Get Home-it-is
I have always seen this phrase used in some articles (non-aviation) but did not stop to wonder how it feels to be a victim of it. So what is it?
I experienced it during a long day at work, flying a six-sector domestic flight schedule. The standard operating procedures in one sector involves the pre-flight, taxi, take-off, short cruise of less than 20 minutes, decent, approach and landing. Of course all the necessary checks and procedures are squeezed in between them. On that day, we did 6 of these. The day started at 0700hrs in the morning and lasted almost till 1800hrs.
As you have guess it, the phrase describes “I had enough of this, just quickly do whatever there is to do and get on with going home!”, feeling. It’s a syndrome whereby pilot’s try to reach their destination at all cost, even deciding to land the aircraft without confirming that the wheels have been extended and locked in the landing position!
That happened to me, on the approach to land on the 6th sector of the day. Embarrassing as it sounds but at the end of the day, the incident was down right dangerous and ignorant of the consequences that may have followed. That day the aircraft automation saved the day (me as well). At the sound of a loud human synthetic voice to “PULL UP! PUL UP! GEAR”, I remembered talking to myself, “that can’t be me, I’m already few hundred feet away from home.” Next thing I knew, the instinctive reaction to that warning was to increase the power of the engines to climb setting and abort the landing. I was lucky. Unfortunately there have been reports of incidents involving pilots continuing the approach to land, ultimately ending in tragic accidents.
One example is quoted from an article by (Berman & Dismukes, 2006)
June1, 1999 – American Airlines Flight 1420 was seconds from landing at little rock, Arkansas, U.S., when the captain’s view of the runway was obscured by heavy rain lashing the windshield. “ I can’t see it,” he said, but the runway quickly reappeared. From 200 ft to the ground, he struggled against the thunderstorm’s crosswinds to align the McDonnell Douglas MD-82 with the centreline, and the ground proximity warning system (GPWS) produced two warnings of excessive sink rate. The first officer thought about telling the captain to go around, but if he spoke, his voice was too sift to be heard. Saturated with high workload during the last stages of the approach, the crew had forgotten to arm the jet’s ground spoilers for automatic deployment and had not completed the last steps of the landing checklist, which included verification of the spoilers; consequently, braking performance was greatly degraded. During the landing rollout, the airplane veered left and right by as much as 16 degrees before departing the left side of the runway at high speed. The crash into the approach light stanchions at the end of runway destroyed the airplane and killed 11 people, including the captain!
The U.S. National Transportation Safety Board (NTSB) concluded that the crew caused the accident.
So what caused us, pilots, to make similar decisions and errors? According to U.S. National Aeronautics and Space Administration (NASA) study, the skilled performance of experts, such as airline pilots, is driven by the interaction of moment-to-moment task demands, the availability of information and social/organizational factors with the inherent characteristics and limitations of human cognitive processes. Whether a particular crew in a given situation makes errors depends as much, or more, on this somewhat random interaction of factors as it does on the individual characteristics of the pilots.
Among the two most common causes are:
1. plan continuation bias – a deeply rooted tendency of individuals to continue their original plan of action even when changing circumstances required a new plan.
2. snowballing workload – workload that builds on itself and increases at an accelerating rate.
Although other factors not discussed here played roles in these accidents, the problems encountered by the crew and myself seem to have centered on these two factors.
These findings were quoted from the article found from the website:
[http://www.flightsafety.org/asw/dec06/asw_dec06_p28-33.pdf]
Other interesting reads:
The Get-Home-It-Is Syndrome:
[http://www.bea-fr.org/etudes/gethomeitis/gethomeitis.html]
Plan continuation Bias:
[http://www.avweb.com/news/pilotlounge/193599-1.html]
Reference
B. A. Berman, & R. K. Dismukes (2006) Pressing the Approach: A NASA Study of 19 Recent Accidents Yields a New Perspective on Pilot Error, Berman, B. A. & Dismukes, R. K. (2006) Pressing the Approach: A NASA Study of 19 Recent Accidents Yields a New Perspective on Pilot Error. Aviation Safety World, December 2006, 28-33.
