Originally Posted by JohnBurke

ASAP does not consider the severity of the event in covering what may be reported, only that it not be illegal or intentional; if a severe hazard were not covered, then it would eliminate the intent of the program, which is to encourage disclosure of safety-related events.

It is evident from the tapes that traffic was departing both 31L and 4L, as aircraft are cleared to line up and wait, and takeoff, on both runways.

The initial clearance, and the subsequent taxi clearance, should have included the destination runway. In fact, that's recorded: "106 Heavy, Kennedy Ground, runway 4 left, taxi left bravo, hold short of kilo."

There are those occasions when one does not know the departure runway at the outset (or, of course, it changes). In this case, absent any information regarding changes, we can only go by what's given; the crew doesn't ask for additional time to re-brief or re-calculate or re-program, if if they do, it's not presented. The departure briefing should have already been done, along with the taxi briefing. The FMC should have included the departure runway, and the crew should have written down the clearance, and in many cases, highlighted the taxi route and discussed it prior to brake release. This may very well have been done, as it's standard procedure and very basic. Any changes to what had been planned, should have resulted in stopping the aircraft while the new routing was discussed and briefed, and verification made on the taxi diagram of the routing, hotspots, etc. JFK, as most of us know, is one big hot spot. It's easy to make a mistake, which means one must be particularly vigilant. Basic.

On the recording, AA106 received taxi clearance with the runway as the destination, but the readback (which may have been edited) does not include the runway reference ("bravo, hold short of kilo, American 106"), which is required. The controller is not recorded as requiring it, and as we also all know, JFK can be a very busy place. The first recording omits a lot of talk, and the second one focuses only on the time of the incursion. That said, the taxi clearance limit was given, and read back: hold short kilo.

A basic tenet of ATC clearances is that any time there is a misunderstanding, we request clarification. But what if we have no sense that there's a misunderstanding?

Confirmation bias: we hear what we expect to hear. The initial clearance does not mention runway 31L. The only runway given is 4L. The subsequent clearance to cross is to cross 31L. Does the crew hear this and transpose the runways, thinking they're going to 31L? Logically, improbable, but practically? Maybe. Regardless, there are safeguards here, starting with the initial clearance and briefing, programming the FMC, and of course, the takeoff data planned for the departure runway: the crew was cleared to 4L; had they planned a different runway, would we have heard them question the runway assignment, or is that simply missing from the tape? We don't know. But, based on what we are given, as presented, there is no such interaction with ATC. The appearance is that the crew had performance numbers for, FMC programming for, and had briefed runway 4L; they never question the clearance and except for reading back the runway assignment, accept the clearance, read back the routing, and the hold short clearance. So, that gets them to holding short of Kilo, on Bravo.

The next clearance, however does invoke runway 31L: "American 106, cross runway 31 left at Kilo." It was read back the same. As the initial taxi clearance was to the departure runway 4L, the clearance to cross does not repeat 4L, as that's already been given (the crew failed to read it back, or at least, was not recorded on the youtube rendering, reading 4L back). Now, with only a clearance to cross, the crew hears cross 31L at Kilo. The obvious question is whether 31L now figures into confirmation bias, whether the crew was disoriented on the runway or location, or some other factor. Given runway and taxiway markings and a clearance given and read back, however, it's difficult to argue that the crew didn't have a clear direction on what to do. If they misunderstood, the obligation was on them to stop the aircraft and query, and certainly to stop the aircraft, verify on the charts, and agree on the next course of action. Given that they seem unaware that something happened, or that they'd gone to the wrong runway, it also seems that the felt in agreement about the taxi path; any discussion otherwise would be on the CVR, not on youtube.

Here's my problem: when I cross a runway, I light the airplane up like a christmas tree, and most places I've operated require confirmation of a clearance to cross, prior to crossing. Places like JFK where it can be an endless sea of lights, and a continuous daisy chain of aircraft, getting any extra verbiage can be a problem. However, personally, if I'm going to cross a runway, after I light the airframe up so it can be seen from outer space on a cloudy day, I seek confirmation of clearance to cross. Cheap insurance. Especially if an aircraft is lined up and waiting, or lining up to wait. My healthy paranoia and fear of anything that makes a shadow prompts me to have that same hair-on-the-back-of-my-neck spidey sense as crossing a train track or covering a body part with the muzzle of a firearm...runways are dangerous places. Given that both intersecting runways, 4L and 31L were active with aircraft lining up to wait, and departing, crossing either one should have merited that same caution. I don't really care if my company requires a confirmation to cross or not: I'm getting confirmation and someone can slap my wrist later if they thought I talked too much.

What could the 777 crew have possibly been thinking was their game plan, as they taxied to runway 31L? We don't know, and shouldn't speculate. Wrong taxiway, wrong routing, wrong runway, wrong direction, wrong signage, wrong clearance, no confirmation. This, in the face of having run performance numbers for a different runway (4L), accepted a clearance for 4L, received taxi directions for 4L, been given a hold short on the way to 4L at Kilo, and almost certaily having briefed the taxi to 4L. What could they have been thinking? I'm quite certain of what they were not thinking: they were not thinking they'd intentionally taxi somewhere they weren't cleared. They were not thinking they'd taxi to a wrong runway. They were not thinking they'd create a runway incursion.

On Bravo, taxiway Kilo intersects at a right angle; there is no direct path forward to cross runway 4L, meaning there is no sign in front of AA106, when holding short of Kilo on Bravo, identifying 4L. The nearest runway sign for 4L is ahead and to the left on Juliet. Immediately to the right, on Kilo, is the runway sign for runway 31L; this would be the nearest and most obvious sign; both Kilo and Juliet should have had red stop bars where they entered the runway. To me, personally, that red stop bar elicits and inner voice that says "get confirmation."

After making the big circle around the airport, perhaps the crew got a little disoriented as to what direction they were going; that's why we have taxi diagrams. Let the first one among us who hasn't at least once either missed a turn, taken the wrong taxiway, or become disoriented at a busy place, throw the first stone (ever try taxiing at Madrid? The person who designed the ramp, runway, and taxi designators should be shot, dragged through broken glass, soaked in lighter fluid, set ablaze, then urinated upon by a troupe of baboons on an all-garlic diet, before being thrown headfirst into a vat of sulfuric acid. I've thought this through).

In Incheon, there's a wonderful system when landing and taxiing to the runway, in which the controller simply identifies the runway and taxi clearance, and says "follow the green." Green lights illuminate for the immediate portion of the taxi to be made, and go no further than the taxi clearance. When cleared to cross, the next portion lights up, and so on, making orientation and identification easy...they do that right into the parking spot. It's great. JFK is neither ICN nor MAD...but it can be, at times, confusing. This appears to be a case in which confusion existed, but was not perceived: the crew did not know, or seem to know, what had happened.

This brings up perhaps the most immediate salient point. At what point did the departing Delta flight become aware of the incursion and reject? A youtube video guesses where the airplanes were in relation to one another, but at what point did AA106 enter the runway and where did the Delta crew see and become aware? At what point did the controller become aware? It appears that the American crew was not aware; there are multiple players. so the question is dynamic with variables. Clearly the Delta crew and the controller both moved to avert what could have been a very bad outcome, and the calm in the voices of both the Delta crew and the controller(s) is commendable. It was handled quite professionally.

The easy choice to to point fingers at the AA crew; it was their incursion. Better to explore why it got there, went there, and how to ensure it doesn't. I think, in general, we all have a keen understanding of what is required to prevent events like this from occurring. We have multiple safeguards, and yet we do continue to see incursions that include crossing the wrong runway, or events such as landing or taking off from the wrong runway, a taxiway, or a closed runway, or even landing at the wrong airport. Rare, but they continue. The procedures and practices to prevent such events are well known, standard procedure, and nearly universal. Perhaps the takeaway here is that failure to adhere to all the standard procedures, omitting even one (if that's what happened here), can place not only us, but others, in jeopardy.

Personally, when taxiing, I like to call out the next turn (coming up on Kilo, hold short Kilo, or approaching kilo, right turn on kilo), with a confirmation. If I'm in a cockpit with additional crew, such as a heavy crew, I want them to have their taxi diagrams out and be following along, too.

This event will go to ASAP, and we probably, as the peanut gallery, won't get the full picture, which is unfortunate. It's still a good object lesson, though.