There are many other examples mentioned in our report that indicate the lack of attention to the human factor in nuclear safety. We note only one more (a fourth) example. The control room, through which the operation of the TMI-2 plant is carried out, is lacking in many ways. The control panel is huge, with hundreds of alarms, and there are some key indicators placed in locations where the operators cannot see them. There is little evidence of the impact of modern information technology within the control room. In spite of this, this control room might be adequate for the normal operation of nuclear power plants.
However, it is seriously deficient under accident conditions. During the first few minutes of the accident, more than 100 alarms went off, and there was no system for suppressing the unimportant signals so that operators could concentrate on the significant alarms. Information was not presented in a clear and sufficiently understandable form; for example, although the pressure and temperature within the reactor coolant system were shown, there was no direct indication that the combination of pressure and temperature meant that the cooling water was turning into steam. Overall, little attention had been paid to the interaction between human beings and machines under the rapidly changing and confusing circumstances of an accident. Perhaps these design failures were due to a concentration on the large-break accidents -- which do not allow time for significant operator action -- and the design ignored the needs of operators during a slowly developing small-break (TMI-type) accident. While some of us may favor a complete modernization of control rooms, we are all agreed that a relatively few and not very expensive improvements in the control room could have significantly facilitated the management of the accident.
In conclusion, while the major factor that turned this incident into a serious accident was inappropriate operator action, many factors contributed to the action of the operators, such as deficiencies in their training, lack of clarity in their operating procedures, failure of organizations to learn the proper lessons from previous incidents, and deficiencies in the design of the control room.
, but 3D? I don't think so
