AOPA Pilot Magazine - December 2019 - 24

SAFETY SPOTLIGHT

BY RICHARD MCSPADDEN
Executive Director
AOPA Air Safety Institute

Sad milestone
Why do good pilots make bad decisions?

AOPA Air Safety
Institute Executive
Director RICHARD
MCSPADDEN owns
and flies a 1950
Navion to safety
seminars throughout the country.

THIS YEAR MARKED A DISAPPOINTING FIRST in my
safety career. I attended a type club safety conference, and at the conclusion of the conference, on the
same day I departed for Frederick Municipal Airport
in Maryland, one of the type club members crashed on
his flight home and died. Crashed. On the way home
from a type club safety conference.
The NTSB is still investigating, but from online
tracking sources, it appears the pilot departed in his highperformance, single-engine experimental airplane and
was attempting to fly below the weather at approximately
1,000 feet agl, while flying in excess of 200 knots when he
crashed. This flight profile is commonly called "scud running," which escalates in difficulty with increased speed.
It was a tragic, ironic end to the safety conference.
Typical of type club fly-ins, the group began trickling
in early in the week from all over the country. They reconnected with each other, many of them obviously friends
for decades, sharing the joys of their airplane and showing
off new upgrades. Type clubs are everything good about
general aviation: a wealth of knowledge, exceptional and
specific instruction, healthy culture, and social events that
help build lifelong friendships.
The conference for this energetic club began midweek with safety seminars, panels, and deep-dive tech
talks. Some took the opportunity for some flying and
flight reviews on the side. We enjoyed a hangar dance
and barbecue Friday night while strolling the flight line
and ogling especially gorgeous airplanes and curious
airplanes with unique modifications. This is especially
interesting with experimental aircraft type clubs.
Saturday was a full day of seminars to include a talk
on "Why Good Pilots Make Bad Decisions." The discussion stems from my experience losing friends in
both military and GA flying, and in reading accidents
of highly experienced and obviously skilled pilots who
made uncharacteristically poor decisions. Seeing people
I respect make a poor decision with devastating consequences made me realize I could be susceptible to the
same peril. "Why Good Pilots Make Bad Decisions"
acknowledges that we are all susceptible to poor decisions and focuses a discussion around how to avoid them.
The discussion pulls from two books dealing with
decision making: Think Again, published by the Harvard
Business Review, and Thinking Fast and Slow, by Daniel
Kahneman. Both books shed light on how the brain

24 | AOPA PILOT December 2019

operates and explain that despite our best efforts, our decision-making process is sometimes hopelessly flawed. We
are prone to make quick decisions, more than optimum
decisions, and we place too much faith in our intuition
or our "gut feel." We are powerfully susceptible to biased
logic when we have a keen self-interest at stake. Once
we make a decision, we tend to over-value data that supports our decision and undervalue data that suggests we
should reconsider. In an aviation setting, the brain's processing-so vital to the thousands of decisions we make
every day-can lead to an oversight of critical information
and incite poor decisions. We must be aware and on guard.
At the banquet Saturday evening, many of us shared
observations about the weather, which had been better
than forecast all weekend. We awoke Sunday to surprisingly deteriorating conditions. A line of weather moving
from the southwest had intensified and would arrive
overhead in just a couple of hours. We were already
experiencing mist and light rain. The environment was
set with just the kind of elements we talked about in the
seminar Saturday that can lead to imprudent decisions.
Sunday departures are already prejudiced by a desire
to put a neat end to the week, get home, and make it to
work the next day. We've already said our goodbyes,
checked out of the hotel, and turned in the rental car;
we've made our decision and it's time to go. We have
an extreme bias to execute on our decision to get home
and we have a difficult time stepping back to review our
entire range of options and reconsider. The approaching
weather that Sunday added more stress and more selfinterest, since the system appeared to be the kind likely
to result in a long delay. Either we departed that morning,
or we were likely to be stuck until Tuesday.
The mishap pilot chose to depart in the direction
of the encroaching weather. We don't know what his
thinking was, or his plan. It will take close to two years
before the NTSB releases a probable cause that may
shed light on whether or not the pilot's decisions were
contributing factors. Until then, we can ponder the setting, put ourselves in the same position, and ask what
protections we have in place to strengthen our decisions-especially in capricious situations.
Go fly. And be especially cognizant of your decisionmaking on Sunday fly-outs.
AOPA
EMAIL richard.mcspadden@aopa.org

AOPA Pilot Magazine - December 2019

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