Autogenic Feedback Training Improves Pilot Performance During

FLIGHT SAFETY FOUNDATION • FLIGHT SAFETY DIGEST • JULY 1993 1

Autogenic Feedback Training ImprovesPilot Performance During

Emergency Flying Conditions

Emergencies in flight create stress factors that can seriouslydegrade pilot performance. A recent study examines how autogenic

feedback training improves pilot performance duringhigh-stress and emergency situations.

byMichael A. Kellar, Raymond A. Folen,

Tripler Army Medical Center, Honolulu, Hawaii;Patricia S. Cowings,

NASA Ames Research Center; William B. Toscano,

University of California at San Francisco;and Glen L. Hisert,

U.S. Coast Guard Station, Barbers Point, Hawaii

Studies have shown that autonomous modebehavior (AMB) is one cause of aircraft fa-talities caused by pilot error. In AMB cases,the pilot is in a high state of psychologicaland physiological arousal and tends to fo-cus on one problem, while ignoring morecritical information.

The following study, conducted under theauspices of the U.S. National Aeronauticsand Space Administration’s (NASA) AmesResearch Center, examined the effect of train-ing in physiological self-recognition and regu-lation, as a means of improving crew cock-pit performance. Seventeen pilots wereassigned to the treatment and control groupsmatched for accumulated flight hours.

The treatment group comprised four pilotsof HC-130 Hercules aircraft and four HH-65Dolphin helicopter pilots; the control groupcomprised three Hercules pilots and six Dol-phin helicopter pilots.

During an initial flight, physiological datawere recorded for each crew member andindividual crew performance was rated byan instructor pilot. Eight crew members werethen taught to regulate their own physiologicalresponse levels using autogenic feedback train-ing (AFT). The remaining pilots received notraining.

During a second flight, treatment pilotsshowed significant improvement in perfor-mance, while control pilots did not improve.The results indicated that AFT managementof high states of physiological arousal may im-prove pilot performance during emergency fly-ing conditions.

FLIGHT SAFETY FOUNDATION • FLIGHT SAFETY DIGEST • JULY 19932

Human Factors Gain IncreasingImportance

Human error is the largest single cause ofaccidental mortality among aviators.1 It isnot surprising, then, that increased attentionhas been placed on the human factors associ-ated with aircraft accidents. The U.S. Avia-tion Safety Research Act of 1988, for example,directed the U.S. Federal Aviation Adminis-tration (FAA) to expand research efforts ex-amining the relationships between humanfactors and aviation safety.2 A central hu-man factors problem, human error has beenidentified as the leading causeof aviation mishaps.3 Recent FAAreports reveal that human erroris a causal factor in 66 percentof air carrier incidents and ac-cidents, 79 percent of commuterand 88 percent of general avia-tion accidents.2 Human errorsaccount for a substantial num-ber of military aviation accidentsas well. It has been estimatedthat at least 50 to 70 percent ofaviat ion mishaps across a l lbranches of the armed forces areattributed to human error.4,5

The Aviation Safety Commission6, 8 narrowlydefines the cause of accidents as pilot erroronly in those instances where the error ap-pears “undeniable.” This definition and thefigures cited above can be misleading, how-ever, as a result of the simplistic approachgenerally taken in the identification of hu-man error as contributory or causal in air-craft incidents. These classifications do notadequately address the fact that human er-r o r s a r e t h eresult of very complex processes. The term“pilot error” carries with it the implicationthat an aircraft commander was solely re-sponsible for a given accident as a result ofsome discrete act of omission or commis-sion. In fact, errors are only rarely attribut-able to a single cause7 and culpability foraccidents lies within the interaction betweenhuman and other factors. These factors typi-cally include mission-demand characteris-

tics, environmental considerations and equip-ment design. Another factor often involvedis the abrupt onset of emergency conditions,where the impact on task performance hasbeen demonstrated.9

Historically, attempts to decrease human er-rors in aviation have focused on the auto-mation of tasks, leading increasingly to thepilot as a backup to the automated systems.2

This approach, however, does not adequatelyaddress the full spectrum of human factorsproblems. As automation and complexity in-crease, so does the potential for human er-ror.10 Within automated systems, there is the

expectation that humans will re-main alert during boring peri-ods and deftly assume controlof the aircraft in the event of acritical situation. However, thecomplacency that accompaniesprolonged reliance on automatedsystems may reduce the pilot’sability to respond effectively inemergency situations.11 It is be-coming increasingly recognizedthat efforts to reduce human er-ror must be aimed more directlyat the human element.

Crew resource management (CRM) is a rela-tively recent attempt to reduce human er-rors in the multicrew cockpit.12 CRM addressesthe human error issue by attempting to en-hance communication and workload distri-bution, and it appears to be a fairly successfulstrategy. A primary assumption of CRM train-ing is that crew coordination will becomeroutine, thereby increasing the probabilitythat it will be practiced during stressful situ-ations. This assumption may be unrealisticbecause crew coordination and communica-tion skills may become peripheral tasks duringan in-flight emergency, because the pilot’scentral focus may well be with stick andrudder activities. Perhaps the primary valueof CRM is as a preventive measure. Thistraining may enhance crew effectiveness,thereby reducing the likelihood of errorscaused by poor crew coordination.

Human erroris the largest

single cause ofaccidentalmortality

amongaviators.


CRM training alone does not sufficiently ad-dress the problem of human error incidents.Reasonable evidence exists to conclude thatpilots may lose control of their aircraft as adirect result of reactive stress.13-17 The con-dition in which a high state of physiologicalarousal is accompanied by a narrowing ofthe focus of attention can be referred to asautonomous mode behavior. This study ex-amined the efficacy of physiological self-regulation training as a means of improvingpilot performance during emergency flyingconditions. A number of studies have pro-duced evidence that this type of trainingeffectively reduces physiological arousal whichaffects operational efficiency in student pi-lots.16, 18 The specific method usedin the present study was AFT,which was developed by Cowingset. al. as a potential treatmentfor space motion sickness of as-t r o n a u t s a b o a r d t h e s p a c eshuttle.19-21 This method has alsobeen used successfully by the U.S.Air Force to control airsicknessin military flight crews.22, 23

AFT has advantages over othermethods for this particular ap-plication because it teaches in-dividuals to regulate the levelsof multiple physiological re-sponses simultaneously, thus enabling a moresystemwide reduction in reactivity to stres-sors. AFT was designed to be administeredin a relatively short period of time (six hours)and can reliably produce the autonomic controlnecessary to reduce responses to severe en-vironmental stressors (i.e., motion sicknessstimuli); it has been demonstrated to be ef-fective in a wide population of subjects un-der a variety of stimulus conditions.19

All the pilots were active-duty U.S. CoastGuard personnel and received no additionalcompensation for their participation. Theirinformed consent was obtained prior to theinitiation of the study. The research proto-col was approved by the Clinical Investiga-tion/Human Use Committee of Tripler ArmyMedical Center. The 17 pilots who served assubjects were volunteers from the U.S. Coast

Guard Air Station, Barbers Point, Hawaii,U.S. These crew members consisted of sevenmen from fixed-wing aircraft (HC-130), andnine men and one woman from rotary-wingaircraft (HH-65). Following an initial flight,pilots were assigned to one of two groups(treatment or control) that were matched foraccumulated flight hours. The treatment groupcomprised four pilots from fixed-wing air-craft and four rotary-wing pilots; the con-trol group comprised three fixed-wing pilotsand six rotary-wing pilots. No attempt wasmade to match groups by sex or type of air-craft.

Physiological responses monitored were res-piration rate, with a pneumo-graph (PNG) placed around thesubject’s chest; heart rate (HR),with electrodes located at pre-cordial sites; skin conductancelevel (SCL), with electrodesplaced on the underside of theright wrist; skin temperature,using a thermistor placed on thelateral side of the right smallf inger ; and muscle act iv i ty(EMG), with surface electrodeplacement bilaterally on the up-per trapezius.

Electrode/transducer wires weresecured to each subject and exited the flightsuit at the collar opening; they were con-nected to a J&J I-330 data acquisition sys-tem mounted behind the subject’s headrest.Cables connecting the modules to a laptopcomputer were taped to the deck of the air-craft. Neither motor movements or sensa-tions of the subject or other crew memberswere inhibited by the instruments. In bothaircraft and ground-based training sessions,these data were digitized and stored as 0.75-second averages on a laptop computer.

Initially, all the pilots participated in an in-tense emergency flying condition “check ride.”Physiological monitoring and evaluation ofperformance commenced with the preflightchecklist and continued throughout the flightscenario, terminating with the aircraft’s re-turn to the ramp. Allowing for the differences

Reasonableevidence exists

to conclude thatpilots may losecontrol of their

aircraft as adirect result ofreactive stress.


in flight parameters of the two types of air-craft flown and given the inherent limitationsof conducting a field study, each flight sce-nario was very similar.

The airborne portion of this study took placeon U.S. Coast Guard HC-130 and HH-65 air-craft. Actual aircraft (in contrast to simula-tors) were utilized for this study primarilybecause it is methodologically desirable tostudy, as much as possible, real-life situa-tions with their inherent uncertainties. Nomodifications to the aircraft weremade, and each flight carriedits routine crew complement.These crew members performedtheir usual duties aboard the HH-65 and HC-130, with one excep-tion on the HC-130 flights: Thenavigator, while on the aircraft,was not stationed at his tableon the flight deck. As the sce-nario did not require his pres-ence in the cockpit, his table wasutilized as a work station forthe physiologic data acquisition.

In the HC-130 emergency flightscenario, subsequent to the pre-flight, taxi and takeoff, the air-craft was flown to a cruisingaltitude designated by air traf-fic control (ATC). As a peak per-formance exercise, the pilot wasinstructed to return to the traffic pattern andexecute a series of touch-and-go maneuvers(one systems-normal, one simulated No. 1engine fire and one automatic direction finderinstrument approach). Upon completion ofthese tasks the aircraft departed the patternat an altitude assigned by ATC for a search-and-rescue (SAR) case in which there wasostensibly a downed A-4 pilot approximately20 miles (32 kilometers) offshore.

To assess the subject’s performance and physi-ologic response while experiencing a con-siderable stressor, a compounding emergencycondition was simulated.

Once the search pattern had been established,the cargo door had been opened and secured,

and the aircraft had descended to 200 feet(61 meters) above ground level (AGL), a tur-bine overheat of the No. 2 engine, followedby an uncontained turbine failure of thatengine, was simulated. The pilot was thennotified of a simulated airframe damage, aminor fuel leak from the No. 2 engine, andthat a crew member had sustained injuriespresumably resulting from shrapnel. This an-nouncement was followed by left-hand andessential AC bus failure indicators. Momentslater, an instructor pilot told the pilot that

there was simulated smoke (with-out fire) emanating from underthe flight deck, that there wascharring on the nacelle paint inthe vicinity of the No. 1 genera-tor, and the master fire light T-handle and a visible confirmationrevealed that the No. 1 enginewas on fire. Upon stabilizing theaircraft, the pilot was directedto maintain a cruising altitudeas instructed by ATC, return tobase and make a two- enginefull-stop landing. This was fur-ther complicated by a simulatedlanding gear malfunction whichrequired a simulated manualextension of the landing gear.

In the HH-65 emergency flightscenario (following preflight andtaxi to a hover-takeoff), the air-

craft was flown to an ATC-designated alti-tude. The pilot was then instructed to executea series of touch-and-go maneuvers (one stan-dard no hover, one standard engine stall attakeoff and one simulated No. 1 engine stallto a running landing). Upon completion ofthese tasks, the aircraft departed the pat-tern at an altitude assigned by ATC for anSAR case in which there was ostensibly adistressed boat that would likely require re-moval of a crew member with unknown in-juries. While proceeding to the vessel’sposition, the aircraft experienced an AC busmalfunction with a resulting loss of the gyroand pitch and roll controls. Upon stabiliz-ing the aircraft and returning to systems nor-mal flight, the pilot was directed to the positionof the simulated craft and was instructed to

To assess thesubject’s

performance andphysiologic

response whileexperiencing aconsiderable

stressor, acompounding

emergencycondition was

simulated.


prepare to hoist the injured party aboard.While in a hover at approximately 50 feet(15 meters) AGL, the pilot was given a servojamwarning followed by a secondary hydraulicfailure indicator, which resulted in the rud-der pedals being locked. The pilot was thenrequested to enter a holding pattern and re-turn to base and land the “impaired” air-craft as instructed by ATC. The pilot wasthen directed to fly the aircraft from the runwayto the outer ramp (helo-pad). As the aircraftwas on short-final approach, the instructorpilot simulated a stall of the No.1 engine from which the pilotwas to recover and land the air-craft as instructed.

Pilot performance measures in-volved subjective assessmentsof two instructor pilots whoserved as observers, with roughlyequal numbers of treatment andcontrol pilots assigned to each.The observers were not told thegroup assignments of individualpilots, and they graded the sameindividuals on both flights. Twotypes of observer ratings wereobtained, both adapted from per-formance scales developed byFoushee et al.24 The first typeinvolved performance judgmentsmade routinely by supervisory check pilotsand were grouped by specific phases of theflight (i.e., checklist execution, taxi/takeoff,cruise, touch-and-go, cruise/SAR, emergencyinitiation, emergency return to base, and emer-gency approach and landing). Performancedimensions examined by this study were stressmanagement; crew coordination and com-munication; aircraft handling; and planningand situational awareness. Each performancedimension was scored on a five-point Likertscale with the following anchors: 1 (belowaverage performance); 2 (slightly below av-erage); 3 (average); 4 (slightly above aver-age); and 5 (above average). The observerwas instructed to circle N/A (not applicable)should a dimension not apply for some rea-son.

The second type of rating was designed toassess the observer ’s overall impression of

performance throughout the flight,24 and wasdone upon completion of each flight. All pi-lots were instructed not to discuss the spe-cific aspects of their participation in the studywith other crew members.

AFT consisted of 12 sessions of 45 minuteseach using a regimen of AFT training basedupon the protocol developed by Cowings.19

This protocol included directed biofeedback,discrimination training and stress challengetraining with and without feedback designed

to increase pilot efficiency inmaintaining appropriate psycho-physiological control. With re-spect to the stress challengecondition, subjects were requiredto maintain physiologic controlwithin identified parameterswhile actively involved in avideo game challenge. The treat-ment group also utilized pro-g r e s s i v e d a i l y r e l a x a t i o nexercises via audio tape. Thecontrol group received no treat-ment. This design was deemedappropriate because previousr e s e a r c h b y To s c a n o a n dCowings25 demonstrated thatcontrol group pilots given “shamtraining,” with the same num-ber of exposures to experiment-

ers as treatment group subjects, had noadvantage over a “no treatment” control groupin improving their tolerance to environmen-tal stress.

Following completion of the treatment con-dition, each pilot flew the simulated emer-gency scenario again at approximately thesame time of day, and with the same rater asin the initial flight.

Figure 1 (page 6) shows the average overallscores obtained from each group on the firstand second emergency flights. Treatment grouppilots show an improvement in all nine per-formance dimensions while control pilots showhigher post-test scores on only two of thenine dimensions measured and actually de-creased performance scores for five of thesedimensions.

As the aircraftwas on short-

final approach,the instructor

pilot simulated astall of the No. 1

engine from whichthe pilot was torecover and land

the aircraft asinstructed.


Figure 1

Changes in Overall Performance During Emergency Flight Scenarios

Source: U.S. National Aeronautics and Space Administration

( E i g h t p i -lots)

( N i n e p i -lots)


Data were analyzed with nonparametric sta-tistics: Mann-Whitney U-tests and WilcoxanSign Ranks tests. Table 1 (page 7) and Table 2(page 8) show the results of analyses that com-pared performance scores between and withingroups during specific phases of the flights.There was no significant difference betweengroups on the first test, with the exceptionthat control pilots scored significantly higheron aircraft handling during cruise search andrescue (Table 2). Treatment group pilots hadimproved their performance after training,and the two groups were no longer signifi-cantly different during the cruise search andrescue phase of the second flight. Followingtraining, the performances of AFT pilots during

specific phases of flight were significantlybetter than that of the controls for stressmanagement, crew coordination and com-munication, as well as planning and situ-ational awareness. There was no significantdifference between groups in aircraft han-dling during any phases of the second flight.

Comparisons within groups revealed that AFTpilots showed significant improvements inspecific phases of the flight for all perfor-mance categories, while control pilots showedno improvement. In fact, control pilots showeda significant decrease in crew coordinationand communication during the touch-and-go phase of flight.

Table 1

Group Performance Dimensions by Phase of Flight:Mann-Whitney U-Test

Crew Coordination and Communication Between Groups Within GroupsAFT vs. Controls Pre- vs. Post-tests

Pre-test Post-test AFT Controls

Checklist Execution — p<0.05 p<0.05 —Taxi/Takeoff — p<0.05 — —Initial Cruise — — — —Touch-and-Go — — — p<005*Cruise Search and Rescue — — p<0.05 —Emergency Initiation — p<0.005 p<0.01 —Emergency Return to Base — — — —Emergency Approach and Landing — — — —

Planning and Situational Awareness Between Groups Within GroupsAFT vs. Controls Pre- vs. Post-tests


Checklist Execution — — — —Taxi/Takeoff — p<0.05 — —Initial Cruise — — — —Touch-and-Go — p<0.05 — —Cruise Search and Rescue — — — —Emergency Initiation — — — —Emergency Return to Base — — p<0.05 —Emergency Approach and Landing — — p<0.05 —

* Control subjects scored significantly lower during the secondflight.Source: U.S. National Aeronautics and Space Administration


Physiological data obtained during flight andtraining sessions were not analyzed.

Table 3 (page 9) shows the results of WilcoxanSign Ranks tests, which were performed toexamine the performance category, crew co-ordination and communication, in detail. AFTpilots performed significantly better than con-trols in 10 of the 13 specific dimensions ofthis category.

The results support the proposition that AFTimproves pilot performance during emergencyflying conditions. Specifically, the data re-veal that those pilots trained in AFT demon-strated improved overall knowledge of the

aircraft and procedures, technical proficiencyand performance through the flight scenario.Of particular importance is a demonstratedimprovement in overall performance andexecution of duties as well as crew coordi-nation and communication during that seg-m e n t o f t h e f l i g h t w h e n m u l t i p l ecompounding emergencies were experienced.This suggests that AFT may be effective as acountermeasure for pilot stress-related per-formance decrements.

The improved crew coordination and com-munication performance found in the AFTpilots is particularly noteworthy, as thesefactors are emphasized in CRM approaches

Table 2

Group Performance Dimensions by Phase of Flight:Mann-Whitney U-Test

Stress Management Between Groups Within GroupsAFT vs. Controls Pre- vs. Post-tests


Checklist Execution — — — —Taxi/Takeoff — — — —Initial Cruise — — — —Touch-and-Go — p<0.05 p<0.05 —Cruise Search and Rescue — — — —Emergency Initiation — p<0.05 p<0.05 —Emergency Return to Base — p<0.05 p<0.05 —Emergency Approach and Landing — p<0.05 p<0.05 —

Aircraft Handling Between Groups Within GroupsAFT vs. Controls Pre- vs. Post-tests


Checklist Execution — — — —Taxi/Takeoff — — — —Initial Cruise — — — —Touch-and-Go — — p<0.05 —Cruise Search and Rescue p<0.05* — p<0.05 —Emergency Initiation — — p<0.05 —Emergency Return to Base — — — —Emergency Approach and Landing — — p<0.05 —

* Control pilots scored significantly higher than AFT subjects during their firstflight.

Source: U.S. National Aeronautics and Space Administration


to the management of human error. AFT treat-ment effects were demonstrated in those di-mensions involving communications with crewmembers, crew briefings, workload delega-tion, planning and overall technical profi-ciency. Because all of the pilots of this studyhad some form of CRM training, as well ascomparable previous experience in emergencyflying conditions, the demonstrated improve-ment of these measures by the treatment groupsuggests that AFT may aid in the successfulutilization and expansion of these skills. Itis hypothesized that this improvement oc-curred because AFT reduced individuals’physiologic reactivity during stress. As a re-sult, crew coordination and communicationfactors were not reduced to the pilot’s pe-riphery. Given the current emphasis on crewcoordination and communication skills inthe reduction of human error in flight, iden-tification and control of the physiologic mecha-

nisms that enhance or inhibit these activi-ties warrant further study.

The problems associated with AMB are mani-fest when the pilot becomes saturated withtasks requiring increased complex decision-making skills. When a major ingredient ofthis saturation includes the pilot’s own physi-ology, the recognition of internal cues thatprecede this hypersympathetic arousal andinitiation of appropriate corrective action be-come increasingly important. Utilizing thepilot’s own physiology as an asset, ratherthan as an undesirable event to be ignored,the available resources to deal with an ex-ternal problem are increased. It is suggestedthat by expanding the pool of available re-sources for dealing with in-flight emergen-cies, the pilot is better able to manage theendogenous and exogenous stressors beingexperienced.

Table 3

Improvement in Specific Dimensions of Crew Coordination andCommunications During the Second Flight Scenario: Wilcoxan Sign Ranks

Test

AFT vs. Control

Dimension N z p<

Briefing thorough, establishes open communication, addresses coordination, planning, team creation and anticipates problems 8 2.20 0.05

Communications timely, relevant, complete and verified 8 2.20 0.05

Inquiry/Questions practiced 8 1.69 0.05

Assertion/Advocacy practiced 8 1.82 0.05

Decisions communicated and acknowledged 8 1.57 —

Crew self-critique of decisions and actions 7 1.82 0.05

Concern for accomplishment of tasks at hand 8 0.91 —

Interpersonnel relationships/group climate 8 1.82 0.05

Overall vigilance 8 1.09 —

Preparation and planning for in-flight activities 8 2.20 0.05

Distractions avoided or prioritized 8 1.34 —

Workload distributed and communicated 8 2.20 0.05

Overall workload 8 0.91 —

Overall technical proficiency 8 2.02 0.05

Overall crew effectiveness 8 2.02 0.05


While the small pilot population in this studyprecluded fixed- vs. rotary-wing compari-sons, airframe and related mission require-ment influences are areas that necessitatefurther study. Future studies will determineif performance improvements are related totype of aircraft and if those pilots of mul-tiple crew aircraft gain more value from train-ing than those flying tactical (single- or dual-crew) aircraft.

Use of ambulatory monitoring equipment forrecording physiological responses in flightwould be less obtrusive than the instrumen-tation used in the present study and willprovide objective indices of the effects oftraining on treatment group subjects.

More comprehensive examinations of AFTand its effect on pilot performance may re-veal that training in recognition and regula-tion of one’s own physiological reactions toenvironmental stress should become a por-tion of the standard curriculum of aerospacecrews. ♦

Editor’s Note: This article is a slightly editedversion of NASA Technical Memorandum104005, an unedited report that was released inMarch 1993 “to quickly provide the researchcommunity with important information.”

References

1. Billings, C.E.; Reynard, W.D. “HumanFactors in Aircraft Incidents: Results of a7-year Study.” Aviation, Space and Envi-ronmental Medicine Volume 55 (1984): 960-5.

2. Federal Aviation Administration. The Na-tional Plan for Aviation Human Factors Vol-ume 1. Washington, D.C., United States:1990.

3. Zeller, A.F. “Three Decades of USAF Ef-forts to Reduce Human Error Accidents1947-77.” 35th Specialist Aerospace Medi-cal Meetings, Paris: 1979.

4. Diehl, A. Understanding and Preventing Air-crew Judgment and Decision Making “Er-

rors.” Norton Air Force Base, California,United States: Headquarters Air ForceInspection and Safety Center, 1989.

5. Hart, S.G. “Helicopter Human Factors.”In Human Factors in Aviation edited byWeiner, E. and Nagel, D. San Diego, Cali-fornia, United States: Academic, 1988.

6. Aviation Safety Commission. Volume 2:Staff Background Papers. Washington, D.C.,United States: 1988.

7. Senders, J.W.; Moray, N.P. Human Error:Cause, Prediction and Reduction. New Jer-sey, United States: Erlbaum, 1991.

8. Alkov, R.A.; Borowsky, M.S. “A Question-naire Study of Psychological BackgroundFactors in U.S. Navy Aircraft Accidents.”Aviation, Space and Environmental Medi-cine Volume 51 (1980): 860-3.

9. Krahenbuhl, G.S.; Marett, J.R.; Reid, G.B.“Task-specific Simulator Pretraining andIn-flight Stress of Student Pilots.” Avia-tion, Space and Environmental MedicineVolume 49 (1978): 1107-10.

10. Bergeron, H.P.; Hinton, D.A. “Aircraft Au-tomation: The Problem of the Pilot Inter-face.” In Proceedings of the Second Symposiumon Aviation Psychology. Columbus, Ohio,United States: 1983.

11. Sloan, S.; Cooper, C.L. Pilots Under Stress.New York, New York, United States:Routledge & Kegan Paul, 1986.

12. Taggert, W.R. “Cockpit Resource Man-agement: New Developments and Tech-niques.” In Proceedings of the Fourth In-t e r n a t i o n a l S y m p o s i u m o n Av i a t i o nPsychology. Columbus, Ohio, United States:1987.

13. Fleming, I . ; Baum, A.; Davidson, L.;Rectanus, E.; McArdle, A. “Chronic Stressas a Factor in Physiologic Reactivity toChallenge.” Health Psychology Volume 6(1987): 221-37.


14. Green, R.G. “Stress and Accidents.” Avia-tion, Space and Environmental Medicine Vol-ume 56 (1985): 638-41.

15. Kakimoto, Y. “Effects of Physiological andMental Stress on Crew Members in Rela-tively Long Flights by C-l Jet TransportAircraft.” Reports of Aeromedical Labora-tory Volume 26 (1985): 131-55.

16. Li, G.X.; Shi, Q.; Zhou, J.J. “Applicationof Biofeedback Relaxation and ImageryExercise in Flight Training.” Aviation, Spaceand Environmental Medicine Volume 62(1991): 456.

17. Simonov, P.; Frolov, M.; Ivanov, E. “Psy-chophysiological Monitoring of Operator’sEmotional Stress in Aviation and Astro-nautics.” Aviation, Space and Environmen-tal Medicine Volume 51 (1980): 46-50.

18. Ivanov, V.I.; Ivanov, E. “Techniques andMeans for Optimizing Functional Statusof Flight School Cadets During PreflightAct iv i ty.” Kosmiche skava B io l og iva iAviakosmicheskava Med. Volume 24 (1990):18-21.

19. Cowings, P.S. “Autogenic-Feedback Train-ing: A Preventive Method for Motion andSpace Motion Sickness.” In Motion andSpace Sickness edited by Crampton, G. BocaRaton, Florida, United States: CRC Press,1990.

20. Cowings, P.S.; Suter, S.; Toscano, W.B.;Kamiya, J.; Naifeh, K. “General AutonomicComponents of Motion Sickness.” Psy-chophysiology Volume 23 (1986): 542-51.

21. Cowings, P.S.; Naifeh, K.; Toscano, W.B.“The Stability of Individual Patterns ofAutonomic Responses to Motion SicknessStimulation.” Aviation, Space and Environ-mental Medicine Volume 61 (1990): 399-405.

22. Jones, D.R.; Levy, R.A.; Gardner, L.; Marsh,R.W.; Patterson, J .C. “Self-control ofPsychophysiologic Responses to MotionStress: Using Biofeedback to Treat Air-sickness.” Aviation, Space and EnvironmentalMedicine. Volume 56 (1985): 1152-7.

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Aviation Community Loses a Voice

Editor’s Note: The U.S. Federal Aviation Administration has ceased publica-tion of its Aviation Safety Journal, a four-color, quarterly magazine, becauseof budget reductions. This is an unfortunate loss of a valuable communicationtool for the dissemination of safety information.

Flight Safety Foundation’s publications and Aviation Safety Journal haveshared information in the interest of aviation safety. Aviation Safety Journalhas reprinted Foundation articles. More recently, Thomas J. Casadevall’s pre-sentation on volcanic ash at the 1992 International Air Safety Seminar in LongBeach, California, was printed in Aviation Safety Journal; the article wasreprinted in an issue of Flight Safety Digest.


Aviation Statistics

Operations and Safety StatisticsUpdated for Worldwide Airlines

Operating Large Jet Transport AircraftCalendar Year 1992

byShung Huang

Statistical Consultant

The Air Carrier Aircraft Utilization and Pro-pulsion Report, published monthly by the U.S.Federal Aviation Administration (FAA), re-ports the daily use, monthly total fleet timeand total engine time for all U.S. airline jettransports.

Similar data for jet transport aircraft usedby non-U.S. airlines are not readily avail-able. Therefore, the data for worldwide air-lines are estimated based on information pro-vided by aircraft manufacturers through anannual inquiry by the Flight Safety Founda-tion. This update does not contain informa-tion directly from airlines.

The number of aircraft in service in this up-date was reported as of December 1992. Notealso that all operational data reported bythe manufacturers was not in the same for-mat and that there are discrepancies in data.Safety information for 1992 is also compiledfrom news media reports as well as fromgovernmental publications.

Some manufacturers, for example, reportedonly the number of aircraft ordered and de-livered as well as the total fleet time for theyear. There is no breakdown of flight hoursby military, commercial and general avia-tion uses. Thus, estimates of active airlinejet transports have been adjusted based oninformation reported by news media, FAA


publications and historical dataused for estimates in previ-ous years. The jet transportaircraft in this update includethe following (Comet, VC-10,Convair 880 and Convair 990are included in all historicaldata for presentation):

Four-engine: Boeing 747, B-707,B-720, DC-8, BAe-146;

T h r e e - e n g i n e : B - 7 2 7 ,McDonnell Douglas DC-10,Lockheed L-1011, Trident; and,

Two-engine: B-757, B-767, B-737, McDonnell Douglas DC-3, MD-80, MD-ll, F-28, F-100,A300, Lockheed Airbus A310,A320, BAC-111, SE-210.

In 1992, worldwide airlines op-erating these large jet trans-port aircraft recorded a totalof 21,367,000 flight hours, anincrease of about 9 percentmore than 1991. This is thefirst annual increase of flighthours since 1989.

Table 1 shows the comparisonof average number of aircraftin service as of December, andhours flown for calendar years1991 and 1992. Table 2 showsthe number of aircraft in ser-vice and hours flown of air-c r a f t m a d e b y U . S .manufacturers and by manu-facturers in western Europe(hereafter referred to as U.S.jets and non-U.S. jets). Table2 also shows that for calen-dar year 1992, U.S. jets ac-counted for 83 percent of totaljet transport aircraft and flew85 percent of total jet hours.In average daily utilization,U.S. jets were used almost onehour longer than non-U.S. jets.

Table 3Worldwide Airline Jet Transport Aircraft in Serviceand Hours Flown by Number of Engines of Aircraft

Calendar Year 1991-1992

Aircraft Aircraft In Service Hours Flown Daily AverageHours

1991 1992 1991 1992 1991 1992

Two-engine 5,809 6,289 12,437 13,968 5.89 6.16Three-engine 2,140 2,072 4,085 4,036 5.23 5.34Four-engine 1,350 1,378 3,096 3,363 6.28 6.68

Total 9,299 9,739 19,618 21,367 5.78 6.01

Source: U.S. Federal Aviation Administration

Table 1

Worldwide Airline Jet Transport AircraftNumber of Aircraft in Service and Hours Flown


Year Aircraft in Service Annual Total DailyAs of Dec. 31 Hours Flown Average Hours

1992 9,739 21,367,000 5.971991 9,299 19,618,000 5.78

Change +/- + 440 + 1,749,000 + 0.19


Table 2

Worldwide Airline Jet TransportAircraft in Service and Hours Flown

Aircraft Made by U. S Manufacturers vs.Aircraft Made by Manufacturers in Western Europe


Aircraft Aircraft in Service Hours Flown Daily AverageHours

1991 1992 1991 1992

U.S.* 7,830 8,108 17,244 18,230 6.2Non-U.S.** 1,469 1,631 2,374 3,137 5.3Total 9,299 9,739 19,618 21,367 6.0

* Includes B-707, B-727, B-737, B-747, B-757, B-767, DC-8, DC-9,DC-10, MD-80, MD-11, L-1011

** Includes A300, A310, A320, BAC-111, BAe-l46, SE-210, Trident,F-28, F-100


(Weighted Average)


Table 3 shows a breakdown of active aircraftand hours flown by number of engines peraircraft. Although aircraft in service increased4.5 percent from 1991 to 1992, the number ofthree-engine jets in service showed a slight

decrease. This may be so because manufactur-ers stopped making three-engine jets in calen-dar year 1992 and the number of three-enginejets in service decreased because of aging. Ac-cording to Boeing Commercial Airplane Group,

as of December 1992 a total of 1,831B-727 three-engine jets had been or-dered and delivered, but it was es-timated that only about 1,515 B-727sand only about 557 L-1011s, DC-10s and Tridents remained in ser-vice. Of the 2,072 three-engine jetsin service, about 1,200 were oper-ated by U.S. air carriers with anaverage of 5.6 hours daily utiliza-tion.

The aircraft daily utilization shownin all tables is a 365-day average.In fact, daily utilization of B-727,DC-10, Trident and L-1011 aircraftvaried greatly. FAA statistics showthat the daily utilization of three-engine (excluding Trident) and four-engine jets used by U.S. air carri-ers was as high as 13 to 14 hours aday; utilization of twin-engine jets12 hours a day. Note that all air-craft must be idle for a period ofdays each year for maintenance/repair.

Worldwide Jet Transport AircraftAnnual Hours Flown

Calendar Years 1959-1992

Table 4Fatal Accidents, Hull Losses and Rates

Worldwide Airlines Operating LargeJet Transport Aircraft


Rate per Rate perAircraft Type Fatal Accidents 100,000 Hours Hull Losses 100,000 Hours

1991 1992 1991 1992 1991 1992 1991 1992

Total 10 14 .051 .066 13 13 .066 .061

U.S.-made 8 10 .046 .056 11 9 .064 .049Non-US-made 2 4 .084 .127 2 4 .084 .127

Two-engine Jet 7 9 .056 .064 8 7 .064 .050Three-engine Jet 0 2 — .049 0 2 — .049Four-engine Jet 3 3 .097 .089 5 4 .161 .119


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Figure 1


During calendar year 1992, large jettransports operated by worldwide air-lines were involved in 14 fatal acci-dents and 13 hull losses, accountingfor 805 fatalities, compared with 10fatal accidents and 14 hull losses in1991. A list of the fatal accidents andhull losses is presented in Appendix A(page 17).

The frequency of fatal accidents andhull losses as well as the rate per 100,000aircraft hours by different aircraft typesis shown in Table 4 (page 14). The world-wide airline fatal accident rate per100,000 aircraft hours flown in 1992was slightly higher, while the hull-lossrate was lower, than in 1991. A com-parison of fatal accident rates and hull-loss rates between U.S. jets and non-U.S. jets revealed that rates for non-U.S.jets were still slightly higher, but theirmargins have been narrowing since 1989.

Figure 1 (page 14) shows that the an-nual jet transport aircraft hours flownhave been increasing since 1959, reach-ing 20 million hours in 1989 and morethan 21 million in 1992. (Jet transporthours flown as a percentage of totalflight time of worldwide airlines op-erating all piston-engine, turboprop-engine and turbine-engine aircraft arenot available.)

FAA reports show that in 1992, U.S.air carrier jet transport aircraft flighttime accounted for approximately 78percent of total flight time of all typesof aircraft operated by U.S. air carri-ers, including major air carriers, re-gional air carriers and commuter aircarriers.

Figure 2 shows annual jet transport air-craft hours flown by U.S. jets and non-U.S. jets. The total flight hours for non-U.S. jets accounted for about 25 percentof worldwide airline total flight time inthe early 1960s but dropped to about 10percent in the late 1970s and early 1980s.The trend turned upward again in 1983

Worldwide Airline Jet Transport AircraftAnnual Hours Flown

U.S. Jets vs. Non-U.S. Jets


Worldwide Airline Jet Transport AircarftAnnual Hours Flown by Engine Type


Figure 2

Figure 3

1959

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0%

10%

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30%

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Two-engine

Three-engine

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Year

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U.S. Jets

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Year

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Worldwide Airline Jet TransportAircraft Fatal Accident Rate vs.

Hull-loss Rate


Worldwide Airline Jet TransportFatal Accident Rates



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❍ Non-U.S. Jets

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e p

er 1

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ou

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n

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❍ ❍ ❍ ❍❍

❍❍ ❍ ❍

❍❍

❍ ❍❍ ❍ ❍ ❍ ❍

1959

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0

0.2

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● Hull-loss Rate

❍ Fatal Accident Rate

Year

Rat

e p

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ou

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n


Figure 4 Figure 5


Worldwide Airline Jet Transport Hull-lossRate



Figure 6


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❍ Non-U.S. Jets

Year

Rat

e p

er 1

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00 H

ou

rs F

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nR

ate

pe

r 1

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,00

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and increased to 15 percent of worldwideairline total flight time in 1992.

Figure 3 shows the trends of hours flownby twin-engine, three-engine and four-engine jets. In the early 1960s, four-enginejets accounted for almost 90 percent ofall jet transport aircraft flight time, whiletwin-engine jets accounted for only 10percent. In 1992, the total flight time re-corded by twin-engine jets accounted for65 percent, or almost two-thirds of world-wide airline total jet hours. In view ofaircraft design advances and fuel economy,it appears that the demand of twin-en-gine jets will continue to grow.

Figure 4 shows fatal accident rates andhull-loss rate trends. In the early years,hull-loss rates generally were higher thanthe fatal accident rates. In the past 10years, the gap between fatal accident ratesand hull-loss rates has narrowed.

Figures 5 and 6 show fatal accident ratesfor U.S. jets and non-U.S. jets since 1967.

♦


Appendix A

Fatal Accidents and Hull Losses Involving LargeJet Transport Aircraft Operated by Worldwide Airlines

Calendar Year 1992

Date Location Aircraft DMG Fatalities Phase of Remarks Type Operation

1/20 Strasbourg, France A320 D 87 Approach Aircraft descended too low to recover.

2/15 Kano, Ghana DC-8 D None Approach Landed short of runway and crashed.

2/15 Toledo, Ohio, U.S. DC-8 D 4 Approach Landed short in fog during instrument landing system(ILS) approach.

3/22 New York, New York, U.S. F-28 D 27 Takeoff Aborted takeoff and overran into water in snowstorm.

3/24 Athens, Greece B-707 D 7 Approach Crashed during emergency landing.

4/3 Dayton,Ohio, U.S. DC-9-32 None 1 Static Mechanic killed by exploding wheel rim.

6/12 Sambu, Panama B-737 D 39 Cruise Broke up before crash in remote jungle area.

6/22 Moa River, Brazil B-737 D 3 Approach Crashed into jungle.

7/31 Katmandu, Nepal A310 D 113 Approach Crashed into mountain near airport.

9/28 Katmandu, Nepal A300 D 167 Approach Crashed near airport.

10/5 Amsterdam, Netherlands B-747 D 4 Takeoff On takeoff climb, crashed into apartment project. At least 250 persons on the ground were killed.

11/24 Guilin, China B-737 D 141 Approach Crashed into hillside.

12/6 New York, New York, U.S. B-737 None 1 Static Ground crewman struck bytug during pushback.

12/20 Faro, Portugal DC-10 D 54 Landing Aircraft lost control in a strong wind shear and crashed. Fire after impact.

12/22 Soukes-Sebt, Libya B-727 D 157 En Route Midair collision near Tripoli, Libya.

DMG=Damage D=Aircraft Destroyed

Source: Shung Huang


Publications Received at FSFJerry Lederer Aviation Safety Library

New Reference Materials

U.S. Federal Aviation Administration. Advi-sory Circular 25.773-1, Pilot Compartment ViewDesign Considerations. January 1993. 6 p. In-cludes one page of illustrations.

This advisory circular (AC) outlines meth-ods for demonstrating compliance with theairworthiness standards pertaining to pilotcompartment view for transport category air-planes.

U.S. Federal Aviation Administration. Advi-sory Circular 25.1523-1, Minimum Flightcrew.February 1993. 9 p. Includes appendices.

This AC outlines methods of compliance withthe requirements of Federal Aviation Regu-lation (FAR) 25.1523, which contains the cer-tification requirements for minimum flightcrew on transport category airplanes.

U.S. Federal Aviation Administration. Advi-sory Circular 90-92, Guidelines for the Opera-tional Use of Loran-C Navigation Systems Out-side the U.S. National Airspace System (NAS).February 1993. vi, 20 and appendices.

This AC contains guidance material for theoperational use of Loran-C navigation systemsunder visual flight rules (VFR) and instru-ment flight rules (IFR) while operating out-side the United States National Airspace Sys-tem (NAS) and beyond the coverage of thestandard International Civil Aviation Organi-zation (ICAO) navigation aids (NAVAIDs). TheseNAVAIDs include very high frequency omnidi-

rectional range stations (VORs), with or with-out distance measuring equipment (DME) andnondirectional beacons (NDBs). This publi-cation also contains guidance that is appli-cable for use over the Gulf of Mexico andother coastal waters. Includes an appendixof Loran-C oceanic and NAS coverage dia-grams and a glossary.

U.S. Federal Aviation Administration. Advi-sory Circular 150/5220-21, Guide Specifica-tion for Lifts Used to Board Airline Passengerswith Mobility Impairments. February 1993. 9p.

This AC contains performance standards,specifications and recommendations for thedesign, construction and testing of lifts usedto assist in the boarding of airline passen-gers with mobility impairments.

Reports

Mead, Kenneth M., director, TransportationIssues, Resources, Community and EconomicDevelopment Division, U.S. General AccountingOffice (GAO). FAA Budget: Important Chal-lenges Affecting Aviation Safety, Capacity, andEfficiency. Testimony before the Subcommit-tee on Transportation and Related Agencies,Committee on Appropriations, U.S. House ofRepresentatives. 1993. 17 p. Includes biblio-graphical references. Available through theGAO**.

Keywords1. United States — Federal Aviation Admin-

istration.

byEditorial Staff


2. United States — Federal Aviation Admin-istration — Appropriations and Expendi-tures.

Summary: This report presents testimony ont h e s t a t u s o f t h e F e d e r a l Av i a t i o nAdministration’s (FAA) programs and activi-ties that make up the framework for its fiscaly e a r 1 9 9 4 b u d g e trequest. At $9.2 billion, the FAA’s budgetrequest represents a 3.5 percent increase morethan the fiscal year 1993 appropriation.

According to Mead’s testimony, the FAA facesimportant challenges that affect the safety, ca-pacity and efficiency of the aviation system inthe areas of facilities and equipment (F&E),operations, grants-in-aid to airports and re-search, engineering and development (RE&D).

This report identifies these challenges and fo-cuses on the status of FAA’s air traffic controlmodernization program, work forces, airportdevelopment, and aviation security.

According to the report, the FAA must ad-dress three major challenges in the F&E area:delivering systems as promised, dealing withthe budgetary impacts of facility consolida-tion and strengthening the acquisition pro-cess to enhance the aviation community’s con-fidence in the agency’s ability to manage themodernization program. In the operations area,the FAA continues to face problems in inad-equate staffing standards, staffing imbalancesat facilities and a lack of systems to directresources to areas that pose the greatest safetyrisk. The report said the FAA must correct itsstaffing standards if it is to correct staffingdisparities at air traffic control facilities.

In the RE&D area, technical problems affect-ing the performance of bomb-detection de-vices will preclude their being implementedat airports in the immediate future. In addi-tion, the FAA has not yet determined howmuch new explosives detection devices willcost the airlines. The report said the FAA needsto determine the relationship and trade-offsbetween explosives detection and aircraft sur-vivability. The report includes bibliographi-cal references of related GAO publications.

Middleton, David B.; Srivatsan, Raghavachari;Person, Lee H. Simulator Evaluation of Displaysfor a Revised Takeoff Performance Monitoring Sys-tem (TOPMS), U.S. National Aeronautics andSpace Administration (NASA) Technical Pa-per 3270. A special report prepared at the re-quest of the NASA, Office of Management,Scientific and Technical Information Program.December 1992. 42 p. Includes bibliographicalreferences.

Keywords1. Flight Simulators.2. Aviation — Training.

Summary: This report covers the evaluationof cockpit displays for a revised TOPMS usedin flight simulators. New developments pro-vide pilots with graphic and alphanumericinformation pertinent to their decision to ei-ther continue or abort a takeoff.

The revised TOPMS includes an out-the-window projected head-up display (HUD)and a panel mounted head-down display(HDD) consisting of a runway graphic withstatus, situational and advisory informationon the current position and airspeed, thepredicted locations on the runway for reachingdecision speed V1 and rotating speed Vr , aground-roll-limit line (GRLL) for reachingVr , the predicted stop point (in the case ofan abort), the engine-status flags, engine-pressure-ratio for each engine, and an over-all situational advisory flag (SAF) that rec-ommends either continuation or rejection ofthe takeoff.

In the study, 17 pilots evaluated the TOPMSdisplays in a real-time transport systems re-search vehicle simulator for the Boeing 737airplane. The pilots rated the HDD as “good”and the HUD as “very good.” The pilotsreported that the HUD enhanced their situ-ational awareness, even though they onlyfocused on it for tracking airspeed or whensome anomaly caused a sudden change inthe display symbology (e.g., when an en-gine failed). Based on the comments and rat-ings of the evaluation pilots, it was con-


cluded that the TOPMS is a desirable andappropriate system for use by pilots duringthe takeoff roll. All the evaluation pilots ex-pressed a desire to have at least a TOPMSHDD in their cockpits.

Wilcox, Bruce C., et. al. Comparison of Por-table Crewmember Protective Breathing Equip-ment (CPBE) Designs, Report No. DOT/FAA/AM-93/6. A special report prepared for theOffice of Aviation Medicine, U.S. FederalAviation Administration. April 1993. 9 p.;ill. Includes bibliographical references. Avail-able through the National Technical Infor-mation Service*.

Keywords1. Aircraft — Oxygen Equipment —

Evaluation.2. Respirators — Evaluation.3. Aircraft Survival Equipment — Evalua-

tion.

Summary: This report provides the resultsof a study to evaluate the performance ofthree types of oxygen production systemsused in crewmember protective breathingequipment (CPBE) certified for transport cat-egory aircraft.

Oxygen production was evaluated for CPBEsusing chlorate candles, potassium superox-ide and compressed oxygen to expose dif-ferences in levels of oxygen production andresulting by-products under different envi-ronmental conditions.

The evaluation employed human test sub-jects in measuring the total oxygen produc-tion, carbon dioxide concentration, internaltemperature, moisture and breathing resis-tance for 15 minutes at ground level (1,300feet [394 meters]) and cabin altitude (8,000feet [2,424 meters]) while subjects exercised.Differences in internal temperature and hu-midity were found between the three sys-tems: all CPBEs produced a mean oxygenlevel of at least 59 percent and maintainedcarbon dioxide below 5 percent at groundlevel. Performance at altitude generally par-alleled these findings. Differences in thewearability of CPBEs, based on internal tem-

perature, humidity and weight, were depen-dent on the type of CPBE oxygen produc-tion system.

Galaxy Scientific Corporation. Human Fac-tors in Aviation Maintenance: Phase Two, ProgressReport, Report No. DOT/FAA/AM-93/5. Aspecial report prepared for the Office of Avia-tion Medicine, U.S. Federal Aviation Admin-istration. April 1993. xi, 195 p.; ill. Includesbibliographical references. Available throughthe National Technical Information Service*.

Keywords1. Aviation Mechanics (Persons) — Psychol-

ogy.2. Airplanes — Maintenance and Repair.3. Aeronautics — Human Factors.

Summary: In this report on the second phaseof research on human factors in aviation main-tenance, the emphasis is shifted from prob-l e m d e f i n i t i o n t o d e v e l o p m e n t o fdemonstrations and prototypes. These dem-onstrations include a computer-based train-ing simulation for troubleshooting an airlinerenvironmental control system and a librarysoftware system to store and display docu-ments. Chapters cover advanced technologyfor aviation training, emerging technologiesfor maintenance job aids, the FAA aviationmaintenance human factors hypermedia sys-tem, human reliability in aircraft inspection,a human factors guide for aviation mainte-nance and the effects of crew resource man-agement training in maintenance. Referencesand appendices are also included.

Books

Robie, William. For the Greatest Achievement:A History of the Aero Club of America and theNational Aeronautic Association. Foreword byYeager, Chuck. Washington, D.C., UnitedStates: Smithsonian Institution Press, 1993.xix, 378 p., 16 p. of photographs. Includesindex and bibliographical references.

Keywords


1. National Aeronautic Association (U.S.) —History.

2. Aeronautics — United States — Societ-ies, etc. — History.

3. Aeronautics — United States — History.

Summary: This book chronicles the historyof the Aero Club of America and its succes-sor, the National Aeronautic Association(NAA). Founded in 1905, the NAA is theoldest national aviation organization in theUnited States. The NAA was formed to pro-mote the safe, scientific development of avia-tion. The Aero Club certified pilots and is-sued flying licenses for more than 20 years

before the U.S. government assumed this re-sponsibility (an appendix documents the Aeroclub license holders, 1905-1919).

During the early 1920s, the leaders of theAero Club brought together several nationalaviation organizations and in 1922 establishedthe NAA, whose objective (among others)was to “aid and encourage the establishmentand maintenance of a uniform and stablesystem of laws relating to the science of aero-nautics and the art of aerial navigation andall allied and kindred sciences and arts.”The history of the NAA parallels the historyand development of aviation as a legal, mili-tary, research, commercial and recreationalpastime in America. The book’s appendicesinclude lists of the recipients of the RobertJ. Collier Trophy, the Gordon Bennett Cupfor Gas Balloons, the Wright Trophy and theBrewer Trophy. Notes and an extensive bib-liography are also included.

*U.S. Department of CommerceNational Technical Information Service (NTIS)Springfield, VA 22161 U.S.Telephone: (703) 487-4780

**U.S. General Accounting Office (GAO)Post Office Box 6012Gaithersburg, MD 20877 U.S.Telephone: (202) 275-6241

Updated Reference Materials (Advisory Circulars, U.S. FAA):

AC Number Month/Year Subject

183-32H 12/18/92 FAA Designated Technical Personnel Examiner’s Directory (can-cels AC 183-32G, dated March 24, 1988).

150-5220-18 10/15/92 Buildings for Storage and Maintenance of Airport Snow and IceControl Equipment and Materials (cancels AC 150/5220-15,dated March 25, 1983).

20-109A 4/8/93 Service Difficulty Program (General Aviation) (cancels AC 20-109, dated Jan. 8, 1979).

20-126D 4/14/93 Aircraft Certification Service Field Office Listing (cancels AC20-126C, dated Jan. 16, 1992).


Accident/Incident Briefs

This information provides an awareness of prob-lem areas through which such occurrences may beprevented in the future. Accident/incident briefsare based on preliminary information from gov-ernment agencies, aviation organizations, pressinformation and other sources. This informationmay not be entirely accurate.

byEditorial Staff

Air Carrier

Distractions Cause PrematureLevel Off

Boeing 737. No damage. No injuries.

The aircraft was cleared to FL280 (28,000feet [8,485 meters]) and the clearance wascorrectly read back.

A few moments later, the captain leveled offat FL270 and the first officer called level atFL280. Radar Mode C indicated that the air-craft was at FL270, and the climb was con-tinued to the assigned altitude.

The captain reported that at the time of thelevel off, the first officer was recording weatherinformation and talking to operations. At

the same time, a flight attendant was pre-senting the captain with refreshments.

Pressure Hull Damage ForcesTurnback

Boeing 757. Minor damage. No injuries.

After takeoff at about 1,000 feet (303 meters)AGL (above ground level) and at a speed of160 knots, the captain retracted the flapsand selected climb power.

Both pilots then heard a loud bang, whichwas followed by airframe vibration. The air-craft returned to the airport and the landingwas uneventful.

A ground inspection determined that a cargovehicle had damaged the pressure hull threefeet (.9 meters) below the first officer ’s win-dow.

Ramp Agent Struck by Nose Gear

Boeing 757. No damage. One serious injury.

The ramp agent was walking underneath thefuselage of the Boeing 757 during pushbackwhen he was struck by the nose gear.

The gear ran over his right leg, crushingand severing it. The daylight accident oc-curred on the yellow taxi line in the gatearea. The agent had just completed his an-nual ramp training.


Air TaxiCommuter

Control System Failure CausesUncommanded Climb

Fokker 28. No damage. No injuries.

While en route, the autopilot disengaged af-ter the aircraft passed through light turbu-lence. There was a flight control system fail-ure and the aircraft began a climb that couldnot be arrested even with full forward controlpressure.

The ascent was finally stopped by movingpassengers forward in the cabin, and by fullcontrol pressure applied by both pilots. Thestall warning activated once and pre-stallaerodynamic buffer was felt. With physicalassistance of one flight attendant, and byadjusting power and flap settings, the air-craft was flown to a safe landing. There wereno injuries among the 49 passengers and fourcrew members aboard.

Flight Ends in Collision with Tree

McDonnell Douglas DC-3. Aircraft destroyed.Three fatalities. Fourteen injuries.

Shortly after the night takeoff, the aircraftbegan to drift off the 40-meter wide runway,and the right wing struck a tree.

The tree severed the wing and the aircraftcrashed. The three crew members on boardwere killed. Fourteen passengers managedto escape with minor injuries.

Fuel Starvation Leads to Tragedy

De Havilland DHC-6 Twin Otter. Aircraft de-stroyed. Sixteen fatalities. Six serious injuries.

The aircraft was on a local parachute jump-ing flight when it crashed shortly after take-off.

A preliminary investigation determined thatthe right engine was not producing powerat impact. The investigation also found thatthe right-engine fuel system and fuel tankwere contaminated by water. The two pilotsand 14 passengers were killed in the day-light crash. Weather was not a factor.

CorporateExecutive

Weather Forces Twin Down

Cessna 402. Aircraft destroyed. Two fatalities.

During a night flight, the pilot contacted airtraffic control (ATC) and advised that hewas descending from 4,500 feet (1,364 meters)mean sea level (MSL) to 3,000 feet (909 meters)MSL to get beneath bad weather.

The aircraft disappeared from ATC radar at3,000 feet MSL and radio contact was lost.The wreckage was found the next morning.An instrument flight rules (IFR) flight planhad been filed but not activated. The pilotand passenger were killed.


Engine Failure Dooms LightTwin

Cessna 310. Aircraft destroyed. Three fatalities.

After takeoff, the aircraft climbed to about75 feet (23 meters) above ground level (AGL)and the landing gear was retracted.

The aircraft gained no additional altitudeand descended suddenly about a mile fromthe departure end of the runway. Accordingto an accident investigation report, a wit-ness said, “It got real quiet and you couldnot hear the engines.” The Cessna collidedwith trees and the ground and caught fire.The pilot and two passengers were killed inthe crash.

OtherGeneralAviation

Low Pass Claims Fatality

Swearingen Merlin III. Aircraft destroyed. Onefatality. One serious injury.

The twin-engine, turboprop Merlin was fly-ing low over the pilot’s house when it strucktrees.

The aircraft exploded and plunged to theground. Witnesses reported that the engines“were running loud and clear.” Weather wasnot a factor in the daylight crash.

Take-off Stall Ends in Death

Reims F172. Aircraft destroyed. One fatality. Threeserious injuries.

The aircraft was observed in a near-stall dur-ing initial climb. The fully loaded single-en-gine aircraft reached less than 100 feet (30meters) above ground level (AGL) beforenosing down and crashing.

An investigation found no engine malfunc-tions. One passenger was killed and the pi-lot and two other passengers were seriouslyinjured in the daylight crash.

Rotorcraft

Bell Plummets During LoggingOperation

Bell 214-B1. Aircraft destroyed. Two fatalities.

The helicopter was attached to two logs whenit began pitching and yawing while in hoverat 200 feet (61 meters) above ground level(AGL).

Witnesses reported that the main rotor RPMreduced to a “slow turn” prior to impact.The pilot and copilot were killed in the crash.There was no fire.

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