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NASA NTRS2017

Quantifying Pilot Contribution to Flight Safety During Dual Generator Failure

Accident statistics cite flight crew error in over 60% of accidents involving transport category aircraft. Yet, a well-trained and well-qualified pilot is acknowledged as the critical center point of aircraft systems safety and an integral safety component of the entire commercial aviation system. No data currently exists that quantifies the contribution of the flight crew in this role. Neither does data exist for how often the flight crew handles non-normal procedures or system failures on a daily basis in the National Airspace System. A pilot-in-the-loop high fidelity motion simulation study was conducted by the NASA Langley Research Center in partnership with the Federal Aviation Administration (FAA) to evaluate the pilot's contribution to flight safety during normal flight and in response to aircraft system failures. Eighteen crews flew various normal and non-normal procedures over a two-day period and their actions were recorded in response to failures. To quantify the human's contribution, crew complement was used as the experiment independent variable in a between-subjects design. Pilot actions and performance when one of the flight crew was unavailable were also recorded for comparison against the nominal two-crew operations. This paper details diversion decisions, perceived safety of flight, workload, time to complete pertinent checklists, and approach and landing results while dealing with a complete loss of electrical generators. Loss of electrical power requires pilots to complete the flight without automation support of autopilots, flight directors, or auto throttles. For reduced crew complements, the additional workload and perceived safety of flight was considered unacceptable.

Etherington, Timothy J.↗

NASA NTRS2019

Reliability, Safety, and Performance for Two Aerospace Revolutions - UAS/ODM and Commercial Deep Space

Aerospace is in the midst of a renaissance, expanding on both the air and space side into major new commercial areas including unmanned air systems (UAS), on demand mobility (ODM), personal air vehicles (PAV), and commercial deep space. These new areas require, in the initial planning, consideration of new safety, reliability, and in some cases, enabling performance approaches for viability. For example, due to their huge numbers, if current accident rates prevail, UAS/ODM/PAV aircraft could crash at an unacceptable rate, causing life and property damage. Also, if humans in commercial space activities have serious health issues and/or there are unacceptable rocket viability issues/crash rates, these new, major markets (order of 1 trillion dollars per year) could be rapidly curtailed until agreeable and effective changes are instituted, producing additional expense, delay, and reduced revenue. This report addresses such safety and reliability issues and includes: performance enhancement possibilities such as an enabling Air Traffic Control System (ATC), crash proof vehicles, increased range for aero, space debris removal, and human health for space.

Crash Proof↗

NASA NTRSDate not supplied

Analyses of the Boeing 737-MAX Accidents: Formal Models and Psychological Perspectives

Two fatal accidents involving the B737MAX resulted from the flight crews’ inability to overcome the effects of the Maneuvering Characteristics Augmentation System (MCAS). MCAS was designed to mimic the control column feel pressure and pitching behavior of the B737NG, which was the certification basis for the B737MAX. We briefly describe the potential role of formally modeling different perspectives during system design, and how such modeling can reveal gaps and conflicts between perspectives. We also discuss some of the relevant human factors issues involved in these accidents and how the aircraft’s behavior may have affected the pilots’ psychological states. Implications for automation design are considered.

5737MAX↗

NASA NTRS2014

Development, Implementation, and Pilot Evaluation of a Model-Driven Envelope Protection System to Mitigate the Hazard of In-Flight Ice Contamination on a Twin-Engine Commuter Aircraft

Fatal loss-of-control accidents have been directly related to in-flight airframe icing. The prototype system presented in this report directly addresses the need for real-time onboard envelope protection in icing conditions. The combination of prior information and real-time aerodynamic parameter estimations are shown to provide sufficient information for determining safe limits of the flight envelope during inflight icing encounters. The Icing Contamination Envelope Protection (ICEPro) system was designed and implemented to identify degradations in airplane performance and flying qualities resulting from ice contamination and provide safe flight-envelope cues to the pilot. The utility of the ICEPro system for mitigating a potentially hazardous icing condition was evaluated by 29 pilots using the NASA Ice Contamination Effects Flight Training Device. Results showed that real time assessment cues were effective in reducing the number of potentially hazardous upset events and in lessening exposure to loss of control following an incipient upset condition. Pilot workload with the added ICEPro displays was not measurably affected, but pilot opinion surveys showed that real time cueing greatly improved their awareness of a hazardous aircraft state. The performance of ICEPro system was further evaluated by various levels of sensor noise and atmospheric turbulence.

simulation training↗

NASA NTRS2016

Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft

It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Pilots participated willingly and enthusiastically in the study, and generally had little difficulty recalling critical incidents. The results suggest that pilot interviews can be a productive method of gathering information on incidents that might not otherwise be reported. Some of the issues described in the reports have received significant attention in the literature, or are analogous to human factors of manned aircraft. In other cases, incident reports involved human factors that are poorly understood, and have not yet been the subject of extensive study. Although many of the reported incidents were related to pilot error, the participants also provided examples of the positive contribution that humans make to the operation of highly-automated systems.

unmanned aircraft systems↗

NASA NTRS1979

Aircraft motion analysis using limited flight and radar data

The development and application of methods for reconstructing, from a limited set of recorded data, a comprehensive scenario of aircraft motions before and during an accident are described. The accuracy of these analytical methods is investigated using data recorded onboard the Ames CV-990 research aircraft. In these experiments, the expanded set of data, derived from either foil or ATC records, is compared with corresponding values measured by the research instrumentation system onboard the aircraft. The results indicate that many of the derived quantities are in good agreement with the corresponding onboard measurements. A recent application of this procedure using actual accident records is presented and potential applications are briefly reviewed.

Wingrove, R. C.↗

NASA NTRS1986

Assessing fatigue

Despite impressive advances in aircraft technology over the past several decades and an overall decline in the airline accident rate since the introduction of turbine-powered aircraft, flight crew performance problems continue to dominate air transport accident statistics. Researchers have offered many hypotheses to explain this finding, and interest in pilot fatigue has stimulated a large volume of laboratory research. Much of this work, however, is difficult to generalize and to apply to the real world of flight operations, and researchers disagree about the extent and operational significance of fatigue-related reductions in pilot performance. As a result, in 1980 Congress asked the National Aeronautics and Space Administration to undertake a comprehensive research program to assess whether fatigue-related problems are prevalent in long- and short-haul flying. The two major goals of this project are: (1) to assess the psychophysiological effects on pilot performance of flying various types of flight and duty cycles, and (2) to determine the operational significance to flight safety and efficiency of flying these flight and duty cycles.

NASA Discipline Space Human Factors↗

NASA NTRS2003

Synthetic Vision CFIT Experiments for GA and Commercial Aircraft: "A Picture Is Worth A Thousand Lives"

Because restricted visibility has been implicated in the majority of commercial and general aviation accidents, solutions will need to focus on how to enhance safety during instrument meteorological conditions (IMC). The NASA Synthetic Vision Systems (SVS) project is developing technologies to help achieve these goals through the synthetic presentation of how the outside world would look to the pilot if vision were not reduced. The potential safety outcome would be a significant reduction in several accident categories, such as controlled-flight-into-terrain (CFIT), that have restricted visibility as a causal factor. The paper describes two experiments that demonstrated the efficacy of synthetic vision technology to prevent CFIT accidents for both general aviation and commercial aircraft.

Prinzel, Lawrence J., III↗

NASA NTRS1990

Summary of the industry/NASA/FAA workshop on philosophy of automation: Promises and realities

Issues of flight deck automation are multi-faceted and complex. The rapid introduction of advanced computer based technology on to the flight deck of transport category aircraft has had considerable impact on both aircraft operations and the flight crew. As part of NASA's responsibility to facilitate an active exchange of ideas and information between members of the aviation community, an Industry/NASA/FAA workshop was conducted in August 1988. One of the most important conclusions to emerge from the workshop was that the introduction of automation has clearly benefited aviation and has substantially improved the operational safety and efficiency of our air transport system. For example, one carrier stated that they have been flying the Boeing 767 (one of the first aircraft to employ substantial automation) since 1982, and they have never had an accident or incident resulting in damage to the aircraft. Notwithstanding its benefits, many issues associated with the design, certification, and operation of automated aircraft were identified. For example two key conceptual issues were the need for the crew to have a thorough understanding of the system and the importance of defining the pilot's role. With respect to certification, a fundamental issue is the lack of comprehensive human factors requirements in the current regulations. Operational considerations, which have been a factor in incidents involving automation, were also cited. Viewgraphs used in the presentation are given.

Norman, Susan D.↗

NASA NTRS1977

Engine Non-Containment: The UK CAA View

Airworthiness accidents account for roughly one quarter of the total number of accidents to public transport turbojet aircraft. The most reliable, practicable, and cost-effective means of minimizing damage outside the confines of the nacelle is to make the aircraft design invulnerable to any debris which may affect the aircraft. A failure model was developed for use by aircraft builders in measuring the freedom from catastrophe factor of their design.

Gunstone, G. L.↗

NASA NTRS1995

Modes in Supervisory Control Systems: Structure and Transitions

Mode confusion is becoming a major drawback in operator interaction with systems that allow for multiple levels of automation. This drawback has manifested itself in several mode related accidents and incidents in commercial aviation, military control systems, as well as high technology medical systems. In the domain of commercial aviation, there have been four recent airline accidents, all involving highly automated aircraft, in which mode related problems were present. Mode problems, we argue, stem from three principal factors: (1) mis-identification of the current mode, (2) difficulty in apprehending current mode behavior; and (3) difficulty in predicting the consequences of the next mode transition. This combination of factors may lead to mode confusion and possibly unwanted results. We define in this paper a mode as the system's manner of behavior. Any given system or machine, may have several ways of behaving. A controller, either human or machine, provides the input that triggers the transition from one mode of behavior to another. At any point in time, a machine may be in one mode or another modes are mutually exclusive. Complex systems are typically comprised of several subsystems, or components, each one with its own set of modes. Therefore, the status of the system at any point in time can be described as a vector of all the active modes.

Degani, Asaf↗

NASA NTRS2012

Safety Risk Knowledge Elicitation in Support of Aeronautical R and D Portfolio Management: A Case Study

Aviation is a problem domain characterized by a high level of system complexity and uncertainty. Safety risk analysis in such a domain is especially challenging given the multitude of operations and diverse stakeholders. The Federal Aviation Administration (FAA) projects that by 2025 air traffic will increase by more than 50 percent with 1.1 billion passengers a year and more than 85,000 flights every 24 hours contributing to further delays and congestion in the sky (Circelli, 2011). This increased system complexity necessitates the application of structured safety risk analysis methods to understand and eliminate where possible, reduce, and/or mitigate risk factors. The use of expert judgments for probabilistic safety analysis in such a complex domain is necessary especially when evaluating the projected impact of future technologies, capabilities, and procedures for which current operational data may be scarce. Management of an R&D product portfolio in such a dynamic domain needs a systematic process to elicit these expert judgments, process modeling results, perform sensitivity analyses, and efficiently communicate the modeling results to decision makers. In this paper a case study focusing on the application of an R&D portfolio of aeronautical products intended to mitigate aircraft Loss of Control (LOC) accidents is presented. In particular, the knowledge elicitation process with three subject matter experts who contributed to the safety risk model is emphasized. The application and refinement of a verbal-numerical scale for conditional probability elicitation in a Bayesian Belief Network (BBN) is discussed. The preliminary findings from this initial step of a three-part elicitation are important to project management practitioners as they illustrate the vital contribution of systematic knowledge elicitation in complex domains.

Shih, Ann T.↗

NASA NTRS2005

The Role of Spatial Disorientation in Fatal General Aviation Accidents

In-flight Spatial Disorientation (SD) in pilots is a serious threat to aviation safety. Indeed, SD may play a much larger role in aviation accidents than the approximate 6-8% reported by the National Transportation Safety Board (NTSB) each year, because some accidents coded by the NTSB as aircraft control-not maintained (ACNM) may actually result from SD. The purpose of this study is to determine whether SD is underestimated as a cause of fatal general aviation (GA) accidents in the NTSB database. Fatal GA airplane accidents occurring between January 1995 and December 1999 were reviewed from the NTSB aviation accident database. Cases coded as ACNM or SD as the probable cause were selected for review by a panel of aerospace medicine specialists. Using a rating scale, each rater was instructed to determine if SD was the probable cause of the accident. Agreement between the raters and agreement between the raters and the NTSB were evaluated by Kappa statistics. The raters agreed that 11 out of 20 (55%) accidents coded by the NTSB as ACNM were probably caused by SD (p less than 0.05). Agreement between the raters and the NTSB did not reach significance (p greater than 0.05). The 95% C.I. for the sampling population estimated that between 33-77% of cases that the NTSB identified as ACNM could be identified by aerospace medicine experts as SD. Aerospace medicine specialists agreed that some cases coded by the NTSB as ACNM were probably caused by SD. Consequently, a larger number of accidents may be caused by the pilot succumbing to SD than indicated in the NTSB database. This new information should encourage regulating agencies to insure that pilots receive SD recognition training, enabling them to take appropriate corrective actions during flight. This could lead to new training standards, ultimately saving lives among GA airplane pilots.

Scheuring, RIchard↗

NASA NTRS2000

Analysis of Complexity Evolution Management and Human Performance Issues in Commercial Aircraft Automation Systems

Autoflight systems in the current generation of aircraft have been implicated in several recent incidents and accidents. A contributory aspect to these incidents may be the manner in which aircraft transition between differing behaviours or 'modes.' The current state of aircraft automation was investigated and the incremental development of the autoflight system was tracked through a set of aircraft to gain insight into how these systems developed. This process appears to have resulted in a system without a consistent global representation. In order to evaluate and examine autoflight systems, a 'Hybrid Automation Representation' (HAR) was developed. This representation was used to examine several specific problems known to exist in aircraft systems. Cyclomatic complexity is an analysis tool from computer science which counts the number of linearly independent paths through a program graph. This approach was extended to examine autoflight mode transitions modelled with the HAR. A survey was conducted of pilots to identify those autoflight mode transitions which airline pilots find difficult. The transitions identified in this survey were analyzed using cyclomatic complexity to gain insight into the apparent complexity of the autoflight system from the perspective of the pilot. Mode transitions which had been identified as complex by pilots were found to have a high cyclomatic complexity. Further examination was made into a set of specific problems identified in aircraft: the lack of a consistent representation of automation, concern regarding appropriate feedback from the automation, and the implications of physical limitations on the autoflight systems. Mode transitions involved in changing to and leveling at a new altitude were identified across multiple aircraft by numerous pilots. Where possible, evaluation and verification of the behaviour of these autoflight mode transitions was investigated via aircraft-specific high fidelity simulators. Three solution approaches to concerns regarding autoflight systems, and mode transitions in particular, are presented in this thesis. The first is to use training to modify pilot behaviours, or procedures to work around known problems. The second approach is to mitigate problems by enhancing feedback. The third approach is to modify the process by which automation is designed. The Operator Directed Process forces the consideration and creation of an automation model early in the design process for use as the basis of the software specification and training.

Vakil, Sanjay S.↗

NASA NTRS2014

A Comprehensive Analysis of the X-15 Flight 3-65 Accident

The November 15, 1967, loss of X-15 Flight 3-65-97 (hereafter referred to as Flight 3-65) was a unique incident in that it was the first and only aerospace flight accident involving loss of crew on a vehicle with an adaptive flight control system (AFCS). In addition, Flight 3-65 remains the only incidence of a single-pilot departure from controlled flight of a manned entry vehicle in a hypersonic flight regime. To mitigate risk to emerging aerospace systems, the NASA Engineering and Safety Center (NESC) proposed a comprehensive review of this accident. The goal of the assessment was to resolve lingering questions regarding the failure modes of the aircraft systems (including the AFCS) and thoroughly analyze the interactions among the human agents and autonomous systems that contributed to the loss of the pilot and aircraft. This document contains the outcome of the accident review.

Dennehy, Cornelius J.↗

NASA NTRS1986

Aircraft performance and control in downburst wind shear

The methods developed for analyses of the winds and of aircraft performance during an investigation of a downburst wind-shear-induced accident have been utilized in a more general study of aircraft performance in such encounters. The computed responses of a generic, large transport aircraft to take-off and approach encounters with a downburst wind field were used in examining the effects of performance factors and control procedures on the ability of the aircraft to survive. Obvious benefits are seen for higher initial encounter speeds, maximum thrust-weight values typical of two-engined aircraft, and immediacy of pilot response. The results of controlling to a constant, predetermined, pitch attitude are demonstrated. Control algorithms that sacrifice altitude for speed appear to provide a higher level of survivability, but guidance displays more explicitly defining flightpath than those commonly in use might be required.

Bray, Richard S.↗

NASA NTRS1989

Flight deck automation: Promises and realities

Issues of flight deck automation are multifaceted and complex. The rapid introduction of advanced computer-based technology onto the flight deck of transport category aircraft has had considerable impact both on aircraft operations and on the flight crew. As part of NASA's responsibility to facilitate an active exchange of ideas and information among members of the aviation community, a NASA/FAA/Industry workshop devoted to flight deck automation, organized by the Aerospace Human Factors Research Division of NASA Ames Research Center. Participants were invited from industry and from government organizations responsible for design, certification, operation, and accident investigation of transport category, automated aircraft. The goal of the workshop was to clarify the implications of automation, both positive and negative. Workshop panels and working groups identified issues regarding the design, training, and procedural aspects of flight deck automation, as well as the crew's ability to interact and perform effectively with the new technology. The proceedings include the invited papers and the panel and working group reports, as well as the summary and conclusions of the conference.

Norman, Susan D.↗

NASA NTRSDate not supplied

Achieving Equilibrium for Dense, Integrated, Vehicle Navigation

Drone usage has proliferated in recent years with many applications that have market-changing potential. Applications that include parcel delivery, wildlife protection, precision farming, law enforcement, and industrial inspection, just to name a few. In this paper, the term drone is used to mean both Unmanned Aerial Vehicle and small Unmanned Aircraft System vehicles. Flight infrastructure can currently only support a few thousand aircraft flying over the United States National Airspace System (NAS) at any given time. A delay atone airport sends ripple effects through the system, causing more delays and missed connections. Once regulations and safety policies are put in place to allow for the widespread use of unmanned drones, the number of aircraft in the NAS is expected to skyrocket to millions, potentially congesting the airspace resulting in possible separation violations. In air traffic control, separation is the concept of keeping an “ownship” aircraft outside a minimum distance from “intruder” aircraft to reduce the risk of the aircraft colliding, as well as preventing accidents due to secondary factors, such as wake turbulence. Maintaining proper separation is a safety critical property for drones in the airspace. This paper addresses separation in time and in distance for high volume corridors (en-route) and lanes(on ground). The requirements and necessary conditions for maintaining proper separation and reaching maximum throughput for a given corridor/lane are addressed assuming unidirectional corridors/lanes where an aircraft arrives from one side and departs from the opposite side. Simulation results are presented that show the presented solution guarantees a set of drones to reach the equilibrium state by adjusting their speed based on their distance to the aircraft in front of them. The equilibrium state is defined as a state when a set of n aircraft moving at a relatively constant speed and uniform spacing from each other in a congested system. A congested system is defined as a state when the aircraft cannot move at their maximum allowed speed. Unlike existing centralized and pre-planned approaches, the proposed solution is fully distributed and enables autonomous aircraft to decide to adjust their speed and distance with respect to the preceding aircraft, dynamically. Simulation results are presented that assess the feasibility of the approach using a large number of drones and evaluate the scalability of the proposed solution.

Mahyar R. Malekpour↗