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glider into a steep right turn and pulls back hard
on the control stick resulting in an accelerated
stall/spin. In the ensuing crash, the pilot is fatally
injured and the glider is completely destroyed.
By discussing the events that led to this accident,
we can understand how a series of judgmental
e r r o r s
contributed to the final outcome of this flight. For
example, one of the first elements that affected
the pilot’s flight was his inability to realize that his
decision-making skills were probably dulled by the
long distance flight, which preceded the accident.
The pilot had flown over this ridge a number of
times and was aware that downdrafts are often
present on the lee side of the peak but had never
had problems in the past.
Next, he let his desire to show-off for the people on
the mountain peak override his concern for arriving
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events unfolded, each poor decision left him with
fewer and fewer options.
ORIGINS OF ADM TRAINING
The airlines developed some of the first training
programs that focused on improving ADM.
H u m a n
factors-related accidents motivated the airline
industry to implement crew resource management
( C R M )
training for flight crews. The focus of CRM programs
is the effective use of all available
resources—human resources, hardware, and
information. Human resources include all groups
routinely working with the cockpit crew (or pilot)
who are involved in decisions required to operate
a flight safely. These groups include, but are not
safely at his home airport, and he failed to recognize
the threat posed by the strong wind blowing
over the ridge. Rather than heading straight for the
airport, he decided to make a low pass over the
ridge with insufficient altitude to maintain the FAA
mandatory minimums in dangerous wind conditions.
Next, rather than aborting his attempt to make
the pass over the peak when he realized his altitude
was not sufficient, he continued to fly toward
the peak rather than making a 180° turn away from
it.
On numerous occasions during the flight, the pilot
could have made effective decisions that may
h a v e
prevented this accident. However, as the chain of
Figure 1-2. These terms are used in AC 60-22 to explain concepts used in ADM training.
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limited to: ground, maintenance, and flight personnel.
Although the CRM concept originated as
airlines developed ways of facilitating crew cooperation
to improve decision making in the cockpit,
CRM principles, such as workload management,
situational awareness, communication, the leadership
role of the captain, and crewmember coordination
have direct application to the general
aviation cockpit. This also includes single pilot
operations, since pilots of small aircraft, as well
as crews of larger aircraft, must make effective
use of all available resources—human resources,
hardware, and information. You can also refer to
AC 60-22, Aeronautical Decision Making, which
provides background references, definitions, and
other pertinent information about ADM training in
the general aviation environment. [Figure 1-2]
THE DECISION-MAKING PROCESS
An understanding of the decision-making process
provides you with a foundation for developing
ADM skills. Some situations, such as towrope
breaks, require you to respond immediately, using
established procedures, with little time for detailed
analysis. Traditionally, pilots have been well
trained to react to emergencies, but are not as
well prepared to make decisions that require a
more reflective response. Typically during a flight,
you have time to examine any changes that occur,
gather information, and assess risk before reaching
a decision. The steps leading to this conclusion
constitute the decision-making process.
DEFINING THE PROBLEM
Problem definition is the first step in the decisionmaking
process. Defining the problem begins with
recognizing that a change has occurred or that an
expected change did not occur. A problem is perceived
first by the senses, then is distinguished
through insight and experience. These same abilities,
as well as an objective analysis of all available
information, are used to determine the exact nature
and severity of the problem.
While going through your pre-landing checklist,
you discover that your landing gear is stuck in
the retracted position.
CHOOSING A COURSE OF ACTION
After the problem has been identified, you must
evaluate the need to react to it and determine the
　
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