IRONIES OF AUTOMATION (Train Accident in Spain-Santiago).

This article is titled Ironies of Automation by Dra. Baindridge and published in 1983, one of the most widely read and cited since then within the discipline of Human Reliability, that part of the safety that you do not hear these days despite the magnitude of Santiago railway accident.
The article was saying that the irony being a combination of circumstances resulting in the opposite of what should be expected, some engineers often tend to give little confidence and seek to supplant operator by automated devices. This may seem paradoxical; one side does not consider designers errors, leaving to the operator just the task was unable to automate. Moreover, even in highly automated systems are needed for cognitively trained human supervisory tasks, concluding with the paradox that automated systems are systems where the person actually plays a crucial role. Moreover, the habit to monitor automated systems can lead to a depletion or forgotten driver skills when you have to take the train in manual mode eg in breakdown or degradation of the automatic system.
While it is true that drivers can make fatal errors when the system has been validated without having foreseen the situation of human error, it is also true that most of the underlying causes were in the system long before active errors were committed. Therefore active errors are heirs to the “System defects” in the words of J. Reason.
Reduce safety problem to “active error” of the driver is to contemplate the illusion of the tip of the iceberg believing view all the evidence and ignoring a fraction where the real risk.
Typically attempts to minimize errors often turn to technological solutions; this is more automation, returning to influence the ironies that describes Bainbridge. Taking into account the bit likelihood that the same combination of causes for that accident should be repeated, efforts to prevent further accidents due to human error just affect the overall safety of the railway system.
It is unthinkable that soon more than 9,000 kilometers of rails are equipped with multiple beacons on each curve; on the other hand the 3,000 kilometers of high speed are not infallible by the fact of ERTMS automatic system, remembering Automation Paradox.
In the UK following the Ladbroke Grove accident in 1999 that killed 31 people, the recommendations of the research were primarily organizational and technology not only giving a definite contribution to the implementation of human reliability methodologies on the railroad. In this in Spain you are many miles to go.
The European Railway Agency has documents and guidelines for incorporating safety improvement expertise on human factors and reliability at all phases of the rail cycle. For what not to continue having doubts 9,000 kilometers and 3,000 kilometers of Ironies of Automation, should incorporate human factors knowledge available in any recommendation for improving railway safety.
Pilar Calvo