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Joys and complications of teaching emergencies

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Old 29th Jul 2016, 10:01
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Joys and complications of teaching emergencies

I instructed an EASA Biennal yesterday - the student, a good PPL I've known for a few years and have instructed before, requested we do a session on handling in-flight emergencies.


Take it as read that we briefed, flew the brief, and debriefed.

The emergencies we covered were full engine failure, partial engine failure, avionics fire, engine fire. All good fun and games, the first two I've dealt with myself in real life, the other two I've certainly briefed and practiced myself more times than I can count myself.


But it concentrated my mind on a few aspects of how PPLs* usually handle emergencies - at least when they're flying with me. Quite a lot of it I tend to think is wrong, and must presumably originate in their original teaching. I'd appreciate other people's thoughts...

(1) STRAIGHT INTO THE PFL
This is definitely the most common fault I see. So, I "fail" the engine on my student, and they throw themselves straight into setting up and executing the field landing, with usually absolutely no thought about trying to investigate and rectify the problem that caused the engine failure - even if there's loads of height and thus time to do so.

This still happens when I partially fail the power, and make it clear that that's what I did. I've heard a few times the expression "the aeroplane now belongs to the insurer", and that seems to be somewhere behind this failure to identify the potential that partial power gives to alleviate and expand the options to solve the situation.

(2) FIELD FIXATION
Okay, engine won't re-start (if they tried!), and the student picks their field, and will then do absolutely everything within their power to make that particular field. Better field presents itself - they ignore it. The selected field starts to seem very poor as they get close to it - won't throw it away and take a different option.

As I said in yesterday's debrief, if you walk away from an engine failure - absolutely nobody will ask if you made the field you were aiming for!

Whilst we're at it, the number of times over my few years of instructing I've pulled the engine well within glide range of the runway of a disused airfield with a clear runway - and they still set up for a field. Is there a mentality that using a runway is somehow "cheating"?


(3) I KNOW WHAT THE PROBLEM IS
I suspect that this has its roots in the very limited number of emergencies that tend to get taught in both the PPL and CPL syllabi. Students will tend to assume from the first sign of any symptom that they know what the problem and correct responses are. I find that I really need to force the issue to get pilots to take enough time to properly diagnose what is going on, and develop an appropriate response.



A lot of this comes down to an acronym that certainly I've met in numerous CRM / safety refreshers - DODAR...

Diagnose
Options?
Decide
Act
Review

(rinse and repeat as often as required).

I believe that this is fairly universally taught nowadays, but I really wonder how often it really finds its way from the briefing room to the cockpit? I seem to see, probably 80% of the time in most PPLs just "Decide, Act", with no initial Diagnosis, and virtually nothing by way of subsequent Review of actions and whether those continue to be appropriate to the developing emergency.


Thoughts anybody?

G



* I single out PPLs, simply because I've instructed only a couple of people with professional licences, and don't think I've seen a meaningful sample.
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Old 29th Jul 2016, 12:06
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It's been a few years since I did instructing, or flew a single engine piston for that matter. Despite, I'll try to share my thoughts.

(1) From the very first week in flight training, even before we actually practiced any form of emergency, we were required to know the engine failure checklist by heart. Following an 'engine failure' we would get it done, touch drilled, within seconds (Fuel selector, Fuel SOV, Mixture, Aux Fuel Pump, Ignition..as for the trouble shooting). Similar to the memory items in an airliner. As I recall we never even picked up the checklist, which resulted in a crude awakening in FAA land where it would be a fail item for not using the checklist. To my knowledge, I never got it wrong though..

We all know it should be weighed against hight (or time) available. This decision - to fly the plane first - will be done close to split second and, for an inexperienced PPL holder, more conservatively than an experienced instructor. I have seen the polar opposite too of those who tried to get the checklist done no matter what, when the situation clearly asked for someone to fly the plane. Could it be that they were too unsure of the checklist content (or memory items if you will) that in the stress they just proceeded to focus on getting the landing done safely?

I always taught the engine failure drill as memory items and only use the checklist if time permits. Sending an emergency message and briefing the passengers I see more important than pulling out the checklist which, if you've studied well, you'll get right 99% of the time anyway. But this might not be how the real world looks like with some only flying a few hours a year?

(2) Dynamic situation with no clear answer, in my opinion. As you've witnessed there are situations of field fixation. I remember being subject to it myself. I think, however, there's also merit to sticking to the plan. I have seen some acts of late decisions leading to a right messy situation. Much depends on the terrain. If there's miles of flat land a late decision to change is more forgiving than if it's forest or rock. As an instructor I think it's our task to find that balance. Tell your student when they missed a perfect opportunity down on their right side, but don't make it black or white. It will widen their perspective. Again, experience level and stress will affect when a field swap is appropriate and when not.

(3) Is DODAR taught also in the context of flying single engine piston? This is just my opinion, take it for what it's worth. Even in an airliner context this mnemonics are a bit overkill. They look good on paper and in CRM classes but is rarely of any real assistance in the flight deck. I was one criticised by a trainer for keeping a 150 nm fix ring of a suitable alternate for time critical emergencies (fire or fumes, heart attack etc.) with the motivation I was suffering from confirmation bias. Instead I should run a decision making process a la DODAR. If anything they are for non time critical abnormal situations as an assistance to channelise our thought process. This is something we rarely practice in single engine private flying, but maybe we should? An example would be you're on a long cross country flight and you recieve reports that the weather is closing in on your destination.

Regards,
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Old 29th Jul 2016, 14:23
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A large majority of PPLs will squander what height they have trying to remember all that's involved with investigate/rectify, usually at 100knots and a 1000fpm down, missing numerous ideal fields along the way. This leaves them with much less time to get it right and far less options. Over the years I've worked at a dozen different schools and, almost without exception, PFLs are usually carried out at around 2300 to 2500 on the QNH (being the most likely altitude for the occurrence) with the first actions being trim for best glide, assess wind, pick field and plan an approach. Only then are restart checks carried out. Otherwise, by the time they've fumbled through trying to find the cause and half remembered the mayday call, they run out of options and are usually too high or too low for the field that was picked in a panic.
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Old 31st Jul 2016, 09:35
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MrAverage wrote:
Over the years I've worked at a dozen different schools and, almost without exception, PFLs are usually carried out at around 2300 to 2500 on the QNH (being the most likely altitude for the occurrence) with the first actions being trim for best glide, assess wind, pick field and plan an approach. Only then are restart checks carried out. Otherwise, by the time they've fumbled through trying to find the cause and half remembered the mayday call, they run out of options and are usually too high or too low for the field that was picked in a panic.
I agree. Unless there are flames visible, requiring immediate action, do as above!

No psychobabbling headshrinker hor$e**** mnemonics are needed - look for a safe place, then try to sort out the cause and rectify if possible (e.g. dry tank), then tell someone, then switch off the radio and concentrate on making a safe landing, not forgetting forced landing preparatory actions.
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Old 1st Aug 2016, 21:46
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Trim and point into a safe area, try and fix by sweeping across the cockpit, if unsuccessful, proceed with PFL, keep reviewing wisdom of actions whatever you did.

Which is DODAR basically, which I like, but only in the briefing room. No, it doesn't belong - as a mnemonic, in the cockpit.



By an uncanny and suspicious coincidence, I had a phone call this morning from the student I did the biennial with. Two days after flying with me, he had a partial power failure on a BE23. He did as we'd drilled - pointed at good fields with the aircraft trimmed aggressively for best glide. Then sweep the cockpit looking for solutions, he switched tanks (as I'd drilled with him), power restored breathed sigh of relief, went home. On the ground they found the remains of a bee partially blocking the breather on one side - preventing continuous high power fuel flow but not readily detectable on the ground in a normal power check. He reckoned from realising he had a problem to solving it he lost 400ft.

He was in a good mood and felt he'd got value from his biennial, I reserve the right to act smug for the next few days.

G
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Old 2nd Aug 2016, 07:57
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DODAR is normally taught at the MCC stage, certainly not during PPL training.

Look at the PPL syllabus, out of 25 hours dual training, that barely leaves 1 hour to teach the PFL Exercise 16. Typically, it will need around 3 flights to ensure the candidate has the skill to glide the aircraft from around 2500 ft to a survivable landing in a field. The object is to walk away, not write a book about it in the 4 miinutes it takes to get there.

There is a huge difference between Professional flying where all these ideas come from and Recreational flying where most PPL holders are operating on the basis of just enough training to cover the basic skills and consolidation is based upon the size of their wallet.

For the PPL:

Diagnose - Engine is not as it should be
Options? - Land or Crash
Decide - Land
Act - Do your best to land in one piece
Review - Could have picked a better field (post landing!)
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Old 3rd Aug 2016, 02:33
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Been years since I instructed, but when I did full time, one thing I did with all my primary students in the C150/152 is distract them enough I could flip the fuel shutoff without being seen.

Didn't matter how many times we'd simulated an engine failure and practiced the flow, when the engine actually quit without my hand on the throttle, they most often froze, and completely ignored the steps to restore power. Only had one or two that found the shutoff without my prompting.

BTW, I always did this within gliding range of a private grass strip I knew of, just in case. Never an issue though, engine was always happy to run when fuel was restored.
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Old 3rd Aug 2016, 07:20
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...one thing I did with all my primary students in the C150/152 is distract them enough I could flip the fuel shutoff without being seen.
Hardly a valid failure scenario - "Your passenger has just turned off the fuel"?

People might have failed to turn on the fuel prior to start and subsequently come to an unexpected stop during taxying, but unless you're flying something with a fuel selector which goes through 'OFF' when switching between 'LEFT' and 'RIGHT', I cannot see that deliberately turning off the fuel supply is a likely event.
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Old 3rd Aug 2016, 07:44
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In my time I have had four engine problems up to 1993.
Since then non, so it looks like the engines are getting more reliable (or me lucky).

1/ Whilst learning to fly PA28, with instructor, PFL, at 200 feet asked to go-around, no response from engine, we landed in wheat filed.
Lesson learnt.....warm the engine and I like to see at least 2-3 times from starting at 2500 feet and full throttle check. Also always pick a field you can get into just in case.

2/ Instructing C150, losing power approaching airfield, chopped power and committed to x/w runway. Next day warned another instructor that the a/c should be grounded, he flew and immediately returned to a/f for a forced landing.
Lesson learnt...slightest suspicion of anything wrong ground the a/c. It apparently had a history of problems. Engine strip, one piston was breaking up, piston rings gone.

3/Loss of power PA28 at 6000 feet doing stalls above overcast haze.
Engine power slowly restored whilst me trying to fix problem and fix my position.
After landing engine stopped and caught fire. Discovered extinguishers only last about 3 seconds. Carb mod not done caused the issue.
Lesson learnt..in an emergency let someone else do the nav. I could have called for a VDF QDM to the field and concentrated on keeping the engine going. a/c ADF u/s.
Although once given a QDM across a built up area following another engine problem, so not always the best.

4/ Partial power PA28 with very rough engine on a T/L at 1300 feet.
Committed to put down straight ahead into a field. Could I have made it back to the a/f 5 miles away? Well I am still here and so is the aircraft, so good decision.
Fault was exhaust valve failure, which punctured the piston head.
Lesson learnt..commitment, make a decision and stick to it.

So all of these have coloured my out look on (p)fl's.

P.S. I have witnessed a trainee kill the good engine on a check flight in a Seneca over the Channel by switching off the mags on the live engine, so using the checklist can't prevent finger trouble. Switching them back on two seconds later is what made us sweat!
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Old 3rd Aug 2016, 07:52
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I get my C152 trainees to check fuel on, it just might be that the headset lead gets caught under the lever and gets pulled off.
Would be interesting to know how far the lever has to be turned to cause a problem.

Mags have been known to be kicked off by large tags and knees.
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Old 3rd Aug 2016, 17:43
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I had a student turn the fuel to off during the restart drills while doing a PFL in our Cub. Fortunately I realised what had happened and managed to get him to turn it back on (I can't reach the fuel valve from the back seat) and the engine restarted at 200ft. Good job too, because we would have hit the far hedge in the field he had chosen if we had to land. Doh!

The lesson I learned from this is to clearly brief "touch drills only" during Emergency drills.
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Old 3rd Aug 2016, 18:58
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Hardly a valid failure scenario - "Your passenger has just turned off the fuel"?
Fuel shutoff between the seats just above the floor. I seriously doubt it's never accidently been bumped off or moved. In any case, the actual purpose was for them to experience a loss of power that wasn't obviously faked. To them, for a few seconds, it was real. The typical reaction was to turn to me and perform a great impression of a goldfish. Their mouths moved, but no sound came out.
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Old 3rd Aug 2016, 23:28
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Have been told of someone who pulled a mixture control on a Arrow thinking it was the prop. control on climb out.
Well it reduced the RPM!
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Old 4th Aug 2016, 09:06
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I think you have a misconception of the purpose of tools like DODAR. They are intended as a structure to help decision making when time is available following completion of any non-normal manoeuvre or checklist. They are not intended as a time-critical guide to cockpit actions.

The initial actions are the same anywhere - ANC and run the appropriate drill or checklist, which in your case boils down to establishing the aircraft in the glide with an option in kind before commencing your relight drills.
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Old 4th Aug 2016, 12:57
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If that's aimed at me JWS, then the CRMI I work and discussed this with has it wrong too.

Yes, make the immediate flight safe - absolutely. But what I'm critiquing is the norm of assuming that people know exactly what's the problem and exactly what to do, rather than taking the time to properly assess and then take appropriate actions - where there's time and height to do so of course.

Similarly, failure to review actions once decided. The "R", as scenarios develop - they aren't simple A happened, so do B, end of story.

G
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Old 4th Aug 2016, 14:36
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Some of the 150/2s I've flown have had the fuel wired open, others you needed a wrench to close it. Seems some schools/operators just don't like having it fiddled with.
I think a pax pulling the mixture or shutting the throttle is an entirely realistic scenario, some folk just can't help but fiddle. Wasn't a Rockwell twin lost many years ago due to pax interference?

Oh, and wasn't a Tristar lost in the Everglades when they were trying to change the bulb in the undercarriage warning and knocked off the autopilot without noticing?

TOO
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Old 4th Aug 2016, 21:59
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GtE, the way I've encountered these tools and been taught to use the. in airline and corporate training has not been as an initial diagnosis tool or model. The sequence taught by my current airline (which uses T-DODAR) is:

Warning/Caution/Bang

1. Fly the aircraft (ANC - manual/automatic flight)
2. Identify the failure
3. Memory and QRH drills
4. Analyse the situation and make a decision (T-DODAR)

And so on depending on the situation and actions.

The point you are making about diagnosing the failure is a very good one (iirc the chances of a fatal outcome are higher for a a partial than a full power loss,) but in my view is different to the D of DODAR. I think the big metal analogy for what you are talking about is running an incorrect checklist or executing an incorrect manoeuvre rather than not running through a decision making process.

A big Irish loco uses PIOSEE to make decisions - Problem, Information, Options, Select, Execute, Evaluate. I believe others use FORDEC - Facts, Options, Risks, Decide, Execute, Check.

In your partial failure case, it might look some thing like:

- Bang/vibration
- Fly the aircraft - level off, wings level, appropriate speed/trim
- Identify the problem - checklist/memory actions ie carb heat, fuel, mags &c

At this point you are left with either a failed engine, limited power or a fully working engine.

In the first case your choice is made and you simply execute a forced landing. In the second and third, you have a decision to make, at which point DODAR, PIOSEE or FORDEC enters the equation and a structured tool is of great value.

Having re-read your original post, I think we are actually coming at the same thing but from different staring points, which is making the appropriate response to the failure, rather than simply incorrectly pattern matching.
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Old 7th Aug 2016, 19:21
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A big part of the problem in training of the engine fail scenario in ab initio flight instruction is, IMO, the fact that it is almost invariably directly linked to passing the flight test forced approach exercise.

This exercise starts with the examiner closing the throttle and announcing "simulated engine failure" so that is generally the way the exercise is presented in training.

The problem is this scenario, a perfectly normally running engine suddenly stops producing all power is the least likely engine failure scenario in the real world.

Most real world engine failures, accident stats show around 80 %, are caused by an action or inaction on the part of the pilot with the majority involving carb icing and fuel exhaustion/mis-selection/contamination.

In addition for every total engine failure incident/accident reports suggest that there are at least 3 partial power losses.

The "AHH HAA" moment for me was a crash of a locally based C 172 flown by a newly licensed PPL. His engine failed over very unforgiving terrain. He made a successful forced approach to a nasty bit of a clear area. The airplane was wrecked and there were some injuries but everyone involved recover fully. The general consensus was his forced approach was pretty good and it was unlikely that any of us could have flown it in such a way as to get a better outcome.

But the killer detail was when the wreck was salvaged. It had 12 gals on fuel in the right tank and no fuel in the left tank and the fuel selector was set to left tank.

I talked to the pilot and he admitted that as soon as the engine failed he reverted to flight test mode. The engine never restarts in the flight test, it is all about flying the perfect forced approach. His instructor never emphasized the engine fail cause check drills and so he defaulted to flying the forced approach when all that was required was to turn the fuel selector 90 degrees and full power would have been restored........

This student was not taught by me, but he could have been. This accident made me start looking into accident stats for an indication of real world engine failures and forced a fundamental re-evaluation of how I prepared students for engine power loss, not just how to pass the forced approach exercise on the PPL flight test

The result is I now teach the Forced Approach lesson in 3 parts

Part 1: How not to cause or abet in causing the engine to fail. This starts on the very first lesson with an discussion about fuel expressed in "time in the tanks". Every subsequent flight will start with the student telling me what duration the fuel load will give and it continues with adding detail to the " so whats" of the what and why of our actions in the pre flight inspection and the run up checks. Also introduced at a very early stage is checklist discipline including effective flow checks

Part 2: Attaining proficiency with all the emergency procedures. especially the vital actions memory drills for the big ticket emergencies including fire ( cabin and engine), EFATO, and loss of engine fire, and loss of visual references

Part 3: This is the actual forced approach lesson. It starts with the aircraft trimmed for best glide a suitable field selected and the aircraft pointed at the field. At this point the power loss cause check is carried out as touch drills. Failure to complete an effective cause check stops the exercise right there and results in a debrief and restart. The first few lessons will be the traditional full loss of power with a glide approach to a suitable landing area. After that I will mix things up by

- Initiating the loss of power by simulating an engine fire requiring an engine shut down
- Restoring full power when the cause check is done
- Instead of closing the throttle, reduce the RPM to a lower value, once with just enough power to sustain level flight and once with less than enough power to sustain level flight
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Old 8th Aug 2016, 08:56
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BPF - I think (some) checklists could be to blame. One instructor taught me to CHECK FUEL FIRST as this is often the cause. THEN the check/restart procedure from the checklist, by memory.
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Old 8th Aug 2016, 12:01
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I think that this is very much about how you use the checklist.

If you treat the checklist as "read-do", then you end up behaving in a very different way in such circumstances to "do - confirm".

I would advocate do-confirm for most emergencies in light GA. Pilots should act according to their understanding and training, then IF THERE IS TIME confirm with the checklist that they've not missed anything critical.

G
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