About Stress, its relevance in CRM, and the effect of CRM training you can read here:
1. The Influence of Stress on Flights
As we will discover in a moment, either stress, which is preexisting and brought to the flight, or stress, which is caused by an unexpected event during the flight, lead to an incident or air accident.
1.1. Preexisting Stress Triggers an Incident
Stress, which pilots bring from their daily lives to their flights, becomes noticeable in their work. Although it is required by many sides or by ourselves as part of our professionality, we are not always able to separate our private lives and their influences on us from our occupation.
One incident, which luckily did not lead to an accident, shall be examined here. As the investigation of this incident showed, stress due to a financial loss, as well as disrupted sleep had impaired the captain´s concentration.
When the pilot next to him, who was the pilot flying at this point in time, asked the captain to pull the landing gear up, the captain retracted the flaps on the wings instead. These flaps are used during take-off and climbing.
At least, the captain had made sure that the airliner had already gained enough speed to carry out the maneouver securely. The crew noticed that the landing gear was still down at an altitude of 1000 feet (ca. 330m) and pulled it up.
1.2. Stressful Events Lead to an Air Crash
On June 1st 2009 an Air France Airbus , flight AF 447, crashed into the Atlantic Ocean en route from Rio de Janeiro to Paris. Only the discovery of the flight data recorder and the cockpit voice recorder in May 2011 revealed what had caused the accident, but also how the crew had acted during the last minutes of the flight.
Sensors, which measure the airspeed (pitot tubes), had frozen and, thus, the autopilot had disengaged. Consequently, the crew had to fly manually without reliable speed indication. In addition, a loss of altitude of about 160m was indicated, which had been artificial. This caused the pilot flying to pull the nose of the plane up making it climb.
He continued his maneouver until the airliner reached a point at which it is not capable of flying any more due to aerodynamics. Instead, it begins to fall. The crew apparently misinterpreted the acoustic and visual warning sign and seemed not to believe that the aircraft was stalled.
Thus, they did not return to a lower altitude in order to regain their speed, which would have recovered their aeroplane from the stall.
Following that, the crew concentrated on manoeuvres that did not yield the desired results, and their communication lost its mandatory discipline. Only right before the crash - much too late - one of the pilots recognised the cause, as well as the necessary action.
Apparent stress (audible in the communication) caused by the events and further critical factors rendered the crew incapable of comprehending and solving the problem.
This accident was examined by the British television programme Channel 4 in 2012. This film, featuring acknowledged experts, was uploaded on YT as "Air France Crash" in the same year.
2. Stress Is an Important Topic in CRM
As you well are aware, stress influences our teamwork. The consequences can be fatal, as we have seen in the example above. This is the reason why the theme is taught so extensively in CRM.
As announced in the first part of this blog article , we will address the interplay of stress and the CRM components here. Using these components, we are still able to solve our tasks in a structured manner and to minimise mistakes when stressed.
Then, we will turn our attention to general CRM training and its goals. We will also look at targeted training of stressful situations in a simulation.
3. Stress and the CRM Components
3.1. The Interrelation Between Workload Management and Stress
Good Workload Management Includes:
- clarity on the tasks
- clarity on who is capable of and going to do what
- overview of the tasks in relation to the situation on the whole
- overview in relation to time and progress, for example, during an entire flight
- overview of task execution
- timely and anticipatory planning of workload management, concerning time and personnel
- task fulfilment as soon as possible in order to have resources available in case of the unexpected
Using Wise Workload Management We Achieve i. a.:
- to avoid unnecessary stress due to uncertainty
- to avoid unnecessary stress due to inadequate preparation
- to avoid pitfalls employing adequate preparation, for instance, regarding the expected weather conditions during a flight
- due to anticipatory planning it is possible to prepare the appropriate actions concerning these conditions
- to detect lacking resources early, when there is still time to make amends
- to find potential faults in good time and to correct them early
- optimised professionality
- better teamwork
Adequate Workload Management is a relevant topic in CRM so that we master it even when we are feeling stressed.
If we maintain good workload management during stress, this helps us to keep an overview and continue our work calmly. Hence, the risk for mistakes is diminished.
3.2. Decision-Making
When applying CRM, we often decide as a team, and the teamleader is responsible for the decision made. Especially when we are stressed, we tend to overlook important facts. Consequently, we find it more difficult to assess benefits and risks with certainty. Decision-making models serve us well particularly then.
In the figure below, you can find examples of decision-making models and see, which aspects these include.
FORDEC, applied by well-known European airlines, as well as in medicine:
- Facts: What are the facts?
- Options: What options have we got?
- Risks: What risks exist?
- Decision: Who is going to carry out which task.
- Execution: Acting as decided.
- Check: Reevaluation of the situation, adjustment of the measures if necessary
TDODAR, applied by British Airways, for example, which has added "time":
- Time: How much time have we got?
- Diagnose: What is the problem?
- Options: What options have we got?
- Decide: Who is going to do what.
- Act/Assign: Carrying out the tasks as decided.
- Review: Reevaluation of the situation, adjustment of the measures if necessary
3.3. Our Situational Awareness Is Deteriorated When We Are Stressed
Employing Situational Awareness, we comprehend our current situation as a whole. This includes:
- spatial awareness, when flying, but also in the emergency medical service in a labyrinth of a flat
- awareness of time, how far have we come in a procedure, how much time have we got left
- information from our surroundings, for instance, the weather during a flight or crossing air traffic
- overview of the tasks or currently needed actions
- overview of the resources
Depending on the concentration that a situation requires, situational awareness can be divided into five levels, ranging from tuned out, for exapmle, when lying on the beach, to comatose, caused by a startling event.
We are most concentrated and, therefore, most alert when we are in the middle levels of awareness. The more tense we are, the shorter we can maintain a good situational awareness. When comatose, our situational awareness is limited due to the related stress.
A good cognition of our situational awareness, as well as the right mix of tension and relaxation also help us to deal with stress adequately.
3.4. Stress and Communication
When we are stressed, our ears can be "shut", remarks, but also warning signals, evade us. At the same time, our own communication can be incomplete. For instance, we may not stick to formal language, which is required in radio communication. We may speak fast and unarticulate or send misleading messages.
As you know, a lack in communication has lent a hand to about 70% of all air accidents. Therefore, the topic is truly important in CRM today. In addition, communication rules have been developed to enhance safety.
Cloosed communication loops, as well as the use of unambiguous standard phrases in CRM help us to continue to send and receive clear messages, even when we are feeling stressed.
4. CRM Offers Us Additional Valuable Tools
Standard operating procedures, SOPs, as well as checklists are of great help. Additionally, there are more mnemonics, as we will see below.
4.1. SOPs and Stress
We cannot apply safe crew resource management without following clearly formulated SOPs, neither in routine situations, nor in extraordinary ones that cause stress.
In many incidents and accidents in aviation deviation from the SOPs played a role. One example are the SOPs, which require a go-around in case of an unstabilised approach, in order to avoid a controlled flight into terrain, CFIT.
Factors, Which Contribute to Deviation from SOPs, Include:
- priority of other aspects such as maximal duty time
- overconfidence and complacency
- wanting to get the job done at all costs
- Distractions
- interruptions
- stress and impaired situational awareness
- too large a workload
- lack of training in using SOPs
- lack of acceptance of SOPs in the company culture
In extraordinary and stressful situations SOPs help us to solve the underlying problem step by step considering all important aspects.
SOPs for routine procedures help us to work stressless and flawless.
4.2. Relevance of Checklists During Stress
Imagine, you are doing the groceries, your mobile phone rings, a neighbour bumps into you and greets you. At the same time, someone wants to pass your shopping trolley and reach the shelf right behind you. Step by step you solve the situation, but what did you want to buy? Well prepared as you are, you grab your shopping list and get your shopping underway.
When we are at work, things aren´t that different. In the emergency medical service, we should not forget any item of our medical equipment when changing cars, but take all of it to the other vehicle.
Such a change of vehicles can be necessary at short notice, for example, when one car is damaged. Of course, we should act quickly. As we cannot remember all items even when we are relaxed, this gets worse when we are feeling stressed. Then, we are glad to have our checklists.
Checklists help us to avoid stress caused by forgotten items and they help us not to forget anything when we are stressed.
4.3. Further Mnemonics
We are at a 78-year-old patient´s place, one corner of the mouth is hanging down, his speech is slurred, perhaps he has suffered a stroke. The relatives are nervous, one tells us about a stroke three years ago, one provides us with the list of medications at the same time.
In order to continue to carry out or work calmly, remembering everything that is important, we use different acronyms in the emergency medical service. One of these is the English "FAST", shown below, which we employ when examining stroke patients:
- F for "face", is there any palsy?
- A for "arms", can one not be held up in front of the body?
- S for "speech", what are the pronounciation and the understanding like?
- T for "time", when did the symptoms first occur?
In addition to the items in the decision-making models, the SOPs and checklists, also simple mnemonics help us to consider all the important facts when we are stressed.
5. General Training of CRM Components
As you already know, CRM comprises several components. Just reading them makes the mind boggle. To adhere to all these concepts in practical teamwork, requires a lot of practice through repeated training.
If we master the CRM components securely, we will deploy them automatically and keep a cool head in stressful situations.
6. Specific Training of Simulated Stressful Situations
An emgergency landing after the outage of important onboard systems? The rescue of an unconscious patient, this time trapped at the foot of narrow basement stairs? Or high up in the driver´s cab of a lorry?
How to deal with stressful situations can be trained in a realistic simulation. In a simulator, no aeroplane can really crash, and no patient will be harmed. Moreover, the scenario can be repeated as often as necessary, until the team masters it successfully.
During the debriefing session, the team members reflect together on what has been carried out successfully and what needs improvement. Peculiar attention is paid to the root cause of mistakes, which can then be addressed accordingly.
Simulation and the confidence we gain there minimise our stress level considerably when we are confronted with the practised scenario in reality. Thus, we reduce our risk of failure.
7. Using CRM, Stress Can Be Handled More Easily
Having elucidated stress and its relevance in CRM, we have seen how the various CRM components and precise communication help us in stressful situations. Thus, it is easier for us to keep an overview and, as a team, to continue to use our personnel and material resources.
The continued training of the CRM components, as well as simulation with its detailed debriefing sessions, round off CRM uniquely. Equipped with it, we are better prepared to control our stress levels and fulfil our tasks with expertise.
8. In My Next Blog You Can Read About:
How the crew of an airbus A380 managed to keep a cool head and make a successful emergency landing despite an engine fire and multiple other malfunctions.
Here, you can find more about my CRM seminars.
Here, you can find more blog articles.
Author: Eva-Maria Schottdorf
Date: May 10th 2021