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Commonwealth, the Supreme Court of New South Wales found the air traffic
controller had been negligent because:
...there was a failure to act in accordance with the standards of a reasonable man in his
position in all the circumstances and to comply with the relevant regulations, orders
and instructions...(cited by Bartsch, 1996:199)
Australian courts have not had to consider topics of wake-turbulence and weather
related accidents. Bartsch cites several cases from the USA where the court decisions
have been consistent with Nicholls and Skyways in that it was held that controllers
were under a duty beyond that prescribed in operational manuals. Of pertinent
interest is Hartz v United States where improper phraseology was used in a warning
given to the pilot of a Beechcraft Bonanza about a departing Douglas DC-7. The
court found that the controller’s warning of “prop-wash” (instead of “wake
turbulence”) was insufficient to adequately warn the pilot of the degree of hazard
created by the DC-7. Furthermore, the controller had an additional duty, beyond that
prescribed by the ATC manual, to delay the take-off clearance of the Bonanza for as
long as reasonably necessary to permit the DC-7’s turbulence to dissipate.
5.3 Duty to Warn of Potential Dangers
The two preceding categories show that when information is available to a controller,
he or she might be liable if that information, when passed to a pilot, was either
inaccurate, insufficient or untimely. What, then, of information that a controller
should have known but had not obtained or pursued? There is no authority from the
courts in Australia in situations not specifically addressed in terms of ATC operating
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procedures but there are several US precedents reviewed by Bartsch (1996). It seems
likely that when attempting to establish whether a controller or pilot is liable, it will
be important to determine which of the parties was in the best position to evaluate the
situation. Should the information be available to the controller, liability may still be
avoided if such information would have been available by some alternative means to a
pilot exercising due care.
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Mend your speech a little
Lest it may mar your fortunes.
—William Shakespeare
King Lear
6. Types of Miscommunication
The following list and short discussions of common forms of miscommunication is by
no means comprehensive but it does give an indication of the scope of the problem.
There is a great deal of overlapping, so the investigation of any incident is likely to
provide examples at several levels, as with the much studied Tenerife accident.
Miscommunication also involves such complex human attributes as complacency,
fatigue, professionalism, personal problems, and so on.
6.1 Absent-mindedness and Slips
Absent-mindedness is a form of miscommunication which controllers and pilots will
make occasionally. For instance, a controller may routinely assign the same level for
descent to arriving aircraft. But on the one occasion that conflicting traffic at that
level has been noted, the controller may still absent-mindedly assign that level to an
inbound aircraft instead of providing level separation. Such slips are usually
associated with some degree of attentional ‘capture’ such as an internal preoccupation
or external distraction. The crucial point about absent-minded errors is that they are a
characteristic of highly skilled or habitual activities (National Research Council,
1997; Reason, 1984). They are not signs of incompetence but of misapplied
competence. They are a problem of experts, not of beginners. Thus the probability of
making a absent-minded slip actually increases with task proficiency because, as we
become more skilled at an activity, the less demands it makes upon our working
memory. We perform at an automatic, subconscious level. Reason (1984) uses this
example: should we inadvertently turn on the toaster instead of the coffee pot, the
result is inconvenient. Should we make precisely the same mistake in the control
room, the result may be catastrophic. The circumstances will determine the extent of
the penalty. In such cases, the standard response of additional training “would appear
to be counter-intuitive” (Shappell and Wiegman, 1997).
Spoonerisms and verbal blends are other forms of slips. Named after the Reverend
W.A. Spooner (1844-1930), who said such things as “queer old Dean” when he meant
“dear old Queen”, they are most likely to occur when a controller is busy as, too, are
verbal blends such as ‘Tangee Yankee Delta’ instead of ‘Tango Yankee Delta’.
　
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