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Transcript

How HF could have helped

Why didn't they catch this?

Confusion due to Similarity played a role in the mistake that occurred

  • The interfaces were on the same display, & the numbers looked similar

Safety was not promoted by basic features such as warning notifications

  • Thick & cloudy weather with overconfidence in autopilot functions led to the pilot not noticing the drastic changing of altitude

No internal or external confirmation was required to set the autopilot in such a drastic altitude shift

  • An action that led to 87 deaths was merely the turn of a knob by a single human
  • Software limits/warnings or secondary human confirmation could have helped

The Air Inter airlines were a fairly successful company at the time, but this was due in part to several malpractices:

  • They purposefully did not install ground proximity warning systems so that pilots could fly faster at lower altitudes without constant audio and visual signals regarding their elevation
  • They boasted about having some of the most advanced piloting systems in the industry, but that also made the cockpit UI one of the most complex in the industry, and their pilot training never reflected the technological advancements
  • The air traffic radio transcript between the pilots and the airport were very informal, with a lack of unit confirmation and several instances where repetition and explanation of commands were required

Activity

Come up with some instances where the User Interface of a computer, vehicle, blender, Polylearn page, jetpack, etc. was misleading or lacking clarity, and caused you to make an error (opened the wrong file, ran out of gas, initiated self-destruct mode, etc )

Have another person design a solution to the issue, whether in training, layout, software/hardware restrictions, or even elimination of the human interaction (and thus the human error)

What went wrong?

Just Another Trip From Point A to B...Right?

Autopilot “descent” display only showed value of rate of descent, not units

The captain thought he set the airplane’s descent to 3.3 degrees (equivalent to 800 ft/min)

What he actually set it to was 3,300 feet per minute (3.3 thousand fpm)

The mix-up was because the single display was used for two different descent modes, of which the pilot was expected to keep track

Vertical speed (3,300 fpm)

Flight Path Angle (3.3’)

Scheduled passenger flight in 1992

Short trip from Lyon (France) to

Strasbourg (France)

Airplane crashed into mountainside during descent to destination runway

87 casualties out of 96 passengers

Air Inter Flight 148

Nathan, Josh, and Robert

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