PPRuNe Forums - View Single Post - Monitoring & Intervention
View Single Post
Old 26th Feb 2012, 17:28
  #1 (permalink)  
safetypee
 
Join Date: Dec 2002
Location: UK
Posts: 2,451
Likes: 0
Received 9 Likes on 5 Posts
Monitoring & Intervention

An aspect of the India Air Express B738 overrun (http://www.pprune.org/rumours-news/4...-crash-27.html) and similar, involves the apparent failure of the monitoring pilot to provide timely or effective alerts, or intervention to avoid a fatal outcome.
A ‘failure’ of the monitoring pilot to intervene is often cited as a factor in accidents. If considered in isolation and particularly with hindsight, this may be labeled as a root cause - as deviant behavior, which is not necessarily appropriate.

The frequency of accidents involving ‘failure to intervene/take control’ in comparison with normal ‘safe’ operations is very low. This could suggest that there should be many successful interventions in normal operations (saves vs failures), including some ‘taking control’. However, there is little, if any evidence of such extreme interventions.
The safety callouts made by the monitoring pilot in the India Air accident and subsequent behaviour was relatively normal, albeit in hindsight, late, and not as required.
This behaviour, and apparently that of monitoring pilots across industry in general, is not as expected by the concept of monitoring; this suggests that all operations have similar weaknesses.

The interventions which I have experienced (or witnessed) fell into three categories:

Type 1. There is a very small number of pilots who experience increasing apprehension of situations which they have not previously encountered, these may be feared due to inadequate knowledge, e.g. stalling, unusual attitudes. Perhaps this class of person should not be a pilot, as a failure to control surprise / fear can be debilitating. (Those which I encountered were predominantly during demonstration / training flights).

Type 2. In normal operations, a low experience ‘novice’ monitoring pilot can provide alerting, but usually late in a developing adverse situation. There appears to be an inability to comprehend the outcome of events (projection - situation awareness). Instead there is reliance on the PF for ‘education’ or a belief that the situation can (will be) corrected, e.g. not appreciating that a late descent and continued use of normal procedures will result in a high/fast approach.
This represents a skills discrepancy in awareness – what and when to scan (why) and how to project and asses an outcome which has not been experienced / considered previously. This is a classic ‘getting behind the game’ behaviour, or being somewhere where you brain hasn’t been first. Any intervention usually states the obvious – what has happened, not what may evolve.
In extreme situations, the inability to keep-up results in an apparent failure to elevate the level of intervention or intervene in time.

Type 3. Where both pilots are highly experienced, the monitoring pilot alerts a disparity very early during an evolving situation. This represents good awareness and projection ability based on experience or visualisation and anticipation. Adverse situations rarely develop as the monitor’s intervention is both timely and with a helpful suggestive attitude – ‘consider this, or this could occur’, i.e. thinking ahead.

In general the interventions (2 and 3) are not driven by SOP deviance, instead they orrigionate from the developing situation – situation assessment.

I wonder what the industry’s experience of monitoring / intervention is:
Is the categorisation of pilots / experience as above, a common feature across the industry?
Are there many significant interventions in normal operations (no incident), vice routine helpful comment / crew interaction?
Is situation assessment the dominant aspect for triggering an intervention, or is SOP ‘mantra’ used (checks by numbers/rote)?
What are the general views of situation assessment and projection skills and training?

Do monitoring / intervention work, or is the concept flawed?
safetypee is offline