9/11
Exploring the limits of organization
The highjacking
• Four long range domestic flights
– American Airlines Flight 11 – Boston to LA
– United Airlines Flight 175 – Boston to LA
– American Airlines Flight 77 – Washingt. to LA
– United Airlines Flight 93 – Newark to SF
• 4 – 5 persons, prior flight training
• Take control using knives, teargas, threats
• Turn of tracking device - transponder
The defense system
• Air control:
– Federal Aviation Administration (FAA)
• Military Air Defense:
– North American Aerospace Defense
Command (NORAD)
• The President / Government
Federal Aviation Administration FAA
• Responsible for regulating safety and
security of civil aviation
• Primary task: maintaining a safe distance
between airborne aircraft
Federal Aviation Administration FAA
• 22 Control Centers –
regions
– Receive information
and make operational
decisions
independently
• 1 Command Center –
national control
– Operations Center
North American Aerospace Defense Command
(NORAD)
• Responsible for defending the airspace in
North America and protecting the continent
• After cold war: new role
• Some exercise on terror attacks but never
on domestic aircraft and not as guided
missiles
North American Aerospace Defense Command
(NORAD)
• 7 alert sites with 2 fighter aircraft on alert
• 3 sectors
• On 9/11 all aircraft were in Northeast Air
Defense Sector (NEADS)
• NEADS reports to CONR, CONR to
NORAD
• 2 alert sites relevant
– Otis Air National Guard Base in Cape Cod
– Langly Air Force Base in Hampton Virginia
National Guard troops stationed at NORAD's
Northeast Air Defense Sector (NEADS) in Rome, New York.
Interagency Collaboration
• Hijack protocol FAA and NORAD
– Pilots notify controller
– Controller notify supervisors
– Supervisors inform Control Center
management
– Manager inform FAA headquarters in
Washington
– Hijack coordinator: director of FAA Office of
Civil Aviation Security
Interagency Collaboration
• Hijack protocol FAA and NORAD
– FAA Highjack coordinator contacts Pentagon
to ask for military escort aircraft
– Pentagon seek approval from Secretary of
Defense
– If approved orders transmitted down
NORADS chain of command
– Pentagon help FAA coordinate with military
Interagency Collaboration
• Hijack protocol FAA and NORAD
– Did not have instructions for interception
– Fighter aircraft mission: “vectored to a
position five miles directly behind the hijacked
aircraft”
Interagency Collaboration
• Protocol assumptions:
– Hijacked aircraft readily identifiable and
would not disappear
– Time to address the problem through proper
chains of command
– The hijacking would aim at landing the aircraft
and placing demands
Interagency Collaboration
• On the morning of 9/11, the existing
protocol was unsuited in every respect for
what was about to happen.
Flight controller Matt McCluskey stands in the
Boston tower where the Flight 11 hijack was first detected
American Airlines Flight 11
• Chain of command not followed
• FAA did not contact NORAD through chain
of command
• Lack of information coordination between
FAA and military
United Airlines Flight 175
• Unnoticed disappearance because of AA
11
• No military notification
American Airlines Flight 77
•
•
•
•
First thought to have crashed
Disappeared
Was then found by Dulles Control Center
FAA never reported to the military before
crash
• FAA did not ask for military assistance
Confusion arises
• At 9:21 FAA misinforms NEADS (NORAD)
about the number of aircraft
• NEADS acts on the confusion that
American 11 was still airborne and
heading towards Washington
• NEADS scrambles Langley to intercept
this “phantom aircraft”
Confusion arises
Confusion arises
Confusion arises
• 9: 34 NEADS contacts FAA to find out
about American 11 (had crashed 8:46)
• Learns about American 77
Confusion arises
Confusion arises
• FAA Boston Center guessed that Delta
1989 might be hijacked and heading south
• NEADS orderd figher aircraft from Ohio
and Michigan to intercept
United Airlines Flight 93
• Chain of command followed fast from
Cleveland Center through FAA
headquarters (2 min.)
• FAA had established and open line
between centers and the Command
Center
• However, FAA did not seek military
assistance
• NEADS informed after crash
United Airlines Flight 93
United Airlines Flight 93
National leadership
• President away
• No serious attention before United 175 hit
2 WTC
• FAA and Department of Defense
teleconference. No impact.
• White House video teleconference
including CIA, FBI, DoS, Justice, Defense,
FAA, White House Shelter.
National leadership
• National Military Command Center
(NMCC)
• Establish the chain of command from
National Command Authority (President
and secretary of Defense) and those
executing orders.
• Problematic teleconferences between top
agencies.
National leadership
• No success in coordinating information
and decisions between the top level
organizations
– FAA
– NORAD
– NMCC
– National Command Authority
• Direct contacts between Secret Service
and FAA
Vice President Cheney pointing a finger inside the
Presidential Emergency Operations Center. Footage of the
World Trade Center plays on the televisions in the background
(exact time is unknown).
The shoot down order
• Unclear when the order was given from
the Vice President from the White House
shelter.
• Confusion within NORAD on the nature of
the order
• Orders not passed on to the operational
level – the pilots.
The Andrews fighters
• Through direct contact between Secret
Service agents and the commander of the
113th Wing fighters were launched from
Andrews Air Force Base at 10:38
• Orders: weapons free
• Scrambled outside military chain of
command.
• Not known by President and Vice
President.
• “The details of what happened on the morning of
September 11 are complex, but they play out a
simple theme. NORAD and FAA were
unprepared for the type of attacks launched
against the United States on September 11,
2001. They struggled, under difficult
circumstances, to improvise a homeland
defense against an unprecedented challenge
they had never before encountered and had
never trained to meet.”
What is this a case of?
• The weakness of established routines in
unexpected circumstances
• How human mistakes creates chains of
interdependent failure
• The problems of coordinating between
large organizations that rarely operate
together on a daily basis
• The impact of an extremely tight schedule