Check Yo' Self!
So in Episode 11, we talked about checklists with the formidable Chris Sharpe, and this week's episode with Lane Abshire mentioned the importance of checklists as well. Aaron and I are real fans of checklists, but after releasing these two episodes about the topic, we found dissension among the EMS community about their usefulness. I am a true believer, and by using them, I and others can decrease the number of mistakes made during patient care. There is research that discusses and shows the use of checklists, even in minor procedures or tasks, among the anesthesiology community (1).
The evidence is clear that checklists improve performance in most of our daily tasks. They are extremely helpful in functions that are essential to perform while under pressure. We use checklists to go grocery shopping or remember items we need from around the house, so why don't we see the value of checklists in patient care.
Most medics would agree that maybe we should definitely use a checklist during RSI attempts but that for the most part, we should know everything else we need to without checklist. I find this to be interesting because as paramedicine has grown, so has the amount of information, i.e., drug doses, procedures, etc. The amount of pathophysiology and different protocols we are expected to remember is growing daily. When we are stressed, we use and process information differently, often making less than ideal decisions (2). Why not use checklists to help to offload information cognitively and allows us to be less stressed, thus making better decisions?
I spend time with some great combat medics, and a surprising aspect of their care is the use of checklists. They commonly talk about how they would use a laminated mechanism of injury, type of injury, signs, and treatment (MIST) report whenever requesting MEDEVACs, even though they spent hours training on calling for MEDEVACs. When under stress, they understood that being able to cognitively offload a simple task allowed them to have better focus and execute the job to the highest standard possible (3).
I think that the need for checklists is vital within EMS, and should be available for the procedures we perform, to include IV cannulation. Anything that someone says is easy, there should be a checklist. For example, needle chest decompressions are "easy," yet there is a multitude of pictures that show misplaced decompression needles in patients. The lack of procedural accuracy in this procedure has to lead to the discussion of how they are ineffective due to training, and a new process is needed. How about we develop a checklist, train on it, and use it to place decompression needles correctly, thus improving our patient outcomes and being the providers we all want to be!
Jason S PragMedic