A combination of factors led to last year's crash of an Asiana Airlines jet in San Francisco, but the one that tops the list of a new report is a straightforward one: "flight crew mismanagement." Federal investigators say the South Korean pilots should have realized that their automatic throttle was bringing them in too low and too slow and overridden it in time, reports the San Francisco Chronicle and the AP. The big problem is that the crew "over-relied on automated systems that they did not fully understand," says Christopher Hart, acting chairman of the National Transportation Safety Board.
The NTSB, therefore, wants Boeing to provide better training for its increasingly complex systems. "In their efforts to compensate for the unreliability of human performance, the designers of automated control systems have unwittingly created opportunities for new error types that can be even more serious than those they were seeking to avoid," says Hart. The report also says the pilots were fatigued at the end of the flight, which didn't help. Three people were killed in the crash, including one young woman who was hit by emergency vehicles. The report generally praised the emergency response but cites problems with training and radio communications.