MISUNDERSTOOD THE CLRNC. WE WERE ABOUT 5 MI OFF COURSE AT THAT TIME. WE THEN PROCEEDED DIRECT BULAN AND CALLED NAHA CTL AND PHONETICALLY SPELLED BULAN TO MAKE SURE OF THE CLRNC. THE FACT THAT BOLOD WAS ON OUR FLT PLAN AND BULAN WAS NOT, CONTRIBUTED TO THIS MISTAKE. JAPANESE ACCENTED ENGLISH MAKES BULAN AND BOLOD SOUND THE SAME. SUGGESTIONS: 1) CHANGE SIMILAR SOUNDING FIXES IN SAME AREA. 2) WHEN RECLRING A FLT, SPELL PHONETICALLY AND USE A-1 (ALPHA 1) AIRWAY DESIGNATOR INSTEAD OF DIRECT BULAN DIRECT APU.

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.