Transcript No Slide Title

Enhancing Flight Crew
Management of Unexpected Events
This presentation is intended to enhance the reader's understanding, but it shall not supersede applicable regulations or airline operational documentation. Should there be any
discrepancy between this presentation and the AFM/(M)MEL/FCOM/QRH/FCTM, the latter shall prevail at all times.
1
Introduction
The objective of this visual guide is to reinforce
the importance of being ready for and properly
handling unexpected events to avoid associated
aircraft upsets. Even though the events
described are mostly unanticipated, a flight crew
can effectively prepare to deal with them,
thereby avoiding problems. The material may be
used for self-study or as part of a formal training
presentation.
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Contents
1.
Defining Unexpected Events
2.
Types of Unexpected Events
3.
Unexpected Events and Aircraft Upsets
4.
Surprise, Stress and Error
5.
Preparing and Responding
6.
Summary
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Unexpected Events Defined
An event is unexpected if it disagrees with
expectations as determined by planning and the context
of the situation.


The nature of an unexpected event may be:
–
Normal
–
Abnormal
–
Emergency
An unexpected event may be:
–
Frequent
–
Infrequent
–
Novel or surprising
The absence of an expected event is an unexpected
event in itself.
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Types and Causes of Unexpected Events
Types of unexpected events:

Events omitted from a plan

Planned events that do not occur at all or at the expected time

Unplanned events (e.g., abnormal events and emergencies)
even if they are included in training
Causes of unexpected events:

System malfunctions

Changes in flight plans while en route

Weather or environmental threats

Crewmember incapacitation

Loss of situational awareness

Failure to receive instructions when they are normally provided

ATC or other crewmember communications

Aerodynamic anomalies
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Aircraft Upset (Loss of Control)
The most serious consequence of an unexpected event
is aircraft upset or loss of control, defined as:

Unintentional pitch > 25 degrees nose-up or 10 degrees nose-down

Bank > 45 degrees

Inappropriate airspeeds for flight conditions

Any other aircraft state not intended by the pilot
Types of Aircraft Upsets:

Environmentally induced

Systems failure induced

Pilot induced
Often, loss of control is due to a fixation on the unexpected
event instead of returning to essential flight duties.
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Factors Involved in Unexpected Events
That Lead to Aircraft Upsets
Factors Leading to an Aircraft Upset
Percentage
of upset
events in
which the
factor was
present*
Aircraft
position
Air
traffic
control
Other
crewmember
actions
Aircraft
state
System
status
Automation
In-flight
turbulence
Low
visibility
65.8
51.1
42.3
31.7
19.3
14.9
11.6
10.0
* Percentages add to more than 100 because multiple factors can be present in a single event.
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Surprise
All unexpected events cause at least some level of surprise.
An
event causing no surprise is not an unexpected event.
Levels of surprise:

Mild surprises are usually caused by unexpected events that are fairly
common or have no significant consequences.

High surprise levels are usually generated by events that are extremely
unlikely, rare or directly threaten safety.
The Process of Surprise
Surprise
Event
Assessing
data about
the situation
Finding no
memory
image to fit
the situation
Analysis
and
evaluation
Action
selection
and
execution
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Surprise Can Cause Stress and Error
Surprise may contribute to an interruption of thought
processes and motor activities that may then lead to error.
•.

The same unexpected event may induce higher stress for some pilots
than for others.

Experience level, personality, attention level and fatigue may influence
the extent of stress generated by surprises.

High levels of stress may lead to a spiraling effect in which loss of
situational awareness causes a larger number of events to be
unexpected.

Eventually, the stress from an unexpected event can lead to aircraft
upset.
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Preparing and Responding
Flight instruction should apply realistic, scenario-based
training to teach students to:

Maintain situational awareness

Recognize and respond to ill-defined events

Modify known procedures to fit novel situations

Learn problem-solving techniques to avoid becoming fixated on
a solution that is not working


Strive for optimal stress/arousal levels — neither too little
(complacency) or too much (overloaded)
Strive for a measured emotional response
–
Do not completely ignore your own senses or internal dialogue
–
Be sensitive to instinctive reactions and the “hair standing up on the
back of your neck”

Integrate creative thinking and emotional control with the
requisite “stick-and-rudder” skills
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Preparing and Responding (continued)

Apply proven procedures for using maximum available flight
control inputs and power — employ alternate control strategies
as required

Deliberately seek all available information during flight and as
part of preflight planning

Continually evaluate the unfolding situation

Practice monitoring thoughts and actions

Continuously ask, “What if?”

Maintain cognitive flexibility by keeping an open mind to
alternatives and possibilities at all times

Approach flying with an appropriate attitude (mental, physical
and social) so that when faced with an unexpected event the
detrimental effects of surprise are minimized
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Summary

There are many types of unexpected events in aviation.

Many events prompt a surprise reaction from the flight crew.

Any unexpected event can produce an undesirable outcome.

The reactions of pilots to unexpected events are major
contributors to loss of control in flight.

When pilots seek all available information in flight and during
preflight planning, fewer events will be unexpected, and
surprise will be less likely.

Flight training should integrate mental skills and emotion
management with the “stick-and-rudder” skills necessary to
promote successful perception, processing and response to
any unexpected event.
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