As pilots we understand that our decisions are crucial and the safety of every flight depends on them, but now other fields that require decision-making are looking to aviation as the model of how it should be done.
Decision making in the cockpit provides a unique environment. Pilot decisions are rarely made in a calm, low-stress, and quiet world. Pilot decisions are usually made in a time-sensitive, high stress, and high stakes environment where second chances at a decision are not always possible. My father always told me that I should ‘sleep on it’ when making a big decision – but pilots don’t have that luxury – we must decide and act often without much time to deliberate and reflect. No wonder pilot error is the leading cause of accidents: decisions under pressure are not always done well.
But aviation has made progress in training people to make decisions under pressure and our techniques are getting noticed by others who also face stressful, fast-paced, and high stakes decisions. Among these are forest fire fighters, hostage negotiators, military commanders, nuclear power plant operators, ship captains, and medical emergency personnel. All of these positions face life and death decisions in time-sensitive circumstances just like pilots – and guess what, they are now learning from us!
The Associated Press reported earlier this year in a story titled ”Time-Out’ System Aims to End Surgical Mistakes’ that surgical teams now are beginning to use pilot techniques to avoid mistakes:
‘Starting July 1, operating rooms are supposed to be a little safer: Surgical teams must take new steps to prevent operating on the wrong body part or wrong patient. Among the [new] requirements: Much as airline pilots go through a safety checklist before takeoff, surgeons and nurses must take what is being dubbed a ‘time out’ before cutting. It is to double check that the right patient is on the table, if he’s really to lose a kidney and not a gallbladder – and if so, on which side.'[AP by Lauran Neergaard]
Although errors in operating on the wrong person or taking out the wrong body part are a small number of the 70 million annual surgeries in the United States, there have been 275 voluntary reports of such situations since 1999 and the cases are increasing each year. The cases include amputation of the wrong foot, removal of a healthy kidney, and even drilling into the wrong side of a patient’s skull! These mistakes were often ‘chain of events’ mistakes that took place when people were in a rush and didn’t notice that an X-ray had been put up on the screen backwards, or a patient’s chart was misplaced. Of course pilots practically invented ‘chain of events’ mistakes. Almost every aircraft accident you can remember was not the result of one mistake, but a series of mistakes when the ‘holes all lined up.’
Pilots use a checklist to be sure nothing has been forgotten before takeoff and try to double-check everything. We yell ‘Clear!’ before we start the engine. Now doctors are using our techniques to check and double-check before they say ‘scalpel!’
Another pilot decision making technique is the use of simulators and flight training devices to teach pilots decision making is real-world scenarios. Simulation is now being used in may areas where high stakes decisions are required. I recently was the guest of Captain Arild Ueland on the bridge of a cruise ship.
Captain Ueland explained that now ship captains go through full scale ‘voyage simulations’ in virtual reality computer projection simulators. Just like pilots, Captain Ueland goes to Miami, Florida once a year for recurrent training. The facility where the training takes place has a real-size ship’s bridge with computer projections out each window. The session begins with the Captain and crew maneuvering the ship from a harbor that is used by the shipping company – say, Fort Lauderdale. Once at sea, the real fun begins. Also like pilot recurrent training, the Captain and his crew will deal with on-board problems like fires, rough seas (turbulence), malfunctioning systems, and emergency procedures. Captain Ueland told me that since the ship only moves at 17 knots, the simulation designers will speed up the enroute portion of the simulation so that the session doesn’t last five days like an actual voyage might. But before the simulated voyage is over the Captain and crew must bring the massive ocean liner into a port despite areas of shallow water, high crosswinds, and low visibility. Shallow water to a ship’s captain is like high terrain to a pilot and we are already accustom to wind is visibility problems – sounds like IFR training to me! Sea-going crews must use teamwork, and skill in tight situations and today they learn to do that better from what aviation has taught them.
There is no question that in the medical emergency room lives are at stake. An incorrect diagnosis under pressure could kill the patient. To help emergency room teams practice under pressure, schools now use ‘patient simulators.’ A patient simulator looks like a mannequin but it breathes in air, has a temperature, a heartbeat, and blood pressure (photo courtesy MTSU School of Nursing by Ken Robinson). Students are told that the ‘patient’ has just been brought into the emergency room. The simulator is set to present a certain set of symptoms like: unconsciousness (mannequins are good at acting unconscious), elevated heart rate, shallow breathing, etc. The students try to figure out
what to do. Sometimes they administer a medicine that creates an allergic reaction, sometimes they save the patient, sometimes they kill the patient. Sometimes pilots in a simulator land safety, other times they crash. It is all about learning how to make decisions under pressure when nobody’s life is actually hanging on the correct decision so we are all safer when lives are actually at stake.
Now aviation is leading the way again. This time with scenario-based training transferred from airplane simulators to actual airplanes. The FAA Industry Training Standards (FITS) uses an emphasis on ‘mission’ rather than total reliance on ‘maneuvers’ to teach pilots to fly. Pilots will always need high level piloting skills (landing in a cross wind, stall recovery, avoiding wind drift, etc.) but those skills don’t take place in isolation. I might be able to land in a stiff crosswind, but am I forced to do so if there are other runway options? Pilots need to be brought up understanding that decision-making is just as much a part of flying as needle, ball, and airspeed.
The Bottom Line: To fly an airplane is to act as a decision maker. And the decision is more than the traditional Go/No Go decision at the beginning of every flight but a constant stream of decision making in time-sensitive, sometimes high stress, and in high stakes situations. But, we must be doing something right – so may are copying us.