Auckland HEMS Checklist Reference Manual

Dear colleagues,

In June of this year our Canadian HEMS Fellow Dr. Robert Gooch shared one of our emergency checklists with the Prehospital and Retrieval Medicine (PHARM) community. Thank you to those of you who provided feedback on this initiative. We continue to draw inspiration from the work of Dr. Atul Gawande.

Now, in the spirit of Free Open Access Medicine, we are keen to share our complete Auckland HEMS Checklist Reference Manual with the PHARM community. At the start of September we made this manual operational within our service.

Innovation is one element of success; implementation is another core element. This article emphasizes the importance of end-users ‘the sharp end’ being involved throughout the checklist development process. We are fortunate to have input into this checklist from our pilots, crewmen, paramedics and doctors. Even our CEO (who is also a pilot) has shared his experience.

We see these checklists as a living document, which will only improve with use, reflection and feedback.Please download, test, then let us know what you think. Below, please find our Checklist SOP:


Auckland HEMS Medical Checklists

Standard Operating Procedure (SOP)

  1. Any crew member may activate an Emergency Medical Checklist (EMC) at any time.

  1. In an emergency, a team member will assume the role of lead clinician.

  1. The lead clinician will take any required immediate actions AND direct a team member to read the appropriate emergency medical checklist (EMC). Immediate actions include three steps:

    1. Identify

    2. Understand

    3. Respond

  1. The lead clinician may delegate tasks to other team members (if available). The priority remains direct patient care. Aviation uses the mnemonic ‘ANCA’:

    1. Aviate – Care for the patient

    2. Navigate – Maintain situation awareness and anticipate next steps

    3. Communicate

    4. Administrate

  1. Our checklist format is ‘Challenge-and-Response.’ Each step has a specific actionable response. If an inappropriate response is given, the checklist reader will prompt the lead clinician for the appropriate response. “Brevity is the soul of wit.” – W. Shakespeare, Hamlet.

  1. The checklist reader will not move on from a step until an appropriate response is given.

    1. Stop the checklist

    2. Complete the respective task

    3. Continue the checklist

  1. A checklist may be aborted if:

    1. The physiologic abnormality resolves and the patient’s condition improves

    2. The team is confident the physiologic abnormality is not an emergency

    3. The checklist is unsafe in the given clinical scenario

  1. Some patients may have multiple physiologic abnormalities. It is up to the clinician’s discretion which checklist is used first. Multiple checklists may be used sequentially. In all situations, the clinicians must assess patient and use good judgment to determine the safest course of action.

  1. Emergency checklists are intended as a cognitive aid to improve initial management of time-critical scenarios. A checklist is neither a teaching tool nor an algorithm. In some cases, further management steps may be required once the checklist has been completed.

  1. Usually, time is available to assess the situation before corrective action is started. All actions must be coordinated and performed in a deliberate, systematic manner.

  1. Reference:


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