The story of Chesley “Sully” Sullenberger – the “Miracle on the Hudson” pilot – is a modern American legend. In my continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, here are excerpts of my interview with Sully, conducted at his house in San Francisco’s East Bay, on May 12, 2014.
If you’re in the cruise portion of a long distance flight, it’s possible to have the airplane programmed to fly a specified vertical and horizontal path for many hours without much intervention at all. The other problem with technology is, at least for now, it can only manage what has been foreseen and for which it’s been programmed. And third, we have this formal lessons-learned process that does root-cause analysis, makes findings about fact, causes and contributing factors, and makes recommendations for improving the system in terms of the designs, the policies, procedures, training, human performance, and standards. BW:  In the early days of aviation, was there an overarching philosophy about the relationship between the people and the machines? I asked whether there was another camp in aviation – folks who believed that the technology could, and should, fly the plane.
BW:  But you had that experience because you had a whole career before all of this technology. SS: As we use the technology more and more – and we’re encouraged to do so by our airlines because it’s so efficient – then we get the sense that it’s almost infallible. Another piece of the problem is that our systems should offer more options than all or nothing.
We turned to January 15, 2009, the day Sully safely landed an Airbus A320 on the Hudson River, within a few minutes of a bird strike that disabled both the plane’s engines.
BW:  Is there a strange part of one’s brain that says, “I hope that something like that would happen because I’ve been training for it my whole life”? And so on this flight, just 100 seconds after takeoff, I saw the birds about two seconds before we hit them. Second, even though we had never trained for this, because I had such a well-defined paradigm in my mind about how to solve any aviation emergency, I was able to impose that paradigm on this situation and turn it into a problem that I could solve.
Finally, because of the extreme workload and time pressure I knew that there was not time for me to do everything I really needed to do. BW:  Did you do all that consciously, as in: “Here are all the things one might do, but here are the six that I’m going to do?” Or was it all instinct? SS: I would say that I was able to quickly synthesize a lifetime of training and experience and intuitively understand that that was the approach I needed to take. But I immediately did two very specific things that I remembered from the dual engine flameout checklist.
As we’re heading toward the water, I’m the one controlling the airplane, but my first officer, Jeff Skiles, is monitoring the performance of the airplane and my performance.
And even though I was not at the minimum speed at which the Airbus flight control protections would have prevented me from raising the nose further no matter how hard I pulled, there was a little-known feature of the Airbus software – that no airline pilots, no airlines knew about, only a few Airbus engineers knew about – that prevented me from getting that last bit of maximum aerodynamic performance out of the wing. BW:  It’s interesting that you spoke about how you were glad you were in this automated envelope of protection. SS:  It was not something I consciously thought about but it was a good thing to have the airplane be fully operational.
I asked Sully what lessons he drew about the relationship between people and machines from the Hudson landing? BW:  You can’t envision a future in which the engineers have built in a “both engines fail” mode and the technology perceives it and starts doing X and Y?
SS:  I think that would be possible, but then that doesn’t take into account the whole divert decision. BW: I can’t help but think that one of the riskiest things about technology is that it seems inconceivable that a young pilot today will have your skills and instincts, because they’ve grown up in such a different environment.
SS:  And that’s another great challenge – we have to find a way to pass on this institutional knowledge.
Sully then discussed the 1989 landing of United Flight 232 in Sioux City, Iowa, after a catastrophic engine failure severed all of the DC-10’s hydraulic systems, rendering the plane’s flight controls completely inoperable. SS: I remember having that radio communication back and forth with Patrick Harten, the air traffic controller. SS:  Yeah, I thought about that flight, because at one point as they were approaching the Sioux City airport, the controllers want to give you the widest discretion they can to solve the problem any way you think is possible. Captain Sullenberger is certainly one of my heroes and the issues you bring up are so timely and relevant in health care. With the Asiana air accident in San Francisco, the Air France accident over the Atlantic, and also the AirAsia accident, one has to wonder whether that time of different errors has come because this generation of pilots given the training and automation of aircraft are fundamentally different than Sullenberger’s era. For us, when will this issue occur in health care and what might we do about it now that we know?
How much of the time that he is in the cockpit does a pilot spend doing data entry chores – do his passengers feel safe in their homes? If our HIT experts were involved in the aviation industry, Captain Sullenberger would be back in the cabin during take-off trying to determine who ordered the fruit plate. Seems to me that the big difference in aviation and medical safety model is that the pilot has skin(all of it) in the game . Surely we, as an industry, need to take the bull by the horns and accept that we need to be more transparent in our performance monitoring?
Such is NOT the program in aviation, because there is aggressive surveillance and remedy for the unintended adversity. In Medicine, Congress is rewriting the F D and C Act to exempt EHRs and CPOE from oversight.
I am thrilled to see that you have taken my comments and those of Koppel and Menoaliitle and incorporated them in to this articulate NY Times op-ed. I’ve gotten to know Captain Sullenberger over the past several years, and he is a warm, caring, and thoughtful person who saw, in the aftermath of his feat, an opportunity to promote safety in many industries, including healthcare.
Rather, it changes the nature of the errors that are made, and it makes possible new kinds of errors. So one of the weaknesses of technology is that it has a hard time handling “black swan” events, like our flight. That the pilot should absolutely be informed about everything going on in his or her aircraft, and ultimately able to affect the outcome, to change it, to control it.
Airbus tended to embrace letting the airplane do a lot of things, where Boeing’s philosophy was that the pilot is and should be in control of every part of the process.
And, because we haven’t done much manual handling of the airplane, we lose confidence in our ability to manually control the airplane as well as the automation can. I’ve been proposing an a la carte menu, with increasing or decreasing levels of technology they can use. And it happened late in my career, after I’d been an airline pilot for 29 years, a captain for 21 of those.
At that point we’re travelling at 316 feet per second, and there was not enough time or distance to maneuver a jet airplane away from them. I knew what the cause was and what that entailed, what that meant for us, and I knew it was going to be, after such a routine career, the challenge of a lifetime.
First, I had to summon up from somewhere within me this professional calm that really isn’t calm at all.


And the power also allowed us to keep intact all the flight envelope protection, which prevented us from getting too fast or too slow or banking too steeply. But it turns out at the end I was not quite at the maximum angle the wing could be allowed to try to create lift. I might have guessed that you would have wanted at that moment to be completely off cruise control and have total control yourself? But it turned out that because of this little known aspect of the flight control system, we hit a little bit harder than we would have had we been able to get that last little bit of lift out of the wing right before we landed. But to handle the whole thing from start to finish required a lot of innovation, a lot of – it required us to take all the things that we had learned, adapt it, apply it in a new way to solve a problem we never anticipated and never trained for and get it right the first time. A pilot named Al Haynes and his crew miraculously conjured up a system of using differential thrust to control the plane sufficiently to save 185 of the 297 people on board. My concerns about the next generation of doctors appears to be something aviation is also worried about with their pilots. If so, what can they do about it, how will they go about doing it, and when will they know they made an impact?
Sherlock Holmes in the new ACGME duty hour restricted world would need to actively seek support – since there are multiple teams caring for any one person.
Structures that used to be praised as entrepreneurial and flexible are now described pejoratively as a “cottage industry.” Unacceptable performance in a small number of practices is being highlighted rather than ignored.
Financial incentives which would enable physicians to spend more thoughtful time with patients, a record system that facilitated patient care rather than detracting from it, and allowed doctors to focus on patients rather than documentation, performance measures which were well thought out and made sense (and did not cause of deterioration of care in areas not being measured).
Considering your defense of HIT that permeates your blog posts, you seem to have had an epiphany. The paradox of cockpit automation is that it can lower the pilot’s workload in phases of flight when the workload is already low, and it can increase the workload when the workload is already high. Witness the TSA security agents, who are screening countless passengers looking for that one time in thousands where there’s a threat.
We look at connectedness, the interrelatedness of all the things that we do, of the systems and the airplane, the human system, the technology system, and the air traffic control system. For example, Airbus would set hard limits in the digital flight control system laws, the fly-by-wire laws that would prohibit the pilot from exceeding certain limitations in how fast or slow the airplane could fly, how steeply it could bank, how many degrees you could tilt the angle of the wing from horizontal or raise the nose above horizontal. That sometimes makes some pilots reluctant to quickly and effectively intervene when they see things going wrong or when the automation isn’t doing what they expect. We cannot design a system that’s so hands off that we are simply required to sit there and watch it for 14 hours.
The only question we have to ask ourselves is what level of technology is most appropriate for this phase of flight. In all that time, 42 years of flying, I had never experienced in flight the actual failure of even a single engine.
It meant having the discipline to compartmentalize and focus on the task at hand in spite of the stress. And I started our aircraft’s auxiliary power unit, which is a small jet engine, a small turbine that has its own electrical generator. Right before landing he intuitively understood that he needed to help me judge our altitude. And yet even though I was pulling back, commanding full nose up on the side stick, the flight control computers prevented me from getting any more performance.
The NTSB recommended that the airlines teach the pilots about this feature, because we didn’t know about it. And someone would have had to have anticipated this specific circumstance, this particular black swan event and programmed it to do that. You see pilots of my generation, especially ones who have wanted to fly since we were five years old – we just couldn’t get enough. The controller said to Haynes, “You’re clear to land on any runway.” At that point the control of the airplane was still so tenuous that Al said, almost laughing, “You want to be particular and make it a runway, huh?” And that thought – of Al’s comment – crossed my mind.
How can one train for specific rare events that are only fully understood in hindsight (rhetorical question)? A specialty that has historically had an admirable reputation for simply absorbing whatever it was asked to do is now struggling to deal with the growing expectations that are being placed on it. And, in the media age, we all see the video of the huge orange fireball as the jet fuel explodes. So we have to be the absolute master of the machine and all the systems, of the passengers, of the environmental conditions… All simultaneously, all continuously. Whereas Boeing takes the approach that there are rare occasions where, to avoid colliding with another airplane or crashing into the ground, you need to pull harder than the flight control system might otherwise allow.
The answer is the one that keeps us engaged and aware and able to quickly and effectively intervene, and also keeps our workload neither too high nor too low.
Calming myself, setting clear priorities, managing the workload, load shedding… those were the key. In a fly-by-wire airplane like the Airbus, it’s especially important to have an uninterrupted supply of electrical power because the plane does not have a mechanical, wires and pulleys connection between the flight control stick or wheel in the cockpit and the flight control surfaces on the wings and tail. And so he stopped trying to use the checklist to regain thrust from what turned out to be irreparably damaged engines and he began to call out to me altitude and airspeed.
We couldn’t learn enough about the history of our profession, about historic accidents, about why we do what we do. First, at some point Captain Sullenberger realized he could not do everything he was supposed to do, so he focused on flying the plane, his primary task. And, in all that time I had never been in a situation in which I had doubted the outcome of a flight.
And as the birds entered the center of both jet engines and began to damage them, I heard terrible noises I’d never heard before, severe vibrations and then within seconds, the burning smell came into the cabin. Instead the pilot’s inputs are interpreted and mediated by flight control computers, which send electrical impulses to actuators that move the flight control surfaces of wings and tail. Because almost every procedure we have, almost every rule in the Federal Aviation rulebook, almost every bit of knowledge we have is because someone, somewhere died. Second, the technology actually prevented him from doing that as efficiently as possible at a critical moment. The downside of that is that every pilot has to be trained well, be highly experienced, and have a deep understanding of airplanes and how they work.
And if I had misjudged that height by even a fraction of a second – I might have raised the nose too early, got too slow, lost lift and then dropped it in hard. From the standpoint of a physician, much of the technology recently has caused us to focus on documentation rather than on patient care, using systems that are designed for billing and coding purposes rather than patient care (in fact are detrimental to patient care) and that have not had the bugs worked out before release.
Would I be clever enough, strong enough to complete the mission and keep the people I was responsible for safe?
If I waited too long we would hit nose first way too fast with too great a rate of descent and that could be very bad. I would bet that if similar systems were implemented in a cockpit the pilots would refuse to fly.
THESE VERY SAME ENFORCEMENT AGENCIES, WHO HAVE SWORN TO PROTECT AND SERVE, OUR COUNTRY, AND CITIZENS ,ARE BUT SOME, OF THE CORRUPT,GREEDY TRAITORS .ENGAGED IN THE TYRANNY AND TORTURE.


Much of the recertification that has been pushed on physicians seems to serve no useful purpose other than making somebody money.
As an example I have been recertified for basic and advanced cardiac life support every two years for decades, learning and unlearning numerous permutations of algorithms. For in-hospital cardiac arrest, the only review I have seen about the efficacy of this was in the NEJM a few years back comparing survival rates for this from 1982 until just prior to the last ACLS revision. There was NO difference in survival (I would have expected some change due to a better selection of patients who are on DNR status, and I think mock codes are a good exercise, for the record, but I’m not sure the recertification itself makes much difference).
Even the ABIM seems belatedly to realize that some of their requirements have been poorly thought out. It doesn’t take a genius to recognize that in a field as comprehensive as medicine, spending CME time doing things that do not improve patient care or practical knowledge are not only useless but detrimental.
The school district has moved to a biometric identification program, saying students will no longer have to use an ID card to buy lunch.A  BIOMETRICS TO TRACK YOUR KIDS!!!!!i»?i»?A TARGETED INDIVIDUALS, THE GREEDY CRIMINALS ARE NOW CONDONING THEIR TECH! Paul Weindling, history of medicine professor at Oxford Brookes University, describes his search for the lost victims of Nazi experiments. The chairman of the board at ESL a€” then proprietor of the desert wasteland in Nevada known as a€?Area 51a€? a€” was William Perry, who would be appointed secretary of defense several years later.
EUCACH.ORG PanelIn a 2-hour wide-ranging Panel with Alfred Lambremont Webre on the Transhumanist Agenda, Magnus Olsson, Dr. Henning Witte, and Melanie Vritschan, three experts from the European Coalition Against Covert Harassment, revealed recent technological advances in human robotization and nano implant technologies, and an acceleration of what Melanie Vritschan characterized as a a€?global enslavement programa€?.Shift from electromagnetic to scalar wavesThese technologies have now shifted from electromagnetic wave to scalar waves and use super quantum computers in the quantum cloud to control a€?pipesa€? a reference to the brains of humans that have been taken over via DNA, via implants that can be breathed can breach the blood-brain barrier and then controlled via scalar waved on a super-grid. Eventually, such 'subvocal speech' systems could be used in spacesuits, in noisy places like airport towers to capture air-traffic controller commands, or even in traditional voice-recognition programs to increase accuracy, according to NASA scientists."What is analyzed is silent, or sub auditory, speech, such as when a person silently reads or talks to himself," said Chuck Jorgensen, a scientist whose team is developing silent, subvocal speech recognition at NASA Ames Research Center in California's Silicon Valley. We numbered the columns and rows, and we could identify each letter with a pair of single-digit numbers," Jorgensen said.
People in noisy conditions could use the system when privacy is needed, such as during telephone conversations on buses or trains, according to scientists."An expanded muscle-control system could help injured astronauts control machines. If an astronaut is suffering from muscle weakness due to a long stint in microgravity, the astronaut could send signals to software that would assist with landings on Mars or the Earth, for example," Jorgensen explained. These are processed to remove noise, and then we process them to see useful parts of the signals to show one word from another," Jorgensen said.After the signals are amplified, computer software 'reads' the signals to recognize each word and sound. Our Research and Development Division has been in contact with the Federal Bureau of Prisons, the California Department of Corrections, the Texas Department of Public Safety, and the Massachusetts Department of Correction to run limited trials of the 2020 neural chip implant.
We have established representatives of our interests in both management and institutional level positions within these departments.
Federal regulations do not yet permit testing of implants on prisoners, but we have entered nto contractual agreements with privatized health care professionals and specified correctional personnel to do limited testing of our products.
We need, however, to expand our testing to research how effective the 2020 neural chip implant performs in those identified as the most aggressive in our society. In California, several prisoners were identified as members of the security threat group, EME, or Mexican Mafia. They were brought to the health services unit at Pelican Bay and tranquilized with advanced sedatives developed by our Cambridge,Massachussetts laboratories. The results of implants on 8 prisoners yielded the following results: a€?Implants served as surveillance monitoring device for threat group activity.
However, during that period substantial data was gathered by our research and development team which suggests that the implants exceed expected results.
One of the major concerns of Security and the R & D team was that the test subject would discover the chemial imbalance during the initial adjustment period and the test would have to be scurbbed. However, due to advanced technological developments in the sedatives administered, the 48 hour adjustment period can be attributed t prescription medication given to the test subjects after the implant procedure. One of the concerns raised by R & D was the cause of the bleeding and how to eliminate that problem. Unexplained bleeding might cause the subject to inquire further about his "routine" visit to the infirmary or health care facility. Security officials now know several strategies employed by the EME that facilitate the transmission of illegal drugs and weapons into their correctional facilities. One intelligence officier remarked that while they cannot use the informaiton that have in a court of law that they now know who to watch and what outside "connections" they have. The prison at Soledad is now considering transferring three subjects to Vacaville wher we have ongoing implant reserach.
Our technicians have promised that they can do three 2020 neural chip implants in less than an hour. Soledad officials hope to collect information from the trio to bring a 14 month investigation into drug trafficking by correctional officers to a close.
Essentially, the implants make the unsuspecting prisoner a walking-talking recorder of every event he comes into contact with.
There are only five intelligence officers and the Commisoner of Corrections who actually know the full scope of the implant testing. In Massachusetts, the Department of Corrections has already entered into high level discussion about releasing certain offenders to the community with the 2020 neural chip implants.
Our people are not altogether against the idea, however, attorneys for Intelli-Connection have advised against implant technology outside strick control settings. While we have a strong lobby in the Congress and various state legislatures favoring our product, we must proceed with the utmost caution on uncontrolled use of the 2020 neural chip. If the chip were discovered in use not authorized by law and the procedure traced to us we could not endure for long the resulting publicity and liability payments.
Massachusetts officials have developed an intelligence branch from their Fugitive Task Force Squad that would do limited test runs under tight controls with the pre-release subjects.
Correctons officials have dubbed these poetnetial test subjects "the insurance group." (the name derives from the concept that the 2020 implant insures compliance with the law and allows officials to detect misconduct or violations without question) A retired police detective from Charlestown, Massachusetts, now with the intelligence unit has asked us to consider using the 2020 neural chip on hard core felons suspected of bank and armored car robbery.
He stated, "Charlestown would never be the same, we'd finally know what was happening before they knew what was happening." We will continue to explore community uses of the 2020 chip, but our company rep will be attached to all law enforcement operations with an extraction crrew that can be on-site in 2 hours from anywhere at anytime.
We have an Intelli-Connection discussion group who is meeting with the Director of Security at Florence, Colorado's federal super maximum security unit. The initial discussions with the Director have been promising and we hope to have an R & D unit at this important facilitly within the next six months.
Napolitano insisted that the department was not planning on engaging in any form of ideological profiling. I will tell him face-to-face that we honor veterans at DHS and employ thousands across the department, up to and including the Deputy Secretary," Ms. Steve Buyer of Indiana, the ranking Republican on the House Committee on Veterans' Affairs, called it "inconceivable" that the Obama administration would categorize veterans as a potential threat.



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