Despite the different reasons for male and female pilot error, cockpit resource management can make single-pilot flying almost as safe as in a two-pilot environment.

Vern Weiss

In the 1970s there was a rash of airline accidents. This was particularly startling because the accidents did not involve inexperienced flight crews but, instead, professional and highly trained flight crews! It was revealed in subsequent accident investigations that the accidents were preventable and largely due to human errors and frailties as well as crew members not utilizing all the resources available to them, including each other.

What I am about to tell you may find disfavor with some and if this is so, it is not my intention to cause controversy, but instead discuss these findings and how they relate to safer flying. In 2001, Johns Hopkins University’s Bloomberg School of Public Health released a report of the findings from research done on behalf of the National Institutes of Health and Centers for Disease Control and Prevention stating:

“Male pilots crash due to inattention. Female pilots crash due to aircraft mishandling.”¹

Johns Hopkins professor Susan Baker pointed out that air crashes by males are most often due to flawed decision-making and inattention. Flying aircraft with known mechanical problems, running out of fuel and landing gear up, the study reported, are typically male problems. Whereas women tend to be more cautious, follow the rules but exhibit more errors such as incorrect rudder use, poor control response and recovery from stalls.

So regardless of who you are there’s work to be done by everyone. Each of us may have weaknesses and though the weaknesses are in different areas we should put our emphasis on mitigating them so we can limit or avoid pilot error.

Crew Resource Management was originally centered around airline operations with 2 or 3 pilot crews (flight engineers on aircraft such as the Boeing 727 and McDonnell Douglas DC-10 were considered the third pilot). However, when cockpits become downsized to a flight staff of only one pilot, things change dramatically. 71-80% of all general aviation accidents are due to pilot error and a single pilot operation statistically is 1.6 times as probable of having an accident.²

Isn’t CRM What We Were Supposed To Be Doing All Along?

When I first heard about the concept of CRM, I didn’t quite understand it because I thought that its methodologies were what pilots did naturally. But apparently they weren’t. I thought the elements of single pilot CRM were pretty much covered by FAR 91.103 (Preflight action – “Pilots are required to familiarize themselves with all available information concerning the flight prior to every flight”) and 91.7 (Aircraft airworthiness – “The pilot in command is responsible for determining that the airplane is airworthy prior to every flight.”). However, NTSB accident reports indicate otherwise. Have pilots just become too lazy to do due-diligence properly when guiding a lethal craft at high rates of speed on invisible roadways without shoulders on which to pull off when things get hectic? Or does the seriousness of what we’re doing when flying get lost in distractions and minutia?

The choices and solutions to the challenges, decisions and tasks of flying seldom are limited to a single one. Single pilot CRM begins with recognizing your own limitations and acknowledging your own experience level, personal minimums and physical and mental health. Are you really cranked-up after a big fight with your boss? Don’t go flying. Think you’re coming down with the flu? Don’t go flying.

Limitations are not absolute. Some days your personal limitations may be different than others. Let’s say you’ve been renting a Cessna 182 a lot but today you arrived at the airport and the only 182 available is one with advanced avionics with which you’re not familiar. Good single pilot CRM might dictate that you should not attempt flying that airplane in deteriorating weather even though you’d be quite comfortable in one of the other airplanes with more familiar avionics. Some of the sloppiest flying I have observed by otherwise skilled pilots was when they were flying sick (and also when they are sick of flying). So single pilot CRM begins with you. Once you determine that you are fit for flight you can begin a running assessment of all the resources available inside and outside of the aircraft before and during the flight.

The FAA developed a simple memory gouge to help single pilots evaluate every component of the pilot’s job. They call it the “5 P Approach” and this mnemonic represents (in order) PLAN, PLANE, PILOT, PASSENGERS and PROGRAMMING.

For each “P” you collect all pertinent information available, analyze it and then make decisions. Most importantly, always be willing to change your plan should conditions indicate the need for a change. Head-strong pilots have got themselves into trouble by making a plan and sticking to it even when alternatives would have been more prudent.

Start by getting a good weather briefing and study your route, carefully working out the fuel requirements based on both. This includes potential deviations you see which might need to be made for weather. Use all the resources that may help. Pilots who have just landed are excellent resources to fill you in on weather conditions. If the FBO has a flight planning room, print out all the weather information you think might be useful so you can take it with you. What good does a METAR report do when it’s an hour or two old? I’ll tell you. You can spot trends in weather and determine if it is deteriorating, improving or staying the same.

Next analyze your plane. Assess its airframe, engine, systems and avionics. If you’re knowledge is a little weak about one of the systems like its avionics, bone up before the flight. Pilots who must use an instruction manual during flight are adding to their workload. It’s helpful to stop by for a brief visit with the mechanic who may have worked on the aircraft you’re flying to ask about recent squawks or maintenance that’s been done. Even if something was recently repaired it might justify extra vigilance as you fly.

The planning portion for a cross-country flight is as important as the planning portion to determine aircraft performance and limitations. If you’re going to have a big fat guy sitting in the back seat, taxiing out to the runway is not the time to be wondering what elevator setting you should set or worse…when rocketing down the runway and wondering why the airplane rotated so soon and controls feel so spongy. Go back to basics and do a careful weight and balance computation. FAR Part 121 and 135 commercial operators do it for every leg they fly.

You may have heard it said that flying is hours of boredom accentuated by moments of “sheer terror,” but it need not be so. If a pilot is paying attention…monitoring…cross-checking…watching the systems, you lessen the chances of pilot error and other surprises befalling your flight. There are usually warnings when things are about to go wrong. The dimming of lights, roughness of the engine, oil pressure fluctuations, they all portend possible problems in the making. Remember, as a single pilot, you are also in the flight engineer’s seat, and can often get a heads-up on potential system problems just by watching, listening, smelling, feeling and comparing.

The third of the “5-Ps” is “pilot.” Are you physically, mentally and emotionally fit to fly? Before you even think about flying you should take a personal inventory. This inventory includes illness. Are you sick or showing symptoms of illness? Are you taking any prescription or over-the-counter drugs? Are there aspects of your life causing stress (job, financial, marital, etc)? How ’bout alcohol? You been tippin’ any? Remember the regs say 8 hours “bottle to throttle” but only then if your blood-alcohol content is less than 0.04%. Are you fatigued? When you’re tired your reflexes, coordination and thinking are dulled. Are you emotionally wrapped-up tight? Sad? Angry? Ecstatic?³ The guy in charge at the FAA (Federal Acronym Administration) stitched together Illness-Medication-Stress-Alcohol-Fatigue-Emotion and came up with IM-SAFE. Get it?

The number four “P” is passengers. Passengers can come in handy especially when there is go- fer jobs to do like, “hand me that pastrami on rye” or on the ground, “go back in the FBO and ask that receptionist’s phone number for me.” However they also can create distractions, especially when they’re a frightened scare-d-cat white-knucklers, airsick or just a blustering blow-hard that will
not shut up. Although you’re busy as a single pilot, you should provide whatever assistance is within your power to do so to alleviate passenger apprehensions. When busy you might just have to “tune them out” so that you can focus on your job as pilot. Commercial operators procedurally adhere to the cockpit rule of no talking except that which is required for conducting checklists or other duties below 10,000 feet. Although your flying may rarely take you above 10,000 feet it isn’t a bad practice to tell passengers there are certain periods that are “sterile” and no talking is allowed such as when it gets busy on the radio as you approach an airport. You can signify this to them by furrowing your forehead and hissing s-h-h-h-h-h loudly. If your passenger is also a pilot, it is important to establish who is flying the plane and who is not. Sometimes rated pilots will move in on a flying pilot’s turf and this can cause confusion and lead to big problems. Make sure the passengers who are pilots recognize they are to behave as passengers.

The final “P” stands for programming. Flying has been inundated with lots of automation and electronic gadgetry. While this gee-whiz technology can reduce the pilot’s workload it can also lure the pilot into pilot error and potentially catastrophic scenarios. An obvious bad one is ignoring control of the aircraft while making programming inputs. It is essential that pilots become functionally familiar with their navigation systems, tablets, flight management systems et cetera so that they’re not “trying to figure it out” during high workload times. Routes should be preprogrammed prior to take-off and then only minor adjustments will need to be made to accommodate any ATC changes. Double-check your work, too. You may plug-in a navigation fix incorrectly by “fat- fingering” the dinky little buttons or touch screen. Once you’re done go back over it to make sure you’re not headed for Norfolk, Virginia (ORF) instead of Chicago O’Hare (ORD).

Unforeseen things still happen while flying, and no matter how much planning and prep you’ve done, doggone it…the demons sometimes still can reach out and grab your plane. When those demons have got you in their clutches keep these rules in mind:

1. FLY THE AIRPLANE. Period. Don’t allow ANYTHING to take you away from doing that.

2. FLY THE AIRPLANE!

3. ISOLATE the problem. Consider probable causes and possible causes.

4. Use the appropriate CHECKLIST for your problem. It will likely lead you to resolution of the problem and probably suggest the best or the only alternative.

5. Calculate how much TIME and FUEL you have to remain aloft and work on the problem.

6. Evaluate all ALTERNATIVES and assign pros and cons to each.

7. You always have 3 choices: LAND NOW, LAND SOON or CONTINUE.

8. Utilize all RESOURCES both on the ground and in the air including ATC and other aircraft to relay your radio message if you’re too low in altitude. Don’t be afraid to confess your predicament.

9.Remember the most important FAR of all is 14 CFR § 91.3(b) “In an in-flight emergency
requiring immediate action, the pilot in command may deviate from any rule of this part to the extent required to meet that emergency.”

10. FLY THE AIRPLANE!

Single pilot flying is busy flying but when you do your best to thoroughly prepare for a flight it greatly lessens chaos and the chance for pilot error. The philosophy of CRM is a good one. And although it is a fairly new term in aviation, it is really a very old concept that good pilots have been practicing for many years.

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Vern Weiss

On December 29, 1972, an Eastern Airlines Lockheed L-1011 with 176 people aboard crashed in Florida’s Everglades only 3 minutes from touching down at Miami International Airport. Three flight crew members, the Captain, First Officer and Flight Engineer became focused on a landing gear indicator light bulb that was not illuminated. As the airplane descended rapidly the three pilots continued to fuss with the indicator lamp. This marked the beginning of a series of horrible aviation accidents in the 1970s involving highly trained, professional flight crews.

The Beginning of Crew Resource Management

Something had to be done and that same year a British aviation psychiatrist and professor, Elwyn Edwards, developed the beginnings of, what originally was called, “Cockpit Resource Management” that since has been expanded. CRM now includes crew members including flight attendants, on or off duty aboard an aircraft as well as others on the ground and today is known as Crew Resource Management. Little by little, Dr. Edwards’ concepts have been built-upon and enhanced culminating in a comprehensive study and proposal by NASA in 1979. The International Civil Aviation Organization (ICAO) has been instrumental in mandating CRM training and vigilance in aviation and has encouraged worldwide government aviation agencies like the FAA to comply with their CRM standards and protocols.

The NASA studies resulted in the belief that the primary cause of aircraft accidents was human errors created from interpersonal communication, leadership and decision-making problems. As defined, Crew Resource Management is a methodology in which the resources of equipment, procedures and people are collectively utilized as needed to safely complete every flying task. The individual components of CRM resources are communications, situational awareness, problem solving, decision making, and teamwork.

How Crew Resource Management Works

You are driving on a busy expressway. The sun is in your eyes. As you attempt to put them on you drop your sunglasses and they slide to the passenger side floor of the car. You should:

• A. Forget about retrieving your sunglasses and continue driving even though the sun occasionally blinds your vision so your passenger doesn’t think you’re a wimp.
• B. Pull over on the shoulder to safely retrieve the sunglasses before pulling back onto the busy highway.
• C. To demonstrate your prowess as a driver, you reach down to the passengers’ side and grab your
  sunglasses.
• D. You ask your passenger to hand you your sunglasses.

Obviously, answer “D” is best because it allows you to remain focused on control of the vehicle while using someone who is not otherwise busy to complete the task. This example is the essence of what Crew Resource Management is all about.

CRM is not about technical knowledge and the skill of flying an aircraft. It is he interpersonal and cognitive processes of situational awareness, communication, problem solving, decision making and working as a team.

Situational awareness is knowing what is going on around you and recognizing your place in the “big picture.” Walk through any Walmart and you’ll see any number of examples of people who lack situational awareness. As you walk down one aisle suddenly some guy who had stooped down to look at canned prunes stands up and immediately backs into you without looking up first. He had no idea that there could possibly have been anyone behind him even though your grocery cart wheels can be heard for miles around as you approached him. We don’t know where his head was but maybe that’s why he’s buying the prunes.

Don’t get me started on those myopic customers walking around glued to their iPhones, although they are great fun to watch when they walk into a clothing rack or knock over a display of ketchup bottles.
Crew Resource Management applies all the resourceful assistance each crew member requires to safely and efficiently perform flight operations. It includes all direct and peripheral personnel. Besides the immediate flight crew, it can include other pilots who are riding as passengers, jump- seaters, flight attendants, mechanics that may be on board; via radio, utilizing air traffic controllers, company dispatchers and pilots of other aircraft. For instance, you hear an aircraft ahead of you report that it flew through a large flock of birds. Use this information for your own benefit. “Old thinking” was that a pilot must be a “super pilot” and be able to do it all without asking for help. Not so. But pilots who are act autonomously and are unwilling to accept outside help tend to make big mistakes.

Crew Resource Management starts with receiving information, analyzing then making it meaningful. From this, analysis of all the choices enables the best decision out of possible alternatives. The consideration of various alternatives should include any available information, knowledge, prior experience, expectation, context, goals and greatest possibility of a successful outcome. There are times when decisions have to be made quickly, such as when an evasive maneuver is necessary to avoid a mid-air collision. In these instances you must fall back on training and procedures. In the example just cited…traffic at 12 o’clock and closing in on you fast, you veer to the right as per the Aeronautical Information Manual. But what if the bonehead closing on you veers the wrong direction and turns left? You must be willing to amend your response now. This is one of those extreme situations that fortunately does not arise very often. Most situations afford enough time to consult the non-flying pilot. There may be considerations that occur to that pilot that you omitted in your decision and the other pilot’s input will make the final decision a better one. Brittle methods practiced for years and unwillingness to consider others’ suggestions and unwillingness to do nothing have been diminished thanks to CRM, which is a giant leap forward in enhanced safety.

What Would You Do?

You’re headed straight for a black cloud. To its left is a blacker one. To your right the clouds are even blacker than the one on your left. Ah! No sweat…do a one-eighty, right? But the front is moving rapidly and has closed off everything behind you. Probably doing nothing and staying on course is one of the choices. Of course, there’s other things that can be tried like changing altitudes (the middle third of a cumulonimbus is usually where the most violent weather is found), slow up so you don’t hit the “potholes” so hard once you’re in the cloud. Ask your non-flying pilot to check on ride reports ahead of you. Maybe the blackest cloud wasn’t all that bad as reported by an aircraft immediately in front of you. What’s the radar show? Turn on your ADF receiver and watch the needle swing. It points to the area of strongest static caused by lightning discharges. Cinch up your seat belt and tell your passengers to do the same. If you have auto-ignition, turn it on. Follow the procedures in the checklist for turbulence and heavy precipitation penetration. And ask you non-flying pilot what he or she thinks. Maybe the non-flying pilot is more skilled at use of the radar than you and can “see” where the passage ahead would be better. Crew Resource Management uses everything at your disposal.

An important component of CRM is use of standardized checklists for normal, abnormal and emergency operations. When pilots start creating impromptu procedures things can turn ugly real fast. Checklists are developed, tested, re-tested, evaluated and authorized from manufacturers and the FAA have worked out the kinks. Obviously, if one pilot starts extemporaneously throwing switches, the other pilot won’t have a clue as to what his partner is attempting to achieve. Checklists. Checklists. Checklists.

Long overdue, awareness of fatigue and workload have fortunately become important considerations the last few years. There are times when the cockpit gets very busy and at those times both pilots should be sharply attentive. Even though one pilot may be listening to, say, the ATIS frequency and not monitoring the active ARTCC frequency, that pilot should continue to monitor that frequency in case something transpires that require urgency in getting back “into the loop.” Even ATC has changed their policies on issuing clearances, recognizing that pilot workload and information retention has its limits. ATC will not issue a clearance with more than 2 numbers at a time. If they want you to turn left to a heading of 160, descend to 4,000 feet and slow to 230 knots, they’ say, “Ercoupe 38 X-ray, turn left heading 1-6-0, descend to 4,000.” You respond with the read back. Then they call you and say, “Ercoupe 28-X-ray slow to 230 knots.”¹

As aviation has developed, automation has increasingly become more integrated into the pilot’s world. Flight management systems (FMS) and a myriad of aircraft-specific enhancements like auto-throttles, thrust management systems and FADEC-controlled engines, to name a few, have placed more importance on staying on top of what’s going on. While the civilian perceives automation on an airplane as something that makes less work for pilots, it’s actually the opposite. In fact, automation requires more vigilance than non-automation, so pilots must now be more in a systems management role than switch-and-control manipulation role. This makes it imperative that Crew Resource Management be applied to inputs, outputs, programming and cross-checking of all automatic systems.

Simply stated, Crew Resource Management is two or more people performing as one. Pilots utilizing CRM help each other by filling in any voids when tasks mount up and one person can’t do the job without sacrificing attention to the airplane. As mentioned earlier, CRM involves people other than the pilots as well. An example is approaching an airport with deteriorating weather. One of the pilots could direct his or her attention to switching radio frequencies to get a weather update, however both pilots may be very busy. The ATC controller has access to the same weather information that pilots can get from the ATIS, so why not just key the microphone and say, “Approach (control)…you got the latest weather for Booger International?”

Done.

Personal Experience with Crew Resource Management

Some years ago I was flying with another pilot who consistently demonstrated acute and superb skills. One Monday morning, we took off to start a trip and he seemed uncharacteristically “behind” the airplane. I thought his unusual sloppy and lethargic performance was maybe just that this was a very early morning departure and he “wasn’t awake yet.” Second leg of the trip, he was flying the approach and the profile for an ILS was at glide slope intercept to call for landing gear down and full flaps. Glide slope intercept came and he started to descend which, of course built up speed rapidly. He then started reducing the power to counteract the speed. Something was wrong. I said, “Gary, you ready for the gear and flaps?” Breaking his reverie he responded, “OH! Oh yeah…uh…gear down…uh full flaps…uh… and the before landing checklist.” We completed the approach and landing without further incident. After shutting down the aircraft and putting our other duties behind us I asked him if everything is alright. He said, “Well, no. On Friday my mom passed away and yesterday my dad had a heart attack and died.” Whoa! What was this man doing flying an airplane? We were not in a position where I could initiate a crew change but I did convince him to blow off the rest of the trip when we got back to our domicile and replace him with another crew member. I wish I had known before we had even started that morning so I could have intervened. Knowing the stress he was experiencing, at the very least my CRM observations would have been heightened to watch for mistakes and omissions earlier. The goal of CRM is for two people to act as one well-tuned machine.

My first exposure to CRM was my first job as a whipping-boy/corporate co-pilot in a two-pilot turboprop. The guy I worked for was a jerk. But I sucked-it up because I needed to build flight time if I was going to make a career in aviation. One night he ordered me to get him a cup of coffee. The galley was toward the rear of the passenger cabin so I responded dutifully. Just as I returned with his %&*# cup of coffee we flew into an area of turbulence. I am standing there holding his cup of coffee and he turns to me and barks, “NOT NOW! Do something…GET RID OF IT!” I was not a coffee drinker but the only thing I could think to do as we were getting the you-know-what kicked out of us was to drink the coffee quickly. I wanted to puke. In retrospect perhaps my choice to alleviate the problem created by the captain’s cup filled with coffee in some abstract way was a bit of CRM. I also know that that first cup of coffee I drank lead me to try it again and that now I am a die-hard coffee drinker.

So the moral of the story is Crew Resource Management is beneficial to pilots because it enhances safety and allows us to discover coffee.

Get Started With Your Flight Training Today

You can get started today by filling out our online application. If you would like more information, you can call us at (844) 435-9338, or click here to start a live chat with us.

Footnote:

1 – Ercoupe? 230 knots? I’m joking, right?

Sources:

Advisory Circular for Air Operators, “Training Programme for Crew Resource Management,” International Civil Aviation Organization, 2013.

Internet Website: http://www.crewresourcemanagement.net/information-processing/decision-making

Featured Image: Kent Wien