Expectation Bias

December 3rd, 2013 by Ron Rapp

I don’t know who first described flying as “hours of boredom punctuated by moments of sheer terror”, but it wouldn’t be shocking to discover the genesis was related to flying a long-haul jet. I was cogitating on that during a recent overnight flight to Brazil. While it was enjoyable, this red-eye brought to mind the complacency which can accompany endless hours of straight-and-level flying – especially when an autopilot is involved.

This post was halfway written when my inbox lit up with stories of a Boeing Dreamlifter – that’s a 747 modified to carry 787 fuselages — landing at the wrong airport in Wichita, Kansas. The filed destination was McConnell AFB, but the crew mistakenly landed at the smaller Jabara Airport about nine miles north. The radio exchanges between the Dreamlifter crew and the tower controller at McConnell show how disoriented the pilots were. Even five minutes after they had landed, the crew still thought they were at Cessna Aircraft Field (CEA) instead of Jabara.

McConnell AFB, the flight's destination, is the Class D airport at the bottom of the chart, about nine miles south of the non-towered Jabara Airport.

McConnell AFB, the flight’s destination, is the Class D airport at the bottom of the chart, about nine miles south of the non-towered Jabara Airport.

As a pilot, by definition I live in a glass house and will therefore refrain from throwing stones. But the incident provides a good opportunity to review the perils of what’s known as “expectation bias”, the idea that we often see and hear what we expect to rather than what is actually happening.

Obviously this can be bad for any number of reasons. Expecting the gear to come down, a landing clearance to be issued, or that controller to clear you across a runway because that’s the way you’ve experience it a thousand times before can lead to aircraft damage, landing without a clearance, a runway incursion, or worse.

I’d imagine this is particularly challenging for airline pilots, as they fly to a more limited number of airports than those of us who work for charter companies whose OpSpecs allow for worldwide operation. Flying the Gulfstream means my next destination could be literally anywhere: a tiny Midwestern airfield, an island in the middle of the Pacific, an ice runway in the Antarctic, or even someplace you’d really never expect to go. Pyongyang, anyone?

But that’s atypical for most general aviation, airline, and corporate pilots. Usually there are a familiar set of destinations for a company airplane and an established route network for Part 121 operators. Though private GA pilots can go pretty much anywhere, we tend to have our “regular” destinations, too: a favored spot for golfing, the proverbial $100 hamburger, a vacation, or that holiday visit with the family. It can take on a comfortable, been-there-done-that quality which sets us up for expectation bias. Familiarity may lead to contempt for ordinary mortals, but the consequences can be far worse for aviators.

One could make the case that the worse accident in aviation history – the Tenerife disaster – was caused, at least in part, by expectation bias. The captain of a KLM 747 expected a Pan Am jumbo jet would be clear of the runway even though he couldn’t see it due to fog. Unfortunately, the Clipper 747 had missed their turnoff. Result? Nearly six hundred dead.

"Put an airliner inside an airliner?  Yeah, we can do that."  Boeing built four of these Dreamlifters to bring 787 fuselages to Seattle for final assembly.  As you can imagine, this thing landing at a small airplane would turn some heads.

“Put an airliner inside an airliner? Yeah, we can do that.” Boeing built four of these Dreamlifters to bring 787 fuselages to Seattle for final assembly. As you can imagine, this thing landing at a small airplane would turn some heads.

The Dreamlifter incident brought to mind an eerily similar trip I made to Wichita a couple of years ago. It was a diminutive thirty-five mile hop from Hutchinson Municipal (HUT) to Jabara Airport (AAO) in the Gulfstream IV. We were unhurried, well-rested, and flying on a calm, cloudless day with just a bit of haze. The expectation was that we were in for a quick, easy flight.

We were cleared for the visual approach and told to change to the advisory frequency. Winds favored a left-hand pattern for runway 36. Looking out the left-hand window of the airplane revealed multiple airports, each with a single north-south runway. I knew they were there, but reviewing a chart didn’t prepare me for how easily Cessna, Beech, and Jabara airports could be mistaken for one another.

We did not land at the wrong airport, but the hair on the back of my neck went up. It was instantly clear that, like Indiana Jones, we were being presented a golden opportunity to “choose poorly”. We reverted back to basic VFR pilotage skills and carefully verified via multiple landmarks and the aircraft’s navigation display that this was, indeed, the correct airfield.

That sounds easy to do, but there’s pressure inducted by the fact that this left downwind puts the airplane on a direct collision course with McConnell Air Force Base’s class Delta airspace and also crosses the patterns of several other fields. In addition, Mid-Continent’s Class C airspace is nearby and vigilance is required in that direction as well. Wichita might not sound like the kind of place where a lovely VMC day would require you to bring your “A” game, but it is.

Pilots in the Southern California area have been known to mistake the former home of Top Gun, MCAS Miramar, for the smaller Montgomery Airport at the bottom of the map.

Pilots in the Southern California area have been known to mistake the former home of Top Gun, MCAS Miramar, for the smaller Montgomery Airport at the bottom of the map.

Expectation bias can be found almost anywhere. I’d bet a fair number of readers have experienced this phenomenon first-hand. In my neck of the woods, MCAS Miramar (NKX) is often mistaken for the nearby Montgomery Field (MYF). Both airports have two parallel runways and a single diagonal runway. Miramar is larger and therefore often visually acquired before Montgomery, and since it’s in the general vicinity of where an airfield of very similar configuration is expected, the pilot who trusts, but – in the words of President Reagan – does not verify, can find themselves on the receiving end of a free military escort upon arrival.

Landing safely at the wrong airport presents greater hazard to one’s certificate than to life-and-limb, but don’t let that fool you; expectation bias is always lurking and can bite hard if you let it. Stay alert, assume nothing, expect the unexpected. As the saying goes, you’re not paranoid if they really are out to get you!

Ron Rapp

Ron Rapp is a Southern California-based charter pilot, aerobatic CFI, and aircraft owner whose 7,000-plus hours have encompassed everything from homebuilts to business jets. He’s written mile-long messages in the air as a Skytyper, crop-dusted with ex-military King Airs, flown across oceans in a Gulfstream IV, and tumbled through the air in his Pitts S-2B. Visit Ron’s website.

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  • http://iflyblog.com Brent

    Well said Ron! Complacency gets a lot of press, but the fact of the matter is expectation bias is worse. Being deceived by your senses is a scary thing indeed!

    Brent

    • http://www.rapp.org/ Ron Rapp

      Right you are. Our senses work well enough for us to trust them… but not so well that they are infallible.

      One thing I didn’t mention in the post was that they were flying at night. The effect of the moon phase, city lights, and any runway lighting (or lack thereof) could have played a role in sensory deception. My research shows the moon was about 80% illuminated, but the Wichita area also had a 3,900 foot ceiling. If the lights at Jabara were on high but those at McConnell were on a lower setting, it might have been easy to miss.

      Expectation bias isn’t limited to the flight crew, either; one wonders why the controllers at McConnell didn’t notice (or fail to notice) an aircraft the size of the Dreamlifter not being where it should have been.

  • http://AOPAePILOT Charles F. Thom II

    As a B727 Capt landing at Greensboro on a clear night, all the Nav aids at Greensboro were inop. We were cleared to land by the tower, but I wanted to be absolutely sure it was actually Greensboro, so I read back the clearance, and added, “Do you have us on final with flashing landing lights? She just repeated the clearance to land without further comment. I finally had to go to plain language, and still had a devil of a time convincing her to acknowledge she had an aircraft on short final with rapidly flashing landing lights. She did, sarcastically, we landed, and all was well. Our airline had had a DC-8 land short of Omaha at Coucil Bluff’s short runway after receiving clearance to land at Omaha, on a similar clear night. Our airline’s Incident Recap folder had jogged my memory years before, and our comfort level returned to a normal level because I insisted on extra verification. As a First Officer, I had saved three different Captains from landing at a wrong airport/runway, but that’s another story

    • http://www.rapp.org/ Ron Rapp

      I’ve heard stories like that from so many people that I can’t help but think that it’s not exactly uncommon. Much like an single engine aircraft experiencing an engine failure, there’s no NTSB investigation, FAA report, or media involvement if the situation resolves safely.

      It’s a shame the controller wasn’t more helpful. Sometimes they get rather testy when we ask for clarification or confirmation of an instruction. If they really stopped to think about it, that only discourages pilots from speaking up when they’re in doubt. Just today AOPA posted a video of a near disaster where the controller got snippy rather than taking action to prevent an accident. It was only the pilot of a departing airliner who broke the accident chain by refusing takeoff clearance until the confusion was resolved: http://www.aopa.org/AOPA-Live.aspx?watch=%7B87DC1B4A-4D85-4A2D-96A3-EC35621F4535%7D

  • http://wrightwayphotography@smugmug.com Scott Wright

    Each time I hear of an aircraft landing at the wrong airport reminds me of my own experience doing so, now twenty years past. I had been on a six month medical leave from my company. I had gone through a procedure to lengthen my right leg due to a congenital defect.

    I still had a metal device around my lower leg, but I convinced the chief pilot I could fly with the device. He said I would need to renew my first class medical, and go for recurrent training before I could resume flying the line. These were diffidently reasonable requirements. The week at Flight Safety was a grueling one. Since it was my right leg in question, I had more left engine failures than I could count, in any and every situation you could think of. It became quite painful by the end of the week, but I stuck it out.

    Now for the error chain leading to my experience. My flight home from Teteboro landed about 2200. I soon realized my bag was still on the, plane because the baggage handler saw my Flight Safety crew tag and thought it belonged to the crew of the airline. It had part of my uniform I need for my0700 scheduled departure the next morning. At about 0300 my luggage finally made it home. I got to the hangar at 0530 for flight planning. I was paired with another captain that would soon become the chief pilot, and was senior to me. He had me fly the first short 100 mile leg of the day.

    I was of course very tired, not only from the night before but also from the grueling week of recurrent, and should of requested him to do the first flight. This would have allowed me to settle in and become familiar with flying again. But I was still relatively young and anxious to get back in the saddle at full speed.

    The weather was marginal VFR at the destination. The nearby approach controller had us descend early to 3000 AGL for traffic. I was following the CDI which was receiving from the GPS All of a sudden I heard the other pilot on the radio calling airport in sight and canceling IFR, without confirming with me. The controller acknowledged the cancellation and cleared us to advisory frequency. I was pretty perturbed with him for doing this, but let it go because I knew he was from this area and new it pretty well.

    I was looking hard for our destination that I new was about 20 miles away at twelve o’clock. He started pointing at the ten o’clock and asking if I had the airport in sight. My situational awareness quickly dissolved. I was trying to reconcile what was programed into the GPS and the information it was giving me with what the other crew member was telling me. As he became more insistent that I start a left turn toward the airport I gave in and turned. I called for the landing checklist and made a perfect landing. As we rolled out I didn’t have a clue where we were. Of course, with my crew member being from the are, he knew right away where we had landed, but a little late! Then from the back, full of company VP’s, I heard them asking where we were. They also knew we were not at the right place. When Ron Rapp referred to expectations, I realized my expectation was that my crew member, being familiar with the area and with more experience than myself, wouldn’t have lead me to land at the wrong airport despite my own confusion.

    As that sickening feeling, that most are familiar with, settled over me my enthusiasm to be back flying again was soon gone. We turned around and taxied back to the end of the runway. After contacting approach control for an IFR clearance, at my insistence, we took off and made the ten minute hop to the correct airport.

    The next day I was called into the aviation managers office to discuss the previous days misadventure. He reminded me of all the dangers involved with the loss of situational awareness and landing at the wrong airport. We could have hit a tower, or gotten mixed up with other traffic since we were announcing our location to be somewhere else, etc.. I was told that since I was PIC on that flight that I would receive a letter of reprimand in my file. The other pilot, being groomed for the chief pilot slot, did not receive any negative consequence for what took place.

    I learned that not only errors, but events and mistakes outside our control, can culminate into an incident or accident. Mine started the moment my bag, with a crew tag attached which many of us are familiar with, didn’t get off the airline.

    I now live in Wichita, KS. It was a great surprise to me when I heard of the Dreamlifter incident.

    (I left out airport identifiers to protect the innocent! I was flying for a fortune 100 company and for various reasons I don’t feel comfortable giving this information.)