Byron Edgington ATP, CRMI

Crew Resource Management Training “I don’t believe in accidents.”

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Making good decisions with CRM

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Objective:  Understand

good decision methods

 Understanding  How

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poor decisions

to tell the difference

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Too bad it’s not this easy

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Promoting good decisions: Teamwork Time An

alert crew Experience

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Barriers: Time

crunch Bad data Pressure Rank differential Personal issues ©2015 The SkyWriter Press LLC

Reasons for poor decisions: Hazardous attitudes  Anti-authority  Impulsivity  Invulnerability  Macho  Resignation  High

authority gradient

 Get-home  Risk ©2015 The SkyWriter Press LLC

disease

shift—the comfort of crowds

 Anchoring

bias

WS

Personnel Conflicts & Decision Making War Story: Here’s an example of how personnel issues can interact with safety and good decisions. Mal was an older pilot who arrived in Iowa City after being laid off in the Gulf of Mexico, where he’d been a senior captain. From our first interaction it was obvious that Mal thought he should be lead pilot instead of me, and his actions demonstrated that. Mal exhibited every hazardous attitude listed, and he was subsequently dismissed, partly because of it. It’s been said that many accidents happen in the hiring process, and if Mal had been involved in an accident it may have been true in his case.

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The D. E. C. I. D. E. Model Detect that change has occurred  Estimate the need to react  Choose a desirable outcome  Identify action  Do take action  Evaluate action 

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Palm 90 & A Poor Decision Air Florida flight 90 was a 737 taking off from National Airport in Washington on the morning of January 13th 1982. The weather in DC that morning was awful, with lots of heavy, wet snow and freezing rain that had air traffic backed up all over the east coast. Palm 90’s crew sat on the taxiway awaiting takeoff for several minutes, snow and ice accumulating on the wings of the aircraft. When they finally received takeoff clearance the airplane seemed sluggish, gauges not reading what the crew expected. They departed anyway, the promise of sunny Florida weather, and the pressure to get in the air forcing them on. Their decision to take off at all with a load of ice on their wings was a poor one. What they did after takeoff compounded their dilemma. Realizing that the airplane was stalling, neither pilot elected to increase power, thinking the engines would be damaged by doing so. Simulator tests afterward showed that there was plenty of power to fly out of the situation. But pilots are trained to never exceed the gauges, to never go past the red lines, so the Palm 90 pilots did not. They crashed into the Potomac, killing 74 people, rather than damage two good turbojet engines. ©2015 The SkyWriter Press LLC

Angling for a helicopter ride… Risk Vs Reward

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EDP-Enroute Decision Point: The 30%/Twice down model  500’ night/300’ day rule  3 to go; 1 to say no  ‘Just’ culture rule 

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EDP: Not easy sometimes, just necessary War Story: On the way to Dubuque, at seven PM, I told the flight nurse we needed to quickly load the young patient, and head back to Iowa City. Misty haloes wrapped the farm lights, so I knew fog was forming, even as we flew on. When I landed at Dubuque at 7:10 the medical team assured us that our young patent would be ready by 7:30, so I breathed a bit easier. At eight PM the child needed more X-rays. At 8:30 she needed another set. The fog rolled in. I began to doubt our chances of getting home. Finally, with an anxious glance at the dim sky, and with the young patient aboard, I lifted the collective and headed home, my heart in my throat. It was 10 PM. Just five miles later I flew into a wall of fog, my EDP. I abandoned the flight and returned to the hospital in Dubuque. My flight nurse and her patient climbed into a ground rig and raced away. I passed the night on a floor at the hospital, chagrined but able to fly another day.

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P.R.O.D: ‘Public Recitation Of Discomfort’ “Sure is dark out here”  “Hope we don’t get any more flights”  ‘Body language’ ala Kauai 

‘Body Language’ was published as ‘After the Rain’ in the May 2011 edition of Gemini Magazine.

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Safety scripts:  “This

is stupid”  “Land this thing”  “Let’s go home”  Your script?

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CRM for good decisions  Vigilance/focus  Hand

off tasks  P.R.O.D.  D.E.C.I.D.E.  The sterile cabin rule  Aviate; Navigate; Communicate ©2015 The SkyWriter Press LLC

Remember…  CRM

can’t change personalities  Only behaviors

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Summary & Objectives Understanding good decisions Understanding poor ones Telling the difference

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The standard for accidents must be…

Zero

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Questions?

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Next: Module #6 Communications

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