Current disaster medicine programs and simulation exercises often fail to adequately incorporate crucial elements such as situational awareness and a disaster mindset. This gap in training can significantly impact the effectiveness of healthcare professionals' responses during real-world disasters and public health emergencies. In this review, we examined the literature to explore the critical role of situational awareness and a disaster mindset in enhancing healthcare provider preparedness for disaster events, proposing the integration of innovative technologies, such as virtual and augmented reality, to create immersive simulations that foster situational awareness and a resilient disaster mindset. Addressing this educational gap will improve healthcare professionals' confidence and optimize patient outcomes during crises.
Citation: Amir Khorram-Manesh, Gulcan Taskiran Eskici, Lesley Gray. Enhancing global disaster preparedness: A scoping review of the current integration of situational awareness and disaster mindset in healthcare education[J]. AIMS Public Health, 2025, 12(3): 735-766. doi: 10.3934/publichealth.2025038
Current disaster medicine programs and simulation exercises often fail to adequately incorporate crucial elements such as situational awareness and a disaster mindset. This gap in training can significantly impact the effectiveness of healthcare professionals' responses during real-world disasters and public health emergencies. In this review, we examined the literature to explore the critical role of situational awareness and a disaster mindset in enhancing healthcare provider preparedness for disaster events, proposing the integration of innovative technologies, such as virtual and augmented reality, to create immersive simulations that foster situational awareness and a resilient disaster mindset. Addressing this educational gap will improve healthcare professionals' confidence and optimize patient outcomes during crises.
| [1] | Spaaij R, Zammit A (2024) The terrorism threat to the 2024 Paris Olympics: Learning from the past to understand the present. International Center for Counter-terrorism . [cited 2025 June 30]. Available from: https://icct.nl/publication/terrorism-threat-2024-paris-olympics-learning-past-understand-present |
| [2] |
Williams G (2008) Disaster medicine: A history. Am J Disaster Med 3: 124-130. https://doi.org/10.5055/ajdm.2008.0017
|
| [3] | Godby S (2017) This is not a drill: How the 1985 disaster taught Mexico to prepare for earthquakes. PreventionWeb . [cited 2025 June 30]. Available from: https://www.preventionweb.net/news/not-drill-how-1985-disaster-taught-mexico-prepare-earthquakes |
| [4] | UNDRRUN: The Mexico earthquake underlines the importance of strict building codes to ensure safe schools and buildings (2017). [cited 2025 June 30]. Available from: https://www.undrr.org/news/un-mexico-earthquake-underlines-importance-strict-building-codes-ensure-safe-schools-and#:~:text=UN%3A%20Mexico%20earthquake%20underlines%20importance,Our%20impact |
| [5] | Abualenain J (2024) Use of technology in disaster medicine. Eurasian J Emerg Med 23: 155-158. https://doi.org/10.4274/eajem.galenos.2024.45452 |
| [6] | Pallardy R 2010 Haiti earthquake (2010). [cited 2025 June 30]. Available from: https://www.britannica.com/event/2010-Haiti-earthquake |
| [7] | BritannicaThe editors of Encyclopedia Britannica, Fukushima accident (2010). [cited 2025 May 12]. Available from: https://www.britannica.com/event/Fukushima-accident |
| [8] |
Rao A, Lee P, Harfouche M, et al. (2025) Principles of humanitarian and disaster response for healthcare systems in the modern era. Trauma Surg Acute Care Open 10: e001552. https://doi.org/10.1136/tsaco-2024-001552
|
| [9] |
Sultan MAS, Carlström E, Sørensen JL, et al. (2023) Incorporating simulation exercises using collaborative tools into disaster and emergency medicine curriculum—A pilot survey among Saudi Arabian professionals. J Conting Crisis Manag 31: 905-912. https://doi.org/10.1111/1468-5973.12491
|
| [10] | Goniewicz K, Burkle FM, Khorram-Manesh A (2024) Transforming global public health: Climate collaboration, political challenges, and systemic change. J Infect Public Health 17: 102615. https://doi.org/10.1016/j.jiph.2024.102615 |
| [11] |
Salam A, Wireko AA, Jiffry R, et al. (2023) The impact of natural disasters on healthcare and surgical services in low- and middle-income countries. Ann Med Surg 85: 3774. https://doi.org/10.1097/MS9.0000000000001041
|
| [12] |
Walsh L, Subbarao I, Gebbie K, et al. (2012) Core competencies for disaster medicine and public health. Disaster Med Public Health Pre 6: 44-52. https://doi.org/10.1001/dmp.2012.4
|
| [13] |
Heino O, Takala A, Huotari V (2021) Unthinkable is not un-educable: New mindset for training preparedness. Int J Disast Risk Sc 63: 102470. https://doi.org/10.1016/j.ijdrr.2021.102470
|
| [14] |
Franc JM, Nichols D, Dong SL (2012) Increasing emergency medicine residents' confidence in disaster management: use of an emergency department simulator and an expedited curriculum. Prehosp Disaster Med 27: 31-35. https://doi.org/10.1017/S1049023X11006807
|
| [15] |
Pikoulis E, Karamagioli E, Kalogeropoulos A, et al. (2022) When the going gets tough, the tough get going: improving the disaster preparedness of health care providers: A single center's 4-year experience. Disaster Med Public Health Prep 16: 520-530. https://doi.org/10.1017/dmp.2020.282
|
| [16] | Endsley MR (2013) Situation Awareness. The Oxford Handbook of Cognitive Engineering . New York: Oxford University Press 88-108. https://doi.org/10.1093/oxfordhb/9780199757183.013.0006 |
| [17] |
Endsley MR (2021) A systematic review and meta-analysis of direct objective measures of situation awareness: A Comparison of SAGAT and SPAM. Hum Factors 63: 124-150. https://doi.org/10.1177/0018720819875376
|
| [18] |
Su Z, McDonnell D, Ahmad J (2022) The need for a disaster readiness mindset: A key lesson from the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 43: 538-539. https://doi.org/10.1017/ice.2021.26
|
| [19] |
Sloan HM (2011) Responding to a multiple-casualty incident: Room for improvement. J Emerg Nurs 37: 484-486. https://doi.org/10.1016/j.jen.2010.07.013
|
| [20] |
Busby S, Witucki-Brown J (2011) Theory development for situational awareness in multi-casualty incidents. J Emerg Nurs 37: 444-452. https://doi.org/10.1016/j.jen.2010.07.023
|
| [21] |
Blancher M, Albasini F, Elsensohn F, et al. (2018) Management of multi-casualty incidents in mountain rescue: evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 19: 131-140. https://doi.org/10.1089/ham.2017.0143
|
| [22] |
Lynn M, Gurr D, Memon A, et al. (2006) Management of conventional mass casualty incidents: Ten commandments for hospital planning. J Burn Care Res 27: 649-658. https://doi.org/10.1097/01.BCR.0000238119.29269.2B
|
| [23] |
Turner CD, Lockey DJ, Rehn M (2016) Pre-hospital management of mass casualty civilian shootings: A systematic literature review. Critical Care 20: 1-11. https://doi.org/10.1186/s13054-016-1543-7
|
| [24] |
Hugelius K, Becker J, Adolfsson A (2020) Five challenges when managing mass casualty or disaster situations: A review study. Int J Environ Res Public Health 17: 3068. https://doi.org/10.3390/ijerph17093068
|
| [25] |
Holt GR (2008) Making difficult ethical decisions in patient care during natural disasters and other mass casualty events. Otolaryng Head Neck Surg 139: 181-186. https://doi.org/10.1016/j.otohns.2008.04.027
|
| [26] |
Glick JA, Barbara JA (2013) Moving from situational awareness to decisions during disaster response: Transition to decision making. J Emerg Manag 11: 423-432. https://doi.org/10.5055/jem.2013.0155
|
| [27] |
Brooks IA, Sayre MR, Spencer C, et al. (2016) A historical examination of the development of emergency medical services education in the US through key reports (1966–2014). Prehosp Disaster Med 31: 90-97. https://doi.org/10.1017/S1049023X15005506
|
| [28] |
Peek L, Tobin J, Adams RM, et al. (2020) A framework for convergence research in the hazards and disaster field: The natural hazards engineering research infrastructure CONVERGE facility. Front Built Environ 6: 110. https://doi.org/10.3389/fbuil.2020.00110
|
| [29] |
Khorram-Manesh A, Ashkenazi M, Djalali A, et al. (2015) Education in disaster management and emergencies: Defining a new European course. Disaster Med Public Health Prep 9: 245-255. https://doi.org/10.1017/dmp.2015.9
|
| [30] |
Khorram-Manesh A, Lupesco O, Friedl T, et al. (2016) Education in disaster management: what do we offer and what do we need? Proposing a new global program. Disaster Med Public Health Prep 10: 854-873. https://doi.org/10.1017/dmp.2016.88
|
| [31] |
Guo L, Fang M, Liu L, et al. (2025) The development of disaster preparedness education for the public: A scoping review. BMC Public Health 25: 645. https://doi.org/10.1186/s12889-025-21664-0
|
| [32] |
Fernandes dos Santos NI, Aires RFDF (2023) Individuals' attitudes about organizational change: the relationship between BPM and resistance to change. Bus Proc Manag J 29: 413-429. https://doi.org/10.1108/BPMJ-08-2022-0385
|
| [33] |
Murphy JP, Kurland L, Rådestad M, et al. (2020) Hospital incident command groups' performance during major incident simulations: A prospective observational study. Scand J Trauma Resus Emerg Med 28: 1-7. https://doi.org/10.1186/s13049-020-00763-4
|
| [34] |
Perpiñá-Galvañ J, Juliá-Sanchis R, Olmos-Castelló E, et al. (2021) European educational programmes in health emergency and disaster management: An integrative review. Int J Environ Res Public Health 18: 11455. https://doi.org/10.3390/ijerph182111455
|
| [35] |
Hammad KS, Arbon P, Gebbie K, et al. (2018) Why a disaster is not just normal business ramped up: Disaster response among ED nurses. Australasia Emerg Care 21: 36-41. https://doi.org/10.1016/j.aenj.2017.10.003
|
| [36] | Ciottone GR, Biddinger PD, Darling RG, et al. (2015) Ciottone's disaster medicine. Elsevier Health Sciences 2-5. https://doi.org/10.1016/B978-0-323-28665-7.00001-7 |
| [37] |
Sukhera J (2022) Reviews in Medical Education: Key Steps for Researchers. J Grad Med Edu 14: 418-419. https://doi.org/10.4300/JGME-D-22-00481.1
|
| [38] |
Schick-Makaroff K, MacDonald M, Plummer M, et al. (2016) What Synthesis Methodology Should I Use? A Review and Analysis of Approaches to Research Synthesis. AIMS Public Health 3: 172-215. https://doi.org/10.3934/publichealth.2016.1.172
|
| [39] |
Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15: 1277-1288. https://doi.org/10.1177/1049732305276687
|
| [40] |
Brennan P, Holden C, Shaw GR, et al. (2020) What can we do to improve individual and team situational awareness to benefit patient safety?. Brit J Oral Maxillofacial Surg 58: 404-408. https://doi.org/10.1016/j.bjoms.2020.01.030
|
| [41] |
Comfort LK, Rhodes ML (2022) Global risk management: The role of collective cognition in response to COVID-19. New York: Routledge. https://doi.org/10.4324/978100325328
|
| [42] | APA Dictionary of PsychologySituation awareness (2018). [cited 2025 June 30]. Available from: https://dictionary.apa.org/situation-awareness |
| [43] |
Dong W, Fang W, Qiu H, et al. (2024) Impact of situation awareness variations on multimodal physiological responses in high-speed train driving. Brain Sci 14: 1156. https://doi.org/10.3390/brainsci14111156
|
| [44] |
Norri-Sederholm T, Kuusisto R, Kurola J, et al. (2014) A paramedic field supervisor's situational awareness in prehospital emergency care. Prehosp Disaster Med 29: 151-159. https://doi.org/10.1017/S1049023X14000132
|
| [45] |
Baumgartner ET, Shea SY, Stern KL, et al. (2025) State of disaster science: A review on management of large-scale patient surge. Health Sec 23: 9-23. https://doi.org/10.1089/hs.2023.0175
|
| [46] |
Jain T, Sibley A, Stryhn H, et al. (2021) Comparison of unmanned aerial vehicle technology versus standard practice of scene assessment by paramedic students of a mass-gathering event. Prehosp Disaster Med 36: 756-761. https://doi.org/10.1017/S1049023X2100114X
|
| [47] |
Remick KN, Shackelford S, Oh JS, et al. (2016) Surgeon preparedness for mass casualty events: adapting essential military surgical lessons for the home front. Am J Disaster Med 11: 77-87. https://doi.org/10.5055/ajdm.2016.0228
|
| [48] |
Devereaux AV, Tosh PK, Hick JJ, et al. (2014) Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 146: e118S-e133S. https://doi.org/10.1378/chest.14-0740
|
| [49] | James H, Paton D, Buergelt P (2016) FORUM - changing the mindset for dealing with natural disasters. Asia & the Pacific Policy Society . [cited 2025 June 30]. Available from: https://researchportalplus.anu.edu.au/en/publications/forum-changing-the-mindset-for-dealing-with-natural-disasters |
| [50] |
Hogg ES, Kinshuck AJ, Littley N, et al. (2019) A high-fidelity, fully immersive simulation course to replicate ENT and head and neck emergencies. J Laryngology Otology 133: 115-118. https://doi.org/10.1017/S0022215118002347
|
| [51] |
Carenzo ML, Bazurro S, Colombo D, et al. (2021) An island-wide disaster drill to train the next generation of anesthesiologists: the SIAARTI academy experience. Disaster Med Public Health Prep 15: 151-154. https://doi.org/10.1017/dmp.2019.163
|
| [52] |
Mårtensson PÅ, Hedström L, Sundelius B, et al. (2013) Actionable knowledge and strategic decision making for bio-and agroterrorism threats: Building a collaborative early warning culture. Biosec Bioterror Biodefense Strat Pract Sci 11: S46-S54. https://doi.org/10.1089/bsp.2013.0039
|
| [53] |
Yoshikawa M, Yoshinaga K, Imamura Y, et al. (2016) Transplant procurement management model training: marked improvement in the mindset of in-hospital procurement coordinators at Hyogo prefecture, Japan. Transpl P 48: 2437-2441. https://doi.org/10.1016/j.transproceed.2016.02.087
|
| [54] |
van Der Haar S, Jehn KA, Segers M (2008) Towards a model for team learning in multidisciplinary crisis management teams. Int J Emerg Manag 5: 195-208. https://doi.org/10.1504/IJEM.2008.025091
|
| [55] |
Seppänen H, Virrantaus K (2015) Shared situational awareness and information quality in disaster management. Safety Sci 77: 112-122. https://doi.org/10.1016/j.ssci.2015.03.018
|
| [56] |
Jokela J, Rådestad M, Gryth D, et al. (2012) Increased situation awareness in major incidents—radio frequency identification (RFID) technique: A promising tool. Prehosp Disaster Med 27: 81-87. https://doi.org/10.1017/S1049023X12000295
|
| [57] |
Magee M, Isakov A, Paradise HT, et al. (2011) Mobile phones and short message service texts to collect situational awareness data during simulated public health critical events. Am J Disaster Med 6: 379-385. https://doi.org/10.5055/ajdm.2011.0076
|
| [58] |
Murphy JP, Bergström C, Gyllencruetz L (2025) Rural hospital incident command leaders' perceptions of disaster preparedness. BMC Emerg Med 25: 45. https://doi.org/10.1186/s12873-025-01201-3
|
| [59] |
Hugelius K, Becker J (2024) Common challenges in the prehospital management of mass-casualty incidents: A systematic integrative review. Prehosp Disaster Med 39: 301-309. https://doi.org/10.1017/S1049023X24000566
|
| [60] |
Argintaru N, Li W, Hicks C, et al. (2021) An active shooter in your hospital: a novel method to develop a response policy using in situ simulation and video framework analysis. Disaster Med Public Health Prep 15: 223-231. https://doi.org/10.1017/dmp.2019.161
|
| [61] |
Walsh L, Craddock H, Gulley K, et al. (2015) Building health care system capacity: training health care professionals in disaster preparedness health care coalitions. Prehosp Disaster Med 30: 123-130. https://doi.org/10.1017/S1049023X14001460
|
| [62] |
Westman A, Kurland L, Hugelius K (2024) Non-technical skills needed by medical disaster responders–A scoping review. Scand J Trauma Resus Emerg Med 32: 25. https://doi.org/10.1186/s13049-024-01197-y
|
| [63] |
Longo BM (2022) Earthquake preparedness and knowledge of recommended self-protective actions: A survey of nursing students. Disaster Med Public Health Prep 16: 495-499. https://doi.org/10.1017/dmp.2020.422
|
| [64] |
Glotzer DL, Rekow ED, More FG, et al. (2007) All-hazards training: incorporating a catastrophe preparedness mindset into the dental school curriculum and professional practice. Dental Clin North Am 51: 805-818. https://doi.org/10.1016/j.cden.2007.06.003
|
| [65] |
Phattharapornjaroen P, Carlström E, Khorram-Manesh A (2022) Developing a conceptual framework for flexible surge capacity based on complexity and collaborative theoretical frameworks. Public Health 208: 46-51. https://doi.org/10.1016/j.puhe.2022.04.012
|
| [66] |
Khorram-Manesh A, Berlin J, Roseke LL, et al. (2018) Emergency management and preparedness training for youth (EMPTY): The results of the first Swedish Pilot study. Disaster Med Public Health Prep 12: 685-688. https://doi.org/10.1017/dmp.2017.144
|
| [67] |
Enck RE (2012) The OODA loop. Home Health Care Manag Pract 24: 123-124. https://doi.org/10.1177/1084822312439314
|
| [68] | Khorram-Manesh A, Shin H, Carlström E (2025) Impact of Technology on Disaster Preparedness and Healthcare Management. Handbook on Smart Health . Amsterdam: Sage/IOS Press. |
| [69] |
McColl K, Debin M, Souty C, et al. (2021) Are people optimistically biased about the risk of COVID-19 infection? Lessons from the first wave of the pandemic in Europe. Int J Environ Res Public Health 19: 436. https://doi.org/10.3390/ijerph19010436
|
| [70] |
Ragazzoni L, Linty M, Della Corte F (2020) Worldwide Experiences in Disaster Medicine Education. Disaster Med Public Health Prep 14: e22-e23. https://doi.org/10.1017/dmp.2020.150
|
| [71] |
Baetzner AS, Wespi R, Hill Y, et al. (2022) Preparing medical first responders for crises: a systematic literature review of disaster training programs and their effectiveness. Scan J Trauma, Resusc Emerg Med 30: 76. https://doi.org/10.1186/s13049-022-01056-8
|
| [72] |
Sawalha IH (2023) Evolution of modern disaster management. Foresight 25: 808-820. https://doi.org/10.1108/FS-08-2022-0093
|
| [73] | Ardito L, Coccia M, Messeni Petruzzelli A (2021) Technological exaptation and crisis management: Evidence from COVID-19 outbreaks. R&d Management 51: 381-392. https://doi.org/10.1111/radm.12455 |
| [74] | Zhu Y, Li N (2021) Virtual and augmented reality technologies for emergency management in the built environments: A state-of-the-art review. J Safety Sci Resil 2: 1-10. https://doi.org/10.1016/j.jnlssr.2020.11.004 |
| [75] |
Misztal-Okońska P, Goniewicz K, Goniewicz M, et al. (2021) Importance of immediate electronic-based feedback to enhance feedback for first-time CPR trainees. Int J Environ Res Public Health 18: 3885. https://doi.org/10.3390/ijerph18083885
|
| [76] |
Nazli NNNN, Sipon S, Radzi HM (2014) Analysis of training needs in disaster preparedness. Procedia-Soc Behav Sci 140: 576-580. https://doi.org/10.1016/j.sbspro.2014.04.473
|
| [77] |
Khorram-Manesh A, Gray L (2025) Global health and human well-being-A systematic review. AIMS Public Health 12: 310-328. https://doi.org/10.3934/publichealth.2025019
|
| [78] | Center for Disease ControlPublic health emergency preparedness program and guidance (2024). [cited 2025 June 30]. Available from: https://www.cdc.gov/readiness/php/phep/index.html |
| [79] | Gunawan I, Afiantari F, Kusumaningrum DE, et al. (2019) Improving disaster response through disaster simulation. Int J Innov Create Change 5: 640-653. |
| [80] | Khorram-Manesh A, Berlin J, Carlström E (2016) Two validated ways of improving the ability of decision-making in emergencies; Results from a literature review. Bull Emerg Trauma 4: 186. |
| [81] | Kritikos N, Grant J (2013) Simulation in healthcare education: what are the essential standards?. World J Method 3: 10. |
| [82] |
Khorram-Manesh A (2025) Teaching triage in disaster medicine–same subject, but different approach. Scand J Trauma Resusc Emerg Med 33: 9. https://doi.org/10.1186/s13049-025-01322-5
|
| [83] |
Issenberg SB, McGaghie WC, Petrusa ER, et al. (2005) Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Med Teach 27: 10-28. https://doi.org/10.1080/01421590500046924
|
| [84] |
Auf der Heide E (2006) The importance of evidence-based disaster planning. Ann Emerg Med 47: 34-49. https://doi.org/10.1016/j.annemergmed.2005.05.009
|
| [85] | Berntzen L, Sørensen JL, Johannessen MR, et al. Using Artificial Intelligence to Support Emergency Management Training - Creating Efficient and Realistic Scenarios with ChatGPT, in: ThinkMind Digital Library (2025). [cited 2025 June 30]. Available from: https://www.thinkmind.org/library/SMART/SMART_2025/smart_2025_1_70_40039.html |
| [86] | Kapucu N (2006) Interagency coordination in disasters: The challenge of collective action. Public Adm Rev 66: 88-98. |
| [87] |
Khorram-Manesh A (2024) Surgeons' roles and responsibilities in disaster and public health emergency management—A transition from multitasking surgeons to a collaborative surgical approach. Annali Italiani di Chirurgia 95: 497-509. https://doi.org/10.62713/aic.3468
|
| [88] | Kyaw BM, Saxena N, Posadzki P, et al. (2019) Virtual reality for health professions education: Systematic review and meta-analysis by the digital health education collaboration. JMIR 21: e12959. https://doi.org/10.2196/12959 |
| [89] |
Burkle FM, Khorram-Manesh A, Goniewicz K (2025) Artificial intelligence assisted decision-making in current and future complex humanitarian emergencies. Disaster Med Public Health Prep 19: e64. https://doi.org/10.1017/dmp.2025.63
|
| [90] |
Voicescu GT, Lamine H, Loșonți AE, et al. (2025) Monitoring and evaluation in disaster management courses: A scoping review. BMC Med Educ 25: 188. https://doi.org/10.1186/s12909-025-06659-0
|
publichealth-12-03-038-s001.pdf |
![]() |