Doc 9870: Manual on the Prevention of Runway Incursions

In 2001, the ICAO Air Navigation Commission took action to address the problem of runway incursions. Several critical areas were identified that needed to be investigated and which had a relation to overall runway safety, including radiotelephony phraseology, language proficiency, equipment, aerodrome lighting and markings, aerodrome charts, operational aspects, situational awareness and Human Factors.

To improve the situation with respect to runway incursions and to encourage the implementation of relevant provisions, ICAO embarked on an education and awareness campaign which began with a comprehensive search for the best available educational material for inclusion in an interactive runway safety toolkit. Information on this toolkit is provided in Appendix J to this manual.

To address aerodromes, air traffic management and flight operations, among other subjects, ICAO also conducted a series of runway safety seminars in the ICAO regions, with the aim of disseminating information on the prevention of runway incursions. Between 2002 and 2005, runway safety seminars were held in the following regions as part of the ICAO education and awareness campaign: Africa-Indian Ocean, Asia and Pacific, Caribbean and South American, European, and Middle East.

Recommendations were made at the runway safety seminars held in the Asia and Pacific and Middle East Regions for ICAO to produce a manual containing runway incursion prevention guidelines. Therefore, the objective of this manual is to help States, international organizations, aerodrome operators, air traffic service (ATS) providers and aircraft operators to implement runway safety programmes taking into account best practices already implemented by some States, international organizations, aerodrome operators, ATS providers and airlines.

All of the above efforts were undertaken to address a specific problem, that of runway incursions. This focus on the so-called “tip of the arrow” was necessary; however, the inherent need to address safety in a proactive and systemic manner cannot be overstressed.

An evolution in safety thinking has led to a change in focus: from that of the individual to that of the organization as a whole. It is now acknowledged that senior management decisions are influential in shaping the operational contexts within which operational personnel perform their duties and discharge their responsibilities. It is also accepted that, regardless of the extent to which operational personnel excel in their job performance, they can never ultimately compensate for systemic deficiencies and flaws in the system that binds them. This new way of thinking is reflected in the following recent Standards and Recommended Practices (SARPs) on safety management which, for the first time, explicitly address the contribution and responsibility of senior management regarding safety.

• Annex 6 — Operation of Aircraft requires operators to establish and maintain an accident prevention and flight safety programme.
• Annex 11 — Air Traffic Services requires States to implement safety programmes and ATS providers, to implement safety management systems (SMS).
• Annex 14 — Aerodromes requires aerodrome operators to implement SMS, as a part of the certification process of an aerodrome, and recommends the same for already certified aerodromes.

Such evolution in safety thinking notwithstanding, it is a fact that properly selected, trained and motivated operational personnel remain the true custodians of safety. When a system breaks down due to unanticipated deficiencies in design, training, technology, procedures or regulations, human performance is the last line of defence against latent conditions that can penetrate the aviation system defences and potentially result in compromised safety. Operational personnel are the true “gatekeepers” of the aviation safety system.

From this broad perspective, it is imperative to avoid the pitfall of focussing safety efforts on organizational issues exclusively, to the detriment of the human contribution to the success and failure of the aviation system. Active failures by operational personnel are sometimes a consequence of flaws in the system, sometimes a result of well-known and documented human limitations, but usually are a combination of the two. A true systemic approach to safety must consider latent conditions in the system as well as active failures on the front lines of operations. Such a systemic approach underlies this manual.