Details of the Frightening Near Miss at Chicago Midway

19 Jun 15 13 Comments
View the Chicago Midway Intl (MDW) Airport Diagram to follow along at home

On Tuesday, two aircraft were on a collision course when ATC instructions weren’t understood at Chicago’s Midway airport in Illinois.

Delta Airlines flight 1328, a Boeing 717-200, was a scheduled flight to Atlanta, Georgia. On the recordings, this flight is referred to as Delta thirteen twenty-eight.

Southwest Airlines flight 3828, a Boeing 737-700, was scheduled for Tulsa Oklahoma. This flight is referred to as Southwest thirty-eight twenty-eight.

The interactions on the ground show the roots of the issue.

Ground ATC recording courtesy of LiveATC

Before pushback, the two aircraft could already be heard talking over each other. By 01:20, the Ground controller had straightened out the gate situation and gave the clearances for both aircraft to taxi.

Delta 1328 was given clearance to taxi to runway 04 right, and cross runway 31 right and hold short of 31 centre.

Southwest 3828 was offered a choice of 4 right or 31 centre. She then cleared them to cross runway 31 right for a departure on runway 31 centre.

Her final calls to the aircraft are clear.

Delta 1328, be advised, similar callsign on frequency is Southwest 3828. Cross runway 31 centre and 31 left and continue via taxiway Yankee to 4 right.

Southwest 3828, be advised, similar callsign on frequency is Delta 1328 and once you approach 31 right, as you are crossing it, you can switch over to tower. Have a good day.

Both aircraft acknowledged the controller’s warning.

Tower ATC courtesy of LiveATC.net

At the start of the second recording, Delta 1328 is lined up on runway 4 right. The Tower controller asked the aircraft to hold position, saying something about a cross runway (possibly a reference to Southwest 3828 on runway 31) and a landing aircraft inbound on runway 4 left (on a four-mile final landing parallel).

Delta 1328 acknowledged the call.

The controller then cleared Southwest 3828 to enter runway 31 centre and wait.

The critical point is at 0:46 of the recording, which goes something like this.

Tower: Traffic holding position on the cross runway, traffic on three-mile final for the cross runway. No delay please, turn left heading 250, runway 31 centre, clear for take-off, the wind 060 9.

This call is completely reasonable except that I never hear him actually state a callsign to make it clear who the controller is talking to. However, there’s only one aircraft on runway 31 centre, and that is Southwest 3828.

This call is meant to impart the following to Southwest 3828:

  • There’s an aircraft holding on the runway which crosses yours (this is Delta 1328 who was lined up and waiting on 4 right
  • There’s another aircraft inbound on the cross runway (04) who is on three mile final
  • Please take off with no delay (as the controller needs him out of the way so that Delta 1328 can take off and the inbound aircraft can then land)
  • Once you’ve taken off, turn left for a heading of 250
  • On runway 31 centre, you are cleared to take off
  • The current wind is coming from 060 and the windspeed is 9 knots

There are two transmissions at the same time. It seems pretty clear (sitting at home, listening to the recording over and over again) that both Southwest 3828 and Delta 1328 have acknowledged the clearance to take off.

The controller didn’t have the opportunity to listen to the transmission again but he’s clearly unhappy that the acknowledgement was so garbled. He repeats his instruction to make sure that it is clear. I have to admit, though, I struggled to understand the call at the speed at which he is speaking.

Tower: Thirty-eight twenty-eight verify: no delay, left 250 and 31 centre clear to take off.

Again, two aircraft responded at the same time. Southwest 3828 on runway 31 centre was the only aircraft clear to take off, but both Southwest 3828 and Delta 1328 acknowledged the clearance.

They both started rolling. The Tower controller realised that both aircraft were moving and started shouting.

Tower:Thirteen twenty-eight! Stop! STOP STOP!
Delta 1328: 1328, stopping.
Tower: 1328 make the right turn on to taxiway Delta, right turn to Delta, hold short runway 4 right.

Again, there are two transmissions at the same time. This time, you can clearly hear Southwest acknowledging the instruction given to Delta. Both aircraft have stopped.

Southwest 3828: Hold short runway 4 right Southwest 3828.

The controller may not always have been as clear as he could be, however I have to admire his calm under the situation, having just watched two aircraft under his control almost run into each other.

Tower:You keep answering for each other. It’s Southwest 3828 and Delta 1328. Southwest 3828, make the right turn onto Golf back to runway 31 centre.

The inbound aircraft is cleared to land and then there’s a moment of silence, presumably while everyone is taking in what just almost happened.

At about 03:00 there’s one last exchange on the subject.

Southwest 3828: We were Southwest on 31 centre. Were we the ones clear for take-off?
Tower: Yes, sir, you were, you were the one. You were doing what you were supposed to be doing.
Southwest 3828: And Delta was rolling also?
Tower: Yes, he took your call sign. Somebody kept stepping on you, I couldn’t figure out who it was and then, that’s why I reiterated that it was you that I was clearing to take-off.

Delta 1328 departed half an hour later and arrived in Atlanta ten minutes late. Southwest 3828 waited on a replacement Boeing 737-700 and departed almost four hours later, arriving in Tulsa 220 minutes late.

The incident is under investigation.

Category: Accident Reports,

13 Comments

  • Hi
    I’m a new subscriber to your website blog. My OH used to pilot and the above reminded me of a situation he described & is the reason that training pilots must 1st pass their radio exam before going solo.
    A solo pilot was coming in to land at Glasgow and being told to expedite as a SAS was on 7mile finals. The pilot who’s 1st language wasn’t English couldn’t understand the controllers strong Scottish accent so came to a halt on the main runway. Still unable to make out what was being said he turned the single engine off arggg! causing the SAS Boeing 707 to overshoot and climb at an acute angle which in turn caused some injury to the passengers

  • Hi Again

    May I ask you a Q? which is when you say your writing up an air accident report what do you mean. The reason I ask os that my OH was for a number of years a Marine & Aviation Investigator who traveled the world when He worked on behalf of Lloyds of London & other aviation insurance under-writers. He investigated & set the money levels expected to cost (usually in 7 figures) for many well known incidents. He has many stories to tell about air accidents some of them quite scary

    • Hi Chris. I should have phrased that better. What I mean is that I’m reading an accident report and writing up an analysis of it – much like this post, going over the basics and keeping it easy to read. Most people don’t have time to wade through a 200-page report to find out what happened, so I write it up as a short analysis with context and explanations. You’ll find quite a few on this site and I am working on a series which collects ten or so from each year in this millenium to take a deeper look at.

      Your OH sounds fascinating and I’d love to hear the stories!

  • Hi

    My friend is my Hubby and yes i’ll ask him for his ‘stories’ about which he may contact you here

    Regards

  • Some fascinating horror stories and much to learn about Sylvia.
    Am I the only one (I am a GA Pilot) who thinks that operating an airport with two crossing runways in use simultaneously is an accident waiting to happen!?
    Wasn’t this incident inevitable?

    • Hi Steve,

      Well, the sad thing is that airports themselves are inherently dangerous because of the amount of traffic that needs to be negotiated in a limited space where there’s a real financial goal on all levels to keep things moving as quickly as possible.

      Coincidentally, I’m just reading the report summarised here: http://avherald.com/h?article=48917c19&opt=1024

      In this instance, we can see that the parallel runways (in close proximity) is also a real issue.

  • Surely this is where a “short cut” becomes a danger. Thirteen and Thirty eight over transmission and receiving equipment could be unclear. Best practice would be use proper number ie one three two eight and three eight two eight. Verbalising the numerics might reduce the frequency of such instances. Established practices may, however, not be easy to initiate change from within.

  • Just found this incident randomly on YouTube and then this page came up when I was searching Google for the aftermath. Pretty groovy.

  • I’m just wondering why Southwest 3828 had to wait on a replacement Boeing 737-700? Was the plane damaged when he acted on the ATC transmission for Delta 1328? i.e. Southwest 3828 also stopped on the runway. Also, if Southwest 3828 was on 31 center, why did he think the ATC transmission “Hold short runway 4 right” was for him. Then ATC directed Southwest 3828 to make the right turn onto Golf back to runway 31 centre. What happened after Southwest 3828 turned onto Golf that necessitated replacement of the aircraft? I hope I understand this correctly.

    • An emergency stop taxes the brakes and the tires. The Chicago Tribune reported: “The Southwest plane taxied back to the terminal for a safety check because of overheated brakes from the emergency stop”. Avherald says, “N223WN resumed service about 11 hours after rejecting takeoff.”

      A commenter on avherald.com had another explanation: “It takes a while for the company to wash and dry the pilots’ seat cushions…” ;-)

      • I was on the Southwest flight. We sat on the tarmac for hours. I recall investigators coming on board and chatter about “removing the black box.” Who knows. We didn’t know what was happening until eventually folks started listening to the ATC recording on their phone. It was a wild ride.

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