On January 29, 2025, PSA Airlines Flight 5342 — a Bombardier CRJ-700 on approach to Ronald Reagan Washington National Airport — collided midair with a U.S. Army Black Hawk helicopter (PAT25) over the Potomac River. All 64 persons on both aircraft perished. The NTSB’s subsequent investigation, published as Report AIR-26-02, spans over 380 pages and represents one of the most comprehensive accident analyses in recent years.
Yet despite its thoroughness, the report contains a fundamental analytical gap: the term “inattentional blindness” does not appear anywhere in the entire document.
This matters profoundly. The helicopter crew were looking through night vision goggles at a visual scene in which the approaching CRJ-700 — lights on, closing at combined speed — was physically present. They did not see it. The NTSB describes this failure in terms of workload, expectation bias, and equipment limitations. But these are symptoms. The underlying cognitive mechanism that explains why a crew can look directly at a threat without perceiving it has a name in human factors science: inattentional blindness.
What the NTSB Got Right
Credit where it is due. The NTSB report correctly identifies several human factors that contributed to this tragedy.
Expectation bias — The report explicitly identifies that the instructor pilot (IP) expected traffic from the right (runway 1 approach, used ~93% of the time), not from the left (runway 33 circling approach, used only 5-7% for northbound arrivals). This is Finding 29.
The report also thoroughly documents the 40-degree field of view limitation of ANVIS NVGs (versus approximately 180 degrees for normal human vision), the see-and-avoid doctrine’s inherent limitations, the blossom effect that makes converging aircraft appear stationary, and the high workload that left the IP with no spare cognitive capacity for traffic scanning. The controller performance analysis applies Endsley’s three-level situation awareness model effectively.
These are real and important findings. But they stop short of the cognitive root cause.
The Gaps: What the NTSB Did Not Address
The following diagrams illustrate the critical human factors mechanisms that the NTSB report fails to identify or adequately explore. Each represents a well-documented cognitive phenomenon directly relevant to this accident.
1. The Compound Field of View Problem
The NTSB treats the NVG’s 40-degree field of view as a fixed hardware constraint. What it fails to recognise is that cognitive task loading under NVGs narrows the effective attentional field even further. When a pilot is managing night NVG flight, instruction duties, terrain avoidance, route navigation, and instrument scanning simultaneously, the brain’s attentional spotlight contracts well within the already narrow physical field.
2. The NVG Light Suppression Paradox
Night vision goggles are engineered to suppress bright light sources to prevent tube blooming. But this means the CRJ-700’s bright landing lights and anti-collision strobes — which to the unaided eye would create a dramatically conspicuous and growing visual signal — were suppressed by the NVGs’ automatic gain control to appear as just another dim point of light amid the dense cultural lighting of the Washington, DC, skyline. The NVGs actively removed the conspicuity cue.
Bright & growing
Same as city lights
3. The Inattentional Blindness Cascade
The NTSB describes each contributing factor in isolation. What it fails to do is connect them into a unified cognitive chain that traces how the IP ended up literally looking at the approaching aircraft without his brain registering its presence.
4. Auditory Exclusion: “Listening Without Hearing”
The NTSB attributes the crew’s failure to respond to alerts to ambient helicopter noise and the tablet not being integrated into helmets. But the deeper phenomenon is auditory exclusion — under extreme visual workload, the brain reduces auditory processing. The IP’s rote “traffic in sight” response is textbook evidence: words processed at a superficial, automatic level without genuine cognitive engagement.
5. Symptoms vs. Root Cognitive Cause
The following maps each observable behaviour the NTSB documents to the underlying cognitive mechanism it represents. The pattern is clear: while the NTSB is thorough in documenting what happened, it systematically fails to explain why at the cognitive level.
6. The Blossom Effect + NVG Compound Problem
Aircraft on a collision course appear stationary — no angular movement cue. Only in the final seconds does the image “blossom” as range closes. Through NVGs, even this last-resort brightness-growth cue is suppressed by gain control.
Conclusion: Why Naming the Mechanism Matters
The NTSB’s recommendations focus on systemic and technological fixes: ACAS X, ADS-B In, route redesign, position de-combining, SMS implementation. These are necessary and important. But because the report fails to identify inattentional blindness as a specific cognitive mechanism, it does not recommend cognitive human factors training for NVG operations, mandatory “break-set” techniques during high-workload phases, multi-sensory alerting that accounts for auditory exclusion (including haptic alerts), or research into NVG glare suppression’s impact on aircraft conspicuity.
NTSB Report AIR-26-02 describes the exact manifestation of inattentional blindness across 380+ pages without ever using the term. This is not a semantic quibble — when the root cause is unnamed, the recommendations cannot target it. The crew did not fail to look. They failed to see. That distinction demands a fundamentally different set of interventions.
Capt. Amit Singh FRAeS is the author of Inattentional Blindness and Bias During Visual Scan and founder of Safety Matters.
Contact: Admin@safetymatters.co.in
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