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United Airlines Flight 232 was a regularly scheduled United Airlines flight from Stapleton International Airport in Denver to O'Hare International Airport in Chicago, continuing to Philadelphia International Airport. On July 19, 1989, the DC-10 serving the flight crash-landed at Sioux City, Iowa, after suffering a catastrophic failure of its tail-mounted engine due to an unnoticed manufacturing defect in the engine's fan disk, which led to the loss of many flight controls. Of the 296 passengers and crew on board, 112 died during the accident, while 184 people survived. Despite the deaths, the accident is considered a prime example of successful crew resource management because of the large number of survivors and the manner in which the flight crew handled the emergency and landed the airplane without conventional control. It is also the deadliest accident in the history of United Airlines.
In aviation, a controlled flight into terrain is an accident in which an airworthy aircraft, under pilot control, is unintentionally flown into the ground, a mountain, a body of water or an obstacle. In a typical CFIT scenario, the crew is unaware of the impending disaster until it is too late. The term was coined by engineers at Boeing in the late 1970s.
Aviation safety is the study and practice of managing risks in aviation. This includes preventing aviation accidents and incidents through research, educating air travel personnel, passengers and the general public, as well as the design of aircraft and aviation infrastructure. The aviation industry is subject to significant regulation and oversight.
Crew resource management or cockpit resource management (CRM) is a set of training procedures for use in environments where human error can have devastating effects. CRM is primarily used for improving aviation safety and focuses on interpersonal communication, leadership, and decision making in aircraft cockpits. Its founder is David Beaty, a former Royal Air Force and a BOAC pilot who wrote "The Human Factor in Aircraft Accidents" (1969). Despite the considerable development of electronic aids since then, many principles he developed continue to prove effective.
Pilot error generally refers to an accident in which an action or decision made by the pilot was the cause or a contributing factor that led to the accident, but also includes the pilot's failure to make a correct decision or take proper action. Errors are intentional actions that fail to achieve their intended outcomes. Chicago Convention defines accident as "An occurrence associated with the operation of an aircraft [...] in which [...] a person is fatally or seriously injured [...] except when the injuries are [...] inflicted by other persons." Hence the definition of the "pilot error" does not include deliberate crash.
United Airlines Flight 173 was a scheduled flight from John F. Kennedy International Airport in New York City to Portland International Airport in Portland, Oregon, with a scheduled stop in Denver, Colorado. On December 28, 1978, the aircraft flying this route ran out of fuel while troubleshooting a landing gear problem and crashed in a suburban Portland neighborhood near NE 157th Avenue and East Burnside Street, killing 10 on board.
Airmanship is skill and knowledge applied to aerial navigation, similar to seamanship in maritime navigation. Airmanship covers a broad range of desirable behaviors and abilities in an aviator. It is not simply a measure of skill or technique, but also a measure of a pilot’s awareness of the aircraft, the environment in which it operates, and of his\her own capabilities.
A runway incursion is an aviation incident involving improper positioning of vehicles or people on any airport runway or its protected area. When an incursion involves an active runway being used by arriving or departing aircraft, the potential for a collision hazard or Instrument Landing System (ILS) interference can exist. At present, various runway safety technologies and processes are commonly employed to reduce the risk and potential consequences of such an event.
The safety of emergency medical services flights has become a topic of public interest in the United States, with the expansion of emergency medical services aviation operations, such as air ambulance and MEDEVAC, and the increasing frequency of related accidents.
Maintenance resource management (MRM) training is an aircraft maintenance variant on crew resource management (CRM). Although the term MRM was used for several years following CRM's introduction, the first governmental guidance for standardized MRM training and its team-based safety approach, appeared when the FAA (U.S.) issued Advisory Circular 120-72, Maintenance Resource Management Training in September, 2000.
Flying Tiger Line Flight 66 was a scheduled international cargo flight from Singapore Changi Airport, to Hong Kong's Kai Tak Airport via a stopover at Kuala Lumpur International Airport, Malaysia. On February 19, 1989, the FedEx-owned Boeing 747-249F-SCD crashed while on its final approach. The aircraft impacted a hillside 437 feet (133 m) above sea level and 12 kilometres from Kuala Lumpur, resulting in all four crew members being killed.
Maritime resource management (MRM) or bridge resource management (BRM) is a set of human factors and soft skills training aimed at the maritime industry. The MRM training programme was launched in 1993 – at that time under the name bridge resource management – and aims at preventing accidents at sea caused by human error.
Northwest Airlines Flight 188 was a regularly scheduled flight from San Diego, California, to Minneapolis/St. Paul, Minnesota, on October 21, 2009, which landed over one hour late in Minneapolis after overshooting its destination by more than 150 miles (240 km) because of pilot error. As a result of the incident, the Federal Aviation Administration (FAA) revoked the pilot certificates of the involved pilots and the National Transportation Safety Board (NTSB) issued recommendations for changes to air traffic control procedures and the rules for cockpit crew. The incident also caused American lawmakers to move to prevent pilots on U.S. airliners from using personal electronic devices while taxiing or flying. In 2013, changes to flight deck automation were suggested, and prototype designs that could mitigate errors leading to similar incidents were described.
In aviation safety, threat and error management (TEM) is an overarching safety management approach that assumes that pilots will naturally make mistakes and encounter risky situations during flight operations. Rather than try to avoid these threats and errors, its primary focus is on teaching pilots to manage these issues so they do not impair safety. Its goal is to maintain safety margins by training pilots and flight crews to detect and respond to events that are likely to cause damage (threats) as well as mistakes that are most likely to be made (errors) during flight operations.
Pilot decision making, also known as aeronautical decision making (ADM), is a process that aviators perform to effectively handle troublesome situations that are encountered. Pilot decision-making is applied in almost every stage of the flight as it considers weather, air spaces, airport conditions, ETA and so forth. During the flight, employers pressure pilots regarding time and fuel restrictions since a pilots’ performance directly affects the company’s revenue and brand image. This pressure often hinders a pilot's decision-making process leading to dangerous situations as 50% to 90% of aviation accidents are the result of pilot error.
Culture can affect aviation safety through its effect on how the flight crew deals with difficult situations; cultures with lower power distances and higher levels of individuality can result in better aviation safety outcomes. In higher power cultures subordinates are less likely to question their superiors. The crash of Korean Air Flight 801 in 1997 was attributed to the pilot's decision to land despite the junior officer's disagreement, while the crash of Avianca Flight 52 was caused by the failure to communicate critical low-fuel data between pilots and controllers, and by the failure of the controllers to ask the pilots if they were declaring an emergency and assist the pilots in landing the aircraft. The crashes have been blamed on aspects of the national cultures of the crews.
The International Civil Aviation Organization (ICAO) defines fatigue as "A physiological state of reduced mental or physical performance capability resulting from sleep loss or extended wakefulness, circadian phase, or workload." The phenomenon places great risk on the crew and passengers of an airplane because it significantly increases the chance of pilot error. Fatigue is particularly prevalent among pilots because of "unpredictable work hours, long duty periods, circadian disruption, and insufficient sleep". These factors can occur together to produce a combination of sleep deprivation, circadian rhythm effects, and 'time-on task' fatigue. Regulators attempt to mitigate fatigue by limiting the number of hours pilots are allowed to fly over varying periods of time.
Stress in the aviation industry is a common phenomenon composed of three sources: physiological stressors, psychological stressors, and environmental stressors. Professional pilots can experience stress in flight, on the ground during work-related activities, and during personal time because of the influence of their occupation. An airline pilot can be an extremely stressful job due to the workload, responsibilities and safety of the thousands of passengers they transport around the world. Chronic levels of stress can negatively impact one's health, job performance and cognitive functioning. Being exposed to stress does not always negatively influence humans because it can motivate people to improve and help them adapt to a new environment. Unfortunate accidents start to occur when a pilot is under excessive stress, as it dramatically affects his or her physical, emotional, and mental conditions. Stress "jeopardizes decision-making relevance and cognitive functioning" and it is a prominent cause of pilot error. Being a pilot is considered a unique job that requires managing high workloads and good psychological and physical health. Unlike the other professional jobs, pilots are considered to be highly affected by stress levels. One study states that 70% of surgeons agreed that stress and fatigue don't impact their performance level, while only 26% of pilots denied that stress influences their performance. Pilots themselves realize how powerful stress can be, and yet many accidents and incidents continues to occur and have occurred, such as Asiana Airlines Flight 214, American Airlines Flight 1420, and Polish Air Force Tu-154.
NOTECHS is a system used to assess the non-technical skills of crew members in the aviation industry. Introduced in the late 1990s, the system has been widely used by airlines during crew selection process, picking out individuals who possess capable skills that are not directly related to aircraft controls or systems. In aviation, 70 percent of all accidents are induced from pilot error, lack of communication and decision making being two contributing factors to these accidents. NOTECHS assesses and provides feedback on the performance of pilots' social and cognitive skills to help minimize pilot error and enhance safety in the future. The NOTECHS system also aims to improve the Crew Resource Management training system.
Atlas Air Flight 3591 was a scheduled domestic cargo flight operating for Amazon Air between Miami International Airport and George Bush Intercontinental Airport in Houston. On February 23, 2019, the Boeing 767-375ER(BCF) used for this flight crashed into Trinity Bay during approach into Houston, killing the two crew members and single passenger on board. The accident occurred near Anahuac, Texas, east of Houston, shortly before 12:45 CST (18:45 UTC). This was the first fatal crash of a Boeing 767 freighter.
References
- ↑ "Risk Management Handbook" (PDF). FAA. 2016. Retrieved 2020-09-10.
- 1 2 "NBAA Training Guidelines for Single Pilot Operations of Very Light Jets and Technically Advanced Aircraft". National Business Aviation Association. 2005. Retrieved 2008-12-10.
- ↑ Kane, Robert (2002). Air Transportation (14th ed.). Kendall/Hunt Publishing Company. p. 751. ISBN 0-7872-8881-0.
- ↑ "Accidents, fatalities, and rates". NTSB . Retrieved 2008-10-25.
- ↑ Wiegmann, D. A.; S. A. Shappell (2001). "A Human Error Analysis of Commercial Aviation Accidents Using the Human Factors Analysis and Classification System (HFACS)" (PDF). Federal Aviation Administration. Archived from the original (PDF) on 2008-10-21. Retrieved 2008-10-25.
- ↑ "General aviation accidents involving visual flight rules flight into instrument meteorological conditions" (PDF). NTSB. 1989. Retrieved 2008-10-28.
- ↑ "Single-Pilot Crew Resource Management" (PDF). FAA. 2015. Retrieved 2020-09-10.
- ↑ Kearns, S. K. (2007). "The effectiveness of guided mental practice in a computer-based single pilot resource management training program".
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