Lecture 9: Generation of Crew

Resources Management

Introduction

• Term generation is used in describing the changes in CRM over the last 3 decades.

• Generation refers to the process of growth & development.

• Till now, CRM have arrive the 6th generation.

1st Generation2nd Generation3rd Generation4th Generation5th Generation6th Generation

Three final image in the deadly accidents that started

(initiated) CRM

1972: Eastern L-1011 crashed during approach in Miami Airport

Flight crew's failure to monitor the flight instruments during a malfunction of the landing gear position indicator system. The crew realised their error too late and were too low to recover. Of the 163 persons on board 112 were killed in the crash.

1st major air disaster that initiated CRM (Loss of Situational Awareness)

1977: Pan-Am Boeing 747 and KLM Boeing 747 runway collision, Tenerife Airport

The KLM B747 Captain initiated a takeoff without permission while the Pan Am B747 aircraft was using the

runway to taxi out for landing.

337 peoples on the Pan Am B747 and 248 on the KLM B747 were

killed.

2nd major air disaster that initiated CRM (Poor Communication)

1978: UAL 173 DC-8 crashed during approach near Portland

First Officer Rodrick Beebe: Portland Tower United 173, Mayday! We're…the engines are flaming out…we're going down. We're not going to be able to make the airport.

•Captain fixation on landing gear problem.•His crews (F/O & F/E) informed about low fuel condition.•Captain ignored them or misunderstood them & continue to solve landing gear problem.•The DC-8 ran out of fuel and finally crashed.•189 Peoples, 10 killed, 23 seriously injured

3rd major air disaster that initiated CRM (Loss of SA & Poor Communication)

Why need CRM?• Many accidents result not from a

technical malfunction but most accidents are caused by the inability of crews to respond appropriately to the situation in which they find themselves.

• For example, inadequate communications between crew members and other parties could lead to a loss of situational awareness, a breakdown in teamwork in the aircraft, and ultimately to a wrong decision or series of decisions which result in a serious incident.

First CRM generationconcepts

1st CRM generation

• Develop from a workshop conducted by NASA in 1979.

• 1st training was initiated by United Airlines in 1981.

• Initially the term was Cockpit Resource Management (CRM).

• 1st CRM generation concerns are– Need to use the right people– Need to use right materials.– Need to use right equipments.– Need to use right technology.

1st CRM generation

OBJECTIVES:• To reduce pilot error by improving

human resources on the flight deck.• To fix the “Wrong Stuff” leaders and

make junior crew members assertive.* “Wrong Stuff” term refers to the

captain’s failure to accept input from junior crewmembers.

• To focus on individual management style & interpersonal style.

1st CRM generation• 1st generation training was

conducted in the classroom and also in simulator settings called Line Orientated Flight Training (LOFT).

• Skills taught in the classroom setting were adapted to training scenarios in simulators where techniques could be practiced without danger.

Second CRM generationconcepts

2nd CRM generation• In 1986, NASA developed another

CRM workshop. • Change in name from “Cockpit” to

‘Crew Resource Management’. • Realized that better outcomes

could be produced if the entire crew was involved.

• Name change in order to acknowledge the roll of cabin crews along with ground handling, maintenance, and dispatching crews.

2nd CRM generationOBJECTIVES:• To improve team building (use of

team-building exercises)• To focus on Situational Awareness

(SA) and stress management. • To break the chain of errors that

could cause an accident.• Much of the training that

originated in this era continues to be used, either in stand-alone modules, or combined within newer programs.

Third CRM generationconcepts

3rd CRM generation• The so-called, CRM 3rd generation

evolved during the early 1990s. • Efforts began to integrate CRM with

TECHINICAL TRAINING.• Also to focus on specific skills and

behaviors that pilots could use to function more effectively.

• Almost courses focus on the need to improve flight crew.

• Several airlines began to include modules addressing CRM issues in the use of ‘FLIGHT DECK AUTOMATION’

3rd CRM generation

• Flight deck automation means machines on the commercial transport aircraft flight deck that perform functions (not pilot).

• Current flight deck automation includes autopilots, flight management systems, electronic flight instrument systems, and warning and alerting systems.

Airbus A320 Glass Cockpit

“The magic roundabout in the UK”

7

“The magic roundabout in the UK”

• This slide shows one of the teaching slides “The magic roundabout in the UK” - Five roundabouts centred around another.

• It is an example of an excessively complicated system lead to error.

Fourth CRM generationconcepts

4th CRM generation• 4th generation saw the change

of CRM training to organisations themselves.

• The first move to recognise that CRM training has to be tailored to the organisation.

• Aim is to solve the problems of human error by making CRM an integral part of all flight training.

Fifth CRM generationconcepts

5th CRM generation• Begin in 1996, 5th generation CRM

showed great maturity in the concept. • Assume human error is pervasive

and cannot be totally eliminated.• Focus on error management with

the development of error countermeasures. (an action taken to counteract a danger)

• There are three lines of defence in these counter measures.– 1: Firstly we can attempt to minimise error– 2: Secondly we can try to trap the errors,

and – 3: Thirdly we can mitigate errors.

3 lines of defence to counter act the dangers

The point of the exercise is to achieve safety – which is a major determinant of morale.

5th CRM generation• For example, consider an advanced

aircraft experiences CFIT because wrong data is entered to Flight Management System (FMS).

• 1st :A careful briefing on procedures combined with communication & verification of FMC entries can avoid the error.

• 2nd: Cross-checking entries should trap the error.

• 3rd : Inquiry & monitoring of the position should result in mitigating the error consequences before CFIT.

Controlled flight into terrain (CFIT)

• CFIT describes about aircraft collision, under pilot control, inadvertently flies into terrain, an obstacle, or water.

• The pilots are generally unaware of the danger until it is too late.

Flight Management System (FMS)

• The flight management system (FMS) is the avionics that holds the flight plan, and allows the pilot to modify as required in flight.

• Given the position and the flight plan, the FMS guides the aircraft along the flight plan.

• The FMS is normally controlled through a small screen and a keyboard.

Sixth CRM generationconcepts

6th CRM generation

• Initiated in 2001.• Finally today we are sitting with 6th

generation CRM. • This is the latest generation that

every airliner in the world practicing it.

• 6th generation CRM looks beyond the aircraft.

• It looks at controllers, weather forecasters, dispatchers and command structures.

6th CRM generation

• This is where A CRM comes into play.• Anyone who is involved with the

aircraft’s mission, anyone who is part of the crew, has a role to play in CRM.

• 6th generation CRM concepts are based on Threat & Error Management (TEM).

• It was developed to help understand, and explain, the interaction between safety and human performance, within an operational context

Topics in 6th CRM generation are:

• Communication and coordination inside and outside the cockpit

• Decision making • Situational Awareness • Stress, stress management,

fatigue• Workload management • Human error and reliability, error

chain, error prevention and detection

• Execution and Error Management

Summary• CRM is not and never will be the

mechanism to eliminate error and assure absolute safety in a high risk endeavor such as aviation.

• Error is an inevitable result of the natural limitations of human performance and the function of complex systems.

• CRM is one of an array of tools that organizations can use to manage error.

• When CRM is viewed in the context of the aviation system, its contributions and limitations can be understood.

• What we do know is that the rationale for human factors training is as strong now as it was when the term CRM was first coined