dogfight, the pilot must “get inside” the opponent’s loop; losing one’s own situational awareness was called being “out of the loop.”1

The term is still used extensively in aviation, and it encompasses the idea of understanding the entire environment of the aircraft, both inside the cockpit and out—what the instruments are indicating, what air traffic control is saying, and what is visible through the windshield. The term is also extensively used by the military. According to the Army Field Manual 1-02 (September 2004), situational awareness is:

Knowledge and understanding of the current situation which promotes timely, relevant and accurate assessment of friendly, competitive and other operations within the battlespace in order to facilitate decision making. An informational perspective and skill that fosters an ability to determine quickly the context and relevance of events that are unfolding.2

Again the emphasis is on understanding actionable information.

What does situational awareness mean in the healthcare context? The concept has been applied to the analysis of patient safety and healthcare quality issues.3 However, the most frequent use of the term in health care relates to emergency management and is often used in reference to computer systems to aggregate data in an emergency operations center, or to collect and transmit disease surveillance data. These systems are useful tools, and may even be essential tools, but they do not in and of themselves provide situational awareness. To achieve situational awareness, the right information (without a lot of noise) is needed at the right time, and the right person is prepared to receive it, is capable of analyzing it, and is then able to do something useful with it.

This raises a number of issues, the most fundamental of which is what information is actually needed in a disaster? What information really makes a difference? In fact, the information needed probably varies with the type of event, and different actors involved in emergency response need different information. For example, the physician in the emergency department needs different information than the state’s Director of Emergency Management or the Secretary of Health and Human Services (HHS).

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