NTSB CAROL · Event
Event OPS16IA002
Registry · N316PQ
FAA Aircraft Registry record.
Make / Model
BOMBARDIER INC CL-600-2D24
Year of manufacture
2014 · 2 years old at event
Engine
GE CF34-8C5
Seats / Engines
95 seats · 2 engines
Last airworthiness date
20140605
ADS-B equipped
Yes — Mode-S A35E6F
Registrant of record
DELTA AIR LINES INC
Source: FAA Aircraft Registry (releasable master file).
Aircraft involved
Probable cause & findings
The local controller's failure to visually scan and ensure that the runway surface was not occupied by a vehicle or other aircraft before issuing a takeoff clearance to the pilot. Contributing to this incident was the relieved controller's failure to monitor and review the position, after completing the relief briefing, to ensure that nothing had been overlooked.
Factual narrative
HISTORY OF FLIGHT
On Wednesday, January 27, 2016, about 0804 eastern standard time (EST), a runway incursion occurred at Detroit Metropolitan Wayne County Airport (DTW), Detroit, Michigan when an airport operations vehicle (OPS), O373, was provided a clearance to operate on runway 22L, and Endeavor Air (Flagship) flight 3860 (FLG3860), a CRJ9, was cleared for takeoff on runway 22L. FLG3860 was operating under the provisions of 14 Code of Federal Regulations Part 121 as a regularly scheduled passenger flight to Norfolk International Airport (ORF), Norfolk, Virginia, and O373 was conducting a routine runway inspection on runway 22L. There was no damage to the aircraft or vehicle, and no reported injuries. Visual meteorological conditions prevailed at the time of the incident. About five minutes prior to the incident, the driver of O373 completed a runway inspection for runway 22R, and informed the local northwest (LNW) controller that he was proceeding to the departure end of runway 22L and would hold short; where he would wait until permission was granted for him to him to drive on runway 22L. The LNW controller responded to the driver by reiterating instructions to hold short of runway 22L at taxiway R. The driver acknowledged and complied. At 0801:37, the LNW controller instructed O373 to, "…turn right and drive on runway two two left…" The driver responded, "…cleared to drive on runway two two left..." The driver proceeded southbound (toward the departure end of runway 22L), made a 180 degree turn on the runway 4R numbers, then proceeded northbound (toward the approach end of runway 22L). About 0802 the local control positions in the tower , LNW and local northeast (LNE), were combined. The LNE controller received a position relief briefing from the LNW controller, and assumed all LNE and LNW duties from the LNE workstation. According to audio data, the local control position relief briefing began at 0802:25 and ended at 0802:40. During the briefing, at 0802:31, the LNW controller informed the LNE controller that, "…Ops 373 is driving runway two two left, ah, he is just turning northbound on it now…." At the same time, the pilot of FLG3860 transmitted on the frequency, "Flagship thirty-eight sixty ready two two left." At 0802:44, the combined local controller (LNE/LNW) instructed FLG3860 to line up and wait on runway 22L. At 0803:46, the local controller cleared FLG3860 for take-off on runway 22L. The pilot acknowledged the take off clearance. About 20 seconds later the airport surface detection system - model X (ASDE-X) alerted, indicating that the runway was occupied by FLG3860 and O373. At 0804:10, the local controller transmitted, "Flagship thirty-eight sixty abort takeoff, Flagship thirty-eight sixty abort takeoff," and then instructed O373 to exit the runway to the right. The pilot and vehicle driver both acknowledged and complied with the instructions. According to ASDE-X data, the closest proximity between the aircraft and the vehicle was about 211 feet laterally. About 0804, the local controller transmitted, "…that was my fault, you can exit the runway to the left and do whatever you want to do right now, just advise ground on point 8 [reference to ground control frequency 121.8] when you are all collected." The driver of O373 exited and reported off the runway, then returned to his base operations location. About 0805, the pilot of FLG3860 exited the runway, switched to ground control frequency, and requested taxi instructions to the runway. The pilot advised the ground controller that he needed about 15 minutes before he would be ready to depart. The ground controller taxied FLG3860 to runway 22L, and advised the pilot to, "let me know when you are ready to go." About 21 minutes later, the pilot informed the ground controller that he needed to go back to the gate.
RADAR DATA
Radar data for this report was obtained from the ASR-9 sensor located at DTW.
METEOROLOGICAL INFORMATION
The DTW weather for January 27, 2016 was obtained from the KDTW automatic surface observing system (ASOS). The current weather at the time of the incident was: METAR KDTW 271253Z 25009KT 10SM -SN SCT025 BKN040 OVC170 M02/M04 A3020 RMK AO2 SLP232 P0000 T10171044= Weather for KDTW at 0753 EST, wind from 250 degrees at 9 knots, 10 miles visibility, light snow, scattered clouds at 2,500 feet above ground level (agl), broken ceiling at 4,000 feet agl, overcast skies at 17,000 feet agl, temperature -2 degrees Celsius (C), dew point temperature -4 degrees C, altimeter 30.20 in Hg. Remarks: station with a precipitation discriminator, sea level pressure 1023.2 hPa, one-hourly precipitation of a trace, temperature -1.7 degrees C, dew point temperature -4.4 degrees C. The Local Northwest (LNW) controller cleared Ops 373 (O373), an airport ops vehicle, to drive on runway 22L to conduct a routine inspection. About 90 seconds prior to the incident, and while O373 was operating on the runway, the LNW and Local Northeast (LNE) positions were combined and the LNE controller assumed all LNE and LNW duties. The LNW and LNE controllers conducted a required position relief briefing but did not conduct the briefing at the relieved position in accordance with standard operating procedures. During the position relief briefing, the LNW controller informed the LNE controller that O373 was driving on runway 22L and at about the same time, Endeavor Air (FLG3860), a CRJ 900, transmitted on the frequency they were ready for departure on runway 22L. About four seconds after completion of the position relief briefing, at 0802:44, the LNE controller instructed FLG3860 to line up and wait on runway 22L and at 0803:46 cleared FLG3860 for takeoff. About 20 seconds later the Airport Surface Detection System – Model X (ASDE-X) alerted indicating the runway was occupied by both FLG3860 and O373. The LNE controller instructed FLG3860 to "…abort takeoff" and instructed O373 to exit the runway. Both complied with the instruction. ASDE-X data indicated the closest proximity between FLG3860 and O373 was about 211 feet. The relieved LNW controller did not conduct a required two-minute overlap upon completion of the position relief briefing in order to monitor and review the position to ensure that nothing had been overlooked or incorrectly displayed. At the time of the incident, the tower was staffed with four personnel; one combined LNE/LNW controller, one combined ground northeast/ground northwest controller, one flight data/clearance delivery controller, and one controller in charge. Source: NTSB Aviation Accident Database Retrieved: 2026-02-12
NTSB Findings
Hierarchical cause / factor breakdown from the FAA bulk avdata database. Each finding tagged C (Cause) or F (Factor).
- F Personnel issues-Task performance-Communication (personnel)-Crew/duty change-over-ATC personnel - F
- C Personnel issues-Task performance-Use of equip/info-Use of policy/procedure-ATC personnel - C
Verbatim from NTSB's published report. Source file
NTSB_2016_OPS16IA002.txt.
Findings + structured fields enriched from FAA avall.mdb.
Full investigation docket on
data.ntsb.gov ↗.
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Related research
What the literature says.
Academic papers and agency reports matching this event's aircraft type or causal vocabulary (runway incursion). Sourced from NASA NTRS, NTSB Safety Studies, FAA CAMI, AOPA Air Safety Institute, Embry-Riddle Scholarly Commons, arXiv, and the Semantic Scholar academic graph.
- SKYbrary (Eurocontrol) 2023 · SKYbrary article
Runway Incursion — SKYbrary Knowledge Base
SKYbrary runway incursion review — taxonomy (operational error, vehicle/pedestrian, pilot deviation), severity categories A-D, mitigation technologies (ASDE-X, ASSC, RAAS, RIAAS).
- Semantic Scholar 2023 · Article (Future Transportation)
Investigating Runway Incursion Incidents at United States Airports
According to the Federal Aviation Administration (FAA), the number of runway incursions is increasing. Over the last two decades, the number of runway incursions at U.S.
- FAA-affiliated R&D (MITRE / Volpe / FAA Tech Center) 2022 · MITRE risk analysis
Runway Incursion Prevention Systems — Surface Domain Risk Analysis
MITRE risk analysis of runway-incursion prevention systems (RIPS) — ASDE-X / ASSC + Airport Surface Detection Equipment performance characterization. Findings drove FAA Surface Safety Action Plan.
- Semantic Scholar 2020 · Article (Journal of Physics: Conference Series)
Comparison of Detection Technology for Runway Incursion Prevention in Airport Hot Spot
The prevention of runway incursion in hot spot of airports has always been one of the research hot spots in the field of international civil aviation.
- Embry-Riddle Scholarly Commons 2020 · Journal article (IJAAA)
Analysis of Runway Incursion Trends: Implications for Cost-Benefit Analysis of Mitigation Investments
This causal-comparative and correlation study investigated the costs of runway incursion safety improvements in relation to their effectiveness to assess potential aviation system benefits.Two airport…
- Semantic Scholar 2020 · Article
Analysis of Runway Incursion Trends: Implications for Cost-Benefit Analysis of Mitigation Investments
Browse the full corpus — academia portal ↗