Cardiac & Resuscitation

Checklist Helps Wake County EMS Improve Cardiac Arrest Care Delivery

What do surgeons, pilots and engineers have in common? Each has drastically improved success rates and increased efficiency by using checklists.1 The EMS industry, thanks to the work of Shaughn Maxwell, an EMS 10 Innovator of the Year award winner, captain and medical services officer for Snohomish County Fire District 1 in Everett, Wash., is now moving to the use of checklists to improve efficiency and the care delivered to their patients.2,3 (See Maxwell’s article, “The Value of Checklists,” in June JEMS.)

Wake County EMS has adopted the use of checklists, applying them to the management of patients in cardiac arrest as well as other serious patient conditions. There are four major benefits of implementing checklists:

1. increased consistency in treatment;

2. reduction of errors;

3. improved coordination; and

4. increased clinical focus of providers.

When working a cardiac arrest, there are a multitude of complex tasks to be completed. Wake County EMS saw a need and developed a pre- and post-ROSC checklist to assist in managing these complex cases and assist in improving resuscitation success rates.

The checklist (see checklist download below) focuses on key performance indicators, customer service objectives and commonly omitted tasks. The pre- and post-ROSC checklist is easily accessible in every cardiac monitor in the system. During a cardiac arrest, providers go through the checklist at intermittent intervals or whenever there is a change in the patient’s status.

The checklist includes reminders for intra-arrest and post-arrest management, such as the appointment of a code commander, continuous monitoring of pulses, removal of the ResQPOD impedance threshold device (ITD), the acquisition of an ECG after ROSC, as well as attending to the needs of grieving family members.

Since the launch of this specialized checklist, Wake County EMS has observed an increase in the standardization of care for cardiac arrest patients. This systematic approach has promoted teamwork and collaboration. Because the checklist addresses technical and peripheral tasks, it enables delegation that allows for increased clinical focus by the code commander and other providers.

As with any change there may be some initial resistance. However, after consistently proving their worth among all variations of cardiac arrest calls, checklists have been fully embraced by the employees at Wake County EMS. The system’s steadily increasing cardiac survival rate adds validity to the practice.

Download the checkists as a PDF here:


1. Maxwell S. The Value of Checklists: We’ve had the solution all along. JEMS. 2014;39(6):54–57.
2. Arriaga A, Bader A, Wong J, et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013;368(3):246–253.
3. Gawande A. 2010. The checklist manifesto: How to get things right. Metropolitan Books: New York, 2009.