A bomb exploded in the Las Palmas passenger terminal. Warned of a possible second bomb, the airport management closed the airport. Many flights were diverted to Tenerife overwhelming the limited facilities. For example, the airport lounge was full so that some aircraft were not able to disembark pax. When pax did embark this took time resulting blockages on the runways and taxiways. Communication failures caused the KLM captain to think that he had clearance to takeoff and did so while a PanAm aircraft was still on the runway. When the aircraft came in sight of each other the KLM aircraft attempted to take off and the PanAm aircraft tried to leave the runway. Neither attempt was successful and the aircraft collided. 583 people died.

Dorothy Kelly’s story – Angels in the sky   –  Highly recommended reading

How and Why did so many people die? That is the question the student must answer. Compare this case to the of the Sioux City crash (Case 306) where the airport was prepared for the crash and good fortune favoured them.

Learning objectives

To expose students to actual operational problems in airside emergency situation, and to illustrate both the application and the potential benefits of using Risk analysis, Failure analysis, and Brainstorming in problem-solving.

Pedagogical Objectives

The teaching plan consists of three phases organized around student research (phase 1) and a set of discussion questions to develop each of the emergency responses (phase 2) in the case. After the actual emergency actions are presented to students, they should be encouraged to review their proposed countermeasures to the airframe damage and the injuries sustained by the passengers and flight crew (phase 3.) Reports of the failure (available online) and in our, or any aircraft library can be used to make the case more interesting. See under the References heading.


Emergency management, ground handling, standard operating procedures, problem-solving and risk analysis, communications, safety.

Target audience    Anyone with an operational or academic interest in problem solving or failure analysis in Air Transport.

Study time        3 hours – 2+ hours research, 1-hour class.

Level    Industry staff or, academically, when emergency management and risk appear in the study curriculum.

Prior knowledge    Failure Modes and Effects analysis – not absolutely necessary.

Aim    To illustrate the importance of following standard ground handling emergency procedures.

Length            5 pages including the solution.

Published by        Air Transport Research Institute. 24 February 2019

Data source/s        Published sources

Similar cases        074, 076, 209, 306



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