In the early morning hours of Dec. 20, 2021, Emirates flight 231, using one of the newest Boeing 777 aircraft, taxied onto the active runway in Dubai to commence a 14-hour nonstop flight to Dulles Airport, in Washington, D.C. Four experienced pilots were in the cockpit, allowing two to initiate the flight and the other two to take over mid-flight because of the trip’s duration. The crew that operated the previous flight with the aircraft had set the altitude to zero in the flight director system (which controls the autopilot); the crew on this flight was supposed to—but did not—set the altitude to 4,000 feet, which is a standard altitude to first climb to after liftoff. During the departure, the pilot flying the aircraft decided to “follow” what the flight director was showing, which was an altitude of zero feet. While the plane typically would lift off at a much lower speed, the plane was still on the ground at 216 knots, and overran the standard runway area, taking off in the runway safety area.
The plane was already flying over houses at an altitude of 75 feet, going a minimum of 234 knots. The plane barely gained altitude, and was 175 feet in the air when it was flying at a speed of 262 knots. As a point of comparison, ordinarily the plane would be well under 200 knots at that altitude, and would be climbing much faster. While it would be standard procedure to return to the airport to assess damage when something like this happens (given the potential for overspeed with the flaps, plus the potential damage if the aircraft did unknowingly hit something), the pilots made the decision to continue to Washington and eventually landed safely.
In analyzing this scenario, airline experts have been critical of the complete lack of control that the crew had exercised during takeoff. The crew was managing the computers instead of flying the aircraft. What would possess a crew to overrun the standard portion of a runway while going over 200 knots, when there was nothing wrong with the plane? Furthermore, there were four pilots in the cockpit who continued to rely on the plane’s automatic technology despite the real likelihood of impending disaster.
In discussing this recent aviation event with a good friend who is a veteran trans-continental commercial pilot and flight instructor, he alerted me to the term “automation dependence,” which, to the aeronautical neophyte, equates to dependence on a plane’s automatic pilot system associated with a lack of confidence or experience in taking over manual controls even when facing impending disaster. This discussion created an immediate “aha moment” for me as I realized that every day surgeons are depending to a greater degree on technology that establishes a vaster interface between the operative team and the patient. The technical advances in robots, virtual reality, artificial intelligence and more may create situations in which surgeons may depend too much on their tools and not enough on their logic and common sense. Similar to the Emirates crew, are we doomed to suffer from “automation dependence”?
As I began preparing this editorial, an article appeared (Sci Robot 2022;7[62]. doi:10.1126/scirobotics.abj2908), touting a platform developed by a leading academic surgical research group that would allow a robot to perform complex surgical maneuvers on a pig without human interference! While this is indeed exciting technology, we need to continue to learn from other disciplines that have created “autonomous” systems that further disengage the human element from critical tasks. I certainly am in favor of modern technology to improve surgical outcomes, but we must resist, at all costs, tumbling into the trap of “automation dependence”!
Dr. Greene is the senior medical adviser for General Surgery News
This article is from the March 2022 print issue.
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