Checklists – Part 1

By Damjan Gaco, MD, ARHT HEMS Fellow


The origin story of checklists goes as follows: A pilot in the 1930’s stepped off a newly built bomber and said something along the lines of “that is too much plane for one person to handle”. In an ever more complicated world, those words echo true today – especially in the field of medicine. For example, the act of intubation carries many steps – all important: pre-treatment, induction, intubation, back-up plans, confirmation of tube placement, post-tube sedation, and post-intubation care. A post written two years ago by then Auckland HEMS Fellow Dr. Robert Gooch outlines this ever-complicated environment, and the ultimate goal of reducing burden on clinicians.

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Auckland HEMS app updates

Firstly, thank you to all of you for your interest in and support of the Auckland HEMS app! In addition to the Auckland HEMS team, we have over 250 app test pilots from other services and locations, and have received valuable feedback about functionality and content.

Prehospital transfusion SOP

Prehospital transfusion SOP

The app has undergone a series of updates in recent days, as you may have noticed from the push notification spam appearing on your phones (apologies, this is an automatic feature that I have not yet figured out how to turn off!) The iBuildapp platform offers automatic updating on users’ phones, so you should (in theory) have the most up-to-date version already; if however the app is crashing I suggest deleting and re-installing it. Android users may encounter an ‘error 961’ when reinstalling the app, if so follow these instructions, or perhaps just buy an iPhone…

The most important additions to the app are the SOP and checklist for prehospital blood transfusion. As of today, Auckland HEMS will be carrying a unit of Whole Blood on prehospital missions.


interactive checklists

interactive checklists

Other additions include:

* Interactive checklists – Auckland HEMS checklists now include tick boxes that can be filled in as the checklist is completed. There is not yet a functional feature to export the data (this is a work in painful progress!) but in the meantime a completed checklist can be preserved on a smartphone by taking several screenshots.

* Expanded ‘resources’ section – a project has begun to turn the resources section into a prehospital and aeromedical reference library, with links to podcasts, video, and other useful clinical material. What do you think should be in the ‘resources’ section? Please use the feedback button in the app to let me know about your favourite resources so they can be included.

* Map feature with live tracking

Thank you again for your interest in the Auckland HEMS app, and please keep the feedback coming!




map feature

map feature

map feature

Auckland HEMS app under development

In the last few days there has been talk on the twittersphere about retrieval apps.

First mock-up - content required!

First mock-up – content required!

Auckland HEMS is currently developing an app for use in our service. For the first iteration we have chosen a DIY web-based application ( to create the app. Examples of features that we can (in theory) include are:

  • text and image pages for checklists, SOPs, and paediatric resuscitation formulae
  • custom HTML forms for job debriefs, RSI audits etc – these can be filled in on the phone and then emailed to a designated collection person
  • live displays of webpages including, weather/tide information
  • live display of a google calendar for HEMS training and events
  • a personal training log for clinicians

Clearly offline functionality will be essential – 3G coverage on the far side of Great Barrier Island may be patchy at best…!

Custom html form - for job debrief

Custom html form – for job debrief

The current plan is to build the app online and test it through the online iPhone simulator prior to testing on devices and eventually distributing it through the app store.

Currently we hope to create a relatively simple (and advertisement-free) version 1.0, test it, and refine it into a more functional version 2.0 which may require input from a professional app developer (and no doubt some $..)

An excellent podcast from SMACC 2013 about medical app development can be found HERE.

Do any readers of this blog have any experience with app development? Please feel free to share pearls and pitfalls using the comments section below.

We will keep you posted on how this project progresses – watch this space!

Emergency Medicine = Combat Aviation!

There is currently a huge amount of interest in lessons that medicine can learn from aviation, including concepts like CRM and the use of checklists. Efforts are being made to select and integrate these concepts into a form specific to emergency medicine – Andy Buck’s blog Resus Room Management is a great example of this, and is well worth a read.

Joe-NovakJoe Novak, an emergency physician who is a former F15 pilot (!) feels that due to its chaotic nature emergency medicine is analogous to combat aviation! These concepts are discussed in a lecture presented on Scott Weingart’s

Click HERE for the show notes and podcast



In combat aviation:

  1. Aviate
  2. Navigate
  3. Communicate

In EM & Critical Care:

  1. Resuscitate
  2. Differentiate
  3. Communicate