Loss of Visual Reference in U.S. Aviation: An Analysis of 129 Accidents

Abstract

A “loss of visual reference” is a term used by the National Transportation and Safety Board investigators to describe a situation in which the pilot has lost reference to the horizon or ground. Previous research has largely focused on the conditions that are often associated with a loss of visual reference (e.g., spatial disorientation) instead of the term itself. The purpose of the present study is to examine the accident and pilot characteristics that are associated with a loss of visual reference and the extent to which both are associated with fatalities. A total of 129 accident reports from 2008 through 2020 were extracted from the NTSB online database in which the term loss of visual reference appeared in the event category. Fatal accidents, which made up more than half of the dataset, were more likely to have occurred during the en-route phase of flight compared to all of the other phases of flight combined. The reports in which “decision making” or “decision making/judgment” was present were more likely to be for fatal accidents compared to reports in which the terms were not listed. It is the pilot’s decision and lack of attention that are most commonly associated with accidents in which a loss of visual reference occurred. Decisions that are likely to cause a loss of visual reference include initiating or continuing in adverse weather or light conditions. The dangers of loss of visual reference need to be part of ongoing training of pilots as opposed to their initial training only.