Monday, May 14, 2012

Threat & Error Management

This is a topic that has been quite difficult for me to grasp with the Human Factors course that I am doing.  Basically:

Threat - a situation (environmental or organisational, etc) that does not involve pilot actions or inactions that could cause errors...etc
Error - an action or inaction caused by a person whether part of the crew or external... etc. that could cause an undesirable aircraft state...etc
Undesirable Aircraft States - fairly self-explanatory, caused by a combination of threats and errors, if not countermeasure-d... such as getting too focused on looking at a random cow and letting the airspeed drop off until the airplane stalled (don't ask me why there was a cow in the flight deck)
Outcome - an accident or incident, probably
and/or Countermeasures - something that you do to prevent the threat-error-UAS-outcome chain!

To put this in a situation that the general public can understand, let me walk you through TEM where my lack of house-keeping is concerned!

Threat
...environmental - lack of dishwasher tablets in the apartment
...internal - lack of oomph to get up and go buy dishwasher tablets
...expected - a knowledge (at least a couple of days) of the lack of dishwasher tablets
Error
...procedural - a lack of briefing where use of dishwashers are concerned
...handling - my use of Fairy liquid in the dishwasher
...this could also be thought of as an Endemic error, as it is part of my human nature...
...knowledge-based behaviour (no prior knowledge) causing an Error of Judgement - the poor training in dishwasher skills
Undesirable Aircraft States - the dishwasher obediently beginning its cycle... and continuing... and continuing... well the photo is fairly self-explanatory
Countermeasures - I did attempt to use Towels, to a certain extent helping with the UAS... but not really
Secondary Outcome - I bought some dishwasher tablets and re-cycled the dishwasher... as the dishes were not even particularly clean :(



THE END.

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