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Aeromedical Forum: December 2014

The day the music died

The Minnesota-Michigan game! The Battle for the Little Brown Jug is one of the great college football rivalries and we were flying to Ann Arbor to see it!

The hand-off from Rochester to Minneapolis Center was uneventful. We settled into cruise configuration with the expectation of two hours of instrument monitoring until we hit Detroit airspace. Unfortunately the day we launched was last September 26th.

You may recall that on that sunny morning, an ATC contract employee decided to burn down Chicago Center before slitting his throat and wrists. He failed in both enterprises but did manage to incinerate a boatload of communications cables and servers in the bowels of the building. This took out most voice and data traffic, severely limiting ATC throughput capacity. Of course we were unaware of the mayhem on the ground, humming over the rolling hills of southeastern Minnesota. Our idyll was broken when Minneapolis Center announced, “Chicago Center has experienced a massive equipment failure and is no longer accepting incoming flights.”

A second of silence on my part. What! So? Apparently our controller was having similar thoughts. “Do you think you can continue VFR?” What did I think? Push on! But wait a minute. In a cross country journey of 400 NM the chances of having to penetrate clouds were very high indeed. The idea of cruising across Lake Michigan without talking to a controller was a definite no.

Re-route south around Joliet and it’s a fuel stop for sure. If I did that, did I want to go VFR around one of the busiest airspaces in the country with Center inoperative? Do we scrap the mission? We had tickets, dinner and hotel reservations in place for months. My epic risk-management-assessment was interrupted by our fast-thinking controller.

“Can you accept niner-thousand for tower to tower?” I was planning to cross Lake Michigan at 13,000 MSL to minimize that short but uncomfortable interval when you are beyond gliding distance.

The Cirrus was four hours out of annual and running like a top. And, yes, flotation gear for all was on board. A few seconds of mental ju-jitsu and I concluded that the risk-benefit ratio of the lower altitude was favorable. So we skipped from Volk to Madison to Milwaukee to Muskegon to Lansing to Detroit Approach without a hitch, shooting RNAV 06 at KARB through a scattered to broken layer.

So what does this have to do with aeromedical issues? Quite a bit as far as human factors research is concerned. One thing I found going on in my own thinking was a tendency to what the clinical psychologists call “Plan Continuation Errors.”

This is discussed as some length in the NTSB report of a 2001 Gulfstream crash on final into Aspen. Some hot-shot exec chartered the craft out of LAX, arrived 41 minutes late and badgered the pilot into shooting the VOR approach into Aspen through mountainous terrain when the visibility was zip in light snow.

Worse, darkness had already enveloped the mountain valley. Three other flights had just gone missed. Common sense would have dictated the pilot going to his alternate. The report concludes, “Pilots, particularly those with considerable experience, try to complete flights as planned, please passengers, and meet schedules, which can compromise safety and impose an unrealistic assessment of piloting skills under stressful conditions.

Also, human performance researchers have noted that pilots tend to adhere to their original plan of action, which interferes with critical analysis processes that are needed to adequately reevaluate the suitability of the original plan and explore an alternate course of action.

As a result, ‘plan continuation errors’ occur; that is pilots elect to continue with an original plan of action despite the presence of cues suggesting that the course of action needs to be modified.” Aggravating this is the tendency we all have to look for information that confirms our plan of action and ignore or minimize contradictory information.

I was fortunate. A revised reasonable plan of action was quickly available thanks to ATC. The Gulfstream pilot was not fortunate. He failed to recognize increasing evidence that attempting the approach was unwise or that at the least he should go missed and fly to his alternate.

Oh and for those of you that don’t follow Gopher football, the final score was Minnesota 30, Michigan 14. The Little Brown Jug has returned to Minneapolis!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.

 

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