"Being Aware!" - Situational Awareness and Its Importance in Safety and Quality Assurance in Neurosurgery.

Situational awareness (SA) is a cognitive skill that is crucial in crisis resource management. Its importance has been known extensively in aviation; however, no methodical training and structured evaluation of SA exist in Neurosurgery. Like aviation, Neurosurgery is a complex and dynamic field where the stakes are high and the permissible errors are nil or negligible. This article describes the concept of SA, by illustrating two common clinical scenarios. On the foundation of these clinical vignettes, the author builds up a strong case for incorporating SA training at all levels of seniority to prevent surgical errors. The author also proposes a safety loop that can be recalled by the surgeon when faced with an adverse surgical event.