Situational Awareness,
Key Component of Safe Flight
Regardless of where or what you fly, pilots will probably find themselves involved in training geared at helping pilots achieve and maintain high-level situational awareness in the cockpit.
by Constance Bovier
This article was featured in the "Focus on Safety" section of FLYING CAREERS magazine's January 1997 issue. It is reprinted here with the permission of David Jones, Editor-in-Chief. For FLYING CAREERS subscription information, telephone (US) 1-800-492-1881.
The moment a student pilot releases the brakes and edges toward a taxiway, "Where am I?" and "What's going on around me?" become paramount concerns. From the first lesson, pilots learn that swift reactions are good ... but not good enough. Getting ahead of the airplane is better. Staying ahead of the airplane is best. Situation Awareness 101.
Scan a list of recent aircraft accidents and you quickly find situational awareness-related tragedies like American Airlines Flight 965 that crashed near Cali, Columbia, on Dec. 20, 1995. After months of study, American reported that a confusing list of waypoints led to an incorrect data entry, which programmed the flight management system to drive the B-757 into a mountain. Distractions and misplaced priorities prevented the crew from noticing that the FMS had changed their intended routing until it was too late.
Then, on April 3, 1996, a U.S. Air Force CT-43A (B-737) crashed near Dubrovnik, Croatia-another controlled flight into terrain. These and other accidents hammer home the fact that even a highly trained professional crew, flying good equipment, can find itself in circumstances where situational awareness has diminished to the point of disaster.
A host of gremlins has always awaited the unwary pilot distractions, ambiguities, poor communications, automation-induced complacency, fatigue, etc. Today, training programs work hard to help Pilots achieve high-level SA and to integrate their SA tools and knowledge into the overall array of professional skills.
The Ace Factor
Researchers have studied situational awareness for years. It's no surprise that the military coined the term-it's hard to imagine a more critical SA environment than air combat. Vince Mancuso, coordinator of line operational simulation for Delta Air Lines, is a former Air Force F-4 pilot who wrote his Ph.D. dissertation on fighter pilot situational awareness. "The most advanced work in SA has been done in the military," he said. "This last year the U.S. Naval Tactical Air Warfare Center sponsored a conference about SA in tactical environments. And for the last several years the U.S. Air Force has been dedicating a lot of research money to SA in fighters."
In a popular book focused on military flyers, The Ace Factor (1989), author Mike Spick concluded that good SA is "the ace factor." The top-scoring aces o f the two World Wars, he wrote, generally avoided high confusion melees and excelled by picking off stragglers. "This is ... a form of SA. The aces were very aware of their own limitations and tended to keep out of situations with which they could not cope adequately." Modern combat, he noted, depends heavily upon electronics and AWACS technology. Today's fighter pilot SA "lies mainly in the ability to make use of the presented information."
10 Tips for Good SA Management
1. Predetermine crew roles for high-workload phases
of flight.
2. Develop a plan and assign responsibilities for handling problems and
distractions.
3. Solicit input from all crew members including cabin, ATC, maintenance,
dispatch, etc.
4. Rotate attention from plane to path to people - don't fixate.
5. Monitor and evaluate current status relative to your plan.
6. Project ahead and consider contingencies.
7. Focus on the details and scan the big picture.
8. Create visual and/or aural reminders of interrupted tasks.
9. Watch for clues of degraded SA.
10. Speak up when you see SA breaking down.
Sources: Vince Mancuso, Pete Wolfe and SA Tiger Team
What Good SA Looks Like
Among the researchers who study SA in civilian cockpits is Judith Orasanu, principle investigator for NASA-Ames Research Center. "We started looking at flight crews' decision-making behavior," she said. "But you can't have a decision out of an emergent situation in flight unless you're aware that you have a problem. That's where SA comes in."
Researchers like Orasanu typically present their findings at aviation conferences and other industry events. Nonetheless, there's been a historical gulf between academia and the practical application of SA in pilot training. Until now.
"Research reports aren't written in a way that an airline manager or pilot can use," said Mancuso. "They require a lot of work and translation." This can be a major problem for smaller carriers, such as many regional airlines, that lack academic folks in their training departments. Many companies depend upon pilots who volunteer during their time off to develop and deliver training.
"I knew there had to be a way to build a bridge between all the great research that's going on and the people who are designing the pilot training programs," Mancuso said, "so ultimately the pilot would become the recipient."
Mancuso's frustration over the status quo led him to mastermind an industry wide task force to address the problem. The Situation Awareness Management Tiger Team of the Industry Human Factors/CRM Developers Group is a small cadre of training people from various airlines and researchers (including Orasanu) from the civilian and military communities. "The concept of this group was to do the labor-intensive work Vince Mancuso, Pete Wolfe and SA Tiger Team that leads up to development of a sound training program," said Mancuso.
The SA Tiger Team recently created and produced materials that any airline or aircraft operator can adapt for its own pilot training: a model SA course outline, a paper titled "Managing Situation Awareness on the Flight Deck or The Next Best Thing to a Crystal Ball," by Sheryl Chappell (published in ASRS' DirectLine), a statistical study of SA related ASRS reports and a heavy-duty bibliography of SA research and publications.
"You need to have frequencies laid out, know your routing, have your sectionals and en route charts out. So if you do get a changed clearance, you can get a quick visual reference and youÕll be familiar with all the fixes and navaids."
Ken Doucette
Assistant Chief Flight Instructor
Embry-Riddle Aeronautical University
Plane, Path, People
The upshot of the Tiger Team's work is the situation awareness management plan. This plan is the foundation for building individual and crew situational awareness.
Mancuso stressed that the management of situational awareness is a skill with definite actions and behaviors. The SA management plan reminds pilots to direct attention to the plane, the path and the people. What's going on right now? And what's likely to happen ahead?
To focus on the present, a crew should monitor and evaluate current status-both the big picture and all the details. But it's important to remember that knowing and understanding the current state of affairs simply keeps you up with the aircraft. It doesn't put you ahead.
To get ahead, you must project into the future, anticipating what will happen with the plane, the path and the people involved if the current situation continues. Consider what-ifs. What if you have to make a missed approach? What if the weather goes down at your destination?
10 Clues to Loss of SA
These clues can warn of an "error chain" in progress - a series of events that may lead to an accident. Most accidents involving human error include at least four of these clues.
1. Ambiguity-information from two or more sources
that doesn't agree.
2. Fixation-focusing on any one thing to the exclusion of everything else.
3. Confusion-uncertainty or bafflement about a situation (often accompanied
by anxiety or psychological discomfort).
4. Failure to fly the plane everyone is focused on non-flying activities.
5. Failure to look outside-everyone heads down.
6. Failure to meet expected checkpoint on flight plan or profile-ETA,
fuel burn, etc.
7. Failure to adhere to standard operating procedures.
8. Failure to comply with limitations, minimums, FARs, etc.
9. Failure to resolve discrepancies- contradictory data or personal conflicts.
10. Failure to communicate fully and effectively- vague or incomplete
statements.
Adapted from Douglas Schwartz, FlightSafety International
Tiger Team member Pete Wolfe, CRM and human factors chairman for Southwest Airlines, pointed out that all pilots learn to "aviate, navigate and communicate," and plane/path/people is an update of that foundation concept. He cited a familiar example of exceptional CRM: United Airlines Flight 232, a DC-10 that crash-landed in Sioux City, Iowa, on July 19,1989. A NASA study of the cockpit voice recorder transcript revealed that Capt. Al Haynes, while bringing the badly damaged aircraft back to earth, shifted his attention and communications with the crew in a continuous loop. How much damage was there to the plane? How was it behaving? Could they control it? What was the status of the troubled flight path? Where could they land? And how might they do it? What were each of the people doing as they worked their way toward a common solution? Round and round again. "Effective SA management demands that kind of attention," Wolfe said, "a continuous rotation from plane to path to people."
SA Traps
Unfortunately, in non-emergency situations, human beings are lackluster monitors. Attention meanders away from the business at hand or becomes preoccupied with one troublesome aspect of a flight.
Mancuso said that research shows ambiguous problems often cause pilots the most difficulty. "Even in a severe emergency like a fire or engine failure, they tend to do better than if they spend a lot of time trying to figure out an ambiguous problem where there's no clear-cut course of action." He said that Delta has incorporated some of the newest SA research in its pilot recurrent training for 1997, and simulator scenarios include both clear-cut and ambiguous problems. Videotaped debriefings show crews how well they managed, particularly whether or not they got fixated, "with nobody minding the store."
Research has also identified distractions as the No. 1 cause of course deviations. So Delta training scenarios interject a low priority distraction-such as a flight attendant call during short final in weather-when the crew should not attend to it. "We want to see if they're going to take the bait," Mancuso said. The point is not to trick the crew, he explained, but to reveal any tendency to get distracted or to misprioritize time. "Their attention, their SA, can be managed."
"Anyone with some flying experience has been caught off guard or unprepared. We're all familiar with the feeling of being ahead of or behind a situation."
-Vince Mancuso
Coordinator of Line Operational Simulation
Delta Air Lines
Individual SA
In early flying, SA often resides in the seat of the pants. Ken Doucette, assistant chief flight instructor at Embry-Riddle Aeronautical University in Florida, said that one of the earliest forms of SA is stall recognition-"What it feels like to be in that flight environment-the pitch attitude, the sound of the engine noise, the air passing over the fuselage."
At ERAU, situational awareness hits full force in commercial pilot training as the student studies the concepts of crew resource management and learns to anticipate emergency situations in IFR flight. If ATC reroutes a flight, Doucette said, "Students have to take an amended clearance, readjust what they were going to do and do something different."
Doucette believes the critical key to single-pilot SA is preflight organization and preparation. "You need to have frequencies laid out, know your routing, have your sectionals and en route charts out. So if you do get a changed clearance, you can get a quick visual reference and you'll be familiar with all the fixes and navaids." That can help a pilot make a quicker mental adjustment, he said, "SO it's not a major evolution to figure out what to do next."
The danger for a disorganized pilot is task saturation, with SA slippage close behind. "The thing that stops that," Doucette said, "is being prepared."
Crew SA
Preparation is vital in crew cockpits as well; so is shared responsibility for collective SA. Note: A situationally aware captain and a situationally aware first officer don't necessarily add up to a situationally aware crew. High-level crew SA can be thwarted by assumptions, inattention, inadequate communication, etc. even by a rugged individualist in the left seat who subtly (or not so subtly) discourages input. Yet every crew member should augment the SA of the pilot in command. The level of the PIC's awareness will heighten or limit the combined SA level of the crew.
Proof? A 1994 NTSB study of 37 accidents revealed that one or more crewmembers failed to monitor and/or challenge the errors or lack of awareness of their fellows in 31 of those events.
At FlightSafety International, Douglas Schwartz, director of the operations and standards division, said, "Our approach to crew resource management is to relate everything we teach back to situation awareness. We say that assertion or advocacy is a communication style that's effective for increasing others' situational awareness. Inquiry, asking questions, is a communication style you would use to increase your own SA."
Keeping other crew members informed can be as simple as relaying the last communication with ATC or asking for a little closer backup than usual if you're feeling tired. Or saying that you're uneasy about the numbers showing up on the computer ... and you're not sure why.
Pilots should also learn to read the cues and take appropriate action. Since SA is a state of mind, we can't see when somebody has it or doesn't. But we can see SA exhibited in words and actions.
If a captain pulls back on the throttles, it's a good sign that he's aware the speed was a tad too fast. If a first officer says, "I'll call ahead and check the weather," it's a good indication he's noticed the thunderstorm building on the horizon.
Not all cues are good signs, of course. Maybe you can't believe your eyes as your captain or first officer lines up for approach to the wrong runway. Believe it. Point it out. Remember the experienced airline crew that delivered a planeload of passengers to the wrong airport in the wrong city in Europe.
The Mental Jumpseat
"Anyone with some flying experience has been caught off guard or unprepared," Mancuso said. "We're all familiar with the feeling of being on ahead of or behind a situation." He likened good SA to having the ability to visualize sitting on the jumpseat of your own flight. "In the Air Force we used to call it chair-flying," he said. "We're trying to get pilots to think about the way they are thinking, to take a giant step back."
While professional crews enjoy the advantage of LOFT scenarios and videotaped debriefings, even people at the single-pilot stage of their careers can learn to see and think about where they are and what's going on around them from a new perspective. And anyone can adopt the SA Management Plan as a personal checklist.
For some pilots, like the aces, high-level situational awareness may be second nature. But for all pilots-individuals and crews-situational awareness management is a set of skills that can be readily learned and steadily refined.
Constance Bovier is a Houston-based aviation writer. She is a frequent contributor to Flying Careers.
Copyright © 1996-2005 by Neil C. Krey unless otherwise indicated.
Non-commercial reproduction rights granted if the following notice is included:
"Source: Neil Krey's CRM Developers Forum, http://www.crm-devel.org"