Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Janet Witucki-Brown

Committee Members

Susan Speraw, Jan Lee, Diane Klein


The purpose of this study was to understand the process of situational awareness (SA) in multi-casualty incidents (MCI). This study is significant because SA provides information on which critical decisions are made during emergency events. The literature concerning SA is mostly drawn from the domains of aviation, military operations and business and not nursing. Current conceptual and theoretical development is insufficient for application to the domain of MCI. MCI occur daily across the United States, yet a literature review revealed no studies involving SA in MCI. Limited issues that are possibly related to SA in MCI have been researched such as triage, scene safety and patient disposition, but none identify or integrate concepts important to SA.

The lack of developed theory in this domain, let to a grounded theory approach to explore, identify and relate concepts that emerged from the data in order to uncover the process of SA. Interview transcripts from 15 emergency responders constituted the bulk of the data. Participants had various professional roles and diverse experiential levels. The data were managed using the software program NVivo 8.

Findings suggested that ―establishing and maintaining control‖ of the scene was the core category, with other categories interacting with and being mediated by this core. Rescuers, given experiential and educational preparation responded to contextually-based situations. By appreciating the context and complexity of the event, rescuers handled information, managed resources, used roles and relationships and dealt with the emotional responses to the actions and interactions on the scene to establish and maintain control of the situation. By establishing and maintaining control, rescuers provided a relatively safe environment in which to provide emergency healthcare. The substantive theory, the ―Busby Theory of Situational Awareness in Multi-Casualty Incidents‖ resulted from this study.

Future research should refine this model with eventual theory testing. This theory may prove beneficial in studying larger-scale events, such as mass-casualty situations and disasters and possibly different managerial hierarchies related to emergency response efforts. It should also serve as an educational tool for emergency responders and may prove helpful in the clinical practice of emergency responders from diverse disciplines.

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Nursing Commons