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Tenerife airport disaster
KLM Flight 4805 · Pan Am Flight 1736
Wreckage of the KLM aircraft on the runway at Los Rodeos
Accident summary
Date March 27, 1977
Summary Runway collision
Place
Los Rodeos Airport, Tenerife, Canary Islands, Spain

28°28′53.94″N 16°20′18.24″W / 28.4816500°N 16.3384000°W / 28.4816500; -16.3384000
Total injuries (non-fatal) 61
Total fatalities 583
Total survivors 61
First aircraft

PH-BUF, the KLM Boeing 747-206B
involved in the accident
Type Boeing 747-206B
Name Rijn ("Rhine")
Airline/user KLM Royal Dutch Airlines
Registration PH-BUF
Flew from Amsterdam Airport Schiphol
Amsterdam, Netherlands
Flying to Gran Canaria Airport
Gran Canaria, Canary Islands
Passengers 234
Crew 14
Fatalities 248
Survivors 0
Second aircraft

N736PA, the Pan Am Boeing 747-121
involved in the accident
Type Boeing 747-121
Name Clipper Victor
Airline/user Pan American World Airways
Registration N736PA
Flew from Los Angeles International Airport
Los Angeles, United States
Stopover John F. Kennedy International Airport, New York City, U.S.
Flying to Gran Canaria Airport
Gran Canaria, Canary Islands
Passengers 380
Crew 16
Injuries (non-fatal) 61
Fatalities 335
Survivors 61

The Tenerife airport disaster occurred on March 27, 1977, when two Boeing 747 passenger jets collided on the runway at Los Rodeos Airport (now Tenerife North Airport) on the Spanish island of Tenerife. The collision occurred when KLM Flight 4805 (IATA: KL4805) initiated its takeoff run during dense fog while Pan Am Flight 1736 (IATA: PA1736) was still on the runway. The impact and resulting fire killed everyone on board KLM 4805 and most of the occupants of Pan Am 1736, with only 61 survivors in the front section of the aircraft, resulting in the worst aviation disaster in Spain. With 583 fatalities, the disaster is also the deadliest accident in aviation history.

A bomb set off by the Canary Islands Independence Movement at Gran Canaria Airport had caused many flights to be diverted to Los Rodeos, including the two aircraft involved in the accident. The airport quickly became congested with parked airplanes blocking the only taxiway and forcing departing aircraft to taxi on the runway instead. Patches of thick fog were drifting across the airfield, so visibility was greatly reduced for pilots and the control tower.

The subsequent investigation by Spanish authorities concluded that the primary cause of the accident was the KLM captain's decision to take off in the mistaken belief that a takeoff clearance from air traffic control (ATC) had been issued. Dutch investigators placed a greater emphasis on a mutual misunderstanding in radio communications between the KLM crew and ATC, but ultimately KLM admitted that their crew was responsible for the accident and the airline agreed to financially compensate the relatives of all of the victims.

The disaster had a lasting influence on the industry, highlighting in particular the vital importance of using standardized phraseology in radio communications. Cockpit procedures were also reviewed, contributing to the establishment of crew resource management as a fundamental part of airline pilots' training. The captain is no longer considered infallible, and combined crew input is encouraged during aircraft operations.

Victims

Both airplanes were destroyed in the collision. All 248 passengers and crew aboard the KLM plane died, as did 335 passengers and crew aboard the Pan Am plane, primarily due to the fire and explosions resulting from the fuel spilled and ignited in the impact. The other 61 passengers and crew aboard the Pan Am aircraft survived. There were initially 70 survivors, but 9 passengers later died of their injuries. Among the survivors were the captain, first officer and flight engineer. Most of the survivors on the Pan Am walked out onto the intact left wing, the side away from the collision, through holes in the fuselage structure.

The Pan Am's engines were still running for a few minutes after the accident despite first officer Bragg's intention to turn them off. The top part of the cockpit, where the engine switches were located, had been destroyed in the collision, and all control lines were severed, leaving no means for the flight crew to control the aircraft's systems. Survivors waited for rescue, but it did not come promptly, as the firefighters were initially unaware that there were two aircraft involved and were concentrating on the KLM wreck hundreds of meters away in the thick fog and smoke. Eventually, most of the survivors on the wing dropped to the ground below.

Notable fatalities

  • Jacob Veldhuyzen van Zanten, chief flight instructor for KLM and the captain of the KLM flight.
  • Eve Meyer, a pin-up model, film actress and producer and second wife of film director Russ Meyer, was on the Pan Am flight.
  • A. P. Hamann, the former city manager of San Jose, California, was on the Pan Am flight.

Aftermath

Het verongelukte KLM-toestel De Rijn, Bestanddeelnr 929-1004 (cropped)
Wreckage of the KLM's vertical stabilizer

The following day, the Canary Islands Independence Movement, responsible for the bombing at Gran Canaria that started the chain of events that led to the disaster, denied responsibility for the accident.

Los Rodeos Airport was closed to all fixed-wing traffic for two days. The first crash investigators to arrive at Tenerife the day after the crash travelled there by way of a 3-hour boat ride from Las Palmas. The first aircraft that was able to land was a U.S. Air Force C-130 transport, which landed on the airport's main taxiway at 12:50 on March 29. The C-130 was arranged by Lt. Col Dr. James K. Slaton, who arrived before the crash investigators and started a triage of surviving passengers. Slaton was dispatched from Torrejon Air Base just outside of Madrid, Spain. Slaton, a flight surgeon attached to the 613th Tactical Fighter Squadron, worked with local medical staff and remained on scene until the last survivor was airlifted to awaiting medical facilities. The C-130 transported all surviving and injured passengers from Tenerife airport to Las Palmas; many of the injured were taken from there to other Air Force bases in the U.S. for further treatment.

Spanish Army soldiers were tasked with clearing crash wreckage from the runways and taxiways. By March 30, a small plane shuttle service was approved, but large jets still could not land. Los Rodeos was fully reopened on April 3, after wreckage had been fully removed and engineers had repaired the airport's runway.

Investigation

Eén de twee verongelukte toestellen, Bestanddeelnr 929-1006 (cropped)
Wreckage of the Pan Am Boeing 747

The accident was investigated by Spain's Civil Aviation Accident and Incident Investigation Commission (CIAIAC). About 70 personnel were involved in the investigation, including representatives from the United States, the Netherlands and the two airline companies. Facts showed that there had been misinterpretations and false assumptions before the accident. Analysis of the CVR transcript showed that the KLM pilot thought that he had been cleared for takeoff, while the Tenerife control tower believed that the KLM 747 was stationary at the end of the runway, awaiting takeoff clearance.

Probable cause

The investigation concluded that the fundamental cause of the accident was that Veldhuyzen van Zanten attempted to take off without clearance. The investigators suggested the reason for this was a desire to leave as soon as possible in order to comply with KLM's duty-time regulations (which went in place earlier that year) and before the weather deteriorated further.

Other major factors contributing to the accident were:

  • The sudden fog greatly limited visibility and the control tower and the crews of both planes were unable to see one another.
  • Interference from simultaneous radio transmissions made hearing messages difficult.

The following factors were considered contributing but not critical:

  • The use of ambiguous non-standard phrases by the KLM co-pilot ("We're at take off") and the Tenerife control tower ("OK").
  • The Pan Am aircraft did not leave the runway at the third exit as instructed.
  • The airport was forced to accommodate a great number of large aircraft rerouted by the terrorist incident, disrupting the normal use of taxiways.

Speculations

This was one of the first accident investigations to include a study into the contribution of "human factors". These included:

  • Veldhuyzen van Zanten, a KLM training captain and instructor for over ten years working on simulators regularly, had not flown on regular routes for twelve weeks prior to the accident.
  • The KLM flight crew, including Veldhuyzen van Zanten, were concerned about exceeding their maximum legally allowable on-duty hours for the day, which Dutch law had recently tightened. This influenced Veldhuyzen van Zanten's decision to refuel at Tenerife for the flight to Amsterdam after as brief a stop as possible at Las Palmas.
  • The apparent hesitation of the flight engineer and the first officer to challenge Veldhuyzen van Zanten further. The official investigation suggested that this might have been due to not only the captain's seniority in rank but also his being one of the most respected pilots working for the airline. This view is questioned by Jan Bartelski, a former KLM captain and the president of the International Federation of Air Line Pilots' Associations (IFALPA), who knew both officers and believes this explanation to be inconsistent with his knowledge of their personalities. The first officer had intervened when Veldhuyzen van Zanten first opened the throttles, but had then failed to do so on the second occasion. Although the flight engineer had indeed asked the captain whether or not the Pan Am was clear of the runway, he seemed reassured by the captain's answer. The co-pilots had clearly challenged the captain's decisions, but were not insistent enough to convince him to abort the attempted takeoff.
  • The flight engineer was the only member of the KLM's flight crew to react to the control tower's instruction to "report the runway clear"; this might have been due to his having completed his pre-flight checks, whereas his colleagues were experiencing an increased workload, just as the visibility worsened.
  • The ALPA study group concluded that the KLM crew did not realize that the transmission "Papa Alpha One Seven Three Six, report the runway clear" was directed at the Pan Am, because this was the first and only time the Pan Am was referred to by that name. Previously, the Pan Am had been called "Clipper One Seven Three Six", using its proper call-sign.

The extra fuel taken on by the KLM added several factors:

  • Takeoff was delayed by an extra 35 minutes, allowing time for the fog to settle in;
  • More than 45 tonnes of additional weight was added to the aircraft, increasing the takeoff distance and making it more difficult to clear the Pan Am when taking off;
  • The increased severity of the fire caused by the additional fuel led ultimately to the deaths of all those on board.

Legacy

De kisten van de slachtoffers van de ramp, Bestanddeelnr 929-1123
Funeral service for the victims of Tenerife airport disaster at Amsterdam Airport Schiphol (April 6, 1977)

As a consequence of the accident, sweeping changes were made to international airline regulations and to aircraft. Aviation authorities around the world introduced requirements for standard phrases and a greater emphasis on English as a common working language.

Air traffic instruction must not be acknowledged solely with a colloquial phrase such as "OK" or even "Roger" (which simply means the last transmission was received), but with a readback of the key parts of the instruction, to show mutual understanding. The word "takeoff" is now spoken only when the actual takeoff clearance is given, or when canceling that same clearance (i.e., "cleared for takeoff" or "cancel takeoff clearance"). Until that point, aircrew and controllers should use the word "departure" in its place (e.g., "ready for departure"). Additionally, an ATC clearance given to an aircraft already lined-up on the runway must be prefixed with the instruction "hold position".

Cockpit procedures were also changed after the accident. Hierarchical relations among crew members were played down, and greater emphasis was placed on team decision-making by mutual agreement. Less experienced flight crew members were encouraged to challenge their captains when they believed something to be incorrect, and captains were instructed to listen to their crew and evaluate all decisions in light of crew concerns. This course of action was later expanded into what is known today as crew resource management (CRM), which states that all pilots, no matter how experienced they are, are allowed to contradict each other. This was a problem in the crash when the Flight Engineer asked if they were not clear, but Veldhuyzen van Zanten (with over 11,000 hours flown) said that they were obviously clear and the Flight Engineer decided that it was best not to contradict the captain. CRM training has been mandatory for all airline pilots since 2006.

In 1978, a second airport was opened on the island of Tenerife, the new Tenerife South Airport (TFS), which now serves the majority of international tourist flights. Los Rodeos, renamed Tenerife North Airport (TFN), was then used only for domestic and inter-island flights until 2002, when a new terminal was opened and Tenerife North began to carry international traffic again.

The Spanish government installed a ground radar system at Tenerife North Airport following the accident.

Memorials

Tenerife disaster memorials
Memorial on Tenerife
Westgaarde Cemetery
Westminster Memorial Park

A Dutch national memorial and final resting place for the victims of the KLM plane is located in Amsterdam, at Westgaarde cemetery. There is also a memorial at the Westminster Memorial Park and Mortuary in Westminster, California, US.

In 1977, a cross in Rancho Bernardo was dedicated to nineteen area residents who died in the disaster.

In 2007, the 30th anniversary marked the first time that Dutch and American next-of-kin and aid helpers from Tenerife joined an international commemoration service, held at the Auditorio de Tenerife in Santa Cruz. The International Tenerife Memorial March 27, 1977 was inaugurated at the Mesa Mota on March 27, 2007. The monument was designed by Dutch sculptor Rudi van de Wint (1942-2006).

Documentaries

The disaster has been featured in many TV shows and documentaries. These include

  • Episode 1 of Survival in the Sky, "Blaming the Pilot" (1996)
  • Episode 12 of Seconds From Disaster, "Collision on the Runway" (2004)
  • Episode 625 of PBS's NOVA, "The Deadliest Plane Crash" (2006)
  • The PBS special Surviving Disaster: How the Brain Works Under Extreme Duress (2011), which was based on Amanda Ripley's book The Unthinkable: Who Survives When Disaster Strikes - and Why
  • An episode of Destroyed in Seconds
  • Episode 133 (S16E03) of the Canadian TV series Mayday (known by different names in different countries), "Disaster at Tenerife" (2016), as well as the earlier in-depth 90-minute special "Crash of the Century" (2005).
  • Footage of the wreckages was included in the 1979 film Days of Fury, narrated by Vincent Price.
  • Episode 5 of the Nebula series "Under Exposure" (2023) by Neo.

Images for kids

See also

Kids robot.svg In Spanish: Desastre aéreo de Tenerife para niños

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