Developing situational awareness (‘helicopter view’)

Key Statistics

• ≥50% — Serious incidents with SA loss
• 97% — Bile duct injury errors = poor SA
• >80% — German anaesthetic incidents (SA)

Don't-miss facts

1. SA loss implicated in ≥50% of serious safety events (HIE, maternal deaths)

2. NUPA: Notice → Understand → Project Ahead

3. NOTSS SA rated 1–4: Poor / Marginal / Acceptable / Good

4. Cognitive capacity ≈ 3–5 items at once — overload → task shedding → SA lost

5. Red flags: ambiguity, target fixation, confusion, failure to meet targets/adhere to SOPs/resolve discrepancies/communicate — most errors show ≥4 cues

6. ‘Sterile cockpit’: avoid non-essential tasks during critical phases

7. Delegate a team member to hold the ‘helicopter view’ when you must fixate during a critical step

8. HEMS: BASTE / STACS called every 10 minutes to update team SA

SA loss — key mechanisms

Target fixation Task saturation / workload Distractions No shared mental model Fatigue Complacency

Good SA behaviours

Briefing / mini-brief Shared mental model Shallow authority gradient Speak up Delegate 'helicopter view'

Abbreviation Key

• SA — situational awareness
• DIC — disseminated intravascular coagulation
• NUPA — Notice, Understand, Project
• Ahead — the 3-level SA
• MBTI — Myers-Briggs Type Indicator framework
• HEMS — Helicopter Emergency Medical Service
• NOTSS — Non-Technical Skills for Surgeons
• CTG — cardiotocograph
• ANTS — Anaesthetists' Non-Technical Skills
• GTIRT — Grenfell Tower Investigation and Review Team
• RCOG — Royal College of Obstetricians and Gynaecologists
• BASTE — blood, arterial blood gases, surgery, temperature,
• GMC — General Medical Council equipment
• SOP — standard operating procedure
• STACS — systolic, temperature, acidosis, coagulation, surgery
• PPH — postpartum haemorrhage

Source: Yoong W et al. Developing situational awareness (‘helicopter view’). The Obstetrician & Gynaecologist 2021;23:60–66. doi:10.1111/tog.12709

Clinically reviewed by NHS obstetricians and gynaecologists

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