- Email: [email protected]
New emphasis on aviation safety
0
"°
OPERATIONS ~S~ SAFETY
......
New Emphasis On Aviation Safety Adriaan de GRAAFF
In 1992,a total of 1,285people were killed in road traffic accidents in the Netherlands, a relative small country with less than 15 million inhabitants. It is accepted by public opinion that the average number of people killed in road accidents is approximately 1,200 annually. Business as usual. n the same year, an El-A1 B747 cargo plane crashed on the suburbs of Amsterdam, killing 43 people. This accident has kept the Dutch public opinion occupied since then. In fact, a Parliamentary Commission has organised hearings in 1999 on this accident, that happened more than six years ago. This illustrates that safety is very much related to perception. Maybe it is the third dimension, maybe the fact that few people learned to how to fly, that most aviation accidents involve more than a few people or that commercial air traffic became available to the mass public only after the Second World War. But to most people, flying is still something special and the media pay a lot of attention to aviation accidents.
I
Public confidence Let me quote one of the early aviators in the Netherlands, Mr. Gijs Kiiller. He bought an Antoinette aeroplane in France in 1909. He emigrated to the Dutch East Indies in 1911 and became one of the first aviators in that part of the world, but he had to quit flying soon after due to lack of money. Mr. Kfiller gave his view on aviation: "A sport for reckless people, that is madly dangerous and has absolutely no future". He proved to be wrong. Today, air transportation is a mature industry and world air traffic is expected to grow at a rate of 5%
annually in the next 20 years. The growth rate is highly dependent on the world economic growth rate, as on average 1% economic growth creates 2% air traffic growth. But there are other factors that influence the growth rate like tariffs (related to direct and indirect operating costs), environmental constraints, passenger appeal and last but not least, public confidence. And public confidence is to a large extent related to safety.
Safety and risk How safe is air transport? In the public perception, safety is related to the number of negative headlines in the worldwide media. In the aviation industry, the familiar way of looking at safety is by analysing the risks involved. Risk analysis covers not only the air transport vehicle and its human complement but also the external risks to people living on the ground. The calculation of external risk is an important issue. Since more than 75% of air transport accidents happen in the take off/climb and approach/landing phases of flight, analysis of external analysis around airports is a valuable tool for regional- and airport planning and addressing the associated liability issues. Based on the safety record of aircraft used, general statistics and the number of aircraft movements, danger zones can be plotted around each airport. The consequences of accepting W
AIR
& SPACE
additional traffic, the construction of additional runways, different approach and take off procedures, etc., can easily be shown in the simulation model. By making external risk visible, we can also contribute by quantifying part of the perceived safety (figure 1). Looking at the air transport mode itself, a distinction is often made between commercial air transport (both scheduled and non-scheduled) and general aviation. Based on NLR data, the average worldwide fatal accident rate in civil air transport is about 0.12 per 100,000 flights (jets and turboprop driven aircraft). The data include air cargo flights which experience a fatal accident probability of four times the average of passenger flights. This can be attributed to the fact that 55% of the air cargo operations are conducted at night (against 18% in passenger operations) and that cargo operators use ageing
EUROPE
• VOL
I • No
2 - 1999
aircraft that require additional maintenance and inspection. This article deals with commercial operations and excludes training and ferry flights, business aircraft and general aviation. The fatal accident rates in general aviation are 25 to 30 times higher than in commercial passenger operation, which in itself explains the increased interest in the US in the issue of General Aviation safety. The average fatal accident rate in commercial aviation as defined above translates into some 25 accidents per year worldwide (average over 19801996), involving nearly 1000 fatalities per year. It is well recognised that with the current expected growth in air traffic and the same relative safety, the absolute number of fatal accidents would at least double, resulting in one major accident per week worldwide. This would certainly have a negative effect on aviation growth as these accidents still make the headlines and the public may feel that it is no longer safe to travel by air.
Lower accident rates The aviation community is therefore convinced that (fatal) accident rates must come down. To achieve this, a number of steps have to be taken: • To reach worldwide agreement on target levels of safety, related not only to the individual equipment but also to the total air transportation system. • To develop a global aviation safety information system, that would be based on the same taxonomy using unified denominators. The information should include both incidents and accidents, being provided by manufacturers, controllers, operators, pilots and mechanics. The information should be protected from disclosure in the media or in lawsuits. There are several sources available to obtain these data (UK-CAA,Airclaims, NASAASRS, ICAO, etc.), but the sources use different taxonomies and denominators. Actions like ICAO-GASP (Global Aviation Safety Plan), GAIN (Global Aviation Information System) by FAA, ECC- AIRS/Eucare by the
European Union are interesting initiatives that should be well coordinated. • To understand the causal factors of the accidents and incidents. Most accident reports reveal what happened, not why it happened, even though their prime function is to learn from mistakes and prevent future accidents. To create a good understanding of aviation safety, it is essential to understand why unwanted events happen. Analysing the relatively few accidents and incidents is not enough and initiatives by airlines (like the BA Basis System) and the NASA Aviation Performance Measuring System (APMS), using normal flight data analysis, are essential to understand the nature of risks and their causal factors. • To create a design approach towards aviation safety, making safety a design requirement rather than a mere spin off from the design process or the operations. The European Commission is sponsoring the DESIRE project under the EU-Framework programme, which addresses three elements:
External risk analysis Schiphol Configuration Schiphol S 5 P 2 0 0 3 ; 4 6 . 0 0 0 inhabitants. IR c o n t o u r s ; Ber. no. 9 8 0 9 0 8 0 2 5.0e - 05 1.0e - 05 1.0e - 06 1.0e - 07
Figure I. External risk calculation result in contours around an airport identifying different risk levels, representing the probability of an aircraft a c c i d e n t (Doc. NLR).
ill
OPERATIONS • SAFETY -the quantified way in which the probability of an accident depends on its causal factors, by means of a causal tree methodology; -the quantified consequences of an event in terms of direct and indirect costs; -the development of a quantitative model to analyse the cost-benefit ratio of proposed measures to improve safety; -this will help to create a design approach towards safety, based on accepted levels of safety. The DESIRE study has not yet provided the answer how to prioritise the aviation safety agenda. In the meantime, several initiatives on both sides of the Atlantic to increase safety have emerged. The contribution of the proposed action to increase safety is not quantified, but the ideas are based on available statistical data and common sense.
International initiatives In the US, the US industry presented its safety initiative in 1997 (CASST: Commercial Aviation Safety Strategy Team), focusing on measures to improve flight safety (concentrating on CFIT, loss of control, human error, approach and landing, turbulence, runway incursions) and cabin safety, as well as engineering/maintenance and material safety. The Flight Safety Foundation proposed similar topics. The FAA published its Safer Skies initiative to improve regulation in view of safety. As a result of the White House initiative (reduce the accident rate by a factor of 5 within 10 years), NASA launched its Aviation Safety Programme covering aircraft design, training and operations. These initiatives have now resulted in a joint action called CAST (Commercial Aviation Strategy Team), where JSATs (Joint Safety Assessment Teams) focus on agreed issues (CFIT, loss of control, approaches and landing, runway incursions, weather, etc.) and recommend actions to improve safety. A similar initiative in Europe resulting from initiatives by Airbus, the
Association of European Research Establishments in Aeronautics (AEREA) and Eurocontrol, as well as proposals by AECMA and JAA, led to the creation of the JAA Strategic Safety Initiative (ISSI). The JSSI work-programme focuses on topics to improve safety like: - CF1T (Controlled Flight Into Terrain), - Approach and landing, - Loss of control, - Design related issues - Weather (in particular in-flight icing), - Occupant safety and survivability. These focus areas cover 89% of the present fatal accidents. The areas provide not only a good starting point for future European safety research, regulation and product development, but also a basis for closer cooperation with the US-JSATs. It is obvious that a clear definition of these areas is needed. For example, a recent UK-CAA study on global fatal accidents, identified collision with terrain/water/obstacle as the most frequent cause of fatal accidents (46.5%), whereas CFIT was seen as a cause in 35% of the accidents. However, this distinction almost certainly underestimates the number of CFIT cases, as it was not clear if the first category occurred in circumstances where the aircraft was under full control or not. The study also showed some remarkable differences with respect of the operator regions.
Safety research Research is needed to correlate the focus areas to primary causal and circumstantial factors leading to these accidents. Only then can, valuable improvements to increase safety be implemented. The focus on the safety measures will primarily be in the crew domain, as more than 65% of the causal factors in (fatal) accidents are crew related. For example, experience in the US has shown that 'wind shear' accidents can be avoided through a combination of better training and the introduction of adequate warning systems. Both solutions contribute to the decrease in wind shear accidents to an equal degree. AIR
&
SPACE
Figure 2. Training is not only an important element for flight and cabin crew, but also for maintenance and dispatch.
Training Flight crew training is highly dependent on flight simulation, both low cost PCbased simulators and advanced high cost simulation facilities. In the area of simulation, major improvements are still desirable. This relates both to the training programme and to the simulation soft- and hardware. One example is the limited simulation of manoeuvres outside the normal flight regime, which makes it difficult to train in recovery from certain manoeuvres that often result in loss of control. Better aircrew training should result in increased situational awareness, alertness, improved flight handling and judgement as well crew resource management. Improved training is not only important for the flight crew. As airline data show that the majority of air transport incidents occur on the ground, extra training of maintenance crew could save costs and lives (figure 2). EUROPE
• VOL.
I
•
No
2 -
1999
............................
...................................... {............................................................................................................................................
F i g u r e 3. Sensor fusion provides the means to create e n h a n c e d a n d synthetic vision systems for pilots (Doc. DLR).
New equipment New devices are being developed to assist the flight crew and maintenance personnel to prevent accidents happening. These devices range from automated checklists, advanced inspection devices and (on-board) health and usage monitoring systems to a range of systems that assist the flight crew in improving. both situational and weather awareness.
Pro-active warning systems will help the pilots in identifying potential hazards at an early stage. Thanks to sensor fusion, the relevant data will be made available to the crew as accessible information. Advanced displays are being developed and knowledge based systems will be able to assist pilots in safety critical circumstances. As an example, new enhanced and synthetic vision systems will help the
pilot both in the air and on the ground. In the Air Traffic Management domain, a substantial improvement is expected thanks to the wide spread use of satellite based navigation and communication. New navigation aids (GNSS-1 and 2, EGNOS), data link and advanced Flight Management Systems will change the whole ATM set up, which up to now is heavily dependent on voice control by using sector controllers in relatively small airspace-sectors and fixed airways. Also in this domain, we have to make sure, using large-scale validation experiments, that these technical solutions will be safe and will increase safety. The same holds true for automated airport movements. New devices are being developed to ensure all-weather, day and night airport operations to increase the capacity at existing airports. This is extremely important, as the airport capacity will become the bottleneck in future air traffic (figure 3). However, one cannot avoid that incidents and accidents will happen. The aviation industry is actively seeking to improve its products so that incidents will not lead to accidents. Examples being the engine damage containment programmes and blastproof luggage containers. Improved crashworthiness, damage tolerance and accident survivability are now key words in aircraft design.
-i . . . .
i
S:4
JJ
3N;Z
Titan; l e 1 5 . ~ 4
\
X; Z3 ~
Y; 1 1 . 8 1
NIL:
3:4
.1~3
SES$:5
TIME: 1514.~
X: Z'~.4
Y: 13.Z
~L:
.733
Figure 4. For quantifying human behaviour, eye tracking can be used. The illustration shows that the design of a display without incorporating a human centered approach can create a situation in which the operator will use only part of the information available, especially in high stress situations (Doc. NLR).
m
OPERATIONS • SAFETY Man Machine Interface It is well recognised that the man machine interface is an important factor influencing safety. The interface should make sure that the pilot still knows what the (highly automated) aircraft is doing and how the information presented should be interpreted. Human factor issues cover a broad spectrum from human errors related to mode-awareness to human performance. It is essential that the man machine interface issues be quantified. It is also essential that the issue is an integral part of the design process for new systems and displays. Experience has shown that the layout of a cockpit panel can easily lead to confusion and eventually to catastrophic results (figure 4).
new technologies but the design should be operator rather than technology driven. That is one of the reasons why it is essential to gain a better insight in normal (flight) operations, in order to identify potentially dangerous events that were solved by the flight crew, the air traffic controller or the maintenance crew without explicitly reporting the event as an accident.
Regulation Finally, regulation has played an important part to improve aviation safety and will continue to do so. Currently, regulation is not only concerned with the failure risk of aircraft (systems), but also with the human operator and the air traffic systems as a
whole. Regulation will change in the future. As increasingly more systems are integrated and use substantial embedded software, a new look at regulation is required. In my view this calls for a closer link between manufacturers, operators, etc., and the regulatory authorities. Without endangering each other's field of competence, closer cooperation is called for. This could be accomplished in Europe using the already mentioned JSSI-initiative. All participants have shown their desire to enter into such a partnership. And referring to the opinion of an early Dutch aviator, all concerned share the view that aviation will stay "a business of responsible people, that is extremely safe and has a bright future ahead". •
Human centered approach Therefore, I see the need for a human centered approach in future flight deck and cabin design as well as in ATMcontroller environments and in maintenance operations. This calls for a different way of addressing technology: no longer should the human operator be adapted to the system by education and training, but the system should be adapted to the human operator. The human operator should be the starting point of the design rather than the last add-on. Future flight decks will still incorporate a substantial number of
AIR
& SPACE
EUROPE
• VOL.
I
• No
2 -
1999
"°
OPERATIONS ~S~ SAFETY
......
New Emphasis On Aviation Safety Adriaan de GRAAFF
In 1992,a total of 1,285people were killed in road traffic accidents in the Netherlands, a relative small country with less than 15 million inhabitants. It is accepted by public opinion that the average number of people killed in road accidents is approximately 1,200 annually. Business as usual. n the same year, an El-A1 B747 cargo plane crashed on the suburbs of Amsterdam, killing 43 people. This accident has kept the Dutch public opinion occupied since then. In fact, a Parliamentary Commission has organised hearings in 1999 on this accident, that happened more than six years ago. This illustrates that safety is very much related to perception. Maybe it is the third dimension, maybe the fact that few people learned to how to fly, that most aviation accidents involve more than a few people or that commercial air traffic became available to the mass public only after the Second World War. But to most people, flying is still something special and the media pay a lot of attention to aviation accidents.
I
Public confidence Let me quote one of the early aviators in the Netherlands, Mr. Gijs Kiiller. He bought an Antoinette aeroplane in France in 1909. He emigrated to the Dutch East Indies in 1911 and became one of the first aviators in that part of the world, but he had to quit flying soon after due to lack of money. Mr. Kfiller gave his view on aviation: "A sport for reckless people, that is madly dangerous and has absolutely no future". He proved to be wrong. Today, air transportation is a mature industry and world air traffic is expected to grow at a rate of 5%
annually in the next 20 years. The growth rate is highly dependent on the world economic growth rate, as on average 1% economic growth creates 2% air traffic growth. But there are other factors that influence the growth rate like tariffs (related to direct and indirect operating costs), environmental constraints, passenger appeal and last but not least, public confidence. And public confidence is to a large extent related to safety.
Safety and risk How safe is air transport? In the public perception, safety is related to the number of negative headlines in the worldwide media. In the aviation industry, the familiar way of looking at safety is by analysing the risks involved. Risk analysis covers not only the air transport vehicle and its human complement but also the external risks to people living on the ground. The calculation of external risk is an important issue. Since more than 75% of air transport accidents happen in the take off/climb and approach/landing phases of flight, analysis of external analysis around airports is a valuable tool for regional- and airport planning and addressing the associated liability issues. Based on the safety record of aircraft used, general statistics and the number of aircraft movements, danger zones can be plotted around each airport. The consequences of accepting W
AIR
& SPACE
additional traffic, the construction of additional runways, different approach and take off procedures, etc., can easily be shown in the simulation model. By making external risk visible, we can also contribute by quantifying part of the perceived safety (figure 1). Looking at the air transport mode itself, a distinction is often made between commercial air transport (both scheduled and non-scheduled) and general aviation. Based on NLR data, the average worldwide fatal accident rate in civil air transport is about 0.12 per 100,000 flights (jets and turboprop driven aircraft). The data include air cargo flights which experience a fatal accident probability of four times the average of passenger flights. This can be attributed to the fact that 55% of the air cargo operations are conducted at night (against 18% in passenger operations) and that cargo operators use ageing
EUROPE
• VOL
I • No
2 - 1999
aircraft that require additional maintenance and inspection. This article deals with commercial operations and excludes training and ferry flights, business aircraft and general aviation. The fatal accident rates in general aviation are 25 to 30 times higher than in commercial passenger operation, which in itself explains the increased interest in the US in the issue of General Aviation safety. The average fatal accident rate in commercial aviation as defined above translates into some 25 accidents per year worldwide (average over 19801996), involving nearly 1000 fatalities per year. It is well recognised that with the current expected growth in air traffic and the same relative safety, the absolute number of fatal accidents would at least double, resulting in one major accident per week worldwide. This would certainly have a negative effect on aviation growth as these accidents still make the headlines and the public may feel that it is no longer safe to travel by air.
Lower accident rates The aviation community is therefore convinced that (fatal) accident rates must come down. To achieve this, a number of steps have to be taken: • To reach worldwide agreement on target levels of safety, related not only to the individual equipment but also to the total air transportation system. • To develop a global aviation safety information system, that would be based on the same taxonomy using unified denominators. The information should include both incidents and accidents, being provided by manufacturers, controllers, operators, pilots and mechanics. The information should be protected from disclosure in the media or in lawsuits. There are several sources available to obtain these data (UK-CAA,Airclaims, NASAASRS, ICAO, etc.), but the sources use different taxonomies and denominators. Actions like ICAO-GASP (Global Aviation Safety Plan), GAIN (Global Aviation Information System) by FAA, ECC- AIRS/Eucare by the
European Union are interesting initiatives that should be well coordinated. • To understand the causal factors of the accidents and incidents. Most accident reports reveal what happened, not why it happened, even though their prime function is to learn from mistakes and prevent future accidents. To create a good understanding of aviation safety, it is essential to understand why unwanted events happen. Analysing the relatively few accidents and incidents is not enough and initiatives by airlines (like the BA Basis System) and the NASA Aviation Performance Measuring System (APMS), using normal flight data analysis, are essential to understand the nature of risks and their causal factors. • To create a design approach towards aviation safety, making safety a design requirement rather than a mere spin off from the design process or the operations. The European Commission is sponsoring the DESIRE project under the EU-Framework programme, which addresses three elements:
External risk analysis Schiphol Configuration Schiphol S 5 P 2 0 0 3 ; 4 6 . 0 0 0 inhabitants. IR c o n t o u r s ; Ber. no. 9 8 0 9 0 8 0 2 5.0e - 05 1.0e - 05 1.0e - 06 1.0e - 07
Figure I. External risk calculation result in contours around an airport identifying different risk levels, representing the probability of an aircraft a c c i d e n t (Doc. NLR).
ill
OPERATIONS • SAFETY -the quantified way in which the probability of an accident depends on its causal factors, by means of a causal tree methodology; -the quantified consequences of an event in terms of direct and indirect costs; -the development of a quantitative model to analyse the cost-benefit ratio of proposed measures to improve safety; -this will help to create a design approach towards safety, based on accepted levels of safety. The DESIRE study has not yet provided the answer how to prioritise the aviation safety agenda. In the meantime, several initiatives on both sides of the Atlantic to increase safety have emerged. The contribution of the proposed action to increase safety is not quantified, but the ideas are based on available statistical data and common sense.
International initiatives In the US, the US industry presented its safety initiative in 1997 (CASST: Commercial Aviation Safety Strategy Team), focusing on measures to improve flight safety (concentrating on CFIT, loss of control, human error, approach and landing, turbulence, runway incursions) and cabin safety, as well as engineering/maintenance and material safety. The Flight Safety Foundation proposed similar topics. The FAA published its Safer Skies initiative to improve regulation in view of safety. As a result of the White House initiative (reduce the accident rate by a factor of 5 within 10 years), NASA launched its Aviation Safety Programme covering aircraft design, training and operations. These initiatives have now resulted in a joint action called CAST (Commercial Aviation Strategy Team), where JSATs (Joint Safety Assessment Teams) focus on agreed issues (CFIT, loss of control, approaches and landing, runway incursions, weather, etc.) and recommend actions to improve safety. A similar initiative in Europe resulting from initiatives by Airbus, the
Association of European Research Establishments in Aeronautics (AEREA) and Eurocontrol, as well as proposals by AECMA and JAA, led to the creation of the JAA Strategic Safety Initiative (ISSI). The JSSI work-programme focuses on topics to improve safety like: - CF1T (Controlled Flight Into Terrain), - Approach and landing, - Loss of control, - Design related issues - Weather (in particular in-flight icing), - Occupant safety and survivability. These focus areas cover 89% of the present fatal accidents. The areas provide not only a good starting point for future European safety research, regulation and product development, but also a basis for closer cooperation with the US-JSATs. It is obvious that a clear definition of these areas is needed. For example, a recent UK-CAA study on global fatal accidents, identified collision with terrain/water/obstacle as the most frequent cause of fatal accidents (46.5%), whereas CFIT was seen as a cause in 35% of the accidents. However, this distinction almost certainly underestimates the number of CFIT cases, as it was not clear if the first category occurred in circumstances where the aircraft was under full control or not. The study also showed some remarkable differences with respect of the operator regions.
Safety research Research is needed to correlate the focus areas to primary causal and circumstantial factors leading to these accidents. Only then can, valuable improvements to increase safety be implemented. The focus on the safety measures will primarily be in the crew domain, as more than 65% of the causal factors in (fatal) accidents are crew related. For example, experience in the US has shown that 'wind shear' accidents can be avoided through a combination of better training and the introduction of adequate warning systems. Both solutions contribute to the decrease in wind shear accidents to an equal degree. AIR
&
SPACE
Figure 2. Training is not only an important element for flight and cabin crew, but also for maintenance and dispatch.
Training Flight crew training is highly dependent on flight simulation, both low cost PCbased simulators and advanced high cost simulation facilities. In the area of simulation, major improvements are still desirable. This relates both to the training programme and to the simulation soft- and hardware. One example is the limited simulation of manoeuvres outside the normal flight regime, which makes it difficult to train in recovery from certain manoeuvres that often result in loss of control. Better aircrew training should result in increased situational awareness, alertness, improved flight handling and judgement as well crew resource management. Improved training is not only important for the flight crew. As airline data show that the majority of air transport incidents occur on the ground, extra training of maintenance crew could save costs and lives (figure 2). EUROPE
• VOL.
I
•
No
2 -
1999
............................
...................................... {............................................................................................................................................
F i g u r e 3. Sensor fusion provides the means to create e n h a n c e d a n d synthetic vision systems for pilots (Doc. DLR).
New equipment New devices are being developed to assist the flight crew and maintenance personnel to prevent accidents happening. These devices range from automated checklists, advanced inspection devices and (on-board) health and usage monitoring systems to a range of systems that assist the flight crew in improving. both situational and weather awareness.
Pro-active warning systems will help the pilots in identifying potential hazards at an early stage. Thanks to sensor fusion, the relevant data will be made available to the crew as accessible information. Advanced displays are being developed and knowledge based systems will be able to assist pilots in safety critical circumstances. As an example, new enhanced and synthetic vision systems will help the
pilot both in the air and on the ground. In the Air Traffic Management domain, a substantial improvement is expected thanks to the wide spread use of satellite based navigation and communication. New navigation aids (GNSS-1 and 2, EGNOS), data link and advanced Flight Management Systems will change the whole ATM set up, which up to now is heavily dependent on voice control by using sector controllers in relatively small airspace-sectors and fixed airways. Also in this domain, we have to make sure, using large-scale validation experiments, that these technical solutions will be safe and will increase safety. The same holds true for automated airport movements. New devices are being developed to ensure all-weather, day and night airport operations to increase the capacity at existing airports. This is extremely important, as the airport capacity will become the bottleneck in future air traffic (figure 3). However, one cannot avoid that incidents and accidents will happen. The aviation industry is actively seeking to improve its products so that incidents will not lead to accidents. Examples being the engine damage containment programmes and blastproof luggage containers. Improved crashworthiness, damage tolerance and accident survivability are now key words in aircraft design.
-i . . . .
i
S:4
JJ
3N;Z
Titan; l e 1 5 . ~ 4
\
X; Z3 ~
Y; 1 1 . 8 1
NIL:
3:4
.1~3
SES$:5
TIME: 1514.~
X: Z'~.4
Y: 13.Z
~L:
.733
Figure 4. For quantifying human behaviour, eye tracking can be used. The illustration shows that the design of a display without incorporating a human centered approach can create a situation in which the operator will use only part of the information available, especially in high stress situations (Doc. NLR).
m
OPERATIONS • SAFETY Man Machine Interface It is well recognised that the man machine interface is an important factor influencing safety. The interface should make sure that the pilot still knows what the (highly automated) aircraft is doing and how the information presented should be interpreted. Human factor issues cover a broad spectrum from human errors related to mode-awareness to human performance. It is essential that the man machine interface issues be quantified. It is also essential that the issue is an integral part of the design process for new systems and displays. Experience has shown that the layout of a cockpit panel can easily lead to confusion and eventually to catastrophic results (figure 4).
new technologies but the design should be operator rather than technology driven. That is one of the reasons why it is essential to gain a better insight in normal (flight) operations, in order to identify potentially dangerous events that were solved by the flight crew, the air traffic controller or the maintenance crew without explicitly reporting the event as an accident.
Regulation Finally, regulation has played an important part to improve aviation safety and will continue to do so. Currently, regulation is not only concerned with the failure risk of aircraft (systems), but also with the human operator and the air traffic systems as a
whole. Regulation will change in the future. As increasingly more systems are integrated and use substantial embedded software, a new look at regulation is required. In my view this calls for a closer link between manufacturers, operators, etc., and the regulatory authorities. Without endangering each other's field of competence, closer cooperation is called for. This could be accomplished in Europe using the already mentioned JSSI-initiative. All participants have shown their desire to enter into such a partnership. And referring to the opinion of an early Dutch aviator, all concerned share the view that aviation will stay "a business of responsible people, that is extremely safe and has a bright future ahead". •
Human centered approach Therefore, I see the need for a human centered approach in future flight deck and cabin design as well as in ATMcontroller environments and in maintenance operations. This calls for a different way of addressing technology: no longer should the human operator be adapted to the system by education and training, but the system should be adapted to the human operator. The human operator should be the starting point of the design rather than the last add-on. Future flight decks will still incorporate a substantial number of
AIR
& SPACE
EUROPE
• VOL.
I
• No
2 -
1999