ASAP Case Studies for August 2025

Altitude Deviation – Potential Wake Turbulence Avoidance

Deviation for heavy Dreamliner that was crossing in front same altitude. With closure rate I felt we would pass right behind him, and they were in a climb so wake turbulence was a major factor. We were east bound, and the Dreamliner was northwest bound. [name] asked ATC what the plane was and when we were told it was a Dreamliner I asked for vectors immediately and I climbed a little to stay above their path until given instructions from ATC. We were given a left turn 090 descend to FL250. We followed instructions and in the process of turning and descending quickly to avoid a possible incident. I undershot the altitude by a few hundred feet and corrected. We also had tuned into a strong head wind. ATC said everything was fine but next time notify them with a loss or gain of more than 10 knots in air speed.

First Officer (Pilot Monitoring):

Flying pilot and PIC, [name], observed traffic crossing about 10 miles in front of us and 600FT above our altitude. After discovering that it was a Dreamliner and fearing for severe wake turbulence, [name] immediately began to climb away from our assigned altitude with no autopilot guidance nor crew communication. We rose about 400FT from our assigned altitude, and I have exclaimed about the altitude deviation several times. He told me to be quiet and firmly held on the controls. I figured my efforts were better spent notifying him of any traffic conflicts rather than trying to take controls myself. He then demanded vectors and a new altitude, which ATC promptly provided. We veered off course abruptly and descended at more than 4000FPM – both the newly assigned heading and altitude were overshot significantly (600FT deviation mentioned above). We soon after corrected our altitude and heading I did not agree with the intensity of the measures taken, but they were effective at avoiding the potential wake turbulence.

Suggestions:

1. ATC does not send a heavy Dreamliner crossing in front of us so as to create the wake turbulence hazard.

2. Pilot flying communicates specific intentions before committing to a possible pilot deviation.

3. Pilot flying calmly responds to the threat.

4. More specific avoidance options are considered by either ATC or flight crew in initial training.

ERC Acceptance & Closing Notes:

  • Event investigated internally.
  • Crew debriefed, reviewed ADSB data. 
  • Aircraft descended to 24500 ft. 
  • PF has been upgraded to Captain position recently, had a previous encounter with severe wake turbulence, contributing to decision making in the event.
  • PF counseled on wake turbulence encounters and avoidance procedures, altitude deviation without clearance. 
  • Both pilots counseled on proper CRM techniques and utilization. 


Navigational Fix Confusion

On February 17, 2025, at approximately 0400Z (February 18, 2025) we were on the CAVLR6 Arrival into KIAD and the approach controller gave us instructions to fly direct to the fix ESPNN (IAF for ILS Rwy 1R), intercept the localizer and descend and maintain 3000ft. My Co Captain responded direct ESPNN and then clarified the fix with the controller. The controller confirmed the fix was ESPNN and my Co Captain and myself distinctly heard the “NN” at the end of the fix name. We proceeded direct to ESPNN and I noticed it was listed on the approach plate at or above 7000ft. I then noticed a fix called ESTYN further down on the localizer which had a crossing altitude of at or above 3000ft, the same altitude we were instructed to descend to; both fixes sounded similar. At this point the controller cleared a “call sign” to fly direct to the fix ELLLA. ELLLA is the fix after ESPNN. I immediately instructed my Co Captain to verify the fix we were to fly direct to. The controller came back with, descend and maintain 4000ft. My Co Captain replied with the new altitude and said again that we were flying direct to the fix ESPNN, he even spelled it out. During this time the controller seemed overloaded and at one point told everyone to standby and stop talking on frequency. We then heard the “call sign” flight on the radio and it turns out they were behind us yet were told to fly direct to the fix ELLLA, one fix in front of ours thus adding more to our confusion. The controller then asked if we had the field in sight and when we responded we did, he cleared us for a visual approach to Rwy 1R and were later handed off to tower. At no time were we told we did anything wrong and were never given a phone number to call.

Suggestions:

Given the initial altitude clearance of 3000ft (the altitude at ESTYN), and the “Copa” aircraft behind us being sent to the fix in front of ours, I do believe the controller meant to send us to the fix ESTYN and mistakenly sent us to ESPNN. We verified it two if not three times with him. I feel this was a controller error that was created by the controller being overwhelmed as exhibited when he told everyone to stop talking.

ERC Acceptance & Closing Notes:

  • Crew debriefed.
  • FAA explored for any waypoint confusion.

Multiple Consecutive TCAS Resolution Advisories

While on an IFR flight plan, enroute from KMLB-KVRB, VMC conditions, daylight hours. We were level at 4000 ft and cleared direct to KVRB, we were told to contact Palm Beach Approach on 123.62. Upon tuning the radio for Palm Beach Approach we could tell right away that the frequency was extremely busy and the controller seemed somewhat overwhelmed. It took three radio check-in calls before the controller acknowledged us, with approximately 1.5-2.0 minutes of lapse time between initial check-in and ATC acknowledgement. There was a lot of radio congestion and tail numbers/call signs being blocked. We saw on TCAS, at very close proximity, about 3 what appeared to be VFR targets. 

The closest target was about -300 feet below us, we received an RA to “climb, climb” as the PF initially started the procedure to comply and climb, we simultaneously received a Traffic Alert for a target slightly above our altitude and we received a TCAS warning to “monitor vertical speed”, which the PF did. We also had a third target in the TCAS window within this cluster of aircraft as well. 

While all this was taking place, the controller did advise us to turn 280 heading, but in this first transmission, the tail number for this assigned heading was blocked and we were already dealing with the multiple TCAS alerts, from multiple locations and altitudes and the PF maneuvered slightly in a manner to keep us in a, best safe condition altitude/heading. We were unable, due to the safety of flight in that current situation, to turn to that 280 heading at that particular time. After passing the multiple TCAS targets, the ATC controller advised us to maintain current heading and altitude and then eventually brought us pass the airport and took us south then north to enter and set up for a visual approach to runway 12R. This all happened in just a few short minutes. The crew had to deal with this situation and focus on the top priority of flying safely and avoiding a potential collision and thus missed calling the RA alerts to the ATC controller. Given the sound in her voice, I strongly believe that she was well aware of the situation and our need to prioritize the hazard. 

Suggestions: 

We currently have multiple SOPs in place for operating in/out of KVRB, given the very high volume of air traffic, particularly training/VFR aircraft. We can continue to look at avenues to find more ways to mitigate these safety situations.

ERC Acceptance & Closing Notes:

  • Sole source. 
  • ERC spoke with pilots – ATC communication, training environment and task saturation were contributing factors.
  • Company plans to send a notice to pilot group –  emphasis to follow up with controller after an incident like this.


Go Rentals Discount

Go Rentals shall provide the following rates for vehicle reservations to agents, employees and members of

  • ACSF Toyota Corolla: $64.99 Daily Rate 
  • Toyota Camry: $74.99 Daily Rate 
  • Toyota Rav4: $92.49 Daily Rate

Go Rentals’ standard rates shall apply to reservations in Colorado, Montana, Utah and Wyoming.

Go Rentals shall provide the clients and customers of ACSF (collectively, “Clients”) a 20% discount for vehicle reservations applied against the daily rate in effect at the time of reservation.

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