Background
death, hypothermia, ROSC, deaths, trauma
AIDS, COMPLICATION
Human error is a leading cause of death in modern patient care. The estimated number of deaths due to medical errors in registered hospital admissions in the USA is 400,000 deaths/year [Individualized and sufficiently implemented cognitive aids like checklists increase performance when solving time-critical and challenging medical emergencies mainly by reducing omissions [Checklists have long been successfully used in high reliability organizations (HRO) such as nuclear power production, military operations and aviation [In medicine, checklists are used in the operating room. The ‘WHO Surgical Safety Checklist’ uses perioperative timeouts at three defined time points (before induction of anesthesia, directly before the skin incision, and before the patient leaves the operating theatre) to check safety-relevant items for the entire surgical team. In a prospective randomized study, the WHO Surgical Safety Checklist achieved a significant reduction in the overall complication rate at all study sites from 11 to 7% (While not mentioning “checklist” or “cognitive aid” in the adult advanced life support section current European resuscitation guidelines encourage the use of safety checklists to minimise human factors during medical procedures or special circumstances [In principle, the use of checklists in medicine allows that the treatment of the patient does not exclusively depend on human memory.For the design of a checklist for the pre-hospital setting a suitable structure and proper methods of usage must be identified. The ‘ABCDE’ mnemonic is an logical choice for the structure as it offers a well-defined linear flow, provides some simplification to the process, the provider have a comprehensive amount of experience at the “sharp-end” use and finally its effects on prehospital treatment time and workflow during trauma resuscitation are proven [Two basic concepts are available for the usage of checklists. The ‘challenge & response’ approach, or ‘cookbook’ approach, takes place between two users, whereby one user calls out an item in the exact order of the checklist (challenge) and the second user executes the item directly under the control of the first user (response). This results in a high level of application security at the expense of an inflexible action framework that is prone to failure. A ‘do verify’ approach is a more flexible method in which the team first works through the known contents of the checklist and then checks the completeness of the checklist during a timeout and completes it if necessary (verify) [Prehospital checklists can increase patient safety and outcome by facilitating adherence of prehospital therapy to currently valid therapy guidelines (i.e. by the European Resuscitation Council [ERC]). For our study, the guideline content of the therapy of return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation was transferred into a prehospital checklist in the form of the ‘ABCDE’ mnemonic. The 2010 version of the ERC guidelines was the first to specifically address this issue and to define complex standards of care. Therapeutic hypothermia (nowadays: temperature target management) was included as a concept in the guideline for the first time and could, therefore, be a surrogate for the rapid transfer of knowledge through checklists [The aim of the study was to demonstrate that professional emergency medical service (EMS) teams working through a simulated ROSC situation using a checklist based on the ‘ABCDE’ mnemonic firstly achieve higher adherence to guideline-recommended actions, secondly manage the scenario more time-efficient, and thirdly demonstrate better adherence to the ABCDE-compliant workflow than EMS teams working without checklist support.