Originally Posted by
NoelEvans
Agreed.
Agreed, we should not "cover it up". But refusing to accept that fatigue could have played a part is a "cover up" on its own!! Fatigue is not an "excuse", if it is a factor it is a reason.
Refusing to accept that fatigue is a possible cause of bad mistakes will simply result in these sort of bad mistakes repeating themselves over and over again.
That pilot did not want to make that bad mistake. So what caused that bad mistake.
Have any of you sat in the right seat of a turbo-prop training a new captain towards the end of a run of tiring (early!) duties? Both of you are in seats that are unfamiliar to you. That had been a very short sector so a very high workload. Add fatigue onto that 'pile' of problems and you run the risk of exactly this sort of disaster. To deny that fatigue can be a very significant factor is a refusal to look at reality.
This report has not sufficiently considered this problem.
What a fatigued brain can do during high stress.
There are fatigued pilots flying every day(or night).
But if a fatigued pilot looks before activating a lever, they are unlikely to do what happened on this ATR. Meanwhile, a non-fatigued pilot activating without looking is quite likely to create a problem. Yes, the flap lever and the condition levers are quite different on the ATR but the flap lever and the gust lock lever on the HS-748 are quite different as well, yet I pulled on the gust lock lever once instead of flaps(fortunately, it has to be pulled straight initially instead of aft). Grabbing and pulling quickly without confirming can cause major issues.
Sometimes, I suspect the people wanting a better schedule like to blame fatigue. I mean seriously.....we are told that it was their third sector of the day. I used to do 8 sectors overnight on one type I flew.
Now don't get me wrong, I believe that fatigue can cause accidents. But one needs to look before activating, whether wide awake or dead tired.