Intended for healthcare professionals

Rapid response to:

Education And Debate

On error management: lessons from aviation

BMJ 2000; 320 doi: (Published 18 March 2000) Cite this as: BMJ 2000;320:781

Rapid Response:

Lessons from aviation

Dear Sir - The article by Helmreich discussing lessons to be learnt
from aviation1 is useful and the principles outlined are mentioned in
several other articles, but they mainly refer to commercial aviation
rather than general (private, small business, aerial photography, medical
services, police work, etc.) aviation (GA). The fatal accident rate in
this group perhaps reflects better the problems, especially psychological,
which affect pilots (often single-handed), when not protected by the vast
machinery of an international flying organisation, cockpit cross checks
etc. The three main causes of death in GA are loss of control (in either
instrument or visual conditions), controlled flight into terrain (flying
into a mountain) or fuel starvation.2 Many loss of control incidents were
due to failure to recognise lack of ability or to being out of current
practice or over-confidence. Controlled flight into terrain incidents
occur in instrument conditions and are usually due to pilots either being
lost, failing to obey the rules for terrain clearance, or both. Most
engine "failures" due to running out of fuel defy belief. Yet in spite of
the fact that each of these groups of error is likely to result in a fatal
outcome for the pilot, let alone passengers, they still occur. Clearly,
the psychological factors involved are complex, but it is unlikely that
any pilot set out on that fateful day with the intention of dying.

Airlines now have rigorous psychological assessment prior to
appointment of a pilot to training and, in light of the GA accident rate,
a section on human factors and performance has been introduced to the
Private Pilot syllabus. It remains to be seen whether this will help to
reduce the human factors involved in GA fatalities, but some will
inevitably still occur.3 However, psychological assessment of doctors
and/or medical students along with training in recognition of personality
types and error prone situations could be of benefit to both practitioners
and patients alike and help prevent such scenarios as related in
Helmreich's article.

Ken McCune, F.R.C.S.(Ed)

Research Fellow and private pilot!


1. Helmreich RL. On error management: lessons from aviation. BMJ
2000; 320: 781-5

2. CAP 667 Review of General Aviation Fatal Accidents, CAA, Gatwick
Airport, London, 1998

3. Beaty, D. The Naked Pilot, Airlife Publishing Limited,
Shewsbury, 1995

Competing interests: No competing interests

19 April 2000
Ken McCune