All language subtitles for Air.Disasters.S03E08.The.Invisible.Plane.1080p.PMTP.WEB-DL.DDP2.0.H.264-maldini_track3_[eng]

A Boeing MD-87
cuts through the morning fog.

The accident
was inevitable.

They were doomed.

The plane,
carrying 110 people,

erupts in flames
at Milan's Linate Airport.

This is the most
serious accident

in the history in Italy.

Incredibly,
no one at the airport

has noticed the catastrophe.

Hello, this is tower.

No, nothing.

Valuable minutes pass.

It was astonishing.

Air traffic control still
doesn't know what happened.

Only when the wounded
come looking for help...

There's a red streak of
fire at the end of the runway.

...do authorities
begin to realize

that something
is seriously wrong...

My God.

...at one of Europe's
busiest airports.

Ladies and gentlemen,

we are starting our approach.

We lost both engines!

Put the mask over your nose.

Emergency descent.

Brace for impact!

I think I lost one.

Investigation starting...

He's gonna crash!

Milan.

The fashion capital of Europe

and Italy's economic
and financial heart.

Milan is served by three
international airports.

Only one, Linate Airport,
lies within city limits.

It handles nine million
passengers a year

on short flights
all across Europe.

Alitalia 226
airborne, zero-five.

On the morning
of October 8, 2001,

dense fog shrouds the airport.

The fog
that day was very bad

and the general visibility
was about 50 and 100 meters.

In the tower,

controllers have
a heavy workload.

There are nearly two dozen
aircraft to get off the ground

in the next 60 minutes.

Alitalia 2120,
buongiorno, start up.

They handle nearly 500

radio communications every hour.

Linate, buongiorno .

Delta India Echo Victor x-ray,
requesting startup.

Delta Victor x-ray,

you are clear
to start your engines.

Ground,
Scandinavian 686,

request taxi from 13.

Scandinavian 686,

taxi to the holding position,
cat three.

Scandinavian 686,

taxi to holding position,
cat three.

One of today's
flights

is Scandinavian Airlines
flight 686.

The Boeing MD-87 is scheduled
for a routine flight

to Copenhagen, Denmark.

There are 110 people onboard.

Taxi holding point, cat three.

The Captain
is Joakim Gustafsson.

He has been with SAS
for more than a decade.

Scandinavian 686,
your position please.

We still haven't reached

the main taxiway,
Scandinavian 686.

First officer
Anders Hyllander--

he has been flying for the
airline for the past four years

and has clocked 2,000 hours
on the MD-87.

The SAS crew were
very highly experienced pilots,

so couldn't ask more
for two qualified pilots.

With thick fog
blanketing the airport,

the pilots have
almost no visibility.

They must rely entirely
on instructions

from air traffic controllers

as they navigate their way
to the runway.

There are
a lot of taxiways,

one runway
for commercial aviation,

and there are a lot

of many different types
of airplanes at Linate,

so it's a very busy airport.

High above the
runway, air traffic controllers

normally have a clear view
of the airport,

but not today.

Air 1937, where are you?

Between 18 and delta.

So you're practically
in front of the tower, right?

Paolo Zacchetti--

he is the ground controller

responsible for guiding flights
to the start of the runway

where planes take off
every two minutes.

Taxi north
via Romeo five.

Call me back at the stop bar
of the main runway extension.

With Linate fogbound,
he's got his hands full.

Scandinavian 686,
your position please.

Now we are
on the main taxiway.

Yes. Now we're
entering the main taxiway,

Scandinavian 686.

At 8:01 a.m.,

Zacchetti hands SAS 686 over
to the tower controller

for final takeoff instructions.

Tower, buongiorno .

Scandinavian 686, sequence
to 3-6 right.

Ciao, Scandinavian 686,

line up and wait,
3-6 right.

Line up and wait 3-6.

The SAS crew must
wait behind other planes

taking off from Linate's
main runway, 36 right.

Alitalia 226,
cleared for takeoff 3-6.

Report when rolling.

Low visibility
is not a problem in the air.

It's a very big problem
on the ground

because the pilots
depend completely

upon the air traffic controller.

Delta Victor x-ray,
confirm your position.

Approaching Sierra 4.

Roger.

Maintain the stop bar.
I'll call you back.

Takeoff data.

57 tons, and it is checked.

Checklist complete.

Scandinavian 686, Linate.

The wind is calm.

Report rolling.

When airborne, squawk ident.

Once the plane ahead
has taken off,

flight 686 begins
its takeoff roll

down the airport's
7,800-foot runway.

And we are rolling,
Scandinavian 686.

Auto-throttle on.

Set thrust.

V1...

At a speed of 140 knots...

Rotate.

...the pilots lift
the plane off the ground.

What's that?!

Come on, come on.

Come on.

Something
catastrophic

has happened to flight 686,

but because of the thick fog,

no one in the control tower
has any idea.

It was astonishing.

It's so close to the tower,
and nobody was aware about this.

Out on the tarmac,

ground workers have heard
a series of loud noises.

Hello,
this is tower.

We heard a number of bangs,
like an engine.

We heard it, too,
but we don't know what it was.

Seemed as if somebody
was climbing the steps.

You don't have
anything abnormal?

A passenger jet
has been in flames

for nearly a minute at one
of Europe's busiest airports,

but so far no one knows.

No, nothing.

This was incredible to believe

that this big accident happened

and nobody could see

what was
happening at that moment.

The crash site
goes undiscovered

until a customs officer
spots an injured baggage handler

stumbling from the wreckage.

It took a while
to figure out

that they had a big disaster
on their hands.

The officer
alerts emergency crews...

...but the controllers
still don't know

there's been an accident.

Incredibly,
Linate air traffic control

still doesn't know
what happened.

Only now does
the tower controller check

for the SAS flight on his radar.

He can't find it.

The radar
does not show the plane

flying away from Linate.

Then they get
a radio call from another plane.

There's a red streak of
fire at the end of the runway.

Finally, almost three
minutes after the accident,

Linate air traffic control
raises the general alarm.

They ground all departing planes

and close the airport
to incoming traffic.

Scandinavian Airlines flight 686

has crashed and exploded
on takeoff,

but no one yet knows
the true scope of this disaster.

11 tons of jet fuel
feed a massive fire

where a Boeing MD-87
has collided

with an airport building.

Awful, terrible devastation.

The collapse of a roof
of the hangar

and the SAS airplane
completely destroyed

in many different parts,

and unfortunately
the dead bodies.

The rescue people had problems

to enter the cargo building
to rescue victims,

because the airplane
was blocking the entrance.

Some 14 minutes
have passed since the crash.

As emergency crews
battle the fire,

Linate air traffic controllers

frantically try to understand
what just happened.

There are two aircraft
unaccounted for.

Paolo Zacchetti
discovers

a private Cessna citation

did not return
to its parking position

after all planes were grounded.

The main attention
was focused on the SAS airplane,

so nobody thought that
there was another airplane.

A private aircraft
is missing, a Cessna, 5-2-5.

Ground crews search
for the missing plane.

Finally, 26 minutes
after the crash,

they find the Cessna burning
and in pieces

halfway down runway 36-R.

It appears there's been
a collision.

It's hard to believe
that after half an hour

people became aware
about the fact

that the Cessna was
on the main runway.

There is another
aircraft in the accident

near Romeo 6.

Air traffic
controllers are mystified.

How did these two planes
end up on the same runway

at the same time?

What's that?!

Come on.

Two planes are
destroyed; a hangar is in ruins.

The scope of the tragedy
is overwhelming.

It's soon clear that no one
from either plane has survived.

The crash has killed 110 people
on the SAS flight...

And four onboard the Cessna.

Inside the collapsed hangar,
four more people have died--

118 fatalities in all.

This is the most
serious accident

in the history in Italy.

You can't imagine.

I haven't taken it all in.

I heard three explosions--

boom, boom, boom--

and then a huge flame,
a long one.

First there was a crash,

then this hot air
that was inside--

this extremely hot air
that burned my head.

My god.

Mario Pica--

he is the lead investigator

for Italy's National Agency
for Flight Safety, the ANSV,

but he's not in command
of the crash site.

It took me a few hours

to get access to the scene
of the accident.

Unlike most
countries,

Italy treats aviation accidents
as crimes.

The police get priority
at the scene.

After an air crash in Italy,

the criminal investigation
automatically begins

and the police is involved

in analyzing this event.

Pica has a different goal.

It was mandatory to
find out really what happened

and find the reasons

that could help us to avoid it
happening again.

Grazie.

First thing I remember

was to have a look
at the baggage hangar

where the rescue workers
were still busy

taking out pieces of rubble
of the aircraft

and looking for bodies
and possibly survivors.

I decided to go and have a look

at the Cessna that was
still on the runway.

I just sketched the first map
of the position

of the various pieces
of the debris

to reconstruct the dynamics
of impact,

and there were intermingled
pieces from the Cessna

and pieces from the MD-87.

As lead investigator
and a pilot, Pica knows

the most valuable information
in any air disaster

comes from the black boxes.

But the Cessna was not equipped

with either
a cockpit voice recorder

or a flight data recorder.

The absence
of the flight recorders

were really a drawback

because they are very helpful
in any investigation

to precisely define
what happened.

The Swedish
Accident Investigation Board

sends a team to Milan.

It includes technical specialist
Tom Zollner

and lead investigator
Frank Kristensen from SAS.

They will work with Pica
to unravel the accident.

We were called
to be part of the investigation,

as it was a Scandinavian
Airlines plane.

I guess we'll have to wait
for authorization.

We realized
that the investigation in Italy

was different what we learned.

In Italy, they conduct it
as a criminal investigation,

and we as investigators
have to wait.

Damn.

We were not happy about that.

We would like to see
what the planes look like,

how the accident site
looked like.

We were not allowed to be
near the accident site.

The media
worldwide attention

was on the Linate disaster.

The SAS airliner
headed for Copenhagen

slammed into the private jet...

And so what happened
at Linate?

What were the main causes
of this accident?

What were the main
responsibilities for this?

Investigators
soon make a troubling discovery

about Linate airport.

So you're telling me

there have been a lot
of these incidents before?

Air traffic controllers reported
we have an average

of nearly one runway
incursion per week.

It appears
the nine million people

who use this airport every year

have been in danger
for some time.

There had been
other runway incursions.

This was shocking.

Less than a month
before the collision,

a near miss on the same runway.

With an aircraft
entering the runway

while another aircraft
was taking off.

It was really
a big shock for us

that it happened that often
at Linate airport.

Clearly something
is very wrong at Linate.

The morning after the crash,

investigators face national
and international pressure

to figure out what it is.

Meanwhile,
there were prayers

for victims of the crash,

Italy's worst ever
civil aviation disaster.

Finally, the entire
investigative team

is given access
to the crash site.

All of us
were trained investigators

and we knew what we
were going to investigate

and how to do it.

But authorities
have thrown a major obstacle

in their path.

So where's the plane?

The police
have ordered airport workers

to move the debris
off the runway

and away from
the baggage hangar.

We got very angry.

The removal of the debris

actually removed
a lot of valid information,

which we now never could see.

Debris from both planes

has been piled on a concrete
helicopter pad.

Locating flight 686's
voice recorder

will be a huge challenge.

We couldn't find
the cockpit voice recorder.

The importance
to find the CVR

was to check
if the crew realized

the collision was actually
going to take place

and to see how well they were
trying to avoid it.

We can't know
what the crew were doing

without the CVR.

We had to learn about
the possible takeoff clearance

and if there were crew errors.

Did they receive takeoff
clearance or did they not?

Here's what we know so far.

The MD-87.

Measuring the distance,
we are certain

that the MD-87 had traveled
for about 40 seconds

and gone 1,500 meters
before striking the Cessna.

It was clear that the collision
had occurred on the main runway

at the intersection
from a taxiway.

The MD-87 had continued its run,

deviating slightly to the right

until hitting
the baggage hangar.

Here.

Weather reports
show that visibility

was only 164 feet
at the time of the collision.

With the heavy fog
that morning,

it was clear that
environmental factor

was a contributing cause
of the event.

V1, rotate.

Imagine an aircraft traveling

at 72 meters per second.

What reaction time
would they have needed

to avoid the collision?

The SAS pilots
would not have been able

to see the Cessna on the runway

until a split second
before impact.

What's that?!

But fog should
not cripple

a major airport like Linate.

Modern airports use a system of
regulations and safety equipment

when operating
in low visibility.

Airports avoid incursions

by having defined
low visibility operating rules.

These rules can be augmented
by technology, ground radars,

alarm systems and other things.

Airport runways
and taxiways are broken down

into a series of checkpoints
known as stop bars.

Aircraft must always wait for
authorization before passing,

like a car must wait
for a green light.

The system is designed
to keep planes from colliding.

Planes can
avoid each other at night,

so why should it be
any different in fog?

We have to consider this
right off the bat.

One of the first thoughts
that came to mind was...

Pilot error.

...the possibility
of a pilot error.

One of the pilots was
not where he was supposed to be.

Investigators need to know
which one.

The worst air disaster
in history occurred

under eerily similar conditions.

In 1977 on the island of
Tenerife in the Canary Islands,

583 people died
when two Boeing 747s

collided on the runway
in heavy fog.

In comparison
with the Tenerife accident,

they were both in dense fog,

taxiing on the wrong taxiway
was involved.

Communication was also involved,

as the KLM Captain thought
he heard a takeoff clearance,

but he didn't.

Investigators wonder
if the Linate disaster

is a case of history
repeating itself.

They learn that the brand new
Cessna citation jet

had arrived in Milan following
a flight from Germany.

The German crew was now taking
two passengers to Paris.

Since the Cessna
was not equipped

with a cockpit voice recorder

and the CVR from SAS flight 686
has not yet been found,

investigators have only
one record of what happened--

the air traffic control
recordings.

We had to listen
to the facts.

Our expectation was
that the ATC recording

would reveal what actually
was being said that morning.

Investigators
pay close attention

to Paolo Zacchetti's
conversations with the Cessna,

call sign Delta Victor x-ray.

Delta Victor x-ray,
taxi north via Romeo 5.

Call me back at the stop bar
of the main runway extension.

Roger, via Romeo 5.

Call you back before
reaching main runway.

The Cessna
was instructed

to go north from the apron
along taxiway Romeo 5

to a taxiway that runs
parallel to runway 36-R.

The route should have kept
the Cessna off the runway.

But he ended up here instead.

Investigators make
a shocking discovery.

The Cessna went south
from the apron,

not north as instructed.

It now appears the pilots
made the fatal error

that caused the accident.

Call you back
before reaching main runway.

The control tower
recording makes it clear.

The Cessna pilots got lost
on the way to the runway.

The Cessna didn't follow
the taxiway Romeo 5,

which had been authorized,

but took instead
taxiway Romeo 6.

The revelation leads
to an important question.

So why didn't
anyone notice, hmm?

Delta Victor x-ray,

continue the taxi
on the main apron.

Roger. Continue the taxi on main
apron, delta Victor x-ray.

That is correct,

and please call me back
entering the main taxiway.

Main apron? Main taxiway?

The recording reveals
that the air traffic controller

did not clearly distinguish
between aprons and taxiways.

His choice of words may have led
the Cessna pilots

to believe they were headed
the right way.

An apron is a restricted
section of an airport

where planes park,
are loaded or refueled.

Taxiways are roads
from the apron to the runway.

The communication
with the tower and the pilots

that morning of the accident
was inconsistent.

They used the word "main"
For different things--

main runway, main apron,
main taxiway.

And please call me
back entering the main taxiway.

But Linate Airport
has several aprons and taxiways,

none of them designated as main.

That was a communication

below acceptable standards.

Play that again.

Investigators also hear

a puzzling transmission
from the Cessna.

Approaching Sierra 4.

I don't see it anywhere.

It's not here.

Listening to the communications,
I was baffled

when I heard the pilots
reporting a Sierra 4.

The controllers' maps
don't show S-4 at all.

Investigators are beginning
to suspect

the error goes beyond
the poor communications

between Zacchetti
and the Cessna.

Approaching
Sierra 4, Sierra 4 .

I asked him if he knew
where Sierra 4 was.

Where is Sierra 4?

I have no idea.

That was very simple.

He confessed he didn't know
where Sierra 4 was.

Pica finds
that Zacchetti's managers

never gave him a tour
of the taxiways

as part of his training.

Approaching Sierra 4.

Delta Victor x-ray, Roger.

Maintain the stop bar.

I'll call you back.

He had no way
of knowing where Sierra 4 was .

The Cessna now has to cross
the runway to get to the apron.

He keeps going
past several signs

that he's approaching
an active runway.

Air traffic controller
didn't stop the Cessna.

Delta Victor x-ray.

At that moment,

the tower clears the MD-87
for takeoff.

Scandinavian 686,
Linate, cleared for takeoff.

Continue your taxi
on the main apron.

He should have stopped
the Cessna, but unfortunately...

Roger. Continue the taxi
on main apron.

...he thought that
the Cessna was on R5 taxiway.

The Cessna pilot
makes a fatal mistake.

With the MD-87 now traveling
at 163 miles an hour,

he taxis across the runway.

Suspicions about procedures
at Linate airport deepen

as investigators learn

that the exact same mistakes
that led to the deadly collision

were made by another plane
less than 24 hours earlier.

Frank, Frank, come.

Come and look at this.

I was shocked to find out that
only the previous afternoon...

Same thing, 24 hours before.

...an aircraft had been cleared
by the air traffic controller

to taxi onto Romeo 5.

24 hour. It happens here
all the time.

The aircraft taxied really
onto Romeo 6.

Because there was
no fog that day,

the two planes saw each other
and did not collide.

Investigators
are beginning to suspect

that something about
the airport, not bad pilots,

may be the cause
of the Linate crash

and the frequent
runway incursions there.

When we found out
that the Cessna pilot

had taken the wrong taxiway,

first question was to explain
what did he see

that brought him
so much off course.

Okay, this is
where they started.

The taxiway
we went on was Romeo 6,

and we walked the whole length
of the taxiway.

We wanted to put ourselves in
the shoes of the pilot

to understand his actions.

They look
for route identification signs

that are supposed to help
guide the pilots.

The status
of those markings

were in very poor condition,
was surrounded by high grass,

and there was only a very few
of those markings.

The markings painted
directly onto the tarmac

are also vital for pilots.

When we came
to the intersection

between Romeo 5 and Romeo 6,

we could see that the markings
on the ground

were so badly painted

that even in good visibility
it was difficult to read them...

Which made us understand

that for a pilot not familiar
with the place

it would have been difficult
to understand

where was Romeo 5,
where was Romeo 6.

The faded markings
help explain

why the Cessna turned right

when it should have turned left
to avoid the runway.

They also come upon the reason
the Cessna pilot

referred to the unknown position
Sierra 4.

Approaching Sierra 4.

There's Sierra 4,
but it's not on the map.

Actually Sierra 4 was the
marking on the Romeo 6 taxiway

going towards the runway

but were not reported
on any official map.

Approaching Sierra 4.

Delta Victor x-ray, Roger.

Had the controller
known where Sierra 4 was,

he would have realized

the Cessna was approaching
the wrong runway

heading in the wrong direction.

But inadequate
markings and maps

still don't explain
the collision.

Linate, like all
modern airports,

is equipped with
motion sensor alarms

to guard against
runway incursion.

Even with the
failures of all other systems,

the acoustic alarm
should have worked,

and we wondered why
it didn't work.

Reading the ATC
communication recordings,

we couldn't find
any alarm going on

when the Cessna aircraft
crossed the stop bars

and entered the runway.

Pica decides to test

the runway incursion sensors
himself.

I was told that possibly
they didn't work,

but we wanted to be certain.

Okay, commencing test
of the motion sensor alarm

on taxiway Romeo 6.

So one night when
the airport was closed,

we made an experiment
going over and over

through the sensors,

but we had a man on the tower

just to make sure
that the alarm didn't go.

Anything?

No, nothing.

Again.

Eventually, we found out

that those alarms had been
deactivated years before

to avoid unnecessary alarms

that were triggered eventually
by an animal crossing

or a car doing an inspection
during the night.

One week
after the accident,

investigators
still have not located

the cockpit voice recorder
amid the aircraft wreckage.

Finding the CVR was crucial

in order to establish that there
was no problems prior to impact.

So I decided to search

through this giant pile
of rubble and,

and concrete and steel,

and eventually we did
find the CVR.

The CVR of the MD-87
was carefully analyzed

to find out what
had been said onboard,

what kind of procedures
had been done.

Scandinavian 686,
Linate.

Cleared for takeoff, 3-6.

The recording shows
that the SAS crew

did receive the proper clearance
to proceed down runway 36-R.

Cleared for takeoff, 3-6 set.

The SAS crew played
no role in causing the accident.

They were the victims
of the airport's failings.

The investigation
has identified one final factor

that underlies how dangerous
conditions at Linate had become.

No. There is no
ground radar at Linate.

We have not had it in years.

The ground radar
at Linate,

the old one was dismantled.

The new one was in boxes.

It had been there for years
and not yet installed.

Why? I don't know.

Airport ground radar systems

detect movement of all aircraft
and vehicles,

a vital piece of safety
equipment at a busy airport.

If you have
ground radar,

it's a good tool to establish
what's going on in the airport,

even in low visibility
conditions.

We can certainly say

that if the ground movement
control radar had been in place,

the ground controller would have
had the opportunity

to see the aircraft
crossing the stop bars

and possibly then would have
stopped the aircraft

before the collision happened.

Delta Victor x-ray,
confirm your position.

The Cessna
took the wrong path

due to flawed taxiway markings.

Without ground radar,

controllers couldn't
properly monitor

the movement of the Cessna.

Add fog into the mix,
and disaster was inevitable.

When the Cessna
and the SAS aircraft

started moving,
they were both doomed.

The accident was now inevitable.

Scandinavian 686, Linate.

Cleared for takeoff, 3-6.

Delta Victor x-ray,
continue taxi on the main apron.

And we are rolling,
Scandinavian 686.

Roger. Continue to taxi
on main apron.

V1, rotate.

What's that?!

The cockpit voice recorder

gives investigators
a detailed picture

of what happened
at the moment of impact.

Noises in the cockpit

will also tell us
a different control's been moved

and the ambient noise
from the area mic

will give us information

on some of the sounds
during the collision.

What's that?!

We realized that the impact

was more than one collision.

It was actually several
collisions in half a second.

When that
half-second of audio

is analyzed more closely,

investigators discover
it contains

several distinct sounds.

So we exposed this data
over a schematic of the aircraft

showing the travel of the sound.

By doing that, we could analyze

that we have several points
of impact during the collision.

The painstaking research

gives investigators
a better understanding

of how the two planes
came together on the runway.

The MD-87
first hit the Cessna

with its nose landing gear
at the Cessna's stabilizer

and then in a short order
of time

the left hand main landing gear
of the MD-87

hit the outer part of the
right hand wing of the Cessna,

and then the biggest impact was

the right hand main landing gear
of the MD-87

cutting through the cabin
of the Cessna.

Investigators
conclude the MD-87

lost its right engine
after the impact.

The plane would have been
almost impossible to fly.

But remarkably, the pilots
almost managed to do just that.

Come on, come on.

After the collision,

the MD-87 did actually get
into the air.

According to
the flight data recorder,

the aircraft was airborne
almost nine seconds.

The Captain made
a heroic attempt

to fly the airplane.

Come on, come on, come on.

He tried to
accelerate the left hand engine

and use it...

But it had ingested
too much debris.

And the pilot did
an amazing work

trying to control it.

Up to the last minute
he tried to avoid impact.

The pilots could not
have done anything

to avoid this accident

because the aircraft
was traveling too fast.

Such a big aircraft
cannot respond on a dime.

It's impossible.

I believe that both crew
and both airplanes

think they did everything right,

right until the moment
of impact.

It's now clear that
a badly flawed control system

at the airport
led directly to the crash.

What's more,
it's beginning to look

like organizational failures

may also have prevented rescue
personnel from saving lives.

Grazie.

How long was it before
the general alarm was sounded?

The investigation
begins to uncover evidence

of how failures
at Linate airport

made for a bad situation...

Please call me back
entering the main taxiway.

...even worse .

Hello, this is tower.

The wreckage of the Cessna
was found

only about 25 minutes
after the accident,

and by the time the fire brigade
arrived on the scene,

all the occupants were dead.

Post mortem exams
confirm

that three people in the Cessna

had high concentrations
of smoke in their lungs.

They were still alive
after being hit by the MD-87.

They were burned alive.

After the collision,

the Cessna burned
for more than 20 minutes.

If the rescue
to the Cessna

had arrived earlier,

certainly the two pilots would
have survived the accident.

After more
than six months

of painstaking investigation,

Mario Pica delivers
his findings.

Though runway incursion
by the Cessna

is listed as the immediate cause
of the accident,

Pica does not entirely blame
the Cessna pilot.

Instead, he points
to the lack of proper signage

and taxiway markings at Linate,

as well as to the airport's
failings overall.

A fairly simple
airport like Linate,

with only one main runway,

it should be easy to cover this
with the signs

and with paintings and so forth,

but apparently everything
which could go wrong

did go wrong at that airport.

Delta Victor x-ray,
taxi north via Romeo 5.

Call me back at the stop bar
of the main runway extension.

And for some
of the people involved,

the fallout is especially harsh.

Ground controller
Paolo Zacchetti,

along with high-ranking
officials from the agencies,

which oversee Linate,
are handed prison sentences.

The judgment sparked
intense debate.

Should human error
in air accidents

be considered a criminal act?

I define the ground controller

as the 119th victim of the case.

I didn't have the equipment

that could have made me aware
of what was happening.

Delta Victor x-ray, continue
taxi on the main apron.

Roger.

Yes, it is true,
he did make a mistake,

but it is the result
of a system that failed.

Because of the tragedy,

Linate airport underwent
a major overhaul

designed to improve safety.

Linate improved
the airport

by installing the ground radar.

Some of the markings and signage
was repainted.

The runway incursion
alarms are functioning now.

Alitalia, 212,
hold your position.

You are crossing
an active runway.

Repeat, hold your position,
Alitalia 212.

The big lesson learned
in this accident, in my opinion,

is that people are prone
to get used to failures.

There is no ground
radar at Linate.

Accepting latent conditions,

getting used to a system
that doesn't work

and by time actually getting
the whole system

more and more dangerous.

An airport
is a highly complicated place.

There's vehicles,
there's airplanes,

baggage lorries, cargo lorries,

all sorts of activities
going around at the same time.

There has to be a very high
level of safety in an airport.

The reforms ushered
in following

the collision on 36-R

have made runway collisions
far less likely

and made Linate
a much safer airport.

So you're practically
in front of the tower, right?

Call me back at the stop bar.

Alitalia 226,
cleared for takeoff, 3-6.