Narrative:

On the early morning of oct/fri/99, at cleveland hopkins international airport, after a 25 min delay due to a late dispatch release, my aircraft was given a taxi clearance as follows: '...taxi to runway 23R hold short of runway 23L.' after a proper readback from my first officer, I began the taxi. We were neither given specific taxi instructions nor a standard, coded taxi route. However ATIS indicated standard taxi routes were in use, so we assumed the standard route of taxiway J, west, U, runway 28, hold short of runway 23L would be appropriate. At a point along the taxi route I sensed that I had missed taxiway U so I continued straight ahead to use taxiway west to enter runway 28. As I made the turn and entered the runway, ground control stated, '...you're on runway 23L, taxi straight ahead and back taxi into position on runway 23R.' only then did I realize what I had done. Where I thought I was eastbound on taxiway west turning onto the taxiway entrance to runway 28, I was actually northbound at the north end of taxiway J turning onto wbound taxiway west. My first officer was fairly new at the company and therefore unfamiliar with the field. Now I was/am very familiar with cleveland hopkins international and its special procedures. I had operated in and out of the field perhaps 40-50 times before. Although it was dark with poor visibility, I blame no one other than myself and the contributing factors in this instance. The sole contributing factor was a degradation of human performance due to a severe lack of sleep. The carrier has a type of trip called a continuous duty overnight (cdo), in which the crew operates the last flight out to an outstation, remain on duty at a hotel for a short overnight, and make the first flight back in the morning. For this cdo, scheduled ground time (act arrival to departure time) is 5 hours 30 mins. The flight is scheduled to arrive at XA45. Provided the flight is not late, by the time we gather our bags, do an aircraft postflt inspection, take the longer-than-average walk through the terminal, wait on the hotel shuttle, ride 10-15 mins, hotel check-in, find the rooms, get cleaned up and ready for bed, it is XB30-XB45. Now we have to be up by XE00 to do the reverse. There really is no way to prepare for this unless the body is accustomed to 3 hours of sleep at night. I believe this operation with so little sleep is unsafe. This brutal lack of sleep dulled my senses, judgements, decision making ability and overall performance. With proper scheduling, cdo's are an efficient use of crew resources, however, they should never contain less than 7 hours ground time.

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Original NASA ASRS Text

Title: ACR PLT, AFTER A CONTINUOUS DUTY OVERNIGHT, FINDS HIMSELF ON A RWY WITHOUT CLRNC. HE CITES FATIGUE AS A FACTOR.

Narrative: ON THE EARLY MORNING OF OCT/FRI/99, AT CLEVELAND HOPKINS INTL ARPT, AFTER A 25 MIN DELAY DUE TO A LATE DISPATCH RELEASE, MY ACFT WAS GIVEN A TAXI CLRNC AS FOLLOWS: '...TAXI TO RWY 23R HOLD SHORT OF RWY 23L.' AFTER A PROPER READBACK FROM MY FO, I BEGAN THE TAXI. WE WERE NEITHER GIVEN SPECIFIC TAXI INSTRUCTIONS NOR A STANDARD, CODED TAXI RTE. HOWEVER ATIS INDICATED STANDARD TAXI ROUTES WERE IN USE, SO WE ASSUMED THE STANDARD RTE OF TXWY J, W, U, RWY 28, HOLD SHORT OF RWY 23L WOULD BE APPROPRIATE. AT A POINT ALONG THE TAXI RTE I SENSED THAT I HAD MISSED TXWY U SO I CONTINUED STRAIGHT AHEAD TO USE TXWY W TO ENTER RWY 28. AS I MADE THE TURN AND ENTERED THE RWY, GND CTL STATED, '...YOU'RE ON RWY 23L, TAXI STRAIGHT AHEAD AND BACK TAXI INTO POS ON RWY 23R.' ONLY THEN DID I REALIZE WHAT I HAD DONE. WHERE I THOUGHT I WAS EBOUND ON TXWY W TURNING ONTO THE TXWY ENTRANCE TO RWY 28, I WAS ACTUALLY NBOUND AT THE N END OF TXWY J TURNING ONTO WBOUND TXWY W. MY FO WAS FAIRLY NEW AT THE COMPANY AND THEREFORE UNFAMILIAR WITH THE FIELD. NOW I WAS/AM VERY FAMILIAR WITH CLEVELAND HOPKINS INTL AND ITS SPECIAL PROCS. I HAD OPERATED IN AND OUT OF THE FIELD PERHAPS 40-50 TIMES BEFORE. ALTHOUGH IT WAS DARK WITH POOR VISIBILITY, I BLAME NO ONE OTHER THAN MYSELF AND THE CONTRIBUTING FACTORS IN THIS INSTANCE. THE SOLE CONTRIBUTING FACTOR WAS A DEGRADATION OF HUMAN PERFORMANCE DUE TO A SEVERE LACK OF SLEEP. THE CARRIER HAS A TYPE OF TRIP CALLED A CONTINUOUS DUTY OVERNIGHT (CDO), IN WHICH THE CREW OPERATES THE LAST FLT OUT TO AN OUTSTATION, REMAIN ON DUTY AT A HOTEL FOR A SHORT OVERNIGHT, AND MAKE THE FIRST FLT BACK IN THE MORNING. FOR THIS CDO, SCHEDULED GND TIME (ACT ARR TO DEP TIME) IS 5 HRS 30 MINS. THE FLT IS SCHEDULED TO ARRIVE AT XA45. PROVIDED THE FLT IS NOT LATE, BY THE TIME WE GATHER OUR BAGS, DO AN ACFT POSTFLT INSPECTION, TAKE THE LONGER-THAN-AVERAGE WALK THROUGH THE TERMINAL, WAIT ON THE HOTEL SHUTTLE, RIDE 10-15 MINS, HOTEL CHK-IN, FIND THE ROOMS, GET CLEANED UP AND READY FOR BED, IT IS XB30-XB45. NOW WE HAVE TO BE UP BY XE00 TO DO THE REVERSE. THERE REALLY IS NO WAY TO PREPARE FOR THIS UNLESS THE BODY IS ACCUSTOMED TO 3 HRS OF SLEEP AT NIGHT. I BELIEVE THIS OP WITH SO LITTLE SLEEP IS UNSAFE. THIS BRUTAL LACK OF SLEEP DULLED MY SENSES, JUDGEMENTS, DECISION MAKING ABILITY AND OVERALL PERFORMANCE. WITH PROPER SCHEDULING, CDO'S ARE AN EFFICIENT USE OF CREW RESOURCES, HOWEVER, THEY SHOULD NEVER CONTAIN LESS THAN 7 HRS GND TIME.

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.