IntroductionUnderground environments present challenges for providing and managing effective emergency care. Situational awareness (SA) has been suggested as a critical process to the management of care.

AimThis study aims to explore the process of SA in the tasks of an ambulance incident commander (AIC) during a fullscale underground mine exercise.

MethodsData consisted of video recordings, audiotapes and fieldnotes; these were subjected to content analysis based on the categories from the Busby Theory of Situational Awareness in Multi-casualty Incidents.

ResultsThe results show that the underground mining environment presented the AIC with specific challenges for the SA process with respect to aspects such as situational information about the scene and the victims, as well as with making decisions for ambulance personnel so they could perform their work safely, and having a structured manner to counteract information overload. Both technical and non-technical aspects influenced the process.

ConclusionThe AIC’s situational awareness was largely built through coordinated communications and actions with collaborating actors. The results of this study can be used for further exploration of how to train and support people in medical leadership roles on aspects of SA in emergency care, as well as on how to evaluate educational outcomes through exercises.