Flashcards in Human Factors Deck (74)
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1
What was in 1920
Dawn of air travel
Rapid development of aircraft = faster, further and more passengers
2
What happened in 1940
Standardisation of ergonomics
Design
Layout of controls
Layout of indicators
Comfort
Ease of use
3
Why are statistics important
To identify trends
4
What is in the 5 M model
Man
Machine
Mission
Management
Medium (operational environment)
5
What % of accidents are due to human error
70%
6
Top 3 causes of accidents in order
1) loss of control in flight (LOC-I)
2) controlled flight into terrain (CFIT)
3) runway excursion - leaving runway
7
What is the biggest reason for the reduction in Hull loss
Gpws- ground proximity warning
8
What does training giving you
Knowledge
Skill
Ability
9
Before training how many mistakes do you make
1 in ever 100 times doing something
10
How many mistakes do you make after training
1 mistake in ever 1000 times doing something
11
How does mcc differ from crm
Mcc focuses on inside the cockpit
Whereas crm is everyone involved in ensuring the aircrafts safety
12
What is the James Reason error chain
Swiss cheese model
13
What is the Swiss cheese model
Swiss cheese has holes
The holes represent errors/ threats / undesired states
If go through all holes = accident
If you hit the cheese = no accident
14
What are the 5 eliminate for a good safety culture
1) informed culture = sharing knowledge
2) reporting culture = people feel able to report their errors
3) flexible culture = able to be flexible
4) learning culture = constantly learning
5) just culture = people encouraged tor providing safety related info
Clear line between acceptable and unacceptable behaviour
National culture can also affect safety culture (eg French speaking French)
15
What is the average accident rate
Accident = resulting in injury or fatality
1.2 / million flights
16
What % of accidents are caused by human error
70-80%
17
What is the most common cause of pilot induced error
Loss of directional control
18
What is the most common form of loss of directional control which results in an accident
Controlled flight into terrain
19
What are the icao competency’s
Knowledge
Skill
Attitude
20
Is it possible to stop humans making errors
Nope
21
What are the 3 basic components of TEM (threat error management)
Avoid threats
Avoid errors
Avoid undesired aircraft states
22
What is a threat
External factor that cannot be influenced by the crew
23
What is a latent threat
A threat that is dormant in the system
Eg a wrongly inputted waypoint but a engineer
Luls you into False sense of security
24
What are some environmental threats
Weather
Atc
Airport
Terrain
Other = similar call signs
25
What are some organisational threats
Operational pressure
Aircraft (poor design)
Cabin
Maintenance
Ground
Dispatch
Crew scheduling error
26
What is a error
Influenced by the crew
27
What are some procedural errors
SOPS
Checklists
Callouts
Briefings
Documentation
28
What are some aircraft handling errors
Manual handling / flight control
Automation
Systems / radios / instruments
Ground nav
29
What are some communication errors
Crew to external
Pilot to pilot
30
What are some undesired aircraft state
Aircraft handling: vertical/ lateral / speed deviations / unstable approach
Ground nav: wrong taxiway etc
Incorrect aircraft configuration: wrong mass and balance / engines / flaps / automation
31
What are the error management strategies (long versions)
Error prevention:
Avoiding all threats / errors
Error reduction:
Minimising likelihood / magnitude of any errors
Error detection:
Making any errors appear as fast as possible = enabling recovery quicker
Error recovery
Error tolerance:
System to be tolerant to errors
32
Error management strategies (short)
Avoid > trap > mitigate
33
What are the 3 categories of individual and team countermeasures
Planning countermeasure
Execution countermeasure
Review countermeasure
34
What is an omission
Missing something out
35
What is a violation
Purposely not doing something properly / missing it out
36
What is a routine violation
Developed from an exceptional violation
Can lead to change in SOP
37
What is an exceptional violation
Can lead to routine violation
BUT
May be one off and can result in a disaster
38
What is an example of a active error
Takeoff over rotate = tail strike
39
What is a active threat / error
Happening at that moment = Immediate consequence
Usually occurs at the human machine interface
40
What is Murphy’s law
If anything can go wrong it will
If a system can be operated incorrectly sooner or later it will be
41
What is the different parts of internal error generation
Sensing errors:
To react from error we must first detect it
Representing errors:
Perception can cause many errors / illusions
Action slips
Faults / mistakes
Decision making:
False hypothesis = confirmation bias
Motivation
Arousal / stress levels
Distractions
42
What are the two forms of distraction
Channelised attention / distraction:
Concentrate so much on getting right pitch = miss turning point (fixation)
Dispersed attention:
Concentrating on so many things forget to put gear down
43
What is external error generation
SHELL
S= software (procedures, symbology)
H = hardware (machine)
E= environment
L= liveware (human)
44
SHELL model what is: liveware to liveware
How you work and interact with other liveware (people)
Mcc crm
45
SHELL model what is: liveware to hardware
How you work with a physical aspect of the system
Eg bells / warnings
If you don’t know what the bells / warnings mean = L>H error
3 point altimeter = difficult to use
46
How much more difficult to use is the 3 point altimeter
3 times harder to read
47
How much do errors increase by using a 3 point altimeter
20%
48
SHELL model what is: liveware to software
Non physical aspect of the system
SOP etc
Manuals / checklists = software
Procedures / training
Mode error = not knowing what mode the aircraft is in
49
SHELL model what is: liveware to environmental
Too hot / noisy / humidity etc
Terrain / weather etc
Fuel policy / rostering (organisational policy) jet lag
50
What is a reversible error
One that can be cleared (deleting words off a page)
51
What are different types of error prevention
Computer = won’t let u retract wheels if still on ground
Cross monitoring = flight deck monitor each other (and yourself)
Machine monitoring = machine monitors what we are doing
52
What is decision making
Evaluating options
Step by step scientific process
= picking solution from possible options
53
What does good decision making process depend on
Subjective / objective criteria
Aim to be achieved
Risks associated with each solution
Personality of the decision maker (stable personality = best personality for good decisions)
Bias
Perception / situational awareness
Stress / emotions
Training
Motivation
Commercial factors
54
What positive factors are there for humans making decisions
Creativity
Innovative
Can cope with novel situations
If have correct skill can solve problems / make quick decisions
55
What are he mechanics of decision making
1) diagnose + design objective
2) collect info
3) risk assessment
4) develop options
5) evaluate
6) decide
7) assign
8) implement decision
9) consequences
10) review / feedback
56
What errors is decision making prone to
Confirmation bias
Expectancy
Saliency (how obvious info is)
Over confidence / complacency
Fatigue / overload
Denial
57
What are the limitations for decision making
Attention
Stress
Lack of experience
58
Judgement / risk assessment / decision making in the air is based on the:
Pilot
Aircraft
Environmental conditions
Time available
59
What is commitment
When no other changes can be made = point of no return
60
How does the eye datum point in the cockpit help
Makes sure you’re in the best position
If eye below point = flatter approach / undershoot
61
Cockpit seat design is made so that they are
Comfy
Good lumber support (evenly distribute pressure in disks in spine
Suspension to absorb vibrations / can protect from heavy G forces
5 point seat belt = protect against G forces
Stood you from submarining (slouching)
Designed around anthropometric data (average persons body dimensions)
62
What is the different between analogue and digital
Digital = quantitive info (numbers)
Analogue = qualitative (gauge)
63
What must controls and instruments be
Standardised
64
What is the difference between primary and secondary engine instruments
Primary:
Larger / usually on the left = more important info
Secondary = normally on right of screen / smaller not essential info
65
What must cockpit lighting do
Should avoid harsh shadows and glare
66
What must warnings and cautions be
Attention getting but not startling
Audio best for getting attention
Visual more informative / precise
67
What are the advantages of automation
Reduces workload
More accurate
Reduces errors
Reliable
Will fly it smoother / do better landings
Reduce flight deck size (increased profits)
68
What are the automation disadvantages
Become more complacent (automation complacency)
Reduced monitoring (passive monitoring)
Reduces situational awareness “out of the loop”
Bored = experimentation “oh what does that button do”
Blinkered concentration (fixation)
Confusion automation “what’s the plane doing Now”
Older pilots miss trust automation
Manual skills deteriorate (can be a result of complacency)
Communication can break down
Automation can reduce communication
Difficult to change plans
69
How to adapt to automation
Treat automation as another crew member
Always keep ontop of automation
70
What is the irony of automation
Thay pilots are to oversee an automated system which they do poorly
71
What is bainbridges irony
The more reliable the system, the less human operators have to do, so the less attention they pay to the system while it’s operating
Automation has acted to lower pilots workload for flight phases in which it was already low and increase workload for phases in which it was already high
72
What are design induced errors
All future EASA design efforts especially avionics / automation will be based upon :
detectability
Recoverability
Tolerability
73
What are the 2 types of error systems
Tolerant / protected system:
If one error occurs the rest of the flight is protected
Vulnerable / unprotected system:
1 error can jeopardise the whole flight and cause other system to fail
74