Situational awareness in public health preparedness settings

September 11 2001 attacks and following Anthrax mailings introduced emergent need for developing technologies that can distinguish between man made and natural incidents in the public health level. With this objective in mind, government agencies started a funding effort to foster the design, development and implementation of such systems on a wide scale. Public health surveillance systems showed great potential for the improvement of the nation's preparedness against the threat of bioterrorist attacks. But the outcomes have not met the expectations set by the resources invested. Multiple elements explain this phenomenon: As it has been frequent with technology, introduction of new surveillance systems to the workflow equation has occurred without taking into consideration the need for understanding and inclusion of deeper personal, psychosocial, organizational and methodological concepts. The environment, in which these systems are operating, is complex, highly dynamic, uncertain, risky, and subject to intense time pressures. Such 'difficult' environments are very challenging to the human as a decision maker. In this paper we will challenge these systems from the perspective of human factors design. We will propose employment of systematic situational awareness research for design and implementation of the next generation public health preparedness infrastructures. We believe that systems designed based on results of such analytical definition of the domain enable public health practitioners to effectively collect the most important cues from the environment, process, interpret and understand the information in the context of organizational objectives and immediate tasks at hand, and use that understanding to forecast the short term and long term impact of the events in the safety and well being of the community.