Australian Flying - July 2018

he tragic death

of an aspiring

commercial pilot

in a Cessna 172S in

2015 was the subject

of a detailed report,

recently released by the

Australian Transport

Safety Board (ATSB),

which is too serious to ignore.

The ATSB found that it was

likely that the pilot manipulated

the f light controls while the

autopilot was engaged, causing

a significant pitch mis-trim, and

was unable to recover from the

subsequent rapid dive before the

aircraft struck the ground.

Perhaps the most worrying

aspect of this accident is that it

occurred in an aeroplane that’s

generally considered easy to f ly, and

which was equipped with the latest

and most sophisticated avionics

available in aircraft of its class.

The ATSB has done a very

thorough job of assembling the

facts and providing analysis, and

everyone interested in the subject

should read the comprehensive

report themselves (on ATSB

website, report AO-2015-105).

There’s nothing to be gained

trying to guess at the remaining

unknowns, but there is much

to be considered in the

report’s conclusions.

In the last few decades, GA

autopilots have evolved from

clumsy electromechanical

contrivances, mechanically

calibrated to support limited

functions, to advanced digital

computers that use sophisticated

software capable of a rich array of

operating modes and f light tasks.

Many pilots learned to f ly in the

1970s and 80s without ever using

an autopilot, and those who did

were often self-taught.

It was common in that era for

f light instructors to frown on

the use of autopilots by those less

qualified, perhaps motivated by

their own lack of understanding.

A working autopilot was often

considered a bonus in rental

aircraft; the criteria for “working”

was usually whether it f lew

straight and held heading.

Single-axis autopilots were

common in small aircraft, and

the potential for catastrophe was

consequently limited.

As a result, lots of GA pilots

f lying today have little training

in proper autopilot use. Whilst

that might be understandable for

seniors, it’s no excuse for those at

the start of their f lying careers,

and it’s unacceptable if it adds

risk. All forms of automation,

whether in aviation or elsewhere,

bring potential hazards. We’ve

all read of recent accidents by

self-driving cars. Everyone with a

smartphone has dialled someone

by mistake; f looded laundries

and kitchen fires highlight

the potential for unintended

outcomes from unattended

automation, even at home.

Aviation certification standards

generally include defined, but

limited, tolerances for automation

malfunctions, which mitigate

risks when things go awry. Beyond

autopilots, all modern GNSS

automate volumes of navigation

calculations, location look-ups and

track-keeping to a level that the

user-pilot simply can’t monitor,

beyond a reasonableness check.

A natural human expectation

is that automation should be

intuitive. Just ask an iPhone X

user if they have read the 664-

page User Guide.

When pilots get in aircraft

today, they expect systems and

controls to function consistent

with their training and experience.

But if the formal training was

incomplete, some expect they can

learn safely by trial-and-error. In

the aviation context, that’s not a

reasonable expectation.

It’s worth more than a little

thought. Airline pilots complete

formal systems courses as they

move between types, and these

include focus on automated

systems. An experienced GA

pilot shouldn’t need to sit in a

classroom for a week to study the

systems of a Piper Archer, but

equally, it should be reasonable

to assume that they understood

the manual. Unfortunately, we all

know pilots who obviously haven’t,

and sometimes, just studying the

book isn’t enough.

When pilots are new to f light

automation, an immediate,

critical, and conservative self-

assessment is essential, with

assistance on-hand if required,

well before anything is engaged.

The Hazards of Automation

ANDREW ANDERSEN

some expect they can learn

safely by trial-and-error

Short Final

Andrew Andersen looks at problems with the proliferations

of airline-level technology in training aircraft.

82 australianflying.com.au

AUSTRALIAN FLYING July – August 2018

The tragedy of VH-ZEW was the

worst possible outcome from not

understanding technology.

AUSTRALIAN TRANSPORT SAFETY BUREAU