In
accident analysis
Accident analysis is carried out in order to determine the cause or causes of an accident (that can result in single or multiple outcomes) so as to prevent further accidents of a similar kind. It is part of ''accident investigation or incident inv ...
, a chain of events (or error chain) consists of the contributing factors leading to an undesired outcome.
Aviation
In
aviation accidents and incidents
An aviation accident is defined by the Convention on International Civil Aviation Annex 13 as an occurrence associated with the operation of an aircraft, which takes place from the time any person boards the aircraft with the ''intention of f ...
, these contributing actions typically stem from
human factor-related mistakes and
pilot error
Pilot error generally refers to an Aviation accidents and incidents, accident in which an action or decision made by the Aircraft pilot#Airline, pilot was the cause or a contributing factor that led to the accident, but also includes the pi ...
, rather than mechanical failure.
A study conducted by
Boeing
The Boeing Company () is an American multinational corporation that designs, manufactures, and sells airplanes, rotorcraft, rockets, satellites, telecommunications equipment, and missiles worldwide. The company also provides leasing and product ...
found that 55% of airline accidents between 1959 and 2005 were caused by such human related factors, while only 17% of accidents were caused by mechanical issues with the aircraft.
The
Tenerife airport disaster
The Tenerife airport disaster occurred on March 27, 1977, when two Boeing 747 passenger jets collided on the runway at Los Rodeos Airport (now Tenerife North Airport) on the Spanish island of Tenerife. The collision occurred when KLM Flight 4 ...
, the worst accident in aviation history, is a prime example of an accident in which a chain of events and errors can be identified leading up to the crash.
Pilot error, communications problems, fog, and airfield congestion (due to a bomb threat and explosion at another airport) all contributed to this catastrophe.
See also
*
Swiss cheese model
The Swiss cheese model of accident causation is a model used in risk analysis and risk management, including aviation safety, engineering, healthcare, emergency service organizations, and as the principle behind layered security, as used in com ...
References
Aviation safety
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