GAO-08-29, Aviation Runway and Ramp Safety: Sustained Efforts to Address Leadership, Technology, and Other Challenges Needed to Reduce Accidents and Incidents


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Report to Congressional Requesters:

United States Government Accountability Office: 
GAO:

November 2007:

Aviation Runway and Ramp Safety:

Sustained Efforts to Address Leadership, Technology, and Other 
Challenges Needed to Reduce Accidents and Incidents:

GAO-08-29:

GAO Highlights:

Highlights of GAO-08-29, a report to congressional requesters. 

Why GAO Did This Study:

While aviation accidents in the United States are relatively 
infrequent, recent incidents have heightened concerns about safety on 
airport runways and ramps. As the nation’s aviation system becomes more 
crowded every day, increased congestion at airports may exacerbate 
ground safety concerns. To safely handle the anticipated larger volumes 
of air traffic, the Federal Aviation Administration (FAA) is 
implementing the Next Generation Air Transportation System (NextGen) to 
better manage air traffic both in the air and on the ground. GAO was 
asked to evaluate (1) the progress being made in addressing runway 
safety and what additional measures, if any, could be taken and (2) the 
factors affecting progress in improving ramp safety and what is being 
done by FAA and others to address those factors. We reviewed runway and 
ramp safety data, interviewed agency officials and industry 
stakeholders, and surveyed experts. 

What GAO Found:

FAA and aviation stakeholders have taken steps to address runway and 
ramp safety, including deploying and testing technology designed to 
prevent runway incursions, which occur when aircraft enter the runway 
without authorization, and overruns, which occur when aircraft run off 
the ends of runways; helping to change airport layout, markings, 
signage, and lighting; and providing training for pilots and air 
traffic controllers. In addition, FAA has made progress in addressing 
runway overruns and reports that 70 percent of the runways at U.S. 
commercial airports substantially comply with runway safety area 
standards, up from 55 percent in 2000. However, the rate of runway 
incursions has not decreased over the last 5 years. In addition, FAA 
has not prepared a national runway safety plan since 2002, despite 
agency policy that it be updated every 2 to 3 years, resulting in 
uncoordinated efforts within the agency. Runway safety technology 
currently being installed is experiencing some operational difficulties 
with its alerting function, while additional technology to prevent 
runway collisions is years away from deployment. FAA also lacks data on 
runway overruns that could be used to analyze the causes and 
circumstances of such incidents. Air traffic controller fatigue, which 
may result from regularly working overtime, continues to be a matter of 
concern for the National Transportation Safety Board (NTSB), which 
investigates transportation accidents, and other aviation stakeholders.

Efforts to improve safety in airport ramp areas, where departing and 
arriving aircraft are serviced by baggage, catering, and fueling 
personnel, are hindered by a lack of complete accident data and 
standards for ground handling, but the aviation industry is taking 
steps to address these problems with the goal of reducing ramp 
accidents. Data from 2001 through 2006 from the Occupational Safety and 
Health Administration (OSHA), which investigates occupational 
accidents, NTSB, and FAA indicated that these agencies had investigated 
29 fatal ramp accidents during that time. The majority of the 
fatalities in these accidents were ramp workers. GAO found no 
comprehensive nonfatal injury data on ramp accidents and neither 
federal nor industrywide standards for ramp operations. The federal 
government has generally taken an indirect role overseeing ramp safety; 
airlines and airports typically control the ramp areas using their own 
policies and procedures. Meanwhile, some airlines and airports have 
initiated their own efforts to address ramp safety, and aviation 
organizations have begun collecting ramp accident data. 

Figure: Three Illustrations: 

[See PDF for image] 

This figure contains the following illustrations: 
Runway Incursion; 
Runway Overrun; 
Terminal and Ramp Area. 

[End of figure] 

What GAO Recommends:

GAO recommends that FAA take several measures to enhance runway and 
ramp safety, such as updating its national runway safety plan, 
collecting data on runway overruns, and working with OSHA and industry 
to collect and analyze better information on ramp accidents. DOT agreed 
to consider the report’s recommendations. 

To view the full product, including the scope and methodology, click on 
[hyperlink, http://www.GAO-08-29]. For more information, contact Gerald 
L. Dillingham, Ph.D. at (202) 512-2834 or dillinghamg@gao.gov.

[End of section] 

Contents:

Letter:

Results in Brief:

Background:

Challenges Remain Despite Numerous Efforts to Address Runway Safety:

Progress in Addressing Ramp Safety Is Affected by a Lack of Data and 
Standards, but the Industry Is Taking Action to Address these Issues:

Conclusions:

Recommendations:

Agency Comments:

Appendix I: Objective, Scope, and Methodology:

Appendix II: Survey Methodology:

Appendix III: Serious Incursions Involving Commercial Aircraft:

Appendix IV: Status of the National Runway Safety Plan Objectives:

Appendix V: Airports with Surface Surveillance Technology:

Appendix VI: Airports Where Ramp Accident Fatalities Occurred:

Appendix VII: GAO Contact and Staff Acknowledgments:

Tables:

Table 1: Experts' Ranking of the Most Effective FAA Actions to Address 
Runway Incursions:

Table 2: Changes in ASDE-X Equipment Cost and Deployment Completion 
Dates:

Table 3: ASDE-X Commissioned Airports as of August 2007:

Table 4: Experts' Ranking of the Actions that FAA Could Take with the 
Most Potential to Address Runway Incursions:

Table 5: Experts' Ranking of the Most Effective Actions by FAA, OSHA, 
Airports, and Airlines to Address Ramp Accidents:

Table 6: Experts' Ranking of the Actions that FAA, OSHA, Airports, or 
Airlines Could Take with the Most Potential to Address Ramp Accidents:

Table 7: List of Organizations that GAO Visited or Contacted Regarding 
Runway and Ramp Safety:

Table 8: Serious Incursions Involving At Least One Commercial Aircraft 
during Fiscal Year 2006 and Fiscal Year 2007:

Table 9: Implementation Status of the Objectives Contained in Federal 
Aviation Administration's (FAA) National Runway Safety Plan for 2002- 
2004:

Table 10: Airports with Airport Surface Detection Equipment, Model 3 
(ASDE-3)/Airport Movement Area Safety Systems (AMASS) or the Airport 
Surface Detection Equipment, Model X (ASDE-X) or Scheduled to Receive 
ASDE-X:

Table 11: U.S. Airports at which Ramp Fatalities Occurred from 2001 
through 2006:

Figures:

Figure 1: Movement and Nonmovement Areas of the General Mitchell 
International Airport in Milwaukee, WI:

Figure 2: Number and Rate of Runway Incursions from Fiscal Year 1998 
through Fiscal Year 2007:

Figure 3: Total Number of Serious Incursions, Fiscal Year 2001 through 
Fiscal Year 2007:

Figure 4: U.S. Commercial Airports that Experienced the Most Runway 
Incursions from Fiscal Year 2001 through Fiscal Year 2006:

Figure 5: Photograph of the December 2005 Runway Overrun at Chicago 
Midway Airport:

Figure 6: Example of an Accident in an Airport Ramp Area:

Figure 7: Airport Surface Detection Equipment, Model X (ASDE-X) 
Deployment Sites:

Figure 8: Runway Status Lights System:

Figure 9: Aircraft Taxiing Routes at the Hartsfield-Jackson Atlanta 
International Airport Without Using the Perimeter Taxiway:

Figure 10: Aircraft Taxiing Route at the Hartsfield-Jackson Atlanta 
International Airport Using the Perimeter Taxiway:

Figure 11: Example of How EMAS Can Stop an Aircraft:

Figure 12: Annual Number of Ramp Fatalities at U.S. Airports from 2001 
through 2006:

Figure 13: Questions Asked in First Survey:

Abbreviations:

ADS-B: Automatic Dependent Surveillance-Broadcast:

AMASS: Airport Movement Area Safety System:

ASDE-3: Airport Surface Detection Equipment, Model 3:

ASDE-X: Airport Surface Detection Equipment, Model X:

CAST: Commercial Aviation Safety Team:

EMAS: Engineered Materials Arresting System:

DOT: Department of Transportation:

FAA: Federal Aviation Administration:

ICAO: International Civil Aviation Organization:

JPDO: Joint Planning and Development Office:

NextGen: Next Generation Air Transportation System:

NTSB: National Transportation Safety Board:

OMB: Office of Management and Budget:

OSHA: Occupational Safety and Health Administration:

OSH Act: Occupational Safety and Health Act: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548:

November 20, 2007:

The Honorable Jerry F. Costello: 
Chairman: 
Subcommittee on Aviation: 
Committee on Transportation and Infrastructure: 
House of Representatives:

The Honorable Frank R. Lautenberg: 
United States Senate:

While aviation accidents in the United States are relatively 
infrequent, recent incidents have heightened concerns about safety on 
airport runways and ramps.[Footnote 1] On August 16, 2007, for example, 
at Los Angeles International Airport--one of the nation's busiest 
airports--two commercial aircraft carrying 296 people came within 37 
feet of colliding, resulting in an incident called a runway incursion. 
In another example, in 2005, an aircraft departing from Seattle-Tacoma 
International Airport, carrying 142 people, experienced sudden cabin 
depressurization caused by a ramp vehicle having punctured the aircraft 
fuselage while on the ramp. As the nation's aviation system becomes 
more crowded every day, increased congestion at airports may exacerbate 
ground safety concerns. To safely handle the anticipated larger volumes 
of air traffic, the Federal Aviation Administration (FAA) is 
implementing the Next Generation Air Transportation System (NextGen) to 
better manage air traffic both in the air and on the ground. At 
airports, FAA focuses its safety oversight on the movement areas-- 
runways and taxiways[Footnote 2]--where the chances of catastrophic 
accidents are greater than other areas. By contrast, safety oversight 
of operations in the ramp areas of airports is handled primarily by 
airlines and airports.

To respond to your request, our objective was to determine how well FAA 
and others are addressing runway and ramp safety issues. To accomplish 
this, we focused on the following questions: (1) What progress is being 
made in addressing runway safety, and what additional measures, if any, 
could be taken? and (2) What factors affect progress in improving ramp 
safety and what is being done by FAA and others to address those 
factors?

To answer these questions, we reviewed data on runway and ramp safety 
incidents and accidents from FAA, the National Transportation Safety 
Board (NTSB), and the Department of Labor's Occupational Safety and 
Health Administration (OSHA) and Bureau of Labor Statistics; relevant 
laws, regulations, and agency policies; and federal government and 
aviation industry efforts to address runway and ramp safety, including 
the development of new technology. We also looked at how taxiways 
affect runway safety. In addition, we interviewed FAA, NTSB, OSHA, 
airport, and aviation trade organization officials reflecting various 
segments of the industry, as well as pilots, air traffic controllers, 
and ramp workers and their union representatives. We also surveyed 
experts[Footnote 3] on the causes of runway and ramp incidents and 
accidents, the effectiveness of measures that are being taken to 
address them, and what additional measures could be taken. A majority 
of the experts was selected with the assistance of the National Academy 
of Sciences, and we identified additional experts during our review. 
The individuals were selected on the basis of their expertise in areas 
such as technology and procedures used to address runway incursions, 
overruns, and ramp accidents; international aviation safety practices; 
human factors issues; general aviation; airports; and ground 
operations. We report the survey results in terms of actions that are 
most effective or future actions that have the greatest potential. 
Through our analyses, the actions that we report as being most 
effective or having the greatest potential were ones that a majority of 
respondents indicated were very or extremely effective for the 
effectiveness questions or great or very great potential for the 
questions asking about potential. Because we asked the experts to 
answer questions only within their areas of expertise, a different 
number of responses were received for various survey questions. Based 
on interviews with officials knowledgeable about the data contained in 
this report, we determined that runway and ramp safety data were 
sufficiently reliable for the types of analyses that we performed for 
this report such as trends in runway incursions, the incidence of 
fatalities in airport ramp areas, and frequency of air traffic 
controller overtime. We conducted our work in Atlanta, GA; Atlantic 
City, NJ; Boston, MA; Burbank, Long Beach, Los Angeles, and San Diego, 
CA; Newark, NJ; Seattle and Spokane, WA; and Washington, D.C. These 
locations included airports that have experienced higher rates of 
runway incursions or where new aviation safety technology was being 
researched or tested. We conducted our work from October 2006 through 
November 2007 in accordance with generally accepted government auditing 
standards. Appendix I contains additional information about our 
methods. Detailed information about our survey methodology and the 
survey questions are contained in appendix II.

Results in Brief:

FAA and other aviation stakeholders have taken steps to address runway 
and ramp safety, but the lack of coordination and leadership, 
technology challenges, the lack of data, and human factors-related 
issues impede further progress. Our analysis showed that FAA had 
completed or was in the process of implementing 34 of the 39 
initiatives contained in its 2002 national runway safety plan; 4 
initiatives were canceled and 1 pertaining to deploying certain 
technology was not met. The completed initiatives included deploying 
and testing other technology designed to prevent runway collisions and 
overruns; helping change airport layout, markings, signage, and 
lighting; and providing training for pilots and air traffic 
controllers. Of the measures that FAA is taking to address runway 
incursions, the results of our survey of experts indicated that the 
most effective actions were lower-cost ones, such as enhancing airport 
markings, lighting, and signage. In addition, FAA has made progress in 
addressing runway overruns and reported in May 2007 that 70 percent of 
the runways at U.S. commercial airports substantially comply with 
runway safety area standards, up from 55 percent in 2000. Runway safety 
areas reduce the chance of aircraft being damaged from overruns. While 
the number and rate of incursions declined after reaching a peak in 
fiscal year 2001 and remained relatively constant for the next 5 years, 
preliminary data for fiscal year 2007 indicate that the overall 
incursion rate increased during fiscal year 2007 and is nearly as high 
as the fiscal year 2001 peak. FAA's Office of Runway Safety has also 
not carried out its leadership role in recent years. The office's role 
is to lead the agency's runway safety efforts by coordinating and 
monitoring runway safety activities to ensure that goals are met. Those 
goals were established in 2002 in a national runway safety plan. 
However, FAA has not updated the plan, despite agency policy that such 
a plan be prepared every 2 to 3 years. The lack of an updated plan has 
resulted in uncoordinated runway safety efforts by individual FAA 
offices. Moreover, runway safety technology currently being installed, 
the Airport Surface Detection Equipment, Model X (ASDE-X), which is 
designed to provide air traffic controllers with the position and 
identification of aircraft and alerts of potential collisions, has 
faced cost increases and schedule delays from its original baselines 
and is experiencing operational difficulties with its alerting 
function. At the same time, additional technology to prevent runway 
collisions is years away from deployment. FAA also lacks reliable 
runway safety data and the mechanisms to ensure that the data are 
complete. Furthermore, air traffic controller fatigue, which may result 
from regularly working overtime, continues to be a matter of concern 
for NTSB, which investigates transportation accidents, and other 
aviation stakeholders. We found that, as of May 2007, at least 20 
percent of the controllers at 25 air traffic control facilities, 
including towers at several of the country's busiest airports, were 
regularly working 6-day weeks. FAA could take additional measures to 
improve runway safety. These measures include starting a nonpunitive, 
confidential, voluntary program for air traffic controllers to report 
safety risks in the national airspace system, which includes runways 
and taxiways, similar to a program that FAA has already established for 
pilots and others in the aviation community, and could help the agency 
to understand the causes and circumstances regarding runway safety 
incidents. The results of our survey of experts indicated that the 
action FAA could take with the greatest potential for preventing runway 
incursions was encouraging the use of lighting systems that guide 
aircraft on their airport taxi routes. The results of our survey of 
experts also indicated that the actions with the greatest potential 
that FAA could take to prevent runway overruns included addressing the 
causes and circumstances of overruns, such as improving communication 
of runway conditions and weather information to flight crews, and 
encouraging improvements in and use of runway condition and friction 
measurements, which provide data regarding the slickness of a runway.

Efforts to improve airport ramp safety are hindered by a lack of 
complete accident data and standards for ground handling. Such data 
could help FAA and the aviation industry to understand the nature and 
extent of the problem, as a first step to identifying what actions are 
needed to reduce ramp accidents. We found no complete source of data on 
ramp accidents, but reviewed ramp fatality data from 2001 through 2006 
from FAA, OSHA, and NTSB, and found that these agencies had 
investigated 29 fatal ramp accidents during that time. The majority of 
the fatalities in these accidents were ramp workers. We found no 
complete nonfatal injury data on ramp accidents. In addition, we found 
no federal or industrywide standards for ramp operations. The federal 
government has generally taken an indirect role in overseeing ramp 
safety; airlines and airports typically control the ramp areas using 
their own policies and procedures. Meanwhile, some airlines and 
airports have initiated their own efforts to address ramp safety, and 
aviation organizations have begun collecting ramp accident data. We 
asked experts to provide their views on those industry efforts, and 
they indicated that the most effective ones were being taken mainly by 
airlines, for example, by setting safety targets and using ramp towers. 
In addition, an international aviation association plans next year to 
start a safety audit program of companies with employees who work in 
airport ramp areas, which would be a step toward applying standardized 
criteria to these companies. Officials from a union representing ramp 
workers said that FAA should increase its safety oversight of ramp 
areas, while other aviation industry officials said that FAA's 
resources are more appropriately focused on the runways and taxiways, 
where there are greater safety risks to passengers. The results of our 
survey of experts indicated that the action FAA, OSHA, airport, or 
airlines could take with the greatest potential for preventing ramp 
accidents was promoting a safety culture in the ramp area.

We are recommending that FAA take several measures to enhance runway 
and ramp safety, which include preparing a new national runway safety 
plan, improving data collection on runway overruns and ramp accidents, 
and addressing air traffic controller overtime and fatigue issues that 
may affect runway safety. We provided the Department of Transportation 
(DOT) and the Department of Labor with drafts of this report for their 
review and comment. DOT agreed to consider the report's recommendations 
and provided technical corrections and clarifications, which we 
incorporated as appropriate. The Department of Labor had no comments 
but provided a technical correction, which we incorporated.

Background:

Demand for air travel has increased in recent years, with over 740 
million passengers flying in the United States in fiscal year 2006, and 
is expected to climb to an estimated 1 billion passengers per year by 
2015. To meet this demand, the Joint Planning and Development Office 
(JPDO), housed within FAA and created to plan and coordinate the 
transition to NextGen, has developed a strategy to establish the needed 
national airspace system infrastructure, including airports. JPDO's 
objectives include providing air traffic control and airport 
authorities with greater flexibility to match capacity with demand, 
reducing congestion, and establishing a comprehensive safety management 
approach. Implementing the plan will include deploying Automatic 
Dependent Surveillance-Broadcast (ADS-B), a satellite-based technology 
that broadcasts aircraft identification, position and speed with once- 
per-second updates, which will provide pilots with greater situational 
awareness and help to keep aircraft at safe distances from each other 
on the runways.

Safety at airports in the United States is a shared responsibility 
among FAA, airlines, and airports. FAA air traffic controllers oversee 
activity in the movement areas--runways and taxiways--but airlines and 
airports provide primary safety oversight in the nonmovement areas-- 
ramps and gates.[Footnote 4] Figure 1 shows the movement and 
nonmovement areas of the General Mitchell International Airport in 
Milwaukee, WI.

Figure 1: Movement and Nonmovement Areas of the General Mitchell 
International Airport in Milwaukee, WI:

[See PDF for image] 

This illustration of the Movement and Nonmovement Areas of the General 
Mitchell International Airport depicts the following data: 

Non-movement areas (ramps and gates): 
Northeast Hangar Area; 
Wisconsin Air National Guard; 
Private Aircraft Services; 
US Air Force Reserve; 
Aircraft Engine Testing Facility; 
Cargo Ramp; 
Corporate Hangars; 
West Ramp; 
C Concourse; 
D Concourse; 
E Concourse. 

Movement area (runways): 
Runway 19R-1L; 
Runway 19L-1R; 
Runway 13-31; 
Runway 25R-7L; 
Runway 25L-7R. 

Movement area (taxiways): 
Taxiway A; 
Taxiway A1; 
Taxiway A2; 
Taxiway A3; 
Taxiway A4; 
Taxiway A5;
Taxiway A6; 
Taxiway B; 
Taxiway C; 
Taxiway D; 
Taxiway D1; 
Taxiway E; 
Taxiway F; 
Taxiway F1; 
Taxiway F2; 
Taxiway G; 
Taxiway H; 
Taxiway M; 
Taxiway N; 
Taxiway P; 
Taxiway R; 
Taxiway R3; 
Taxiway R4; 
Taxiway S; 
Taxiway T; 
Taxiway U; 
Taxiway V; 
Taxiway W; 
Taxiway Z. 

Other areas depicted: 
Terminal; 
International Arrivals; 
Parking Structure; 
Control Tower; 
Firehouse; 
Maintenance; 
Fuel Farm. 

Source: General Mitchell International Airport and GAO. 

[End of figure] 

Runway safety is a major aviation safety concern that involves measures 
to prevent runway incursions and overruns. Through September 2007, FAA 
defined a runway incursion as "any occurrence in the runway environment 
involving an aircraft, vehicle, person, or object on the ground that 
creates a collision hazard or results in a loss of required separation 
when an aircraft is taking off, intending to take off, landing, or 
intending to land." On October 1, 2007, FAA began using a definition of 
a runway incursion developed by the International Civil Aviation 
Organization (ICAO), a United Nations specialized agency.[Footnote 5] 
ICAO's definition of an incursion is any occurrence at an airport 
involving the incorrect presence of an aircraft, vehicle, or person on 
the protected area of a surface designated for the landing or take-off 
of aircraft. Runway incursion prevention has been on NTSB's list of 
most wanted transportation improvements since 1990 because runway 
collisions can have serious consequences. Six runway collisions have 
occurred in the United States since 1990, resulting in 63 deaths. The 
worst runway accident in the United States occurred at the Los Angeles 
International Airport in 1991, when an aircraft that was landing 
collided with another that was holding on the same runway, killing 34 
people. The most recent fatal runway collision in the United States 
occurred in 2000, when two general aviation aircraft collided on the 
runway at the Sarasota Bradenton International Airport in Florida, 
resulting in 4 fatalities.[Footnote 6] Other runway incidents, which 
FAA did not classify as incursions, also can have serious consequences. 
On August 27, 2006, for example, a Comair regional jet crashed in 
Lexington, KY, after taking off from a wrong runway that was too short 
for the aircraft, killing all but one of the 50 people onboard. 
[Footnote 7]

The number and rate of runway incursions rose in the 1990s before 
peaking in fiscal year 2001 (see fig. 2). In fiscal year 2001, there 
were 407 incursions at a rate of 6.1 incursions per 1 million air 
traffic control tower operations, compared to fiscal year 2006, when 
there were 330 incursions at a rate of 5.4 incursions per 1 million 
tower operations. As shown in fig. 2, the rate of incursions remained 
relatively constant from fiscal year 2002 through fiscal year 2006, at 
an average rate of 5.2 incursions per 1 million tower operations. 
However, preliminary FAA data indicate 370 incursions occurred during 
fiscal year 2007, representing a rate of 6.05 incursions per 1 million 
air traffic control tower operations. The preliminary rate of 
incursions for fiscal year 2007 is about 12 percent higher than during 
fiscal year 2006 and is nearly as high as when the rate of incursions 
reached a peak in fiscal year 2001.

Figure 2: Number and Rate of Runway Incursions from Fiscal Year 1998 
through Fiscal Year 2007:

[See PDF for image]

This figure is a combined vertical bar and line graph. The left 
vertical axis of the graph represents number of runway incursions, from 
0 to 500 (indicated by bars for each fiscal year). The right vertical 
axis of the graph represents rate of runway incursions (indicated by a 
line). The horizontal axis of the graph represents fiscal year from 
1998 through 2007. The following data is depicted (number are 
approximate):

Fiscal year: 1998; 
Number of runway incursions: 300; 
Rate of runway incursions (per 1 million tower operations): 4.7. 

Fiscal year: 1999; 
Number of runway incursions: 325; 
Rate of runway incursions (per 1 million tower operations): 4.8. 

Fiscal year: 2000; 
Number of runway incursions: 400; 
Rate of runway incursions (per 1 million tower operations): 6.o. 

Fiscal year: 2001; 
Number of runway incursions: 407; 
Rate of runway incursions (per 1 million tower operations): 6.1. 

Fiscal year: 2002; 
Number of runway incursions: 325; 
Rate of runway incursions (per 1 million tower operations): 5.4. 

Fiscal year: 2003; 
Number of runway incursions: 310; 
Rate of runway incursions (per 1 million tower operations): 5.3. 

Fiscal year: 2004; 
Number of runway incursions: 315; 
Rate of runway incursions (per 1 million tower operations): 5.3. 

Fiscal year: 2005; 
Number of runway incursions: 315; 
Rate of runway incursions (per 1 million tower operations): 5.3; 

Fiscal year: 2006; 
Number of runway incursions: 330; 
Rate of runway incursions (per 1 million tower operations): 5.4. 

Fiscal year: 2007; 
Number of runway incursions: 370; 
Rate of runway incursions (per 1 million tower operations): 6.05. 

Source: FAA. 

Note: Fiscal year 2007 data are preliminary.

[End of figure] 

Since 2001, FAA has classified the severity of runway incursions into 
four categories--A through D.[Footnote 8] The number and rates of 
serious incursions--categories A and B, where collisions were narrowly 
or barely avoided--have continued to occur at about the same level from 
fiscal year 2002 through fiscal year 2006 at an average of about 30 
serious incursions per year and an average rate of 0.5 serious 
incursions per 1 million air traffic control tower operations. 
Preliminary data indicate that 24 serious incursions occurred during 
fiscal year 2007, compared to 31 during fiscal year 2006. The 
preliminary rate of serious incursions for fiscal year 2007 is 0.39 per 
1 million air traffic control tower operations, which is about 24 
percent less than during fiscal year 2006, when the rate of serious 
incursions was 0.51 per 1 million tower operations.

Although most runway incursions involve general aviation aircraft, 
[Footnote 9] about one-third of the most serious incursions from fiscal 
year 2002 through fiscal year 2007 (categories A and B)-- about 9 per 
year--involved at least one commercial aircraft that can carry many 
passengers (see fig. 3). For example, on July 11, 2007, a collision 
between two aircraft carrying 172 people was narrowly averted at the 
Fort Lauderdale-Hollywood Airport in Florida, when a Boeing 757 that 
had just touched down was able to become airborne again to avoid 
hitting an Airbus A320 aircraft that was approaching the same runway. 
An NTSB preliminary report indicated that the two aircraft missed each 
other by less than 100 feet. According to NTSB, it has investigated 
several near collisions in recent years that could have been 
catastrophic if they had not been averted through pilot skill and luck. 
Appendix III contains a list of serious incursions involving at least 
one commercial aircraft during fiscal year 2006 and fiscal year 2007.

Figure 3: Total Number of Serious Incursions, Fiscal Year 2001 through 
Fiscal Year 2007:

[See PDF for image]

This figure is a stacked bar graph. Each bar depicts both serious 
incursions not involving commercial aircraft and serious incursions 
involving at least one commercial aircraft. The vertical axis of the 
graph represents number of incursions from 0 to 60. The horizontal axis 
of the graph represents fiscal years from 2001 through 2007. The 
following data is depicted (numbers are approximations): 

Fiscal year 2001: 
Serious incursions not involving commercial aircraft: 27; 
Serious incursions involving at least one commercial aircraft: 25; 
Total number of incursions: 52. 

Fiscal year 2002: 
Serious incursions not involving commercial aircraft: 26; 
Serious incursions involving at least one commercial aircraft: 10; 
Total number of incursions: 36. 

Fiscal year 2003: 
Serious incursions not involving commercial aircraft: 24; 
Serious incursions involving at least one commercial aircraft: 8; 
Total number of incursions: 32. 

Fiscal year 2004: 
Serious incursions not involving commercial aircraft: 19; 
Serious incursions involving at least one commercial aircraft: 8; 
Total number of incursions: 27. 

Fiscal year 2005: 
Serious incursions not involving commercial aircraft: 20; 
Serious incursions involving at least one commercial aircraft: 8; 
Total number of incursions: 28. 

Fiscal year 2006: 
Serious incursions not involving commercial aircraft: 21; 
Serious incursions involving at least one commercial aircraft: 9; 
Total number of incursions: 30. 

Fiscal year 2007: 
Serious incursions not involving commercial aircraft: 17; 
Serious incursions involving at least one commercial aircraft: 6; 
Total number of incursions: 23. 

Source: FAA. 

Note: Fiscal year 2007 data are preliminary. 

[End of figure]

FAA officials, experts we surveyed, and officials at some airports that 
have experienced the most incursions said that runway incursions were 
caused by many different factors, including airport complexity, 
frequency of runway crossings, the amount of air traffic, 
miscommunication between air traffic controllers and pilots, a lack of 
situational awareness on the airfield by pilots, and performance and 
judgment errors by air traffic controllers and pilots. According to 
FAA, 54 percent of incursions from fiscal year 2003 through fiscal year 
2006 were caused by pilot errors, 29 percent were caused by air traffic 
controller errors, and 17 percent were caused by vehicle operator or 
pedestrian errors.

In the United States, most runway incursions have occurred at major 
commercial airports. Figure 4 shows the 10 U.S. commercial airports 
that have experienced the most runway incursions from fiscal year 2001 
through fiscal year 2006 and the overall number of incursions and the 
number of serious incursions that occurred at those airports during 
that time.

Figure 4: U.S. Commercial Airports that Experienced the Most Runway 
Incursions from Fiscal Year 2001 through Fiscal Year 2006:

[See PDF for image]

This figure is a stacked bar graph. Each bar depicts both serious 
incursions (categories A and B) and All other incursions (categories C 
and D). The vertical axis of the graph represents number of incursions 
from 0 to 50. The horizontal axis of the graph represents airports. The 
following data is depicted (numbers are approximations): 

Airport: Los Angeles; 
Serious incursions (categories A and B): 8; 
All other incursions (categories C and D): 39; 
Total incursions: 47. 

Airport: Chicago O'Hare; 
Serious incursions (categories A and B): 8; 
All other incursions (categories C and D): 35; 
Total incursions: 43. 

Airport: Philadelphia; 
Serious incursions (categories A and B): 1; 
All other incursions (categories C and D): 35; 
Total incursions: 36. 

Airport: Boston Logan; 
Serious incursions (categories A and B): 2; 
All other incursions (categories C and D): 30; 
Total incursions: 32. 

Airport: Atlanta; 
Serious incursions (categories A and B): 3; 
All other incursions (categories C and D): 27; 
Total incursions: 30. 

Airport: Phoenix; 
Serious incursions (categories A and B): 4; 
All other incursions (categories C and D): 26; 
Total incursions: 30. 

Airport: Dallas/Fort Worth; 
Serious incursions (categories A and B): 3; 
All other incursions (categories C and D): 25; 
Total incursions: 28. 

Airport: St. Louis; 
Serious incursions (categories A and B): 2; 
All other incursions (categories C and D): 26; 
Total incursions: 28. 

Airport: Newark; 
Serious incursions (categories A and B): 2; 
All other incursions (categories C and D): 24; 
Total incursions: 26. 

Airport: Las Vegas; 
Serious incursions (categories A and B): 1; 
All other incursions (categories C and D): 24; 
Total incursions: 25. 

Source: GAO analysis of FAA data. 

[End of figure]

In addition to incursions, overruns are a runway safety concern. When 
an aircraft overruns the end of a runway during an aborted takeoff or 
while landing, the results can be serious. In December 2005, for 
example, a Southwest Boeing 737 overran the runway at the Chicago 
Midway Airport during a snowstorm, ran through airport fencing, and 
collided with a car on an adjacent roadway, resulting in one fatality 
(see fig. 5).[Footnote 10] Since 2001, NTSB has investigated 12 runway 
overruns that resulted in 18 fatalities, usually involving smaller 
general aviation aircraft. NTSB attributed the overruns primarily to 
pilot error, such as misjudgments of speed and distance.

Figure 5: Photograph of the December 2005 Runway Overrun at Chicago 
Midway Airport:

[See PDF for image]

Source: Copywrite, Allan Goldstein, Aerial Images Photography 
(Illinois). Reprint with permission. All rights reserved. 

[End of figure]

FAA has established standards for runway safety areas, which are 
unobstructed areas surrounding a runway, to enhance safety in the event 
that an aircraft overruns, undershoots, or veers off a runway. FAA 
airport design standards generally require commercial airports to 
establish, to the extent practicable, 1,000-foot runway safety areas at 
both ends of a runway.[Footnote 11] In 1999, FAA established its Runway 
Safety Area Program, administered by the Office of Airport Safety and 
Standards, to help commercial airports meet runway safety area 
standards.[Footnote 12] In 2005, FAA set a goal of having commercial 
service airports make all practicable improvements to runway safety 
areas by 2015.[Footnote 13] Also in 2005, Congress enacted legislation 
requiring the owner or operator of a commercial service 
airport[Footnote 14] to meet FAA runway safety area standards by 
December 31, 2015. The importance of establishing a runway safety area 
was demonstrated during the crash of an American Airlines MD-82 in 
Little Rock, AR, on June 1, 1999, when it overran the runway, went down 
a rock embankment, and collided with a structure supporting a lighting 
system, killing 11 passengers and crew. According to NTSB, the airport 
had a runway safety area that was only 550 feet in length beyond the 
end of the runway. Experts we surveyed said that runway overruns are 
caused by factors such as pilot misjudgments about speed, altitude, or 
distance; inadequate information on weather and runway conditions; and 
aircraft equipment failure.

Although not considered part of the movement area of an airport, ramp 
areas can be dangerous for ground workers and passengers. Airport ramps 
are typically small, congested areas in which departing and arriving 
aircraft are serviced by ramp workers, including baggage, catering, and 
fueling personnel. Other personnel present on ramps include airport 
police, FAA officials, and other airport, airline, and vendor staff. 
The presence of a large number of people utilizing equipment in a 
relatively small area, often under considerable time pressure, creates 
an environment in which injuries and fatalities and aircraft and 
equipment damage can occur. Figure 6 shows an example of a ramp 
accident.

Figure 6: Example of an Accident in an Airport Ramp Area:

[See PDF for image] 

This figure is a photograph of a ramp accident. 

Source: Copywrite, Rogerio Carvalho. Reprinted with permission. All 
rights reserved. 

[End of figure]

Activities in the ramp area can also affect the safety of air crew and 
passengers once they leave the ramp area. Undetected aircraft damage 
from ramp activities can cause in-flight emergencies. In December 2005, 
for example, an Alaska Airlines MD-80 that had departed from Seattle to 
Burbank, CA, experienced a sudden cabin depressurization. After the 
aircraft safely returned to Seattle, it was discovered that a ramp 
vehicle had punctured the aircraft fuselage, but the incident had not 
been reported.

Aviation organizations have attempted to quantify the nature, extent, 
and cost of ramp accidents. According to the experts we surveyed, these 
errors occur as a result of multiple causes, such as carelessness, 
distractions, confusion, and inadequate training of ramp workers; lack 
of supervision; and time pressure. The Flight Safety Foundation, an 
aviation safety research organization, has estimated that ground 
accidents worldwide cost air carriers $10 billion annually, including 
costs associated with injuries and fatalities and other indirect costs 
such as canceled flights.[Footnote 15] However, these research efforts 
have also been hindered by a lack of data. In a 2002 study of ramp 
worker accidents, FAA noted the difficulty of obtaining nonfatality 
data.[Footnote 16] The Flight Safety Foundation also noted the limited 
amount of data available for its 2004 study of damage and injury on 
airport ramps.[Footnote 17]

Federal Roles in Runway and Ramp Safety:

FAA has primary federal responsibility for runway safety. Several FAA 
offices carry out these responsibilities, including:

* the Air Traffic Organization, which manages air traffic control-- 
including the hiring, training, and managing of more than 14,300 air 
traffic controllers--and develops and maintains runway safety 
technology;

* the Office of Runway Safety, created in 1999 as part of the Air 
Traffic Organization to lead and coordinate the agency's runway safety 
efforts--including developing a national runway safety plan and metrics 
for runway safety--and evaluate the effectiveness of runway safety 
activities;

* the William J. Hughes Technical Center in Atlantic City, NJ, which 
conducts aviation safety research;[Footnote 18]

* the Office of Airports--which, as of July 2007, employed 45 safety 
inspectors to check airports' compliance with regulations--develops 
standards for airport signage, markings, and lighting, and manages the 
agency's Runway Safety Area Program to address runway overruns;

* the Office of Aviation Safety, which conducts safety inspections of 
airlines, audits air traffic safety issues, and administers a program 
to obtain information from pilots about the circumstances of runway 
incursions; and; 

* the Civil Aerospace Medical Institute in Oklahoma City, which 
conducts aerospace medical and human factors research.

FAA's oversight of ramp areas is provided indirectly through its 
certification of airlines and airports.[Footnote 19] FAA has statutory 
authority to investigate aviation accidents including those that occur 
in ramp areas.[Footnote 20] Pursuant to an FAA order, it is responsible 
for "ensuring that all facts, conditions, and circumstances leading to 
the accident are recorded and evaluated and action is taken to prevent 
similar accidents."[Footnote 21] According to NTSB officials, that 
agency also investigates aviation accidents, including incursions and 
overruns that result in accidents, and selected runway incursions-- 
those that are the most severe or those that the board believes 
represent the most safety benefit. NTSB investigates ramp accidents 
when someone is onboard the aircraft, when flight is intended or when a 
death or serious injury or substantial damage to the aircraft occurs. 
Under the Occupational Safety and Health Act (OSH Act), OSHA has 
statutory authority to govern the occupational safety and health of 
employees.[Footnote 22] According to OSHA officials, the agency 
investigates ramp accidents when they involve fatalities or the 
hospitalization of three or more employees and conducts workplace 
inspections in response to complaints from workers.[Footnote 23] 
According to a 2000 memorandum of understanding between OSHA and FAA 
relating to coordination and enforcement of the OSH Act, OSHA does not 
investigate accidents involving crew members on aircraft in operation.

Challenges Remain Despite Numerous Efforts to Address Runway Safety:

FAA has undertaken a number of efforts to address runway safety 
problems involving incursions and overruns. The agency has taken a 
layered approach to meet many of the runway safety strategic objectives 
it set in 2002. However, the lack of coordination and leadership among 
FAA's runway safety efforts, technology challenges, the lack of data, 
and human factors issues impede further progress in addressing runway 
safety. Because the number and rate of runway incursions did not 
decrease from fiscal year 2002 through fiscal year 2006 and remains at 
a level higher than any time during the 1990s, FAA could take 
additional cost-effective measures to improve runway safety. These 
measures include ensuring that FAA's Office of Runway Safety operates 
as a coordinating entity for the agency's runway safety efforts, as 
well as establishing a new voluntary safety incident reporting program 
for air traffic controllers.

FAA Uses a Layered Approach to Reduce the Risks of Runway Incursions 
and Overruns:

FAA's layered approach to addressing runway safety includes a range of 
actions, such as deploying, researching, and testing new technology; 
encouraging airport improvements, such as changes to layout, markings, 
signage, and lighting; and providing human factors training for pilots 
and air traffic controllers. Our analysis found that FAA completed or 
was in the process of implementing 34 of the 39 runway safety 
objectives it set in its most recent national runway safety plan, 
issued in 2002, as a means of reducing the severity, number, and rate 
of runway incursions[Footnote 24] (see app. IV). Most of the completed 
objectives involved (1) developing and distributing runway safety 
education and training materials to controllers, pilots, and other 
airport users; (2) supporting and developing new technologies intended 
to reduce the potential for runway collisions; and (3) assessing and 
modifying procedures to enhance runway safety.[Footnote 25] The results 
of our survey of experts indicated that the most effective actions that 
FAA was taking were lower-cost measures, such as enhancing airport 
markings, lighting, and signage (see table 1). Some experts noted that 
markings, lighting, and signage help keep aircraft from becoming lost 
on the airfield and accidentally entering an active runway. The testing 
of runway status lights--technology that is more expensive to deploy 
than improving airport markings, lighting, and signage--is another 
action that a majority of the experts rated as being most effective. 
Further, one expert noted that all of FAA's actions in addressing 
runway incursions must be continued because one fix alone will not 
improve safety.

Table 1: Experts' Ranking of the Most Effective FAA Actions to Address 
Runway Incursions:

Ranking: 1; 
Action: Enhancing airport markings and lighting.

Ranking: 2; 
Action: Enhancing airport signage.

Ranking: 3; 
Action: Approving perimeter taxiways, which provide aircraft with 
access to gates without crossing active runways.

Ranking: 4; 
Action: Establishing Runway Safety Action Teams, groups of airport 
safety stakeholders to identify and implement safety improvements.

Ranking: 4; 
Action: Testing runway status lights, which provide a visible warning 
when runways are not clear to enter or cross.

Source: GAO analysis of responses from survey of experts.

Note: Rankings are based on responses from 22 experts and reflect the 
actions that a majority of experts indicated were "very effective" or 
"extremely effective." 

[End of table] 

FAA Is Using Technology as a Major Part of its Risk Reduction Strategy:

Surface surveillance technology is a major part of FAA's strategy to 
improve runway safety. FAA has deployed the Airport Movement Area 
Safety System (AMASS), which uses the Airport Surface Detection 
Equipment, model 3 (ASDE-3) radar,[Footnote 26] and is deploying the 
Airport Surface Detection Equipment, Model X (ASDE-X) to provide ground 
surveillance, both of which give air traffic controllers better 
visibility of activity on the airfield and could help prevent 
collisions. FAA completed the deployment of ASDE-3/AMASS at 34 of the 
nation's busiest airports (see app. V) in 2003, and is now deploying 
ASDE-X at 35 major airports (see fig. 7). Although ASDE-3/AMASS and 
ASDE-X are both radar-based, ASDE-X integrates data from a variety of 
sources, including radars and aircraft and vehicle transponders, to 
give controllers a more complete view of airport activities.[Footnote 
27] ASDE-3/AMASS and ASDE-X are both designed to provide controllers 
with alerts when the system detects a possible collision.

Figure 7: Airport Surface Detection Equipment, Model X (ASDE-X) 
Deployment Sites:

[See PDF for image]

This figure is a map of the United States depicting the location of 
Airport Surface Detection Equipment, Model X (ASDE-X) deployment sites. 
The following data is depicted:

Scheduled ASDE-X deployment sites: 
Boston Logan International; 
New York LaGuardia; 
John F. Kennedy International (New York, NY); 
Newark International; 
Philadelphia International; 
Baltimore Washington International; 
Ronald Reagan Washington International; 
Washington Dulles International; 
Ft. Lauderdale/Hollywood; 
Miami International; 
Detroit Metro Wayne County; 
Chicago Midway; 
Minneapolis-St. Paul International; 
Memphis International; 
Dallas-Ft. Worth International; 
George Bush Intercontinental (Houston, TX); 
Denver International; 
Salt Lake City International; 
Phoenix Sky Harbor International; 
Las Vegas McCarren International; 
San Diego International; 
John Wayne-Orange County (Santa Ana, CA); 
Los Angeles International; 
Honolulu International-Hickam AFB. 

ASDE-X commissioned sites as of August 2007: 
Bradley International (Hartford, CT); 
Theodore Francis Green State (Providence, RI); 
Charlotte Douglas International; 
Hartsfield-Jackson Atlanta International; 
Orlando International; 
Louisville International-Standiford Field; 
General Mitchell International (Milwaukee, WI); 
Chicago O'Hare International; 
Lambert-St. Louis International; 
William P. Hobby (Houston TX); 
Seattle-Tacoma International. 

Source: FAA and GAO. 

Note: ASDE-X-commissioned airports identified in bold.

[End of figure] 

Runway status lights, which FAA is testing at the Dallas-Ft. Worth 
International Airport and the San Diego International Airport, are a 
series of lights embedded in the runways that give pilots a visible 
warning when runways are not clear to enter, cross, or depart 
on.[Footnote 28] They are a fully automatic, advisory safety system 
requiring no input from controllers, and currently consist of takeoff 
hold lights and runway entrance lights (see fig. 8).[Footnote 29] Ten 
of 17 experts[Footnote 30] we surveyed indicated that FAA's testing of 
runway status lights was very or extremely effective in addressing 
runway incursions. Surface surveillance systems, such as ASDE-3/AMASS 
and ASDE-X, provide the data needed to operate runway status lights, 
and the systems' safety logic assesses any possible conflicts on the 
airfield and provides alerts of potential collisions.

Figure 8: Runway Status Lights System:

[See PDF for image] 

This figure is two illustrations of the runway status lights system. 
The first illustration indicates that runway entrance lights illuminate 
red when a runway is unsafe to enter or cross. The second illustration 
indicates that takeoff hold lights illuminate red to indicate an unsafe 
condition when an aircraft is in position for takeoff and another 
aircraft or vehicle is on or about to be on the runway in front of it.

Source: Lincoln Laboratory, Massachusetts Institute of TEchnology, and 
GAO. 

[End of figure]

Another technology that FAA is testing, the Final Approach Runway 
Occupancy Signal, is designed to provide a visible warning to aircraft 
on approach. This system, which is being tested at the Long Beach 
(Daugherty Field) airport in California, activates a flashing light 
visible to aircraft on approach as a warning to pilots when a runway is 
occupied and hazardous for landing. FAA is also testing low cost 
surface surveillance systems for small to medium airports at the 
Spokane International Airport.[Footnote 31] FAA would need to certify a 
low cost surface surveillance system before it could be used at 
airports in the United States. A low cost surface surveillance system 
is being used at 44 airports outside of the United States.

Infrastructure Improvements and Research Efforts Are Being Made to 
Prevent the Risk of Collisions:

Some airports are also making changes to their runways and taxiways to 
reduce the risk of collisions. FAA has helped fund, for example, the 
construction of perimeter taxiways (also called end-around taxiways) 
that provide aircraft with access to gates without crossing active 
runways. As discussed earlier in this report, the crossing of active 
runways is one of the many causes of incursions. The Hartsfield-Jackson 
Atlanta International Airport opened a perimeter taxiway in April 2007, 
and the Dallas-Ft. Worth International Airport plans to open one in 
October 2008.[Footnote 32] According to Atlanta airport officials, use 
of the perimeter taxiway eliminates about 560 aircraft runway crossings 
per day, or about one-third of the airport's total daily runway 
crossings.[Footnote 33] Figure 9 shows the typical route that aircraft 
landing on the northern runways at the Hartsfield-Jackson Atlanta 
International Airport would take to taxi to the gate without using the 
perimeter taxiway. Figure 10 shows that, by using the perimeter 
taxiway, aircraft landing on the northernmost runway no longer need to 
cross a parallel runway to reach the gates. Eleven of 16 experts we 
surveyed indicated that FAA's approval of perimeter taxiways was very 
or extremely effective in addressing runway incursions.

Figure 9: Aircraft Taxiing Routes at the Hartsfield-Jackson Atlanta 
International Airport Without Using the Perimeter Taxiway:

[See PDF for image] 

This figure is an illustration of aircraft taxiing routes at the 
Hartsfield-Jackson Atlanta International Airport without using the 
perimeter taxiway. The illustration depicts active runways 08L and 08R 
and the taxiing routes used to reach the concourses.

Source: Hartsfield-Jackson Atlanta International Airport and GAO. 

[End of figure]

Figure 10: Aircraft Taxiing Route at the Hartsfield-Jackson Atlanta 
International Airport Using the Perimeter Taxiway:

[See PDF for image]

This figure is an illustration of aircraft taxiing routes at the 
Hartsfield-Jackson Atlanta International Airport using the perimeter 
taxiway. The illustration depicts active runways 08L and 08R and the 
taxiing routes used to reach the concourses.

Source: Hartsfield-Jackson Atlanta International Airport and GAO. 

[End of figure]

FAA has also helped fund other runway and taxiway changes at various 
airports. For example, the Los Angeles International Airport, the U.S. 
commercial airport that has experienced the most runway incursions in 
recent years, is modifying its runway and taxiway configuration in an 
area where many of the incursions have occurred.[Footnote 34] FAA and 
airports have made many runway safety improvements at airports that 
were identified by local and regional Runway Safety Action Teams, which 
are groups of FAA and airport officials, as well as other aviation 
safety stakeholders, which were formed as part of the agency's runway 
safety program in 2002. In addition, FAA has standardized airport 
signage and markings, including issuing new standards for surface 
markings that require the use of glass beads for better reflectivity, 
requiring new taxiway markings that alert pilots that they are 
approaching runway entrances, and doubling the size of markings 
indicating where aircraft should hold before proceeding onto the 
runway. A majority of the experts we surveyed confirmed the measures' 
effectiveness, indicating that FAA's enhancement of airport markings, 
lighting, and signage was very or extremely effective.[Footnote 35]

FAA has funded runway safety research that has led to the testing and 
deployment of new technology and other measures. During fiscal year 
2006, FAA spent about $3.5 million on runway incursion prevention 
research at its William J. Hughes Technical Center on projects such as 
visual guidance, including signs and lighting; and about $55,000 on 
research at its Civil Aerospace Medical Institute regarding vehicle 
incursions and operational errors. Also during fiscal year 2006, FAA 
funded about $1 million for runway safety-related research that was 
conducted at DOT's Volpe National Transportation Systems Center on 
projects such as runway status lights, analyses of runway incursion 
data, FAA's runway incursion severity calculator, and the electronic 
flight bag.[Footnote 36]

FAA Training and Industry Outreach Includes Human Factors Issues:

Because most incursions are caused by human error, FAA is making 
outreach and awareness efforts to address errors made by pilots, air 
traffic controllers, and airport vehicle operators. The agency issued 
booklets in 2004 and 2005 for pilots that highlight communication 
procedures for safe surface operations at towered and nontowered 
airports. In collaboration with the aviation industry, FAA helped to 
create two online courses that educate pilots on runway safety and 
conducts safety seminars for pilots across the country to encourage 
safe practices on the airfield. To enhance air traffic supervisor and 
controller education, FAA is developing for training purposes simulated 
recreations of actual incursions. In addition, in recent years, FAA 
developed and initiated controller training on human factors, including 
skills enhancement regarding teamwork, communication, problem solving, 
situational awareness, and managing workloads. FAA also provided 
airline maintenance personnel operating "tug and tow" vehicles with 
best practices while operating on the airport surface and requires 
driver training programs for all airport workers who access the 
airfield movement areas at commercial airports. Many of the items 
implemented as a result of recommendations made by Runway Safety Action 
Teams also involved human factors. FAA data indicated that Runway 
Safety Action Teams recommended 4,441 action items for implementation 
between April 2001 and mid-December 2006. Of these, 3,338 actions, or 
about 75 percent, were completed, with the largest combined grouping 
(945 actions) relating to pilots, air traffic controllers, and vehicle 
drivers regarding actions such as training and improved procedures. Ten 
of 19 experts we surveyed indicated that FAA's establishment of Runway 
Safety Action Teams was very or extremely effective in addressing 
runway incursions. Only 5 of 22 experts we surveyed indicated that 
FAA's pilot educational initiatives were very or extremely effective 
and 8 of 21 experts said that FAA's air traffic controller training was 
very or extremely effective in addressing runway incursions.

FAA and Airports Have Improved Runway Safety Areas in Case of Overruns:

To address runway overruns, FAA and airports have made progress in 
recent years to bring runway safety areas into compliance with FAA 
standards. According to FAA, as of May 2007, 70 percent of the 1,014 
runways at 573 commercial airports in the United States substantially 
comply[Footnote 37] with runway safety area standards, up from 55 
percent in 2000. Progress has also been made in bringing runways at the 
nation's busiest airports into compliance with FAA runway safety area 
standards pursuant to the congressional mandate to have all airports in 
compliance by December 31, 2015. As of June 2007, 21 of 47 runways at 
the 10 busiest U.S. commercial airports did not meet FAA runway safety 
area standards,[Footnote 38] down from 30 runways at those airports 
that did not meet standards in October 2006. Increased compliance with 
runway safety area standards reduces the chance of aircraft being 
damaged from overruns.

Recognizing the difficulties of meeting the runway safety area 
standards at airports that do not have enough space to establish 1,000- 
foot runway safety areas, FAA conducted research during the 1990s that 
led to the development of the Engineered Materials Arresting System 
(EMAS), a bed of crushable concrete designed to stop overrunning 
aircraft. In 1999, FAA began accepting EMAS as an alternative to 
constructing a runway safety area when its construction is not 
practicable and, in 2004, began considering EMAS as generally 
equivalent to a full-length runway safety area. As of June 2007, EMAS 
was installed at 24 runway ends at 19 U.S. airports and 12 additional 
EMAS systems were under contract at 8 airports. In addition, EMAS had 
successfully stopped four aircraft that had overrun runways, including 
a Boeing 747 that overran a runway at the John F. Kennedy International 
Airport in January 2005 and was traveling at an exit speed of about 70 
knots, or about 80 miles per hour. Figure 11 shows an example of how 
EMAS can stop an aircraft. The effectiveness of this measure was 
supported by a majority of experts we surveyed, who indicated that 
FAA's acceptance of EMAS as an alternative to constructing a runway 
safety area when its construction is not practical was very or 
extremely effective in addressing runway overruns.[Footnote 39] One 
expert, for example, said that because many airports no longer have the 
ability to expand existing runway safety areas, EMAS may be the only 
practical solution. Other experts noted that preventive measures, such 
as training to improve pilot skills, are also needed.

Figure 11: Example of How EMAS Can Stop an Aircraft:

[See PDF for image]

This figure is a photograph depicting how EMAS can stop an aircraft. 

Source: Bob Hope Airport, Burbank, CA. Reprinted with permission. 

[End of figure]

Since 2000, about $300 million per year from FAA's Airport Improvement 
Program has been spent on runway safety area improvements, and $1.1 
billion is expected to be needed to complete the remaining 207 
projects. FAA officials told us that, if the current funding levels are 
maintained for the Airport Improvement Program, sufficient resources 
will be available to complete the planned runway safety area 
improvements. An official from an airport association said that even if 
sufficient airport improvement funds are available for runway safety 
area improvements, all airports will not be able to acquire the land 
needed to establish the safety areas. Eleven of 14 experts we surveyed 
indicated that FAA's use of airport improvement funds to construct 
runway safety areas was very or extremely effective in addressing 
runway overruns.

Lack of Coordination and Leadership, Technology Challenges, Lack of 
Data, and Human Factors Issues Impede Further Progress in Improving 
Runway Safety:

Although FAA took many steps to address runway safety problems 
involving incursions and overruns, especially since the number and rate 
of incursions peaked in fiscal year 2001, its efforts have waned in 
recent years, and the number and rate has remained steady. Additional 
measures by FAA would enhance the coordination and leadership of runway 
safety issues, technology, data collection and analysis, and human 
factors issues.

FAA's Office of Runway Safety Is Not Carrying Out its Coordination and 
Leadership Functions:

FAA is not following its order, issued in 2002, that directs the Office 
of Runway Safety to coordinate and monitor activities throughout the 
agency to ensure that runway safety goals are met.[Footnote 40] The 
absence of coordination and national leadership impedes further 
progress on runway safety because no single office is taking charge of 
assessing the causes of runway safety problems and taking the steps 
needed to address those problems. Under the FAA order, FAA's Office of 
Runway Safety is to prepare a national runway safety plan every 2 to 3 
years and to provide updates as needed. However, we found that the most 
recent national runway safety plan, issued in 2002, is no longer being 
used and the status of its objectives are not being tracked. FAA 
officials told us the national runway safety plan has been replaced by 
the FAA Flight Plan, which is a high-level planning document covering 
all of FAA's programs. However, we agree with the conclusion in a May 
2007 audit report by the DOT Office of Inspector General[Footnote 41] 
that replacing the national runway safety plan by the higher-level FAA 
Flight Plan, with the goal of having each FAA office separately include 
its runway safety initiatives in its own business plan, does not have 
the same national focus and emphasis on runway safety that a national 
plan for runway safety provides. In addition, although the Airports 
Office and the Air Traffic Organization included runway safety 
objectives in their business plans, the Office of Aviation Safety's 
business plan for fiscal year 2007 did not include plans to reduce 
runway incursions.[Footnote 42] Moreover, the lack of a comprehensive, 
targeted plan has resulted in uncoordinated efforts that may not be the 
most effective.

In addition, although FAA hired a permanent director at the Senior 
Executive Service (SES) level for the Office of Runway Safety in August 
2007, the Office of Runway Safety did not have a permanent director for 
the previous 2 years, resulting in a lack of national program 
leadership, and its staff was reduced by about 45 percent over the last 
4 years. Before 2004, the runway safety office had 66 full-time staff 
led by an SES-level manager in headquarters, compared to about 37 full- 
time runway safety staff led by a non-SES-level acting director as of 
May 2007.[Footnote 43] Moreover, although contractors represented about 
60 percent of the Office of Runway Safety staff in 2004,[Footnote 44] 
funding for the office's contract employees was reduced from about $4 
million in 2005 to about $2.5 million per year in 2007. An FAA official 
told us that because the Office of Runway Safety relied heavily on 
contractors for staff, it lacked a career path for potential managers 
in the field and at headquarters and lost expertise that the 
contractors had developed when their contracts expired. In addition, as 
of May 2007, the Office of Runway Safety no longer had as many full- 
time detailees from other FAA offices with runway safety 
responsibilities, including FAA's Airports and Air Traffic 
Organization's Terminal Service offices, as it had in the past.

Several FAA officials and others said that the lack of leadership in 
the Office of Runway Safety had negatively affected the program. A 
regional runway safety program manager said, for example, that having 
had no permanent director for the office resulted in a lack of 
direction from headquarters, leaving regions to carry out runway safety 
efforts in different ways. This situation prevents FAA from identifying 
systemwide causes of runway safety problems that may require 
coordinated solutions. Furthermore, an official currently working on 
the runway safety program said that no quarterly performance review 
meetings were held between the Acting Director of Runway Safety and the 
regional runway safety program managers for over a year during 2006 and 
2007. These meetings had been held, for example, to discuss regional 
initiatives. Such sharing of information between regions could help 
address runway safety issues from a national perspective and implement 
changes systematically. FAA research officials also told us that after 
having completed a study for the Runway Safety Office, they could not 
find anyone to give it to in FAA headquarters. The new permanent 
director of the Office of Runway Safety indicated that the office plans 
to restart some initiatives, including conducting quarterly runway 
safety performance reviews, starting in December 2007. However, other 
plans for the office are still being developed.

Technology Challenges Impede Progress in Improving Runway Safety:

FAA has faced significant challenges in deploying and developing 
technology for runway safety. Technology currently being installed, 
ASDE-X, has experienced cost increases and schedule delays from its 
original baselines, and is encountering some operational 
difficulties.[Footnote 45] At the same time, additional technology to 
prevent runway collisions is years away from deployment. Because FAA 
relies heavily on technology as part of its runway safety strategy to 
supplement a controller's vision of the airfield, these challenges 
impede progress in addressing runway safety.

FAA has revised its cost and schedule plans twice since 2001 to deploy 
ASDE-X at 35 airports by 2011. The current program costs have increased 
by about $125 million over the 2001 estimate, as FAA added nine 
airports to its deployment schedule (see table 2). FAA currently 
estimates that the total ASDE-X program cost will be about $806 
million, including the cost to operate and maintain the system through 
fiscal year 2030. This includes facilities and equipment costs of about 
$550 million, which is approximately $40 million more than what we 
reported in 2005, plus about $257 million in operations and maintenance 
costs. As of August 2007, ASDE-X was commissioned[Footnote 46] at 11 
airports. Regarding their plans to deploy ASDE-X to the remaining 24 
airports by 2011, FAA officials said that they had focused their 
efforts at the beginning of the program on software development, which 
is nearly complete, and on system enhancements, which have been 
completed, allowing them now to concentrate on system deployment. In 
addition, FAA officials said in November 2007 that ASDE-X deployment is 
ahead of the agency's revised 2005 schedule and that costs have 
remained consistent with its revised 2005 cost estimate. Nonetheless, 
as discussed below, our concerns about the schedule plans for ASDE-X 
remain.

Table 2: Changes in ASDE-X Equipment Cost and Deployment Completion 
Dates: 

Cost targets; 
2001 estimate: $424.3; 
2002 estimate: $505.2; 
2005 estimate: $549.8; 
2007 estimate: $549.8.

Number of planned operational systems; 
2001 estimate: 26; 
2002 estimate: 33; 
2005 estimate: 35; 
2007 estimate: 35.

Deployment completion targets; 
2001 estimate: 2007; 
2002 estimate: 2007; 
2005 estimate: 2011; 
2007 estimate: 2011.

Source: GAO analysis of FAA data.

Note: Cost is millions of dollars.

[End of table] 

Although it took about 4 years for ASDE-X to be commissioned at those 
11 airports, FAA plans to deploy the system at the remaining 24 
additional airports in less than 4 years (see app. V). Furthermore, not 
all 11 ASDE-X commissioned airports have key safety features of the 
system. For example, as of August 2007, three of the ASDE-X 
commissioned airports did not have safety logic, which generates a 
visible and audible alert to an air traffic controller regarding a 
potential runway collision. Moreover, five airports, including the 
three lacking safety logic, do not have a system enhancement that 
allows ASDE-X to alert controllers of potential collisions on 
intersecting runways or runways intersecting taxiways during inclement 
weather (see table 3). Because of these issues, the DOT Inspector 
General reported,[Footnote 47] and we agree, that the program is at 
risk of not meeting its current cost and schedule plans to deliver ASDE-
X systems at 35 airports by 2011.

Table 3: ASDE-X Commissioned Airports as of August 2007:

Airport: General Mitchell International Airport (Milwaukee, WI); 
Commissioned date: October 30, 2003; 
Safety logic: Yes; 
System enhancements[A]: Yes.

Airport: Orlando International Airport; 
Commissioned date: September 30, 2004; 
Safety logic: Yes; 
System enhancements[A]: Yes.

Airport: Theodore Francis Green State Airport (Providence, RI); 
Commissioned date: May 16, 2005; 
Safety logic: No; 
System enhancements[A]: No.

Airport: William P. Hobby Airport (Houston, TX); 
Commissioned date: August 31, 2005; 
Safety logic: No; 
System enhancements[A]: No.

Airport: Seattle-Tacoma International Airport; 
Commissioned date: February 24, 2006; 
Safety logic: Yes; 
System enhancements[A]: No.

Airport: Lambert-St. Louis International Airport; 
Commissioned date: May 24, 2006; 
Safety logic: Yes; 
System enhancements[A]: No.

Airport: Hartsfield-Jackson Atlanta International Airport; 
Commissioned date: June 7, 2006; 
Safety logic: Yes; 
System enhancements[A]: Yes.

Airport: Bradley International Airport (Hartford, CT); 
Commissioned date: June 21, 2006; 
Safety logic: No; 
System enhancements[A]: No.

Airport: Louisville International-Standiford Field; 
Commissioned date: July 19, 2007; 
Safety logic: Yes; 
System enhancements[A]: Yes.

Airport: Chicago O'Hare International Airport; 
Commissioned date: August 29, 2007; 
Safety logic: Yes; 
System enhancements[A]: Yes.

Airport: Charlotte Douglas International Airport (Charlotte, NC); 
Commissioned date: August 30, 2007; 
Safety logic: Yes; 
System enhancements[A]: Yes.

Source: FAA. 

[A] These enhancements include rain configuration, which maintains the 
system functioning during inclement weather such as moderate or heavy 
rain; converging taxiway logic, which generates an alert when an 
aircraft or vehicle on a taxiway is predicted to enter a runway; 
intersecting runway alerts, which generate alerts when aircraft are 
predicted to collide at intersecting runways; and tower configuration, 
which directs an alert regarding potential conflicts on particular 
runways to certain controllers.

[End of table] 

Recent serious runway incursions at airports with fully operational 
runway safety technology reveal persistent problems with their alerting 
functions. For example, air traffic controllers at eight airports with 
ASDE-3/AMASS told us that the alerting function does not work well 
during heavy precipitation and that they disable the alerting function 
during inclement weather.[Footnote 48] As a result, air traffic 
controllers at those airports with ASDE-3/AMASS do not have the benefit 
of an incursion alerting system in poor weather conditions, when it may 
be most needed. Furthermore, the ASDE-X commissioned airports are 
experiencing problems with false alerts, which occur when the system 
incorrectly predicts an impending collision, and false targets, which 
occur when the system incorrectly identifies something on the airfield 
as an aircraft or vehicle and could generate a false alert. (These 
problems are discussed in more detail below.) Although FAA officials 
acknowledged that ASDE-X is experiencing problems with false alerts, 
they said the system is operating within specifications. An April 2007 
FAA internal audit of the ASDE-3/AMASS and ASDE-X safety logic systems 
concluded that the runway safety logic system was not providing 
consistent information to controllers, creating a lack of confidence in 
the system.[Footnote 49] Furthermore, NTSB, after several 
investigations of incursions at airports equipped with ASDE-3/AMASS, 
determined that the alerting process was ineffective because the delay 
was too long before pilots would receive the alert relayed by 
controllers. As a result, NTSB asked that FAA develop a system that 
provides a direct warning to the cockpit.[Footnote 50]

Of the 11 ASDE-X commissioned airports, the control tower at the 
Seattle-Tacoma International Airport reported the most problems with 
false targets.[Footnote 51] In addition, of the eight ASDE-X 
commissioned airports with the alerting function, the control tower at 
the Hartsfield-Jackson Atlanta International Airport reported the most 
problems with false alerts.[Footnote 52] When an ASDE-3/AMASS or ASDE- 
X alert sounds, air traffic controllers are required to instruct 
landing aircraft to follow a go-around procedure, sending the aircraft 
back into the airspace for another landing attempt, even if nothing is 
visible on the runway that could cause a collision.[Footnote 53] The 
controllers said the effect of this practice is to increase air traffic 
and flight times. Officials from the ASDE-X manufacturer said an 
elevated number of false targets, on average, at the Seattle-Tacoma 
International Airport is caused primarily by the location of the 
surface movement radar relative to the airport facility structures, the 
movement area, and the airport's configuration. The location of these 
structures is determined by FAA and the airports. Officials from the 
manufacturer also said ASDE-X at the Hartsfield-Jackson Atlanta 
International Airport is experiencing an elevated number of nuisance 
alerts, which are caused by real conditions that are not safety 
threats, such as a vehicle on a runway, but landing aircraft are far 
enough from the airport not to constitute a threat. They said the 
nuisance alerts being experienced at the Hartsfield-Jackson Atlanta 
International Airport are caused by the site-specific configuration 
parameters of the system, and that they are working with air traffic 
controllers, FAA engineers, and the ASDE-X program office to adjust the 
parameters of the system to minimize the nuisance alerts while 
maintaining the required performance. The officials noted the 
difference between nuisance alerts and false alerts, which are issued 
after the system detects potential threats that are not real. The 
officials said they examine false alerts very closely with FAA and 
determine whether to make design modifications to the system to ensure 
that they are minimized.

FAA ASDE-X program officials said that the problems with false alerts 
and false targets are site-specific, rather than systemic issues, 
relating to the location of sensors and radar towers. The officials 
said they are working to address the problems by adjusting the 
sensitivity of the systems, which they described as a time-consuming, 
continuous process with no single fix. For example, they said that at 
the Seattle-Tacoma International Airport, the system's level of 
sensitivity was increased at the site's request because of its 
experience with heavy fog, and that a certain number of false targets 
cannot be eliminated without sacrificing the sensitivity. At the same 
time, FAA officials acknowledged that the location of the ASDE-X 
surface movement radar at the Seattle-Tacoma International Airport has 
affected system performance much more than originally anticipated. FAA 
also noted that all radar systems experience false targets as a 
function of detection and that the majority of false targets at the 
Seattle airport occurred on taxiways near the terminal. They also said 
that new software being deployed at airports starting in September 2007 
would help address the problems involving false alerts and that with 
the addition of the new software, ASDE-X is operating under system 
requirements not to generate more than two false alerts within 24 
hours. This software enhancement was deployed at the Hartsfield-Jackson 
Atlanta International Airport in September 2007, and FAA program 
officials said they believe it has resulted in improved ASDE-X system 
performance. We were not able to confirm this information.

Only 3 of 17 experts we surveyed indicated that FAA's deployment of 
ASDE-3/AMASS was very effective,[Footnote 54] and 4 of 17 experts said 
that ASDE-X was very or extremely effective in addressing runway 
incursions.[Footnote 55] One expert, for example, said that ASDE-X 
appears to be a great technology to aid controllers, but is not 
trustworthy at this point because the rate of false alerts is somewhat 
high. In addition, this expert said that because ASDE-X has been 
deployed only to a few airports, it is not doing much to address runway 
incursions within the national airspace system as a whole. Another 
expert said that ASDE-X and runway status lights would greatly enhance 
both pilot and air traffic controller awareness, particularly at 
complex airports.

Most airports in the United States have no runway safety technology to 
supplement a controller's vision of the airfield and will not have such 
technology even after FAA completes its plan to deploy ASDE-X at 35 
major airports. FAA's original plans called for 34 airports to receive 
ASDE-3/AMASS and 35 airports to receive ASDE-X. In total, 59 
airports[Footnote 56] were to receive either technology, but this 
number was reduced to 44 in August 2006 after FAA canceled plans to 
deploy ASDE-X at 15 of the originally scheduled airports.[Footnote 57] 
The 35 major airports to receive ASDE-X handle 70 percent of the 
enplanements at U.S. airports but represent only 6 percent of all U.S. 
commercial airports,[Footnote 58] leaving most airports without this 
type of technology. Six of 12 experts who indicated that they had 
knowledge of or experience with the deployment of ASDE-X indicated 
that, considering the benefits and problems with ASDE-X, including 
false alerts and false targets, deployment of the system at the 
remaining 27 airports[Footnote 59] by 2011 should be kept as planned, 4 
said that deployment should be accelerated, and 2 said that deployment 
should be slowed down. One expert, for example, who indicated that the 
deployment of ASDE-X should be kept as planned, said that the problems 
with the system will be worked out as the system is deployed.

FAA is testing additional runway safety technology, but these systems 
are still years from being deployed in the United States. Runway status 
lights, which warn pilots when runways are unsafe to enter or cross, 
have had positive preliminary test evaluations, but need a surface 
surveillance system such as ASDE-3/AMASS or ASDE-X to operate. FAA 
officials expect to decide in 2007 whether to deploy runway status 
lights at the 35 ASDE-X airports at an estimated cost of $300 million 
but do not expect to make a final investment decision on another runway 
safety lighting technology, the Final Approach Runway Occupancy Signal, 
which provides a visible warning to aircraft on approach, for another 2 
years. In addition, an FAA official said the agency is still exploring 
the capabilities of the low cost surface surveillance system and does 
not yet have a deployment schedule. Only 2 of the experts we surveyed 
indicated that FAA's testing of the low cost surface surveillance 
system was very effective in addressing runway incursions.[Footnote 60] 
FAA announced in March 2007 that it was changing the certification 
process to enable the use of electronic flight bags (electronic display 
systems that give pilots a variety of aviation data such as aircraft 
operating manuals and navigational charts) and airport moving 
maps,[Footnote 61] which can show an aircraft's position on an 
airfield, but a system that shows the location of other aircraft on the 
airfield is still under development. In addition, although officials 
from the Hartsfield-Jackson Atlanta International Airport cited the 
benefit of reducing aircraft runway crossings from using the airport's 
new perimeter taxiway, FAA officials said that few U.S. airports have 
the space to construct perimeter taxiways and noted that they are 
expensive to construct.

Lack of Runway Incident Data Impedes Causal Analysis:

In addition to its technological challenges, FAA lacks reliable runway 
safety data and the mechanisms to ensure that the data are complete. 
FAA's tabulation of the number of incursions does not reflect the 
actual number of incidents that occur. FAA only counts incursions that 
occur at airports with air traffic control towers, so the actual number 
of incursions, including those that occurred at airports without air 
traffic control towers, is higher than FAA reports. In addition, FAA's 
information on incursions that occurred at towered airports may not be 
complete, according to some experts we surveyed. For example, one 
expert said that the airline industry's reporting of runway incursions 
is higher than FAA's data and that most or all air carriers are aware 
of significant events that controllers failed to report. Although the 
airline industry provides data to FAA on safety incidents that may 
involve runway incursions, the information lacks sufficient specificity 
for FAA to use in its tabulation of incursions.

Furthermore, although FAA requires errors[Footnote 62] that may result 
in incursions to be reported, the information collected does not always 
contain complete data on the causes and circumstances involved. Without 
more complete data, FAA cannot conduct in-depth analyses to ensure that 
the most effective corrective measures that address the causal factors 
are being implemented. An FAA program to obtain detailed information 
about the circumstances regarding runway incursions by administering 
questionnaires to pilots involved in incursions--the Runway Incursion 
Information and Evaluation Program--could help to identify root causes 
of pilot deviations and provides a mechanism to obtain information that 
may not otherwise be reported. However, only 19 percent of pilots 
involved in runway incursions and surface incidents participated in the 
program during 2004 through 2006, and FAA did not provide any evidence 
that it analyzed the data that were collected.

Certain FAA efforts that are in the early stages have the potential to 
improve runway safety data. For example, FAA plans to start a 
nonpunitive, confidential, voluntary reporting program for air traffic 
controllers, similar to the Aviation Safety Action Program[Footnote 63] 
as part of the FAA safety management system.[Footnote 64] The program 
will enable air traffic controllers to report anything that they 
perceive could contribute to safety risks in the national airspace 
system. The benefit of such program is that the information obtained 
might not be reported otherwise, and could increase the amount of data 
collected on the causes and circumstances of runway incursions. Many 
industry stakeholders such as the National Air Traffic Controllers 
Association, the Air Transport Association, the Air Line Pilots 
Association, and the Air Safety Foundation, support establishing such a 
program, which could also help reduce any underreporting of incidents. 
FAA has been working on establishing such a program since 2004, and 
indicated at a runway incursion meeting with the aviation community in 
August 2007 that it would implement a short-term runway safety plan 
that included implementing such a voluntary self-reporting program. 
According to FAA, it signed a partnership agreement with the National 
Air Traffic Controllers Association regarding the program in October 
2007; however, the agency did not indicate when the plan would be 
implemented.

We also found that FAA's categorization of the severity of runway 
incursions involves a level of subjectivity, raising questions about 
the accuracy of the data. An internal FAA audit of 2006 runway 
incursion data found that the subjectivity of the severity 
classifications has the potential to affect the accuracy of the 
classifications. The audit found that incursion severity 
classifications were subjective and partially incomplete. In addition, 
18 percent of the incursion severity classifications for 2006 were 
found not to be in compliance with FAA severity classification 
requirements or could not be classified accurately.[Footnote 65] The 
audit also found that since August 31, 2006, the Office of Runway 
Safety has been using a computer program called Runway Incursion 
Severity Classification to calculate initial assessments of 
severity.[Footnote 66] FAA indicated that use of the computer program 
ensures consistent ratings based on available data. However, most of 
the information regarding incursions, which is entered into the 
computer model, is based on observations of incidents, rather than 
instrument readings, because many airports do not have the technology 
needed to collect such information or the information is not available 
to FAA, according to agency officials.[Footnote 67] Observations 
regarding matters such as how close two aircraft came to colliding on a 
runway may be less accurate than instrument readings and, therefore, 
raise questions about the accuracy of the severity assessments. These 
findings were supported by the experts we surveyed. The majority of the 
experts who responded to a question about the accuracy of FAA's 
incursion severity classifications indicated that, based on their 
knowledge of specific incidents, FAA classified the incidents as being 
less severe than they actually were.[Footnote 68]

Furthermore, FAA does not have complete information on ASDE-3/AMASS and 
ASDE-X system abnormalities, which could be used to analyze the 
performance of the systems' alerting functions. An internal FAA 
audit[Footnote 69] concluded that 54 percent of all alerts--false and 
real--from the ASDE-3/AMASS and ASDE-X systems and 40 percent of 
instances when the systems' alerting functions were disabled were not 
recorded.[Footnote 70] The audit also found no evidence of alerting 
standards for the runway safety logic systems, which limits the 
systems' capability of assessing risks and providing timely alerts to 
air traffic controllers.

We also found that FAA does not systematically collect data on the 
number of runway overruns that do not result in damage or injury that 
could be used for analytical purposes to study trends and causes of 
these incidents. FAA officials said it would be useful to collect such 
data because it would help them tailor standards to what has actually 
occurred, for example, how far an aircraft overran a runway before 
stopping.

Controller Fatigue Continues to Be a Runway Safety Concern:

Air traffic controller fatigue continues to be a human factors issue 
affecting runway safety. In April 2007, for example, NTSB recommended 
that FAA mitigate concerns about air traffic controller fatigue by (1) 
working with the National Air Traffic Controllers Association to revise 
controller work-scheduling policies and practices so controllers would 
have enough sleep and to modify shift rotations to minimize disrupted 
sleep patterns for controllers, and (2) developing a fatigue awareness 
and countermeasures training program for controllers and for the 
personnel involved in scheduling their work. In supporting its 
recommendation, NTSB cited four instances from 2001 through 2006 when 
tired controllers made errors while performing their duties that 
resulted in serious incursions. NTSB said that although FAA regulations 
and policies place limits on controller work schedules, for example, by 
requiring that controllers be provided at least one full 24-hour day 
off per week, they do not adequately consider the potential effect of 
work scheduling on fatigue and performance. FAA officials said they 
were analyzing NTSB's recommendations on air traffic controller fatigue 
but that implementing them would require renegotiating the agency's 
contract with the union representing the controllers.

According to FAA data, as of May 2007, at least 20 percent of the 
controllers at 25 air traffic control facilities, including towers at 
several major airports, were working 6-day weeks,[Footnote 71] which 
could cause fatigue. FAA officials said that it may take 2 to 3 years 
before controller overtime can be reduced at some facilities, as the 
agency acts to replace retiring controllers. In the meantime, the 
agency officials indicated that they had no plan to mitigate the 
effects of air traffic controller fatigue.

While FAA has taken some actions to address controller fatigue, 
problems have been identified with some efforts. For example, an FAA 
human factors initiative, the National Air Traffic Professional 
Program, is aimed at identifying how controllers' performance can be 
affected by factors such as fatigue and distraction. The program 
consists of training designed to sharpen and maintain controllers' 
mental skills most closely associated with visual attention and 
scanning. However, the DOT Inspector General reported in May 
2007[Footnote 72] that the program had not been implemented at towers 
where visual attention and scanning are key factors in preventing 
runway incursions. Although FAA has taken some steps to address human 
factors issues through the educational initiatives that were discussed 
earlier, progress on addressing runway safety will be impeded until the 
human factors issues involving fatigue are addressed.

FAA Has Not Implemented NTSB's Runway Safety Recommendations:

FAA has not implemented any of NTSB's six runway incursion prevention 
recommendations, made in 2000,[Footnote 73] that FAA:

* require all airports with scheduled passenger service to deploy a 
ground movement safety system that will prevent runway incursions and 
provide a direct warning capability to flight crews;

* require that all runway crossings be authorized by specific air 
traffic control clearance;

* require that, when aircraft need to cross multiple runways, air 
traffic controllers issue an explicit crossing instruction for each 
runway;

* discontinue the practice of allowing departing aircraft to hold on 
active runways at night or at any time when visibility conditions 
preclude arriving aircraft from seeing traffic on the runway in time to 
initiate a safe go-around maneuver;

* adopt an ICAO landing clearance procedure that forbids multiple 
landing clearances for the same runway; and; 

* require the use of ICAO phraseology for airport surface operations, 
and periodically emphasize to controllers the need to use this 
phraseology and to speak at reasonable rates when communicating with 
flight crews.

Since NTSB made these recommendations 7 years ago, FAA has made some 
efforts to address them, but NTSB has not accepted FAA's responses. 
Regarding NTSB's recommendation that a direct incursion warning 
capability be developed for flight crews, FAA indicated in 2006 that, 
among other efforts, it had successfully completed promising initial 
field tests of runway status lights at the Dallas-Ft. Worth 
International Airport but that additional tests would be needed to 
determine if the system could be deployed to airports throughout the 
country. An NTSB official told us that the board would need to evaluate 
the runway status lights system before it could determine whether the 
system would satisfy this recommendation. Regarding NTSB's 
recommendations that FAA change certain air traffic control procedures, 
FAA said that implementing the recommendations could possibly transfer 
the risk to another segment of the operation by increasing pilot and 
controller workload and radio frequency congestion, and causing 
unexpected and unnecessary go-around procedures. However, NTSB 
disagreed, indicating that it remained concerned about situations where 
pilots may be lost, or believed they have received permission to move 
to different positions other than those that air traffic controllers 
intended and that air traffic controllers should not clear aircraft to 
land on runways that are occupied by other aircraft.

Regarding NTSB's recommendation that FAA adopt ICAO phraseology, FAA 
indicated in 2004 that adopting certain ICAO phraseology would create 
inconsistency and nonstandardization throughout the national airspace 
system. However, NTSB noted that by not adopting the ICAO phraseology, 
FAA has not harmonized its phraseology with the rest of the world. Two 
of our survey respondents also suggested that FAA adopt ICAO 
phraseology in communications between the air traffic controllers and 
pilots. In August 2007, FAA announced that it plans to assess whether 
it needs to change the phraseology of taxi clearances given by 
controllers to better align with ICAO standards, among other planned 
actions.

FAA Has Opportunities to Improve Runway Safety:

The results of our survey of experts indicated that the actions that 
FAA could take with the greatest potential to prevent runway 
incursions, considering costs, technological feasibility, and 
operational changes, were measures to provide information or alerts 
directly to pilots (see table 4). For example, the actions that FAA 
could take with the most potential were lighting systems that guide 
pilots as they taxi at the airport and technology that provides 
enhanced situational awareness on the airfield and alerts of potential 
incursions.

Table 4: Experts' Ranking of the Actions that FAA Could Take with the 
Most Potential to Address Runway Incursions:

Ranking: 1; 
Action: Encourage the use of a taxi guidance lighting system.

Ranking: 2; 
Action: Encourage the development of runway incursion warnings in the 
cockpit.

Ranking: 2; 
Action: Encourage the development of cockpit moving maps that show the 
location of other aircraft and vehicles on the airfield.

Ranking: 2; 
Action: Encourage the use of yellow embedded lights for hold short 
lines[A].

Ranking: 3; 
Action: Encourage the use of Runway Awareness and Advisory System 
technology, which provides aural situational advisories to pilots on 
the airfield.

Ranking: 3; 
Action: Improve airport markings.

Source: GAO analysis of responses from survey of experts.

[A] Hold short lines are markings indicating where aircraft should hold 
before receiving permission from air traffic control to enter a runway.

Note: Rankings are based on responses from 22 experts and reflect 
actions that a majority of experts indicated had "great potential" or 
"very great potential." Although other actions also received a majority 
of positive responses, this table reports those that received the 
highest number of positive responses. 

[End of table]

Our survey respondents and international aviation safety experts also 
said that certain runway safety procedures in other countries have the 
potential, if adopted, to improve runway safety in the United States. 
International aviation organization officials said that there is some 
benefit to having air traffic controllers clear aircraft to holding 
points--a practice being followed at some airports outside of the 
United States--rather than directly to runways but that it would 
increase already-busy radio communications between pilots and the air 
traffic control tower. In addition, some experts suggested that because 
of the safety risks involved, FAA should stop using land and hold short 
procedures, which are mainly used in the United States and involve 
instructing landing aircraft to land and hold on their runway before 
crossing an intersection or another runway. Officials from an 
international aviation organization said that U.S. carriers are 
generally comfortable with land and hold procedures and understand that 
they are necessary to manage the large volume of traffic at certain 
airports. However, they added that the procedures would be greatly 
improved if they could be agreed upon and promulgated internationally. 
An expert also suggested that FAA consider deploying progressive 
taxiway lights that activate as aircraft taxi to or from the runway to 
help keep aircraft from making wrong turns or entering the runway 
environment. However, other experts said that progressive taxiway 
lights are difficult to see in the daytime.

Recognizing the need for additional actions to improve runway safety, 
on August 15, 2007, FAA met with the aviation community and agreed on a 
short-term plan, which included some measures that our experts had also 
recommended. The participants decided to take the following actions 
during the subsequent 60 days: (1) conduct safety reviews at the 
airports where runway incursions and wrong runway departures are the 
greatest concern, (2) disseminate runway safety information and 
training across the entire aviation industry, (3) accelerate the 
deployment of improved airport signage and markings at the top 75 
airports, and (4) review cockpit and air traffic control procedures, 
which could include changing cockpit procedures to minimize pilot 
activities and distractions while an aircraft is moving on the ground 
and to make air traffic control procedures more precise. On October 22, 
2007, FAA announced that among the actions taken, (1) safety reviews at 
20 airports had been completed, (2) 104 of 112 air carriers provided 
pilots with simulator and other training incorporating runway 
scenarios, (3) runway markings had been upgraded at 52 of 75 medium-and 
large-sized airports, and (4) 101 of 112 air carriers had reviewed 
cockpit procedures to identify and develop a plan to address pilot 
distractions when taxiing to runways. In addition, FAA indicated that 
it had completed analyzing air traffic control procedures regarding 
taxi clearances and found that more explicit taxi instructions were 
needed.

The experts we surveyed also provided suggestions to prevent runway 
overruns. They said the actions that FAA could take with the greatest 
potential, considering costs, technological feasibility, and 
operational changes, included improving communication of runway 
conditions and weather to flight crews and encouraging improvements in 
and use of runway condition and friction measurements (data regarding 
the slickness of a runway). Regarding overseas practices to help 
prevent overruns, some survey respondents said that more detailed 
information about runway conditions is provided to pilots in some other 
countries, which could be communicated to pilots in the United States 
as they prepare to land. Furthermore, on October 4, 2007, NTSB 
recommended that FAA require pilots to conduct landing distance 
assessments before every landing on the basis of existing aircraft 
performance data, actual conditions, and incorporating a minimum 15 
percent safety margin. FAA has not yet responded to this recommendation.

Progress in Addressing Ramp Safety Is Affected by a Lack of Data and 
Standards, but the Industry Is Taking Action to Address these Issues:

The aviation industry has made efforts in recent years to address the 
incidence of ramp accidents. However, these efforts have been hindered 
by a lack of data on the nature, extent, and cost of ramp accidents and 
the absence of industrywide ground handling standards. In response, the 
federal government and the aviation industry have undertaken additional 
steps to collect data and develop standards as a means of understanding 
the problem and reducing the number of accidents.

Lack of Complete Accident Data Hinders Efforts to Address Ramp Safety:

We found no source of comprehensive data on airport ramp accidents. 
Various aviation entities collect ramp accident data, but they are not 
complete enough to be useful for industrywide analyses, and, in many 
cases, the entities were not willing for competitive reasons to 
publicly disclose the data. Many industry stakeholders indicated to us 
that they lack complete ramp accident data. Without such data, it will 
be difficult for the aviation industry to understand the nature, 
extent, and cost of ramp accidents and to allocate appropriate 
resources and methods to improve ramp safety.

We found that data on ramp fatalities was more readily available than 
data on nonfatal injuries and accidents without injuries. We reviewed 
FAA, NTSB, and OSHA ramp fatality data[Footnote 74] from 2001 through 
2006 and determined that these agencies investigated 29 fatal ramp 
accidents during that time. (See fig. 12.) These accidents occurred at 
airports of various sizes--from large hubs to small general aviation 
airports.[Footnote 75] No airport experienced more than 2 fatalities 
during this time period. (See app. VI.) Of the 29 fatalities, 17 were 
ground workers, 8 were passengers, and 4 were pilots. The ramp 
fatalities generally occurred when these employees were struck by 
objects (such as vehicles), were crushed, or fell. Most aviation safety 
officials told us that ramp accidents represent little or no danger to 
passengers, although a potential danger exists if, for example, damage 
to an aircraft is left unreported. Of the 8 passengers who were killed 
in ramp accidents from 2001 through 2006, 5 were struck by propellers. 
Although we obtained data on fatal accidents, it is difficult to 
determine the true nature and extent of all ramp accidents, including 
those that result in injuries, because OSHA, the primary source of ramp 
fatality data, does not collect or report data on occupational injuries 
other than fatalities that occur in ramp areas. Furthermore, because 
FAA and NTSB only investigate certain ramp accidents, as discussed 
earlier, they do not have complete ramp accident data.

Figure 12: Annual Number of Ramp Fatalities at U.S. Airports from 2001 
through 2006:

[See PDF for image]

This figure is a vertical bar graph. The vertical axis of the graph 
represents number of ramp fatalities from 0 to 10. The horizontal axis 
of the graph represents years from 2001 through 2006. The following 
data is depicted: 

Year: 2001; 
Number of ramp fatalities: 9. 

Year: 2002; 
Number of ramp fatalities: 3. 

Year: 2003; 
Number of ramp fatalities: 5. 

Year: 2004; 
Number of ramp fatalities: 2. 

Year: 2005; 
Number of ramp fatalities: 4. 

Year: 2006; 
Number of ramp fatalities: 6. 

Source: GAO analysis of FAA, NTSB, and OSHA data. 

[End of figure]

Lack of Standards for Ramp Operations Could Hinder Safety:

We found no federal or industrywide standards for ramp operations. Each 
airport authority has its own rules and regulations, which may be based 
on local ordinances or state laws. In the United States, airlines 
typically control the ramp areas, and each operates its ramps with its 
own specific set of policies and procedures. In addition, in recent 
years, more airlines have been contracting out some or all of these 
services, and often one ground handling company services the aircraft 
of several airlines at an airport. In this situation, ground handling 
companies must carry out their duties in accordance with each airline's 
policies and procedures, and, because there is no standard for ramp 
operations, this could lead to confusion about operating procedures and 
safety rules and increases the likelihood of accidents.

The Federal Government and the Aviation Industry Are Taking Some 
Measures to Address Ramp Safety:

FAA, OSHA, airports, and airlines are taking various measures to 
address ramp accidents. According to experts we surveyed, three of the 
four most effective actions are being taken by airlines, for example, 
by setting safety targets and using ramp towers (see table 5).

Table 5: Experts' Ranking of the Most Effective Actions by FAA, OSHA, 
Airports, and Airlines to Address Ramp Accidents:

Ranking: 1; 
Action: Airlines setting safety targets for reducing injuries in ramp 
areas.

Ranking: 1; 
Action: FAA's use of Runway Safety Action Teams.

Ranking: 2; 
Action: Airlines' use of ramp towers.

Ranking: 2; 
Action: Airlines entering into safety alliances with OSHA.

Source: GAO analysis of responses from survey of experts.

Note: Rankings are based on responses from 15 experts and reflect the 
actions that received the highest number of responses indicating that 
they were "very effective" or "extremely effective." However, none of 
these actions received a majority of positive responses.

[End of table]

The federal government has generally taken an indirect role in 
addressing ramp safety. Since August 2000, FAA and OSHA have operated 
under a memorandum of understanding that gives FAA responsibility for 
investigating occupational accidents involving flight attendants; in 
the memorandum, OSHA agreed to continue its enforcement efforts on 
behalf of other aviation employees, such as ramp workers. However, 
neither agency has developed a plan or policy to reduce ramp accidents 
and address ramp safety in a strategic, coordinated manner. FAA's 
primary tool for enhancing ramp safety is the promotion of a safety 
management system for aviation service and airport operators through 
advisory circulars issued in 2006 and 2007.[Footnote 76] FAA defines a 
safety management system as the application of a systematic, proactive 
approach to identifying and mitigating safety risks. The use of safety 
management systems increases the likelihood that safety problems would 
be detected and corrected before they result in an accident. However, 
advisory circulars are voluntary in nature. Although FAA expects to 
issue a Notice of Proposed Rulemaking in 2008, which would make this 
guidance mandatory for airport operators, rulemakings often take years 
to complete.

According to an official with the Air Transport Association, a trade 
organization representing the airline industry, the safety management 
system concept invites FAA's acceptance of the continuous improvement 
process adopted by the carrier and its airport stakeholders. The 
official added that measuring the effectiveness of mitigation efforts 
is an essential part of safety management systems. However, only two of 
the experts we surveyed indicated that FAA's issuance of advisory 
circulars on safety management systems for airport operators and 
aviation service providers was very effective in addressing ramp 
accidents.[Footnote 77] One expert said that FAA's issuance of an 
advisory circular does not prompt change, but is a way to reduce the 
agency's inspection workload. However, another expert said that when 
safety management systems are required, airports and air carriers will 
assume a larger role in oversight, data collection, and safety 
assurance.

OSHA uses industry participation in its voluntary programs to promote 
ramp safety while also conducting workplace inspections and taking 
enforcement actions when needed. Twelve[Footnote 78] airlines and the 
National Safety Council, a nonprofit, nongovernmental, public service 
organization dedicated to protecting life and promoting health, 
maintained a national alliance addressing ergonomic issues associated 
with customer checked baggage handling with OSHA from November 2002 to 
November 2006. This alliance resulted in several tools for enhancing 
ramp safety, including an OSHA e-Tool on baggage handling safety and an 
OSHA Web page detailing the agency's assistance for the airline 
industry. The Air Transport Association has initiated discussions with 
OSHA about forming an alliance to address ramp vehicle safety. Three of 
13 experts we surveyed indicated that airlines entering into safety 
alliances with OSHA to address ramp accidents was very or extremely 
effective.[Footnote 79] One expert, for example, said that OSHA safety 
alliances are an extremely effective way for air carriers to develop 
mitigation strategies in concert with OSHA. However, another expert 
said that airlines entering into alliances with OSHA have no real 
effect on ramp safety because OSHA's focus is on preventing personal 
injury, not aircraft damage.

OSHA's workplace inspections--which are initiated in response to 
fatalities or serious injuries, such as amputations, complaints, or 
data indicating that an industry is experiencing a high rate of illness 
or injury--may result in OSHA proposing that the employer be fined. For 
example, on July 25, 2007, OSHA proposed fines totaling about $72,500 
against an airline for alleged violations of workplace safety standards 
in its ramp area at one airport.[Footnote 80] According to OSHA safety 
enforcement officials, proposed fines are intended to serve as a 
deterrent to unsafe practices in the workplace and are sometimes 
reduced after the employers take corrective actions, show good faith, 
or have a favorable safety history.[Footnote 81] However, as we 
reported in 2005 on FAA's safety enforcement efforts, reductions in 
proposed fines may weaken any deterrent effect that would be expected 
from sanctions.[Footnote 82] Only 2 of 13 experts we surveyed indicated 
that OSHA's safety enforcement actions were very effective in 
addressing ramp accidents.[Footnote 83]

Several airport officials we interviewed had initiated efforts to 
improve ramp safety at their airports, even though their ramp areas are 
typically under the control of one or more airlines. For example, a 
Massachusetts Port Authority official said that ramp accidents at the 
Boston Logan International Airport were reduced by 50 percent during a 
6-month period during 2004 and 2005 after they implemented a ramp 
safety program. Other airport officials said they had used their local 
Runway Safety Action Teams as forums or initiated their own efforts for 
addressing ramp safety issues. In addition, the Seattle-Tacoma 
International Airport uses a ramp tower and ASDE-X surface movement 
radar to monitor ramp activities. Of 15 survey respondents, 4 experts 
indicated that the use of Runway Safety Action Teams was very or 
extremely effective in addressing ramp accidents, and 2 indicated that 
surface surveillance technology was very effective.[Footnote 84] One 
expert indicated that Runway Safety Action Teams are an extremely 
important venue that can involve all airport stakeholders in a 
collaborative process to identify hazards, perform a risk assessment, 
and develop mitigation strategies and measure their effectiveness. Of 
15 survey respondents, 2 experts indicated that airports' use of ramp 
towers was very or extremely effective in addressing ramp 
accidents,[Footnote 85] and 3 indicated that airlines' use of ramp 
towers was very effective.[Footnote 86] One expert said that ramp 
towers improve operational safety but that all operations are still not 
completely visible.

We spoke with officials from two U.S. airlines about measures they were 
taking to improve ramp safety. One of those airlines is using and the 
other plans to use a Web-based surface surveillance system at certain 
hubs to track the movements of ground vehicles and aircraft. Although 
the airline's purpose for purchasing the system was for greater 
efficiencies in its ground operations, an official from that airline 
said he believed that increased safety was an additional benefit of the 
system because it significantly improved situational awareness. 
Although not specifically tracked, the airline believes it has had 
fewer ground accidents and incidents since implementing the system. 
Officials at another airline said they were addressing ramp safety 
further by incorporating a safety management system into the ramp 
procedures in the airline's operations manual, including specific 
ground safety training as a component of recurrent training required 
annually. In addition, the airline has established annual goals for 
reducing employee injuries and ground damage. The airline reported the 
setting of a goal appears effective and has resulted in a significant 
decrease in employee injuries and ground damage over the prior year. 
Officials from this airline also said that the airline had formed a 
safety action team to share best practices with its ground handling 
partners and to review their safety performance, resulting in an 
incident rate for the airline's partners that has been greatly reduced 
in the last two years and continues to improve. The experts we surveyed 
had mixed views on the effectiveness of airlines setting safety targets 
for reducing injuries in ramp areas in addressing ramp accidents. Four 
of 15 experts indicated that it was very effective, 6 said it was 
moderately effective, and 5 indicated it was slightly or not at all 
effective. One expert said that airlines have set safety targets for 
reducing injuries in ramp areas for years and failed to achieve 
discernable results.

Aviation industry groups also have efforts under way to address the 
lack of data for ramp accidents as well as the lack of standards for 
ramp operations. In 2003, the Flight Safety Foundation, an 
international nonprofit membership organization that researches and 
promotes aviation safety, started the Ground Accident Prevention 
Program to "analyze equipment damage and human injuries and develop 
methods of preventing such accidents." The program is now in its third 
phase, in which it will identify and encourage technical solutions to 
ramp safety problems along with continued data collection and analysis. 
Next year, the International Air Transport Association, an 
international airline association, plans to start a safety audit 
program of ground handling companies with the aim of improving 
operational safety by establishing a "worldwide ground operational 
safety benchmark and standard." The program will be available to all 
ground service providers, who, after successfully completing the audit, 
will be placed on a registry for an agreed-upon period. In addition, 
the National Air Transportation Association, which represents companies 
that own, operate, and service aircraft primarily for the general 
aviation community, has launched an industry-wide effort to collect 
ramp incident data and has goals of identifying best practices, 
reducing insurance claims, and lowering insurance costs. The Airports 
Council International, an organization that represents airports 
worldwide, publishes the Airside Safety Handbook as one component of 
its efforts to help airports operate more safely. Finally, the Air 
Transport Association collects, aggregates, and shares ground incident 
damage and injury data to its members. The data are reviewed at the 
association's quarterly Ground Safety Committee meetings and form a 
basis for assessing risk, developing mitigation strategies, and 
measuring effectiveness. According to the association, airlines freely 
share best practices concerning safety and many airlines perform ground 
servicing of aircraft (fuel, potable water, baggage handling, etc.) for 
one another.

Additional Measures May Improve Ramp Safety:

The results of our survey of experts indicated that the actions that 
FAA, OSHA, airports, or airlines could take with greatest potential of 
preventing ramp accidents, considering costs, technological 
feasibility, and operational changes, included promoting a safety 
culture, standardizing airport ramp markings, improving or increasing 
training of ramp workers, increasing the supervision of ramp workers, 
and developing safer equipment designs (see table 6).

Table 6: Experts' Ranking of the Actions that FAA, OSHA, Airports, or 
Airlines Could Take with the Most Potential to Address Ramp Accidents:

Ranking: 1; 
Action: Promote a safety culture in ramp areas.

Ranking: 2; 
Action: Standardize airport ramp markings.

Ranking: 2; 
Action: Improve or increasing training of ramp workers.

Ranking: 2; 
Action: Increase supervision of ramp workers.

Ranking: 3; 
Action: Develop safer designs of ramp equipment.

Source: GAO analysis of responses from survey of experts.

Note: Rankings are based on responses from 15 experts and reflect the 
actions that a majority of respondents indicated had "great potential" 
or "very great potential." 

[End of table]

One expert said that as part of an improved safety culture--which 
experts in our survey indicated was the most effective action to 
address ramp accidents--management must recognize the connection 
between the occurrence of ramp incidents and accidents and its demand 
for quick aircraft turnaround times. Turnaround times are an important 
cost factor for airlines. Another expert said that standardizing ramp 
markings would be beneficial because the markings can be confusing for 
pilots. One of the experts indicated, however, that while improving and 
increasing the training of ramp workers would be beneficial, high job 
turnover among ramp employees is also part of the problem. Furthermore, 
a report prepared by an aviation industry group in 2004[Footnote 87] 
cited inadequate training and high turnover of ramp workers, 
particularly aircraft fuelers, as contributing factors in ramp 
accidents. The report also indicated that low wages contributed to high 
rates of employee turnover. One of the experts we surveyed indicated 
that poor pay attracts a group of ramp workers that exhibit high 
turnover rates, language issues, and work ethic challenges. Similarly, 
in reports that we issued before the September 11, 2001, terrorist 
attacks, we cited high turnover and low wages among airport security 
screeners as factors affecting the effectiveness of performing their 
security duties.[Footnote 88]

Some aviation industry officials and experts said that ramp safety in 
the United States might be improved through the use of new technology. 
One example is a ground pop-up system[Footnote 89] to handle aircraft 
fueling and other ramp services, which is used at airports in Zhuhai, 
China, and Stockholm, Sweden. An expert said that a ground pop-up 
system reduces ramp congestion and the chance of vehicle collisions and 
injuries. In addition, some aviation officials said that new baggage 
loading technology could help make the ramp environment safer for ramp 
workers. New baggage loading technologies include the sliding 
carpet[Footnote 90] and RampSnake®.[Footnote 91] However, an 
international aviation safety official said that although these new 
baggage loading devices could improve working conditions and effort 
required by baggage loaders, it is not readily apparent how such 
devices could help prevent ramp accidents. This official also noted the 
high cost of a ground pop-up system and that it is inflexible to 
accommodate changed aircraft parking arrangements and different 
aircraft types. The potential effectiveness of safer designs of ramp 
equipment was supported by the experts we surveyed, the majority of 
whom said that developing safer designs of ramp equipment had great or 
very great potential in addressing ramp accidents.[Footnote 92] An 
International Air Transport Association official also indicated that 
high-density airports outside of the United States typically have a 
higher degree of control and coordination between the ramp and air 
traffic controllers, which can contribute to safety.

Aviation industry stakeholders expressed diverse views about whether 
the federal government should increase ramp safety oversight and if so, 
which agency should carry out that increased oversight. Officials from 
a union representing ramp workers favored increased FAA and OSHA 
oversight of ramp operations because they felt this would lead to more 
and better training for ramp workers, the implementation of 
standardized procedures, and a focus on ramp safety equal to that 
provided to runway safety. However, an airport association official 
said that increasing FAA's oversight in the ramp area would not be the 
best use of the agency's resources because the safety risks are greater 
on the airfield, where an aircraft collision could result in many 
fatalities. In addition, a Flight Safety Foundation official said that 
additional FAA ramp safety oversight is not needed because FAA's focus 
is on passenger safety and that the agency would have difficulty 
identifying additional resources to oversee ramps. An author of reports 
on ramp accidents issued by an aviation industry group said that OSHA 
should do more to regulate safety on the ramp because, in his view, FAA 
lacks knowledge of industrial safety issues. However, an airline 
association official said that increased OSHA oversight of ramp 
operations would have little potential until OSHA develops national 
standards and appropriate regulations for airport ramp operations. This 
airline association official also said that the lack of a voluntary 
disclosure reporting program for OSHA-regulated incidents impedes 
improving safety in the ramp area. OSHA officials, however, said that 
very few industries have their own workplace safety standards, and that 
the agency is devoting the appropriate amount of resources for 
inspecting airport ramps because its safety inspections overall are 
selected largely on the basis of injury and illness data and 
complaints. However, they were not able to identify how many 
inspections of ramp areas were prompted by data. FAA officials said 
that they do not have responsibility for ramp safety and that their 
jurisdiction is limited to the movement areas. They also noted that 
ramp areas are normally under the jurisdiction of state and local 
authorities but that ultimately the airport operator has responsibility 
for ramp safety unless the area is leased to an air carrier or fixed- 
base operator.

Conclusions:

FAA took a number of actions to address runway safety since the number 
and rate of incursions reached a peak in fiscal year 2001. However, as 
runway safety incidents declined, FAA's runway safety efforts 
subsequently waned. During that period of decreased attention, the 
number and rate of incursions remained relatively constant and at a 
level higher than any time during the 1990s. Moreover, preliminary data 
for fiscal year 2007 indicate the overall incursion rate increased to a 
level nearly as high as the 2001 peak. In addition, serious incursions, 
where collisions were narrowly or barely avoided, continue to occur-- 
about 30 per year since fiscal year 2002--suggesting a high risk of a 
catastrophic runway collision occurring in the United States. 
Furthermore, in recent years, FAA's Office of Runway Safety has not 
been fulfilling its mission to coordinate and lead the agency's runway 
safety efforts. The absence of national leadership and a current 
national runway safety plan impede further progress on runway safety 
because no single office is taking charge of assessing the causes of 
runway safety problems. This situation has resulted in uncoordinated 
runway safety efforts by individual FAA offices. FAA recently hired a 
runway safety director, which is a good first step. However, other 
plans for the program are still being developed, and it is too early to 
know if the office will provide sustained attention to runway safety 
problems.

FAA's runway safety program also lacks certain data on the causes and 
circumstances of incursions and overruns. FAA has planned since 2004 to 
develop a voluntary reporting system for air traffic controllers, which 
would increase the amount of data available on runway incursions, but 
it is not clear when such a program will be established. Without 
additional data, FAA cannot conduct additional analysis of the causes 
and circumstances of runway incidents to ensure that the most effective 
corrective measures that address the causal factors are used. In 
addition, the fact that air traffic controllers at some of the nation's 
busiest airports are regularly working 6-day weeks due to staffing 
shortages raises questions about the extent to which regularly working 
overtime may cause fatigue, which NTSB has cited as a contributing 
factor in air traffic control errors. Furthermore, the nature and scope 
of ramp accidents are unknown. FAA is not working with the aviation 
industry and OSHA to help collect and analyze ramp accident data, which 
could identify the causes and circumstances of ramp accidents, and 
identify corrective actions. Without such data, FAA and the aviation 
industry will be hindered in understanding the nature and extent of 
ramp accidents, which would help identify measures to improve ramp 
safety.

Recommendations:

To advance efforts to improve runway safety, we recommend that the 
Secretary of Transportation direct the FAA Administrator to take the 
following five actions:

* Implement the FAA order establishing the Office of Runway Safety to 
lead the agency's runway safety efforts, including preparing a new 
national runway safety plan. The plan should include goals to improve 
runway safety; near-and longer-term actions designed to reduce the 
severity, number, and rate of runway incursions; timeframes and 
resources needed for those actions; and a continuous evaluative process 
to track performance towards those goals. The plan should also address 
the increased runway safety risk associated with the expected increased 
volume of air traffic.

* Develop an implementation schedule for establishing a nonpunitive 
voluntary safety reporting program for air traffic controllers.

* Develop and implement a plan to collect data on runway overruns that 
do not result in damage or injury for analyses of trends and causes 
such as the locations, circumstances, and types of aircraft involved in 
such incidents.

* Develop a mitigation plan for addressing controller overtime that 
considers options such as shift changes and incentives to attract 
controllers to facilities with high volumes of air traffic and high 
rates of controller overtime.

* Work with the aviation industry and OSHA to develop a mechanism to 
collect and analyze data on ramp accidents and, if the analysis shows 
it is warranted, develop a strategic plan aimed at reducing accidents 
involving workers, passengers, and aircraft in the ramp area. The plan 
should include a discussion of roles and responsibilities, performance 
measures, data collection and analysis, and milestones, and consider 
ramp safety practices being followed in other countries.

Agency Comments:

We provided DOT and the Department of Labor with drafts of this report 
for their review and comment. FAA agreed to consider the report's 
recommendations and provided technical corrections and clarifications, 
which we incorporated as appropriate. The Department of Labor had no 
comments but provided a technical correction, which we incorporated.

As arranged with your offices, unless you publicly announce its 
contents earlier, we plan no further distribution of this report until 
30 days