For the pilots.......

[aap1966]

Aircraft accidents are useful analogies for ICU incidents, so I find the study of such incidents interesting, and useful. In several accident reports, the pilots fail to respond appropriately to "stick shaker" in an incipient stall. As a non-pilot, why? I would have thought that it would be drilled in (if altitude allows) stick shaker--> nose forward--> THEN work the situation. In several incidents, the pilots seemed to have tried to work the situation first, or even pull nose up, before taking action to increase air-speed.
This is NOT a criticism, I'm just trying to understand. Is it a training issue? Panic? Am I missing something?
In explanations, feel free to assume intelligence but ignorance.

[Seahawk]

I did a number of aircraft accident investigations.

Oddly enough, accidents like the one you mention generally fall into two distinct categories: Either boredom, inattention (routine/inexperience) or high workload/stress (already engaged with another emergency/lost comms/lost nav, etc.)

It is amazing what cues pilots will ignore. All military pilots are drilled incessantly: Aviate, navigate, communicate. In other words, fly the damn airplane first.

It is funny you mention ICU and aircraft. I also did a lot of operational flight test in the Navy which meant I dealt with a lot of human factors issues: Presentation of data to the pilot, keystrokes to get to primary pages (early glass cockpit stuff) location of switches, circuit breakers, etc. We did exhaustive "crew station working groups" in simulators, part task trainers, etc. in order to try and get the sequence(s) right to help avoid pilot error and streamline the pilot workload.

Every time I have been to an ICU (Mom/Dad, etc.) I am struck by how haphazard the flow is...to my untrained eye nothing seems intuitive. I also noticed that from hospital to hospital there was little standardization. As a systems engineer, you'd think that standardized procedures and ICU set up would be in place.

Best and good luck.

[Nate2046]

Originally Posted by aap1966

In several incidents, the pilots seemed to have tried to work the situation first, or even pull nose up, before taking action to increase air-speed.

Here's how we were trained for YEARS in the sim to handle an 'incipient' stall. As soon as the stick shaker activates, full power, and lock the pitch, as the engines spool (fuselage mounted) they will push the nose down, add back pressure to keep the nose up. I always HATED this technique because its so counter to everything I learned in primary flight training. The reason for this you ask? The FAA's main emphasis on stall recovery was minimizing loss of altitude. Most turbine aircraft will easily power out of an incipient stall so it did work. Muscle memory being what it is, though, I always thought it was the wrong technique to emphasize. Every time I think of the Colgan accident, I wonder what those guys drilled in the sim.

[aap1966]

Originally Posted by Seahawk

Every did I have been to an ICU (Mom/Dad, etc.) I am struck by how haphazard the flow is...to my untrained eye nothing seems intuitive. I also noticed that from hospital to hospital there was little standardization. As a systems engineer, you'd think that standardized procedures and ICU set up would be in place.

Best and good luck.

Medical system safety is 40 years behind Aviation........some of us are trying to change the culture.....it ain't easy.

[widgeon13]

If you are sick you go to the hospital, if you want to get really sick you stay there for a while.

When my father was in the hospital (cancer) on his way out many years ago, I actually caught the nurse giving him the wrong IV meds meant for another patient. I don't think much has changed for the better.

[BigInJapan]

Originally Posted by Seahawk

It is amazing what cues pilots will ignore. All military pilots are drilled incessantly: Aviate, navigate, communicate. In other words, fly the damn airplane first.
Best and good luck.

^^^This. Fly the airplane. I had a couple really good instructors (old school) who I'm happy to have flown with for a while.

[flipper35]

Originally Posted by Seahawk

I did a number of aircraft accident investigations.

Oddly enough, accidents like the one you mention generally fall into two distinct categories: Either boredom, inattention (routine/inexperience) or high workload/stress (already engaged with another emergency/lost comms/lost nav, etc.)

It is amazing what cues pilots will ignore. All military pilots are drilled incessantly: Aviate, navigate, communicate. In other words, fly the damn airplane first.

It is funny you mention ICU and aircraft. I also did a lot of operational flight test in the Navy which meant I dealt with a lot of human factors issues: Presentation of data to the pilot, keystrokes to get to primary pages (early glass cockpit stuff) location of switches, circuit breakers, etc. We did exhaustive "crew station working groups" in simulators, part task trainers, etc. in order to try and get the sequence(s) right to help avoid pilot error and streamline the pilot workload.

Every time I have been to an ICU (Mom/Dad, etc.) I am struck by how haphazard the flow is...to my untrained eye nothing seems intuitive. I also noticed that from hospital to hospital there was little standardization. As a systems engineer, you'd think that standardized procedures and ICU set up would be in place.

Best and good luck.

This was drilled into us on the general aviation side as well. The Air France flight 470 comes to mind and reading the transcript you can't help but wonder what was going through the junior pilots head the whole time. Sad thing is they had nearly 50k feet to recover from his first mistake.

[pavulon]

There are lots of things to cause problems in the ICU but one of the largest is that patients there are often in dire straits...aircraft analogs would (should) not be flown. For most people, there were no mandatory annual inspections or repairs.

Another is that the people working there go home despite any terrible events. They have emotional skin in the game but typically not their own hides. So, training after school often takes a back seat to their personal lives.

We could go on and on about differences but having worked in ICUs and flown as pilot in command, I think standardization in healthcare can only go so far. People are not mechanical things.