Safety Recommendation A-86-008

From the Aviation Investigation Report AIR-26-02, “Midair Collision over the Potomac River PSA Airlines Flight 5342, Mitsubishi Heavy Industries (MHI) RJ Aviation CL-600-2C10 (CRJ700), and US Army Priority Air Transport Flight 25, Sikorsky UH-60L Washington, DC January 29, 2025”

Helicopter Route Development and Modification

The first edition of the Baltimore-Washington Helicopter Route Chart was published in February 1986, and remained unchanged until 1991, when a compulsory reporting point was added at the Wilson Bridge. Footnote: The chart was developed following an NTSB recommendation (A-86-8) to publish a chart depicting VFR helicopter routes for civilian and military operators in the DC area. This recommendation was the result of an investigation into an incursion between a Boeing 727 and a Bell 206 helicopter in which both aircraft were cleared for takeoff from DCA about the same time (NTSB, 1986).

The helicopter’s most direct flightpath to its intended route of flight intersected the airplane’s departure runway. During takeoff, the pilots of both aircraft recognized the conflict. The 727 captain rejected the takeoff and the airplane came to rest on the grass overrun off the end of the runway approximately 130 ft from the Potomac River. There was no damage to the airplane and no injuries to the passengers or crew.

The helicopter pilot maneuvered to avoid crossing the runway and returned to the helicopter pad without further incident.Between 1991 and the time of the accident, there had been changes to the route altitudes and police zone boundaries; however, there were no significant alterations to the route structure. Footnote: Police zones on VFR helicopter route charts are depicted operating areas where police helicopters, once they contact ATC upon entry, may operate with minimal further coordination up to a specified maximum altitude within the zone, providing access and designated altitude ranges to facilitate their missions while minimizing conflict with other traffic.

FAA Order JO 7210.3DD, “Facility Operation and Administration,” chapter 12, section 4, Helicopter Route Programs, described the process by which an ATC facility’s air traffic manager (ATM) was required to develop and/or revise helicopter route charts. Footnote: Section 1.7.2 contains more information on ATC positions and responsibilities.

The order stated that, when initially seeking to develop a helicopter route chart, the requesting ATM must establish a task force composed of local air traffic, FAA flight standards district office (FSDO), military, law enforcement, and helicopter operator personnel to recommend the area of chart coverage and the paths, routes, and operating zones to be included in the chart. Revisions to existing helicopter route charts were to be initiated by the ATM and proposed to the task force for collaboration.

The order also noted:

ATMs must seek the cooperation of local FSDO personnel in informing local aviation interests about the Helicopter Route Chart program. Special emphasis should be placed on:

1. The voluntary nature of pilot adherence to designated routes, operating zones, altitudes/flight ceilings, and procedural notes;

2. The importance of chart use to operational safety and IFR [instrument flight rules] traffic avoidance; and

3. The “see and avoid” nature of operations within the chart area.

The order additionally stated that Terminal Operations Service Area Directors were responsible for reviewing and approving new or revised helicopter route chart proposals and assuring that they complied with all prescribed criteria. These directors were also responsible for conducting annual reviews of existing VFR helicopter route charts to determine their accuracy and continued utility. Revisions to existing helicopter route charts could be initiated by any facility ATM, but could only be approved by Terminal Operations Service Area Directors.

The FAA was unable to provide documentation of the required annual reviews for the Baltimore-Washington Helicopter Route Chart.

Safety Recommendations A-86-7 and -8 were classified "Closed--Acceptable Action," in the Special Investigation Report "Runway Incursion at Controlled Airports in the United States" report number NTSB/SIR-86/01 issued on May 13, 1986.

As a result of a runway incursion incident at Washington National Airport on September 24, 1985, the Safety Board issued the following safety recommendations on January 15, 1986, to the FAA: A-86-7 through A-86-12.

The FAA responded to these recommendations in its letter of April 10, 1985. The FAA informed the Safety Board that it had published a new chart for helicopter traffic arriving and departing Washington National Airport, which depicts the Washington, DC area as well as Washington National Airport, and provides helicopter routes to be used. The Board has classified Safety Recommendations A-86-7 and -8 as CLOSED-- ACCEPTABLE ACTION.

In response to Safety Recommendation A-86-9, the FAA informed the Safety Board that it has begun a study of the feasibility of establishing standard visual flight rules helicopter routes and arrival and departure procedures at major airports. Pending its review of the results of this study and subsequent FAA action, the Board has classified Safety Recommendation A-86-9 as "Open-Acceptable Action.”

With regard to Safety Recommendation A-86-10, the FAA stated that the ATC Academy was revising the classroom portion of the training program to include simulation of airport ground and local control situations involving helicopter operations, and that the on-the-job training portion requires the demonstration of the 1use of standard arrival and departure route procedures prior to position certification. Pending further information from the FAA on the status of revising the tower controller training program, the Safety Board has classified Safety Recommendation A-86-10 as "Open1 Acceptable Action."

In response to Safety Recommendation A-86-11, the FAA stated that an evaluation had found Washington National Airport to be in full compliance with the Technical Performance Appraisal Program and that every effort would be made to ensure that the program is properly administered in the future. However, there was no indication or the actions taken to achieve this result. Therefore, the Safety Board requests that the FAA provide additional information as to the actions taken to correct the discrepancies found during the investigation. The Board has classified Safety Recommendation A-86-11 as

-From Donald D. Engen, Administrator: Standardized departure/arrival routes have been developed for helicopter traffic arriving and departing Washington National Airport. These routes are designated as the Glebe Transition Routes and apply to both departures and arrivals. The recommended chart was printed during the week of January 26, 1986, with an effective date of February 13, 1986, This new chart depicts visual flight rules helicopter routes, as well as standardized departure/arrival routes, in both graphic and narrative form.

I consider the Federal Aviation Administration's (FAA) action to be completed on Recommendations A-86-7 and A-86-8.

At 1722 eastern daylight time on September 24, 1985, the captain of an Eastern Airlines Boeing 727 (B-727) rejected a takeoff on runway 36 at Washington National Airport (DCA) when he observed a Bell 206-Ll helicopter depart the north helicopter pad in a direction that would cross the B-7271s projected takeoff path. The B-727 came to rest on the grass overrun off the end of runway 36, approximately 130 feet from the Potomac River. There was no damage to the aircraft or injuries to the passengers or crew during the rejected takeoff.

The National Transportation Safety Board's preliminary investigation of this incident disclosed that the B-727 was cleared for takeoff by the tower local controller while, about the same time, the Bell 206 was cleared for takeoff by another controller who was staffing the helicopter control position. The Bell 206 pilot, who had access to a Special Military Helicopter VFR Route Chart, had requested a departure via "Route 1 to Greenbelt."

The Bell 206 pilot interpreted the controller's subsequent takeoff clearance as authorization to proceed to the east by the most direct route to intersect "Route 1 to Greenbelt." The flightpath for this route crosses runway 36. During his takeoff, the pilot observed the Eastern B-727 on takeoff roll, and he also maneuvered to avoid crossing runway 36. He subsequently returned to the north helicopter pad without damage to the helicopter or injury to persons on board.

In a post-incident interview, the helicopter controller stated that she normally would direct a pilot requesting this departure to proceed northwest to join Route 1 at the Memorial Bridge and that she thought she had issued these instructions to the Bell 206. A helicopter flying from the north helicopter pad to the northwest would not interfere or pass over airplanes departing runway 36.

'Ille recorded tower communication, however, showed that the controller transmitted the winos, altimeter, and takeoff clearance information without amplifying departure instructions. 1be helicopter controller stated that she had not coordinated the Bell 206 departure with the local controller because she expected the helicopter to depart northwest, causing no traffic conflict. Further, she stated that even without specific departure clearance instructions, she would have expected the departure helicopter to remain clear of runway 36.

'Ille tower cab supervisor, however, stated that he would assume that the helicopter would cross runway 36 during a