Situational awareness can be defined simply as “knowing what is going on around us”,[i] or – more technically – as “the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning and the projection of their status in the near future” (Figure 10).[ii]
The first part of situational awareness can be achieved by situation assessment using perception and attention. Comprehension follows this, the interpretation of the situation assessment. Knowing how the situation is likely to evolve is projection.[iii] Once complete,situational awareness forms the foundation of good decision making.[iv] Once we have formed a mental model of the environment, our communication skills allow us to share this with others.
Figure 10. Components of situational awareness
In an ideal situation, one has a complete ‘helicopter view’ of the overall picture in any given situation and can share it with colleagues. However, it is easy to see how failure to interpret a key finding or result, or failure to process one element of a complex item such as a CTG correctly, could be part of a critical chain of events leading to a catastrophe.[v] Working memory is limited to up to seven items, depending on genetics and environmental factors such as stress, fatigue and health. If working memory becomes overloaded, items will simply be forgotten. Given that there may be many more variables to contend with on a labour ward at any one time, the essentially fallible nature of situational awareness becomes apparent. Figure 11 is a common model of situational awareness which expresses this limitation.
Figure 11. Model of ideal and practical situational awareness
The construct of situational awareness, the limitations of human memory and the complexity of any given situation mean that, inevitably, situational awareness will be suboptimal at any one time. Put simply, we cannot remain aware of everything which is going on around us. When looking retrospectively at an incident with all of the available information, it will always be possible to highlight where situational awareness failed because the key, critical variables will be obvious. This is an inherent bias we have to consider when conducting investigations, and when analysing reports.
[i] Flin R, O’Connor P, Crichton M. Safety at the Sharp End: A Guide to Non-Technical Skills. Boca Raton, FL: CRC Press; 2008.
[ii] Endsley MR. Toward a theory of situation awareness in dynamic systems. Human Factors 1995;37(1):32–64.
[iii] Flin R, O’Connor P, Crichton M. Safety at the Sharp End: A Guide to Non-Technical Skills. Boca Raton, FL: CRC Press; 2008.
[iv] Flin R, O’Connor P, Crichton M. Safety at the Sharp End: A Guide to Non-Technical Skills. Boca Raton, FL: CRC Press; 2008.
[v] Reason J. Managing the Risks of Organizational Accidents. Aldershot: Ashgate Publishing; 1997.