By Ganase Dharrie-Maharaj
It was the evening of 29th December, 1972. After a two-hour flight from New York, Eastern Air Lines flight 401 was descending into a calm, moonless night as it approached Miami.
In command was Captain ‘Bob’ Loft, who had nearly 30,000 flying hours and 30 years of airline experience under his belt. The Tristar aircraft he was commanding was still relatively new but he and his crew knew the route well. The flight had so far been routine and uneventful. As they began the final approach towards the runway, in the cockpit Captain Loft reached across and moved the gear lever. Moving the gear lever lowers the wheels and locks them into place for landing.
This is an action Captain Loft would have done thousands of times before in his career and this time there was the same familiar bump, followed by a roaring sound which grew louder and louder as the wheels began to protrude into the rushing airflow.
A few seconds later, Captain Loft looked across at an indicator panel expecting to see three green lights, each light telling him that a particular section of the undercarriage was down and correctly locked into position. It’s a simple but essential check that all airline pilots learn for landing; “gear down, three greens”.
Except this time there was a problem.
One of the indicator lights was blank; there were only two green lights illuminated. The aircraft was rapidly approaching the runway and Captain Loft must have known he was short on time. He attempted an old trick. Moving the gear lever up and down again, he attempted to recycle the wheels, a quick fix that often resolved problems like this.
But the indicator light, again, failed to illuminate.
Uncertain about the position of his wheels, Captain Loft ordered his co-pilot to abandon the approach and take up a circling pattern away from the airport, giving him time to troubleshoot and fix the problem.
Captain Loft would have felt like he was in trouble; a wheel problem is a serious emergency situation. He would have known that there were 176 people onboard, and that he was responsible for getting them safely on the ground, at any cost.
Flying away from the airport, he began to focus on the problem. Firstly, he attempted to re-seat the indicator in its housing but struggled with the new design, even with his co-pilot attempting to help.
A third pilot was ordered to begin the difficult task of visually checking the wheels by descending into a maintenance bay.
With the two flight crew focused on fixing the indicator light, a third pilot and a flight engineer in the maintenance bay, everyone was focused on solving the problem.
What no one was doing, was effectively flying the aircraft. With both pilots totally distracted, the autopilot had been mis-set.
The aircraft entered a shallow, descending turn, which neither pilot detected. At the last minute a warning chime sounded, but the startled crew were too late and too overloaded to understand what was happening.
In the final few seconds before impact, the crew can be heard querying their altitude but intervention was too late to prevent the Tristar smashing into the Everglades, killing 99 people on board.
The reason behind the gear indication fault was found to be a burnt-out light bulb. The cause of the crash was attributed to Human Factors; distraction and a failure to monitor the flight path.
Eastern Air Lines flight 401 has become a classic case study in the field of Aviation Human Factors. By studying accidents such as this case, and others, the aviation industry has developed strategies, tools and training that allow pilots, crew and engineers to manage similar situations as a matter of routine, increasing safety with the intention of avoiding accidents and incidents.
So why and how is this relevant in the dental context?
It is a well-known fact, both anecdotally and evidenced based, that dentistry is a high stress profession, even when taking into account our everyday lives.
The sources of stress are many and varied, and can all have an adverse effect on the performance of our professional duties. Sadly, in today’s highly litigious world of medicine and dentistry, we have the added burden of worrying about whether or not we might be sued, or investigated by the GDC.
As a result, we may not perform to our optimum and this can increase the risk of mistakes and adverse outcomes.
The principles of Human Factors have been applied within the aviation industry for decades and have had a significantly positive effect.
Imagine if there were 9,600 deaths per year in a civil aviation scenario with one crash every 30 hours; would this be acceptable? This would have been the case had the aviation industry not embraced Human Factors.
In fact, the benefit of Human Factors training is considered to be so important, that it is mandated for many aviation employees. Lessons from cases like Eastern Air Lines flight 401 ensure today’s crews are much better equipped to handle stress and deal with the unexpected, ensuring a safe outcome.
Increasingly, the concept has started to take hold in medicine, and now dentistry, and hopefully this will lead to a similar reduction in our fields. Human Factors training can achieve this in a number of ways.
Firstly, when applied, Human Factors training can help us to recognise when our stress levels are increasing and what triggered the increase in the first place. It can then guide us to manage these levels and bring them back to a level where we can perform to our optimum, or near enough.
Secondly, it can help us to recognise when a situation is about to, or already has, taken a turn for the worse, and how to manage that situation as effectively as possible to minimise, or eliminate if possible, any adverse outcomes and their consequences.
In addition to the above, this training will help to guide delegates to plan and think ahead, so that any possible adverse scenarios could be legislated for and dealt with efficiently and effectively. After all, prevention is better than cure!
Overall, we believe that our profession’s patient safety record will be significantly improved, which should lead to a reduction in complaints and potential litigation. The added bonus will not only be a happier workforce, but ultimately could lead to a reduction in the cost of indemnity for the profession as a whole.
Andy Perkins and Richard Garner, both highly experienced airline pilots and experts in the field of Human Factors, first approached my wife, Laura, and me to get involved in running the Black Box DentistryÔ courses a couple of years ago.
Initially, I was not convinced what connection the aviation concept of Human Factors could possibly have with everyday dentistry. Initially, my thoughts were that every-day dental practise can be quite mundane and that there were generally no life-threatening situations encountered, as one could easily imagine in the skies or even in a medical hospital.
However, since Andy patiently explained how the concepts could be applied, my eyes were opened and I have benefitted from applying them to both my own personal and professional lives!
On a day-to-day basis, I look at where little things at home and at work can be changed to optimise my performance and functionality, which ultimately leads to a reduction in stress levels. This reduction in stress levels has resulted, for me, in improved mental health and wellbeing and a happier home and family life, as well as in the workplace.
From a professional perspective, as mentioned previously, it has led to significantly improved patient safety and reduction in adverse outcomes and near misses.
About Ganase Dharrie-Maharaj
Gan qualified BDS from The Royal London Hospital in 1993 and then went on to complete a MSc in endodontics at Guy’s Hospital in 1999. Since then he has worked predominantly in referral endodontic practice, alongside his role in general practice, and has for over ten years, also been a clinical demonstrator in adult oral health, back at The Royal London. More recently, in 2012, Gan completed a Master’s in Medical Law (LLM, Cardiff) and has used this training to produce over 100 expert witness reports for both the GDC and the MDDUS.