基于HFACS的空中相撞事故分析及建议

空中相撞事故往往是由诸多人为差错相互叠加、耦合和作用而导致的，要找出事故的真正诱因，防止类似事故再次发生，难度非常大。为了有效地分析和定位人为差错，以更好地服务于防相撞的管理与决策，提出一种基于人为因素分析分类系统（HFACS）的空中相撞事故分析方法，它按照从显性差错到隐性差错的思路来分析事故的诱因，最终找出组织因素对事故的影响。并利用HFACS对巴西卡欣布上空发生的一起空中相撞事故进行了系统分析。案例分析结果表明，该方法不仅能够找出导致空中相撞事故的人为差错，解释事故发生的原因和过程，而且能够据此提供防止相撞事故发生的安全建议。

Analysis and suggestion of midair collision accident based on HFACS

The midair collision accident is usually cased by the mutual overlying, coupling and acting of many human errors, thus it is very difficult to find out the real causation of accident for preventing similar accidents. In order to effectively analyze and locate human error for better management and decision-making of collision avoidance, an analysis method based on Human Factor Analysis and Classification System (HFACS) was proposed for midair collision accident. It analyzes the causation of accident according to the thinking from dominant error to latent error, and finally finds out the effect of organizational factors on accident. The method was used to analyze a midair collision accident that occurred in the airspace of Cachimbo in Brazil. The analysis result of case showed that, the method can not only identify the human errors leading to midair collision accident with the explanation of the reasons and processes, but also provide the safety suggestions for the collision avoidance.