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Situational awareness in medicine
  1. G McCarthy
  1. Veterans Administration, USA
  1. Correspondence to:
 G McCarthy
 1601 E. 4th Plain Blvd, Vancouver, WA 98661, USA; geoffrey.mccarthy2{at}

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As a retired United States Air Force pilot-physician, I commend Singh et al for their excellent use of situational awareness as an analysis tool in aviation.1 I wish only to add a subtle dimension to their illustration of situational awareness: LSA (loss of situational awareness) began as a universally recognised acronym of the North Atlantic Treaty Organization. But one cannot lose what one never had. Situational awareness in military and air carrier aviation universally begins at a maximum, and may deteriorate backwards from level 3 of Endsley’s model. Maximal situational awareness at …

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  • Competing interests: None.