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firesafety101  
#1 Posted : 29 July 2015 17:41:03(UTC)
Rank: Super forum user
firesafety101

http://www.space.com/300...o-crash-pilot-error.html

Interesting comment here

"I don't mean this flippantly, because I've made plenty of mistakes, but humans will screw up anything if you give them enough opportunity," Sumwalt said. "And I don't mean that with any disrespect to the crew. The fact is, a mistake was made here, but the mistake is often a symptom of a flawed system."

You may find the report interesting, I did.
RayRapp  
#2 Posted : 30 July 2015 09:37:05(UTC)
Rank: Super forum user
RayRapp

I saw a tv news report and recall thinking...the co-pilot activated the 'feathering' system 14 seconds too early...sounds like a design flaw to me.

The comments are ill placed in my opinion. To err is to be human. A robust design will eliminate human error, either by 'fail safe' or to a tolerable extent.
Ian Bell  
#3 Posted : 30 July 2015 10:16:50(UTC)
Rank: Super forum user
Ian Bell

RayRapp wrote:


The comments are ill placed in my opinion. To err is to be human. A robust design will eliminate human error, either by 'fail safe' or to a tolerable extent.


I work in engineering design, looking at the safety aspects. Yours is a bold statement that a robust design will eliminate human error. A design tries to identify potential human errors. Its normal to try and incorporate as much inherent safe design features as possible etc to minimise human error
johnmurray  
#4 Posted : 30 July 2015 11:04:42(UTC)
Rank: Super forum user
johnmurray

"The NTSB determined that the probable cause was manufacturer Scaled Composite's failure to mitigate against the human factor of unlocking the system early. They said this set the stage for the co-pilot’s error.

The NTSB heard there had not been an emphasis on the catastrophic effects of an early unlock, with no reference made to the consequence of doing so in the pilots’ handbooks"

"According to the NTSB, Alsbury manually unlocked the system around nine seconds after motor ignition. Subsequently the tail booms apparently moved themselves into the feather position, provoking a catastrophic structural failure at "just above approximately Mach 1.0"

"Virgin Galactic has added an inhibitor so its feather locks cannot be unlocked in certain conditions"

Horse. Cart. Before.
RayRapp  
#5 Posted : 30 July 2015 13:16:44(UTC)
Rank: Super forum user
RayRapp

Ian Bell wrote:
RayRapp wrote:


The comments are ill placed in my opinion. To err is to be human. A robust design will eliminate human error, either by 'fail safe' or to a tolerable extent.


I work in engineering design, looking at the safety aspects. Yours is a bold statement that a robust design will eliminate human error. A design tries to identify potential human errors. Its normal to try and incorporate as much inherent safe design features as possible etc to minimise human error


In a nutshell that is what I implied. I am not unfamilair with Human Factors (Ergonomics) and realise designing out human error is an integral aspect of designing. There have been many flawed designs which did not properly consider the physical or cognitive aspects of equipment. AWS springs to mind, which was neither a fail safe system or by today's standards fit for purpose. Technology moves on.

The profound statement I always remember from my uni days is - 'Human failure, or last line of defence?'
A Kurdziel  
#6 Posted : 31 July 2015 12:25:32(UTC)
Rank: Super forum user
A Kurdziel

From what I have seen there is tendency in aviation to blame 'human error' rather than systematic error for example blaming an individual rather than their poor training, bad cockpit design etc. it's cheaper that way I suppose. People like Dekker re trying to get way from that but it's just too easy.
mylesfrancis  
#7 Posted : 04 August 2015 11:51:21(UTC)
Rank: Forum user
mylesfrancis

A Kurdziel wrote:
From what I have seen there is tendency in aviation to blame 'human error' rather than systematic error for example blaming an individual rather than their poor training, bad cockpit design etc. it's cheaper that way I suppose. People like Dekker re trying to get way from that but it's just too easy.

Having worked in aviation, I fundamentally disagree. Where the potential outcome for "missing" something in training (or any other part of the systems and processes) is the death of 100+ people in one go, it's vital that the learnings of any incidents are taken on board. As a result, commercial aviation businesses have robust safety management systems designed to do just that.
Kate  
#8 Posted : 04 August 2015 11:58:24(UTC)
Rank: Super forum user
Kate

I have the impression that the aviation industry is a leader not a lagger in a proper human factors approach instead of just blaming the individual.
Ian Bell  
#9 Posted : 04 August 2015 13:01:35(UTC)
Rank: Super forum user
Ian Bell

A Kurdziel wrote:
From what I have seen there is tendency in aviation to blame 'human error' rather than systematic error for example blaming an individual rather than their poor training, bad cockpit design etc. it's cheaper that way I suppose. People like Dekker re trying to get way from that but it's just too easy.



Poor training/cockpit design etc is part of human factors.

The trouble with human factors is that it is such a broad term it can mean just about anything - there are many aspects to human factors.

I also worked in aviation for many years - safety management systems, in my experience and attention to detail far out weight anything I have seen since in conventional industry.
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