Any pilot of a twin engined aircraft recognizes the phrase “dead foot, dead engine”, as it explains concisely and easily how to recognize which engine has failed when an emergency occurs. For example, when the right engine fails, the power from the left engine will turn the aircraft to the right, requiring left rudder to keep the airplane straight.  The right rudder would be the “dead foot” indicating the dead engine.  Apparently, such recognition this was not the case in February’s crash of a TransAsia Airways ATR-72 in Taiwan that was captured on video crossing a freeway bridge and crashing dramatically into the Keelung River.  Factual data now emerging from investigation, including the cockpit voice and flight data recorders indicate pilot error and confusion in the cockpit.

Two issues emerge from this situation that are important from a safety perspective.  The first is the adequacy of fundamental training in emergency situations to recognize an engine failure and properly react by increasing power with the engine that is working.  In this situation, the pilot failed to recognize that the number 2 engine had failed, and on the voice recorder said “I will pull back engine 1 throttle”.  The crew then went on to shut down engine 1, the only working engine, and feather its propeller.  That error sealed the fate of the aircraft, as without any power, it could not maintain flying airspeed, and by the time they realized their error and attempted an engine restart, it was too late.  It seems strange that two experienced pilots would each make such a fundamental mistake.

The second issue which emerged is crew coordination, and the ability for a co-pilot to correct a captain when a mistake is imminent.  In this case, the cockpit voice recorder indicates that the co-pilot urged caution before shutting down the engine, but the captain went ahead and shut it down.  As we have seen in previous pilot-error crashes with Asian airlines, including the Asiana crash in San Francisco in 2013, there is often a cultural reluctance to question the authority of a higher ranking individual.  The result is that situations in which the co-pilot knows an error is being committed, and could have been corrected, go unchecked resulting in tragedies.

A crew must work as a team, and because humans are prone to error, deferring to the higher ranking individual at all times entails risk.  A co-pilot must learn how to say “no” to a Captain if he believes actions are incorrect or could endanger the aircraft.   But this is quite difficult to accomplish in a culture that abhors such behavior, and avoids “loss of face”.  Solving this problem is not easy.

Training is one answer, and from a cultural perspective, since the goal of every first officer is to move to the Captain’s seat, to couch such crew coordination activities as “Captain in training actions”. Introducing actions to simulate how a new captain would correct an error from other crew members, practicing them with some on-board exercises, and training first officers to be more assertive is essential to safety.  While this is difficult in a hierarchical society, it is not impossible, if attention is directly given to the issue in a non-threatening way.  Working as a team in which both parties are challenged to keep each other sharp is the best way to overcome the potential for human error, and all parties could likely embrace increasing proficiency.  It might be possible if Captain’s could purposely introduce potential errors to ensure that his co-pilot is sharp, and challenges authority when appropriate as a part of his responsibility in training his crew.  That would begin to change the tone of responses, as the co-pilot would recognize that he might be being tested on his ability to challenge, and do so.

Crew coordination is essential to safety, and two sets of eyes are better than one.  Making it happen is the real challenge ahead, particularly for Asia-based airlines.


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