Implement / Use

Why Implement

Reasons institutions should institute an emergency manual (supported by published literature in multiple fields).

  • Medical simulation studies show that integrating an emergency manual into the operating room results in better management during crises events.
  • Pilots and nuclear power plant operators use similar cognitive aids for emergencies and rare events.
  • During a crisis event, the stacks of relevant literature are rarely accessible.
  • Memory worsens under stress and distractions interrupt our planned actions.
  • Expertise requires significant repetitive practice, so none of us are experts in every emergency.
  • Above, there’s a 10 minute video for leaders on why and how to implement Emergency Manuals.

Recent research suggests that Emergency Manual (EM) use improves teamwork, facilitates coordination, decreases stress, and enables delivery of better patient care. The Stanford EM, and other similar tools, are used effectively in both clinical and educational settings:

  • Pre-event for ‘just in time’ review for at-risk patients
  • During event for crisis management
  • Post-event for team debriefing


  • Self-review
  • 1:1 or small group teaching
  • Studying for oral exams
  • During simulation cases and debrief sessions

Implementation Toolkit

Provided in the toolkit below are a customizable implementation roadmap, broad considerations for clinical implementation, modifiable training resources, and answers to Frequently Asked Questions (FAQs) regarding implementation experience at Stanford, Harvard, and many other early-adopting institutions. These are provided in the context of a detailed literature search, iterative simulation testing of perioperative cognitive aids that started at Stanford in the late 1980s, and tips from many leading institutions that have implemented during the past decade. Please note that each institution is different and successful methods at one may not always apply to all. We look forward to hearing about your experiences, challenges, and successes.

Design Overview

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Customization & Permissions - Yes!

Research supports that local customization of cognitive aids is helpful for many reasons. We allow all needed modifications for use at your local institution, without further permissions.

  • You should keep original authorship attribution and add ‘Adapted By ___.’
  • For more than minor PDF modifications or local phone list for back cover, we suggest requesting our original InDesign file: Email
  • We are not responsible for any errors introduced and caution that there are usability cons to adding too much information.
  • No derivatives may be shared beyond local use without explicit permission (e.g. translations or hospital systems that contact us first), and all use must be non-commercial.

We use Creative Commons 4.0 International Licensing, With Attribution, Non-Commercial, and No Derivatives.
Click here to learn more about how to modify for your local institution.

Relevance for Every Healthcare Specialty

The downloadable pdf of this Emergency Manual is most relevant for the operating room, other anesthetizing locations, and perioperative acute care contexts (e.g. Recovery Room, ICU). However, the concept of emergency manuals and downloadable resources with implementation tips, Crisis Resource Management handouts, and other downloadable resources on this website may be broadly useful for champions of effective teamwork and emergency manual use in many healthcare specialties.


An emergency manual is a resource that contains sets of cognitive aids or checklists relevant for a specific clinical context. The term ‘emergency manual’ is purposefully used as a clear reference to a familiar and accessible emergency resource at the point of care. This term is parallel to the emergency section of ‘Flight Manuals’ for pilots and aviation crews. Operating rooms and other acute care settings now have many ‘checklists,’ including the helpful and widespread WHO surgical safety checklist. The term ‘cognitive aid’ is the longstanding academic term encompassing all resources that help people to remember or apply relevant knowledge appropriately. However, this term is often not yet well understood by many practicing clinicians. Naming this context-relevant book ‘emergency manual’ quickly developed broad cultural acceptance among interdisciplinary clinical team members. Nurses are using empowering questions, such as “Should I get you the Emergency Manual?” and team leaders are assigning a ‘reader’ role for complicated events such as Pulseless Electrical Activity (PEA) cardiac arrest.


The material in this Manual is not intended to be a substitute for sound medical knowledge and training. Clinicians using this Manual should use their clinical judgment and decision making for patient management. Since treatment for the medical conditions described in this Manual can have variable presentations, departure from the information presented here is encouraged as appropriate.

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