Friday, January 15, 2021

The Rules are Written in Blood.

     In 1977 two Boeing 747's collided on a runway in the Tenerife killing 583 people (Driefus, 1978). The official report found that the pilot-in-charge overrode his Engineer's concerns and failed to change his actions when presented with new information, significantly contributed to the accident. (Driefus, 1978).



     In 1979, as a response to this, NASA created the workshop Resource Management on the Flightdeck a predecessor to Crew Resource Management (CRM) (Helmreich, 2002). Over the years several companies took on CRM for themselves and implemented it (Helmreich, 2002).  

What is CRM?

     Crew Resource Management is the use of resources to improve safety and performance while avoiding  errors (Diehl, 2013). One of the most important factors of CRM is the emphasis on teamwork and acknowledgement that even the most senior and experienced people can make mistakes. This calls for assertiveness on the part of everyone on the crew, but it should be encouraged in newer, younger members who may feel they have not "earned" the right to speak up. 

     A second factor is the clear communications and standards of language. This was clearly demonstrated in the Tenerife accident when the controller told one of the pilots to turn onto the third runway, this was a matter of counting and not labelling the runway (Driefus, 1978). 



Effects of CRM

     In 1990 the FAA required that air carriers integrate CRM into their crew training (Helmreich, 2002). However carriers where afforded flexibility in the design of their program (Helmreich, 2002).

    The overall results and affects of CRM are inconclusive (Helmreich, 2002). It is difficult to quantify the effectiveness of CRM as not all incidents are reported and more importantly incidents which did not result in an error are reported even less (Helmreich, 2002). But it does still influence the way we fly. 

    However, CRM is now constantly evolving and even accepting that error is inevitable (Helmreich, 2002). The aviation industry both at the federal level and the corporate level continues to examine the current standards and reevaluate as new information and new incidents occur. This idea of constantly reevaluating and watching for errors is at the heart of CRM. 

Word count: 353

Diehl, Alan (2013) "Air Safety Investigators: Using Science to Save Lives-One Crash at a Time."
          http://www.prweb.com/releases/DrAlanDiehl/AirSafetyInvestigators/prweb10735591.htm

Dreifus, E. Douglas (1978). Collision Aeronaves Boeing 747 PH-BUF DE K.L.M. Y Boeing 747 N 736            Pa de Panam En Los Rodeos (Tenerife) El 27 De Marzo De 1.977. http://www.project-  
          tenerife.com/engels/PDF/Tenerife.pdf

Helmreich, Robert L., Merritt, Ashleigh C., Wilhelm, John A. (2002). The Evolution of Crew Resource            Management Training in Commercial Aviation. 
          https://web.archive.org/web/20130306162247/http://homepage.psy.utexas.edu/homepage/
          group/HelmreichLAB/publications/pubfiles/Pub235.pdf


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