In 1981, following years of aircraft accidents caused by distracted flying, the Federal Aviation Administration enacted Federal Aviation Regulations 121.542 and 135.100. Commonly known as the “sterile cockpit rule,” these regulations prohibit air crews from performing non-essential duties during critical phases of flight. Though there are many differences between flying and tactical operations on the ground, a similar rule should be incorporated to reduce distraction-related accidents during critical phases of Marine Corps and Army ground operations.
Sterile Cockpit Rule Overview
The sterile cockpit rule defines “critical phases of flight” as ground operations involving taxiing, takeoff and landing, and all flight operations below 10,000 feet except cruise flight. Per federal regulations, prohibited activities during these times include taking calls not related to the safety of the flight, dealing with administrative issues, eating meals, having nonessential conversations, reading publications not related to the conduct of flight, and using a cell phone. Also, the cabin crew is not allowed to distract the cockpit crew for anything that is not related to the safety of the flight.1 While it is difficult to measure just how many aviation accidents have been avoided since the rule was adopted in 1981, its consistent and nearly ubiquitous use in aviation for almost 40 years is a testament to its efficacy. Two important aspects of the rule that should be considered when incorporating into other fields are: 1) defining what the “critical phases” of the operation are; and 2) establishing a structured way of communicating during these phases.
Applications in a Ground Environment
In one review of accidents related to distracted flying, some of the biggest causes were extraneous conversation, distractions from flight attendants, non-pertinent radio calls, public address announcements, and sight-seeing.2 Some of these distractions, such as non-pertinent radio calls and distractions from other team members, are common in ground operations, and can also distract operators from tasks requiring focus.
The sterile cockpit rule has valuable applications in any operation requiring high cognitive workload to execute a task and that would bear a considerable safety risk if the task were not performed correctly. Such tasks can include maneuvering a unit in contact with the enemy, countering improvised explosive devices, executing fire missions, employing crew-served weapons, inserting and extracting troops from a helicopter landing zone, and many others. Unit standard operating procedures should include rules similar to the sterile cockpit rule. Examples may include: no radio traffic not relating to the immediate execution of the task; no discussion or small talk not relating to the task; and a structured way of communicating during defined critical phases of an operation. Some of this is covered by standardized reporting formats, but these tend to be used in only one direction: from lower echelon to higher. It is important that higher echelons also understand their role in a structured communication protocol, so they do not unnecessarily distract task-saturated units. Reducing distractions will improve safety, communications effectiveness, and mission accomplishment.
Many tactical operations are not as cut-and-dry as aircraft taxiing, takeoff, and landing, so the ground interpretation of the sterile cockpit rule will not be the same as in aviation. What is important is that a protocol for structured communication is established during critical periods, and that everyone involved in the operation understands this structure.
The intense focus required for these missions cannot be sustained for long periods of time, so the rule should only apply to specific and critical phases of operations. These will vary depending on the mission, and it is up to each unit to rehearse and refine these rules, balancing the need for focus with the limited ability of human beings to remain focused for extended periods of time.
Incorporating structured communication protocol is important in a highly connected information environment, where units can communicate immediately across long distances. Leaders located in an operations center distant from the fight need to resist the urge to want every detail as an operation is taking place. Trying to pull information from an engaged unit during critical and potentially dangerous periods could greatly increase the chance of a mishap. Instead, leaders need to exercise tactical patience, trusting that those on the ground will push relevant information up the chain when able. What needs to be avoided at all costs is “the tactical general,” who tries to insert him or herself into every tactical situation simply because communication technology allows them to.3 The second- and third-order effects of this are distracted operators on the ground, lack of trust between leader and subordinate, and junior leaders bred to rely on their commander to make every decision for them.
Lessons from Hospital Operating Rooms
Healthcare settings can be prone to distractions that lead to mistakes in many of the same ways mistakes are made in aviation and tactical ground operations. Examples of how the sterile cockpit rule can be incorporated into disparate fields can be seen in how some hospitals are adapting their own versions of it.
Distractions in the operating room can be fatal to a patient. A study on the use of structured communication at critical events during cardiovascular surgery found that such communication greatly reduced the number of communication breakdowns during surgery.4 To determine when a structured communication protocol should be used, surgeons first identified the critical phases of the operation—those periods when mental workload was highest and communication was most likely to breakdown. Surgeons in this study identified eight critical stages where communications were likely to break down, including initiation of cardiopulmonary bypass, applying a crossclamp, and removing a crossclamp. They then established communication protocol during these critical phases, including making call-back of all verbal exchanges a standard procedure.5 The result was a major decrease in communication breakdowns during surgery and safer operations.
Applying the sterile cockpit rule in a hospital setting comes with its own challenges. One study examined a version of the sterile cockpit rule used by nurses administering medication. The study found that factors such as the complex and constantly changing nature of the work, the need to interact with multiple different people at different times, and family members and physicians ignoring the rule made it difficult to implement. It was also poorly received by nurses, who saw regular interaction with family members and patients as a critical part of their job.6
When to Speak Up
One potential issue arises when the sterile cockpit rule is in place but another team member notices that something is wrong. Should they speak up? What criteria would allow one to break the rule? Indeed, aviation accidents have happened because a flight attendant noticed something was wrong but did not speak up because of the rule.7 To prevent such accidents, it is important to establish clear criteria for extenuating circumstances when the rule is allowed to be broken, and to educate all team members on these criteria.
Another issue is that just like nurses who have to deal with patients, family members, physicians, and other nurses, the tactical environment can be dynamic and involve interactions with multiple different parties. Because of this, the sterile cockpit rule will look different in ground operations than it does in aviation. The important thing is to identify critical phases when cognitive workload and potential danger are highest, and to establish structured communication protocols during these phases. As previously mentioned, some of this already exists as standardized reporting formats. These structure communications for those involved in the tactical operation, but it is vital that operations centers and higher headquarters also abide by the protocols to avoid becoming “tactical generals.”
When and how to incorporate the sterile cockpit rule into tactical operations will depend on the type of unit, mission, and lessons learned from rehearsals and employing it in practice. One point is clear, however: The rule can have significant positive impacts on unit effectiveness and safety at almost no cost.
1. Code of Federal Regulations 121.542 and 135.100, “Flight Crewmember Duties.”
2. Robert L. Sumwalt, “The Sterile Cockpit,” Aviation Safety Reporting System, June 1993.
3. Peter Singer, “Tactical Generals: Leaders, Technology, and the Perils,” Brookings, 7 July 2009.
4. Rishi K. Wadhera, BS, Sarah Henrickson Parker, MS, Harold M. Burkhart, MD, Kevin L. Greason, MD, James R.Neal, CCP, Katherine M. Levenick, CCP, Douglas A. Wiegmann, PhD, and Thoralf M. Sundt III, MD, “Is the ‘sterile cockpit’ concept applicable to cardiovascular surgery critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass,” The Journal of Thoracic and Cardiovascular Surgery, 139, Issue 2, February 2010, 312–319.
5. Wadhera, et al, “Is the ‘sterile cockpit’ applicable.
6. Michelle Federwisch, Hortencia Ramos, and Shonte’ C. Adams, “The Sterile Cockpit: An Effective Approach to Reducing Medication Errors?” American Journal of Nursing, 114, Number 2, February 2014, 47–55.
7. Hugh Morris, “The rule that forbids pilots from chatting below 10,000 feet—and the farcical crash that created it,” The Telegraph, 17 May 2017.