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Part 3 Crew Resource Management > Threat and Error Management > Flashcards

Threat and Error Management Flashcards

1
Q

What is the ICAO definition of threat and error management?

A

The THREAT and ERROR MANAGEMENT FRAMEWORK is a CONCEPTUAL MODEL that ASSISTS in UNDERSTANDING , from an OPERATIONAL PERSPECTIVE the INTER-RELATIONSHIP between SAFETY and HUMAN PERFORMANCE in DYNAMIC and CHALLENGING operational CONTEXTS

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2
Q

What is the CAA definition of threat and error management?

A

The PROCESS of DETECTING and RESPONDING to THREATS and ERRORS to ensure that the ENSUING OUTCOME is INCONSEQUENTIAL

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3
Q

Slide 4 - 8 missed

A

.

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4
Q

How does thinking ahead assist in threat and error management?

A

ANTICIPATING FACTORS which could LEAD to ERRORS or a REDUCTION in SAFETY MARGINS;

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5
Q

What are threats defined as?

A

EXTERNAL EVENTS or ERRORS that:
Occur OUTSIDE the INFLUENCE of the flight CREW;
INCREASE the operational COMPLEXITY of the flight;
INCREASE the PROBABILITY of an ERROR;
Require CREW ATTENTION and MANAGEMENT if SAFETY MARGINS are to be MAINTAINED

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6
Q

What are the 3 categories of external threats?

A

ENVIRONMENTAL;

ORGANISATIONAL: OPERATIONAL and LATENT

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7
Q

What are some examples of environmental threats?

A 
ADVERSE WEATHER;
DENSITY ALTITUDE;
RUNWAY LENGTH;
OTHER TRAFFIC;
HIGH TERRAIN or OBSTACLES;
ATC
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8
Q

What are some examples of latent threats?

A

SYSTEMATIC or ORGANISATIONAL DEFICIENCIES;
HARDWARE DESIGN;
TRAINING DEFICIENCIES;
ATC SYSTEMATIC DEFICIENCIES

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9
Q

What are some examples of operational threats?

A 
OPERATIONAL PRESSURE;
AIRCRAFT MALFUNCTIONS;
MAINTENANCE ERROR;
GROUND HANDLING ERROR;
CABIN EVENTS;
CREW SCHEDULING ERROR
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10
Q

What are some examples of internal threats?

A 
STRESS;
FATIGUE;
DISTRACTIONS;
COMPLACENCY;
OVER/UNDER CONFIDENCE;
HAZARDOUS BEHAVIOURS;
LACK OF CURRENCY
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11
Q

What are errors defined as?

What are the characteristics of errors?

A

Flight crew ACTIONS or INACTIONS that lead to DEVIATION from CREW or ORGANISATIONAL INTENTIONS or EXPECTATIONS, REDUCES SAFETY MARGINS, and INCREASE PROBABILITY of ADVERSE operational EVENTS on the GROUND and during FLIGHT;
Errors are INEVITABLE and CANNOT be fully ELIMINATED

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12
Q

What are the 3 classes of error?

A

HANDLING errors;
PROCEDURAL errors;
COMMUNICATION errors

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13
Q

What are some examples of handling errors?

A

Aircraft MISS-HANDLING;
FAILURE to MEET flight STANDARDS (poor speed control);
INCORRECT SYSTEMS OPERATION or MANAGEMENT;
INCORRECT NAVIGATION (air and ground);
INACCURATE flight PLANNING;
INCORRECT performance CALCULATIONS

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14
Q

What are some examples of procedural errors?

A 
CHECKLIST errors;
SOP VIOLATION;
BRIEFING MISSED;
INCORRECT DOCUMENTATION;
INCORRECT APPLICATION of MEL or QRH procedures
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15
Q

What are some examples of communication errors?

A

CREW to EXTERNAL;

PILOT to PILOT

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16
Q

What are the main aspects of the threat model?

What is included in each of these aspects?

A

EXTERNAL threats: EXPECTED events and risks, UNEXPECTED events and risks, and EXTERNAL ERRORS;
INTERNAL threats: CREW BASED errors;
CREW actions (CRM behaviours): Threat RECOGNITION and error AVOIDANCE behaviours, and error DETECTIONS and RESPONSE behaviours;
OUTCOMES: A SAFER flight, RECOVERY to a SAFER flight, ADDITIONAL ERROR, and CREW BASED INCIDENT/ACCIDENT

17
Q

In terms of the threat model how is a safer flight achieved?

A

EXPECTED and UNEXPECTED events and risks are COUNTERED through THREAT RECOGNITION and ERROR AVOIDANCE behaviours

18
Q

In terms of the threat model how is recovery to a safer flight achieved?

A

EXTERNAL ERRORS, EXPECTED and UNEXPECTED events and risks lead to CREW BASED ERRORS which are then countered by a good ERROR DETECTION and RESPONSE behaviours or;
EXTERNAL ERRORS are countered by a good ERROR DETECTION and RESPONSE behaviours;
ADDITIONAL ERRORS may occur if the behaviours are poor but if appropriately dealt it may end as RECOVERY to a SAFER flight

19
Q

In terms of the threat model how does a crew based incident/accident outcome occur?

A

EXTERNAL ERRORS, EXPECTED and UNEXPECTED events and risks lead to CREW BASED ERRORS which are then unresolved due to POOR ERROR DETECTION and RESPONSE behaviours or;
EXTERNAL ERRORS are unresolved due to POOR ERROR DETECTION and RESPONSE behaviours;
ADDITIONAL ERRORS may occur when the behaviours are poor and if not appropriately dealt it may end as a CREW BASED INCIDENT/ACCIDENT

20
Q

What are the main aspects of the error model?

What is included in each of these aspects?

A

Error TYPES: INTENTIONAL NONCOMPLIANCE, PROCEDURAL, COMMUNICATION, PROFICIENCY, and OPERATIONAL DECISION;
Error RESPONSES: TRAP, EXACERBATE, and FAIL to RESPOND;
Error OUTCOMES: INCONSEQUENTIAL, ADDITIONAL ERROR, and UNDESIRED AIRCRAFT STATE;
UNDESIRED STATE RESPONSES: MITIGATE, EXACERBATE, and FAIL to RESPOND;
UNDESIRED STATE OUTCOMES: RECOVERY, ADDITIONAL ERROR, and INCIDENT/ACCIDENT

21
Q

What are the categories of threat and error management countermeasures?

A

PLANNING countermeasures;
EXECUTION countermeasures;
REVIEW countermeasures

22
Q

What are the examples of planning countermeasures

A 
PRE-FLIGHT;
Thorough PLANNING;
BRIEFINGS (TC-TWO);
BACK UP plans;
IMSAFE;
COMMUNICATION of plan to OTHERS
23
Q

What are the examples of the execution countermeasures?

A 
MONITORING;
CROSS-CHECKING;
SITUATIONAL AWARENESS IMPROVEMENT;
PRIORITISING TASKS/WORKLOAD MANAGEMENT;
CHECKLIST DISCIPLINE;
SOP ADHERENCE;
DECISION MAKING/KDPS;
AIRCRAFT SAFETY SYSTEMS;
AVIATE NAVIGATE COMMUNICATE
24
Q

What are the examples of the review countermeasures in terms of TEM?

A

EVALUATING and MODIFYING plans to IMPROVE TEM as the flight progresses;
Using effective INQUIRY and ASSERTIVENESS appropriately with YOURSELF and OTHERS;
Performing a SELF-REVIEW on oneself AFTER the FLIGHT;
Asking for HELP/ADVICE from more EXPERIENCED/QUALIFIED crew;
REPORTING

25
Q

What countermeasures must the crew implement at each stage?

A

ANTICIPATION of, and AVOIDANCE of THREATS;
RECOGNITION and PREVENTION of ERRORS;
CORRECTION and RECOVERY from UNDESIRED STATES;
REVIEW countermeasures

26
Q

What is the definition of an undesired aircraft state?

A

A comprising situation that REDUCES the MARGINS of SAFETY in flight ie: a PRECURSOR to a NEGATIVE OUTCOME;
Requires IMMEDIATE ATTENTION to RECOVER back to NORMAL;
Requires SWITCHING from ERROR MANAGEMENT to UAS MANAGEMENT

27
Q

What is an example of an undesired aircraft state and recovery priority?

A

A pilot realises the AIRCRAFT is SUBSTANTIALLY OFF TRACK on arrival;
Must PRIORITISE dealing with potential TRAFFIC CONFLICT BEFORE diagnosing and CORRECTING the ERROR

28
Q

What are some examples of undesired aircraft state in terms of handling?

A 
AIRCRAFT CONTROL (ATTITUDE);
VERTICAL, LATERAL or SPEED DEVIATIONS;
UNNECESSARY WEATHER PENETRATIONS;
UNAUTHORISED AIRSPACE PENETRATION;
Operation OUTSIDE aircraft LIMITATIONS;
UNSTABLE APPROACH;
LONG, FLOATED, FIRM or OFF-CENTRELINE LANDING
29
Q

What are some examples of undesired aircraft state in terms of ground navigation?

A

Proceeding towards WRONG TAXIWAY/RUNWAY;

WRONG TAXIWAY, RAMP, GATE or HOLD SPOT

30
Q

What are some examples of undesired aircraft state in terms of incorrect aircraft configurations?

A 
Incorrect SYSTEMS CONFIGURATION;
Incorrect FLIGHT CONTROLS CONFIGURATION;
Incorrect AUTOMATION CONFIGURATION;
Incorrect ENGINE CONFIGURATION;
Incorrect WEIGHT and BALANCE CONFIGURATION

Part 3 Crew Resource Management (7 decks)

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