Wednesday, 27 November 2013

Medical Practice at a Flying Doctor's Remote Site Clinic

Leading the team of medical personnel under the auspices of Flying Doctors Nigeria, our primary medical service is to respond quickly to any medical emergencies that may ensue from oil and gas exploration process. We also run a clinic where ailments like malaria, Respiratory Tract Infections e. t. c and some Chronic Medical conditions are attended to, to forestall complications. 

Exploration and Production as parts of upstream sector of oil and gas are the major activities embarked on in this field.
The oil and gas exploration site where we attend to patients is a marginal field still at the early production facility (EPF) phase located about ten minutes from the residential camp.
As a resident doctor in conjunction with other medical personnel, we do embark on a routine patrol with our well equipped Ambulance from the residential camp where the Clinic is located to the exploration site. 
Indigenous contractors and also Expatriates from Europe and Asia are the Clients who have been benefiting from our medical coverage. Weekly up to date reports of medical emergencies vis-à-vis clinic attendance are relayed to our head office for expertise feedback.

Since inception of my practice on site, there has not been any overwhelming medical emergency necessitating the need for medical evacuation. However there have been cases of referral to a nearby hospital from the site clinic for further management. 
The major challenges encountered on the field ranges from intermittent unrest on the part of host community to a complete disconnect from the larger society.
Remote site medical coverage in oil and gas is a worthwhile experience that will forever linger in my memory.

Dr Wale Amerijoye

Flying Doctors Nigeria.

Wednesday, 23 October 2013

Every Second; A Night in the Middle East

This is a column that will be featured on our blog every month titled 'EVERY SECOND' and it is going to be a  series of  brief personal accounts by our flying doctors on some of the evacuations we have undertaken.
This is a personal account by Dr Tolu Taiwo, one of the doctors of Flying Doctors Nigeria team.
One of our first international evacuations this year was a really hectic one. We had to transfer a critically ill, elderly patient via air ambulance from Lagos to the Middle-East under strict intensive care. All hands had to be on deck, from the trauma physicians, support staff to the cabin crew, to ensure the patient was successfully taken home alive. Even the equipment were not left out as they worked full time - the monitors, infusion pump, ventilator, oxygen tanks and the rest – while the required drugs and infusions were continuously administered.
Matters were only made more arduous as we could not fly directly to the destination since we were not allowed to fly over Libya considering it was still a no-fly zone. The implication was that we had to take a longer route and stop over at Khartoum, Sudan, adding more precious hours to the already critical journey.
But, all’s well that ends well, as we delivered the patient to the family alive. We could heave a sigh of relief with a sense of fulfillment as we rested for the night to fly back to Lagos the following morning. Mission accomplished in the Middle-East!  

Thursday, 19 September 2013

Every Second Counts; An Account of a Flying Doctor's Nigerian Evacuation

This is another concise report of a Flying Doctor from our team of Flying Doctors Nigeria on one of our evacuations in this second quarter of 2013.


The index patient is a Nigerian, well schooled and highly experienced with a penchant for acquiring knowledge of any subject of Human Endeavour.

On receiving the emergency call, our team was immediately assembled, equipments were checked and double-checked, these include; airway management devices, drugs, intravenous fluids, equipments for emergency resuscitation (ALS), patient transfer equipments (stretcher /special vacuum mattress). International passports with appropriate visa availability also crossed-checked. The aircraft (fixed-wing) challenger jet, that we were using as an air ambulance for our medvac with experienced and polite crew members made ready on red alert.

An advance-party (experienced flying doctor Nigeria health personnel) sent ahead to ensure co-ordination of the stabilization of the patient prior to evacuation by air.

Primary survey on ground revealed a non intubated patient, breathing spontaneously but with difficulty. However, patient suffered an acute exacerbation of his condition while being secured for the flight but was treated successfully with aminophyline and hydrocortisone injected intravenously.

The Flying Doctors’ Senior Flight Physician (my humble self) was also in attendance until patient was fully handed over and admitted into the I.C.U. before signing-off after yet another challenging but successful air ambulance Medevac.

An account by;

DR RAJI A. VICTOR MBBS,AFMC,ALS. (Senior flight physician FDN)

Tuesday, 3 September 2013

At the Speed of Life: The Importance of Rapid Response


 Chances are very good that if you have never had to use the services of an air ambulance or medical transport you might never have heard of it. In a nutshell, an air ambulance is an aircraft that has had its interior specially configured so it can operate as a mobile hospital complete with intensive care unit. 


Also an air ambulance can be seen as a specially outfitted aircraft that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance. 

Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications, ventilators, ECGs and monitoring units, CPR equipment, and stretchers. A medically staffed and equipped air ambulance provides medical care in flight which is referred to as medical evacuation (MEDEVAC)
Air ambulance services have established their usefulness in other countries, but their role in Nigeria is developing slowly.
With the awareness of the importance of air ambulance services, the services will be provided to different types of patients, with different ailments and accidents at different locations. This will bring about the reduction of the mortality rates of the patients in question.
If you ever found yourself in either a remote location or in an area of Nigeria that doesn’t offer the specialized medical emergency care you or your family need, this is when the expertise of an air ambulance comes to the forefront of your mind. 

Timely response via Air ambulance is very important in Nigeria because we have cities that simply don’t have good roads that are good enough to accommodate a traditional ambulance all the time.
Also, our bigger cities seem to be overcrowded which brings about traffic. Traffic can cause the death of a patient in a critical condition. Immediately a patient overwhelms the level of medical care at any healthcare centre, such a patient needs timely response to get to the other healthcare centre that suits his condition. The transfer needs to be done at the speed of life. Every second that leads to a minute matters in this process.

The importance of timely response in Nigeria via Air Ambulance cannot be over emphasized. It cuts the issue of traffic and any form of road transport delay.
Even though the services of air ambulances are offered 24 hours a day, seven days a week, 365 days a year, it is better to be prepared. Being prepared could be as simple as contacting a potential service provider like “Flying Doctors Nigeria”, speaking with the medical specialist and describing not only your current health issues – if any – but also the location to which you are traveling. Doing this will not only save you precious time in the event of an emergency but it will help you know how long it could take for a provider to reach you in the event of an emergency evacuation. While it is unlikely that you will need a medical evacuation, it’s better to be prepared.

Tuesday, 27 August 2013

Giving Trauma Victims A Chance Of Survival ; Dr Ola Orekunrin Of Flying Doctors Nigeria On CNBC Africa!

Dr Ola Orekunrin, Medical Director and Founder, Flying Doctors Nigeria 

It is no news that the medical director and Founder of Flying Doctors Nigeria, Dr Ola Orekunrin has a strong passion for saving lives and educating people on the importance of emergency evacuation services. She is an advocate for preparing well in advance for the possible use of air ambulances and flying doctors who make it possible for lives to be saved.

In a recent interview with CNBC Africa, Dr Ola talked about the effects of medical trauma in low income African countries and how this accounts for majority of the deaths in Africa. She also talked about the need for emergency air evacuation services.

Click HERE to watch Dr Ola's interview on CNBC Africa

Monday, 15 April 2013

When the Heart Stops...

When your heart stops beating, chances of recovery diminish by the second. This is extremely important for people who work in remote locations. Although air ambulances can save lives, there is still unfortunately a wait to pass through before they arrive.

There are many things that can cause the heart to stop not just ischemic heart disease. The heart runs on an internal electrical system that regulates the rate and rhythm of the heart beat. From time to time, the electrical system can have problems, causing abnormal rhythms called arrhythmias. Some arrhythmias can cause the heart to stop pumping blood, causing sudden cardiac arrest. This can happen to anyone.  You, you staff, your friends or colleagues.

Now, it is important for us to know that cardiac arrest is not synonymous to a heart attack. However, a cardiac arrest may be a complication of a heart attack. Although, people with heart problems have a high risk of Sudden Cardiac Arrest, most Sudden Cardiac Arrests happen in completely healthy people with no history of heart disease.
  There are many things that can interfere with the heart’s electrical system and these are:

  • Coronary heart disease (CAD)/Heart attack
  • Electric shock/electrocution. 
  • Respiratory arrest. 
  • Overdose on certain drugs. 
  • Trauma

What are the signs of a stopped heart?
According to the American Heart Association (AHA), the warning signs are;

  • Loss of consciousness
  • Cessation of normal breathing
  • Absence of pulse
  • Absence of blood pressure

Death occurs within 4 to 6 minutes after the heart stops. It is estimated that 95% of such cases result in death.

How can a stopped heart be reversed?
In a situation like this, every second counts. To save the patient, it is imperative that the heart be restarted as soon as possible. It can happen that heart function is restored but brain death has already set in due to interruption of blood and oxygen supply.

There are several ways to restore a normal heartbeat:
Electric shock using defibrillators, a scene that we often see in emergency rooms. In settings away from hospitals, the use of automated external defibrillators (AEDs) has saved many lives.
Cardiopulmonary resuscitation (CPR) is to manually restore the heart beat by applying pressure on the chest region.
According to the AHA ,
A stopped heart can be reversed if it’s treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation.

Defibrilation is a common treatment for life-threatening cardiac dysrhythmias, ventricular fibrillation, and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator. Defibrillators can be external, transvenous, or implanted, depending on the type of device used or needed. Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little or in some cases no training Defibrillation at all.

A victim’s chances of survival are reduced by 7 to 10 percent with every minute that passes without defibrillation and cardiopulmonary resuscitation(CPR). Few attempts at resuscitation succeed after 10 minutes… It’s estimated that more than 95% of stopped heart victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden stopped heart is as high as 30-45 percent.

Because a stopped heart is very time critical, waiting for emergency services to arrive may be too late. This is why Automated External Defibrilators are available in crowded public places, e.g. airports, sports stadiums, public events where people gather.

The Flying Doctors Nigeria can supply AED’s and train your staff to use them, we can also provide essential air ambulance transportation to facilities where essential post-cardiac arrest treatment can be obtained.

To learn more, visit our website www.flyingdoctorsnigeria or email us:, sales@|,

Wednesday, 10 April 2013

Flying doctors Nigeria Empowers Medical Students with Award

The Flying Doctors Nigeria, medical director and founder, Dr Ola Orekunrin has together with her FDN team, come up with an initiative to help encourage medical students and they have come up with a project where medical students research and write an essay on a topic given by Flying Doctors Nigeria to  the students.
The project is to appreciate and reward excellence in research skills of medical students and for Flying Doctors Nigeria to help improve the Nigerian medical system starting with the students.
This year's essay topic was titled 'why Nigerians die' and over 20 medical students from Lasuth and Medilag sent in amazing essays from which the best 4 were chosen. The award ceremony organized by Flying Doctors Nigeria held on the 28th of march,2013 at the LASUTH auditorium.
The awards played host to medical students from lasuth and medilag as well as some medical professors and a representative of the provost of LASUTH. Dr Ola Orekunrin gave a speech on why Nigerians die from a medical perspective and educated the students on how they can help change and improve the medical system in  Nigeria.The 4  medical students whose essay were chosen as the top 4 were called to each give a minuite speech on why Nigerians die as well.
The winner of the essay competition was a 300L student from medilag, Ade-Akingboye Opemipo and she was presented with a cheque of 100,000 Naira given by Flying Doctors Nigeria.

Flying Doctors Nigeria plans to make this an annual event and hopes to get more medical students from all medical schools across Nigeria to participate.

Thursday, 21 March 2013

Founder of Flying Doctors Nigeria, Dr Ola Orekunrin Listed As a Young, Global Leader by the World Economic Forum

Every year, the honour of being a 'young global leader' is bestowed by the world economic forum to distinguished and inspiring individuals below the age of 40 years.
The young global leaders is a global network of peers from diverse backgrounds and fields, with the goal of significantly impacting world affairs and shaping the global agenda. It is a forum for young leaders to be a voice for the future and change agents for positive action.
2013 is proving to be a good year globally for Nigeria and Africa as a whole as distinguished and creative Africans, including Nigerians, have been recognized in this year's list of Young Global Leaders at the World Economic Forum.
Flying Doctors Nigeria's medical director and founder, Dr Ola Orekunrin, who is barely 27 years old is one of the few Nigerians that have been honoured by the world economic forum,2013. she made the list alongside other young creative Nigerians like Cobhams Asuquo, Tara Durotoye and Alex Okosi.
The Young Global Leader nominations is a "recognition of your record of professional accomplishments, your commitment to society and your potential to contribute to shaping the future of the world through your inspiring leadership”.
Dr Ola is a medical doctor and a trained helicopter pilot who started flying doctors Nigeria at the very young age of 24 years old.she was recently featured on the forbe's list of 30 best Young African Entrepreneurs under the age of 30 and has been a recipient of numerous awards for excellence within and outside Nigeria.
Her aim as a flying doctor is to help save lives in Nigeria and beyond.

Tuesday, 19 March 2013

Highlights of the Nigerian Oil and Gas Conference 2013

 1. Nigeria's Oil And Gas Strategy In The Next Five Years- A New Dawn To Boost Investment And Production?

  • What are the next steps to Nigeria's oil and gas production?
  • How are the global economic crisis and uncertain oil prices impacting Nigeria?
  • How can Nigeria continue to attract investment amidst competition from other sub-Saharan African countries?
 2: Leading Lights Session
  • What is required to make Nigeria's oil and gas industry globally competitive?
  • How can countries place themselves in equal footing with other competitive resource holders?
  • Best practices in defining policy options

3: Setting Nigeria's Oil and Gas  Industry In A Domestic And Global Context- What Are The Challenges And Opportunities Ahead?
  • How are the global economic crisis and uncertain oil prices impacting Nigeria?
  • How can Nigeria continue to attract investment amidst competition from other Sub-Saharan African countries?
  • Creating an enabling environment for investment to boost oil and gas production
4: Revamping Nigeria's Oil and Gas Industry Through Increased Investment- From Upstream To Downstream
  • Boosting deep water production- what is needed to enhance investment in sector?
  • How can more players enter into deep water operations?
  • What is the best business model for the refining sector and how can private equity be obtained?

5: Panel Discussion; Gas, Power and Renewable- What Has Been Achieved And Where Are We Heading?
  • What has been achieved so far in terms of investment in the gas and power industries?
  • What is the financing strategy for domestic gas infrastructure
  • What progress has been made in electricity sector reform?
6: Leader's Panel; The Nigerian Oil And Gas Industry Moving Forward- What Are The Next Steps?
  • How will joint ventures evolve in Nigeria going forward?
  • Where will the drive for new exploration projects be?
  • Development plans in deep water projects
  • How will the PIB impact future E&P activities in  Nigeria
7: Focus On Independents; How Are Indigenous Companies Transforming The Nigerian Oil And Gas Industry?
  • Creating an enabling environment to encourage Nigerian Companies to enter and expand operations 
  • What are the fiscal and regulatory incentives that indigenous companies require?
  • How can indigenous companies access the technical know-how and financing to further their operations?
  • The divestment process from IOCs to indigenous companies: success and pitfalls?
8: Oil And Gas Stakeholders Forum; Community participation- What Has Been Achieved In Creating Win-Win Solutions For All Stakeholders In The Niger-Delta Region?
  • How are HSE initiatives impacting security in the Niger Delta Region
9: Focus on Petroleum Industry Bill- Is this A New Dawn For Nigeria?
CHAIR: Adeoye Adefulu, Partner, Odunjunrin & Adefulu
  • How will the PIB be implemented?
  • To what extent will the new fiscal terms encourage investments in deep water operations and increase production?
  • What is the impact of the PIB on indigenous Oil and Gas companies and what incentives exist?
  • What is the impact of the PIB on natural gas development projects?
10: Financing For Energy projects Along The Value Chain. What Are The Structures In Place?
  • What domestic and international markets are readily available for financial institutions in Nigeria to fund oil and gas projects?
  • What risks do bankers face in funding E&P project and what kinds of structures are used?
  • What is the appropriate framework for financing gas to power project?
  • What is the most effective ways for indigenous oil service companies to access funding in a typical Nigerian financial market? case study: The shell kobo fund.
  • How can downstream sector in Nigeria be financed sustain-ably?
11: Nigeria Content implementation So Far; How Do Different Stakeholders Interpret The Nigerian Content Act?
  • What has been achieved in Nigeria content implementation so far and what else needs to be done?
  • How have oil and gas divestment of assets boosted Nigerian content?
  • Lessons learnt from around the globe, how can Nigeria continue to succeed in Nigeria content implementation?
12: What Are The Legal And Operational Challenges And Opportunities Of Nigerian Content?
  • How can indigenous companies access adequate funding?
  • Implementing training to fill the skills gap
  • What support do suppliers need to meet operation requirements?
  • Improving the effectiveness of local contractors through technology transfer
  • Lowering costs through procurement and contracting strategies

13: What Are The Challenges And Opportunities Of Complying With Nigeria Content Requirement?
  • How do Nigeria content regulations provide a source of business opportunities?
  • How can indigenous companies access the technical know-how and training to further their operations?
  • What needs to be done to reach Nigeria content targets?
14: Human Capacity Development And HSE
  • Developing human capacity in the Nigerian Oil and Gas Industry
  • Remote health care in the Nigerian Oil and Gas industry (Dr Ola Orekunrin, Medical Director of Flying Doctors Nigeria)
  • Nigeria: A systematic approach to managing fire safety on offshore installations
15: Gas To Power And Alternative Sources
  • Flare gas to power initiative in the Niger- Delta
  • Electricity provision to the host community MPNS sustain-ably and reliability 
  • The development of industrial estates powered by gas in non-producing oil and gas regions
  • Review on Methane Hydrate; A cost efficient potential source of future Energy
  • Gas process for power generation
  • The Nigeria midstream challenge caterpillar dynamic gas blending reducing and fuel cost 
16: Deep Water Engineering And Maintenance

  • Addressing challenge for unconventional gas condition using advanced integrated technology
  • Design for reliability in subsea production control systems
  • Oil and Gas asset life extensive
  • Asset integrity corrosion survey system
  • Flow assurance news innovating ways to manage your MEG reclamation and regeneration with pure mega

17: Flare Reduction And Gas Gathering Technology
  • Critical overview of gas flaring reduction in Nigeria Oil sector and its challenges
  • Safe and increased protection without extra flare load: has integrity pressure protection system
  • FPSO system with integrated GTL solution for associated gas
  • Associated gas haring reduction
  • A cost efferent solution for flare gas recovery
  • Innovating rotary slide drilling system: an indigenous rotary steer able system alternative.

Friday, 8 March 2013

Air Ambulances - Their Importance and Value

Have you ever heard of air ambulances? Well if not then, air ambulances are specialized aircraft where the interior has been configured as a mobile Intensive Care Unit, ICU. They are used when a more traditional means of medical transportation cannot be used to rescue a patient and transport him or her to the nearest hospital and are a new concept that is gaining a lot of importance and popularity.
Helicopters are the main form of this medical transportation, but now private Corporate Jets are also gaining a lot of popularity due to their flexibility, range, reliability, and flight comfort. This type of aircraft is significantly more flexible then other types of aircraft because of their ability to be configured with the latest intensive care unit equipment, these jets are well suited for transporting patients long distances, quickly, comfortable, and safely.
Fixed wing jet aircraft are best for transporting people who have had severe accidents or have fallen ill where they cannot be transported by conventional means either because of time or distance.For instance,An example would be during winter sports athletic competitions where there is a high probably for the competitors to face serious accidents during playing winter games.
Air ambulances are very well equipped with medical items and the quantities of medicine and specialized equipment are tailored for each specific mission. By reducing the amount of excess equipment the airplane carrying we are able to reduce the amount of weight that the aircraft has to carry. An example of this mission tailoring would be not bringing a kidney dialysis machine on a mission to transport someone who has a broken leg. All carry some standard equipment such as ventilators, CPR's, ECG's, monitoring units etc. All this equipment allows the crews to monitor and stabilize the patients till they reach to the hospital.
You do not need to worry about whether or not the crews onboard the aircraft are efficient and are very well trained. The crew knows how to handle a patient to stabilize their condition before they reach to a safe location. The crews are a team who know how to work together as a team and have the medical and flying experience. They have the experience and the training to stop profuse blood flood, any crushes and falling, cardio attack any many more.
The services that are offered by air ambulances are available 24 hours a day and seven days a week which means that whenever you call them you will be able to report to them regarding where you are stuck or have fallen ill. These services are provided for people who are within the local country or somewhere outside which means internationally as well. Once the advocate or the patient is able to contact the medical transportation provider, the flight coordinator will decide how urgent the situation is and what kind of medical treatment is needed for the patient to stabilize them before he or she is admitted to the hospital.
Air ambulances are also called Aero-medical evacuation, Medevac, Airevac, and Medical Flight. There are many different agencies that own or one can say operate aircraft configured as ambulances. Two of the main agencies are the government and those owned by private enterprise agencies.
Written by John Bohn, a professional pilot with Mercy Jets.

Article Source:

Wednesday, 20 February 2013

The Nigerian Oil & Gas Industry welcome Flying Doctors Nigeria

For Immediate Release

Lagos, Nigeria

February 20, 2013


            Flying Doctors Nigeria, the leading air ambulance service in Nigeria is available for emergency services and general health care services 24 hours a day and 365 days a year.

With a competent medical and aviation team of experts, flying doctors Nigeria provides prompt response to distress calls throughout the 36 states of the country.

Flying Doctors Nigeria is sensitive to the emergency needs of oil and gas workers who are mostimes located in remote/offshore areas where prompt medical services are lacking. Following this, Flying Doctors Nigeria wishes to partner with the Nigerian oil and Gas industry to be able to provide the necessary and immediate health services to its workers in the case of emergencies that occur in their offshore/remote locations.

Flying Doctors Nigeria is always looking to inform and educate Nigerian oil and gas industry workers/stakeholders…e.t.c on the importance and necessity of having prompt medical services in a continually growing industry like ours.

As the Nigerian oil and gas industry holds it conference in Abuja from the 18th of FEB to the 21st of FEB 2013, Flying doctors Nigeria has been invited to speak in one of its session on ‘INNOVATIONS IN REMOTE SITE HEALTH CARE FOR THE OIL AND GAS INDUSTRY’.

On the 21st Feb. 2013, speaking on behalf of Flying Doctors Nigeria will be its medical director, Dr Ola Orekunrin who has a vast medical experience and is also very familiar with the aviation industry as she doubles as a pilot as well.

The session which will take place at the international conference center, Abuja promises to be highly stimulating and also features a Flying Doctors Nigeria exhibition booth for guests to visit.

For more information and enquiries on the speaking engagement please call; 07069201299 or 08023339911.

For more information and enquiries on flying doctors Nigeria, please visit
For all press matters please contact
Noka Agudah
The Bobby Taylor Company 
P: 08025869032

Tuesday, 19 February 2013

The Importance of a Surgical Safety Checklist...


Surgical care is an integral part of health care throughout the world, with an estimated 234 million operations performed annually. This yearly volume now exceeds that of childbirth. Surgery is performed in every community: wealthy and poor, rural and urban, and in all regions. The World Bank reported that in 2002, an estimated 164 million disability-adjusted life-years, representing 11% of the entire disease burden, were attributable to surgically treatable conditions. Although surgical care can prevent loss of life or limb, it is also associated with a considerable risk of complications and death. The risk of complications is poorly characterized in many parts of the world, but studies in industrialized countries have shown a perioperative rate of death from inpatient surgery of 0.4 to 0.8% and a rate of major complications of 3 to 17%. These rates are likely to be much higher in developing countries. Thus, surgical care and its attendant complications represent a substantial burden of disease worthy of attention from the public health community worldwide.

Data suggest that at least half of all surgical complications are avoidable. Previous efforts to implement practices designed to reduce surgical-site infections or anesthesia-related mishaps have been shown to reduce complications significantly. A growing body of evidence also links teamwork in surgery to improved outcomes, with high-functioning teams achieving significantly reduced rates of adverse events.

In 2008, the World Health Organization (WHO) published guidelines identifying multiple recommended practices to ensure the safety of surgical patients worldwide. On the basis of these guidelines, a team of medical experts in America designed a 19-item checklist intended to be globally applicable and to reduce the rate of major surgical complications. They hypothesized that implementation of this checklist and the associated culture changes it signified would reduce the rates of death and major complications after surgery in diverse settings.


Study Design

They conducted a prospective study of preintervention and postintervention periods at the eight hospitals participating as pilot sites in the Safe Surgery Saves Lives program. Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. These institutions were selected on the basis of their geographic distribution within WHO regions, with the goal of representing a diverse set of socioeconomic environments in which surgery is performed. Each hospital identified between one and four operating rooms to serve as study rooms. Patients who were 16 years of age or older and were undergoing non-cardiac surgery in those rooms were consecutively enrolled in the study.


The intervention involved a two-step checklist-implementation program. After collecting baseline data, each local investigator was given information about areas of identified deficiencies and was then asked to implement the 19-item WHO safe-surgery checklist to improve practices within the institution. The checklist consists of an oral confirmation by surgical teams of the completion of the basic steps for ensuring safe delivery of anesthesia, prophylaxis against infection, effective teamwork, and other essential practices in surgery. It is used at three critical junctures in care: before anesthesia is administered, immediately before incision, and before the patient is taken out of the operating room.

Data Collection

Perioperative data included the demographic characteristics of patients, procedural data, type of anesthetic used, and safety data. Data collectors followed patients prospectively until discharge or for 30 days, whichever came first, for death and complications. Outcomes were identified through chart monitoring and communication with clinical staff.

They enrolled 3733 patients during the baseline period and 3955 patients after implementation of the checklist.


The primary end point was the occurrence of any major complication, including death, during the period of postoperative hospitalization, up to 30 days. Complications were defined as they are in the American College of Surgeons' National Surgical Quality Improvement Program: acute renal failure, bleeding requiring the transfusion of 4 or more units of red cells within the first 72 hours after surgery, cardiac arrest requiring cardiopulmonary resuscitation, coma of 24 hours' duration or more, deep-vein thrombosis, myocardial infarction, unplanned intubation, ventilator use for 48 hours or more, pneumonia, pulmonary embolism, stroke, major disruption of wound, infection of surgical site, sepsis, septic shock, the systemic inflammatory response syndrome, unplanned return to the operating room, vascular graft failure, and death. Urinary tract infection was not considered a major complication. A group of physician reviewers determined, by consensus, whether postoperative events reported as “other complications” qualified as major complications, using the Clavien classification for guidance.

They assessed adherence to a subgroup of six safety measures as an indicator of process adherence. The six measures were the objective evaluation and documentation of the status of the patient's airway before administration of the anesthetic; the use of pulse oximetry at the time of initiation of anesthesia; the presence of at least two peripheral intravenous catheters or a central venous catheter before incision in cases involving an estimated blood loss of 500 ml or more; the administration of prophylactic antibiotics within 60 minutes before incision except in the case of preexisting infection, a procedure not involving incision, or a contaminated operative field; oral confirmation, immediately before incision, of the identity of the patient, the operative site, and the procedure to be performed; and completion of a sponge count at the end of the procedure, if an incision was made. They recorded whether all six of these safety measures were taken for each patient.


Introduction of the WHO Surgical Safety Checklist into operating rooms in eight diverse hospitals was associated with marked improvements in surgical outcomes. Postoperative complication rates fell by 36% on average, and death rates fell by a similar amount. All sites had a reduction in the rate of major postoperative complications, with a significant reduction at three sites, one in a high-income location and two in lower-income locations. The reduction in complications was maintained when the analysis was adjusted for case-mix variables. In addition, although the effect of the intervention was stronger at some sites than at others, no single site was responsible for the overall effect, nor was the effect confined to high-income or low-income sites exclusively. The reduction in the rates of death and complications suggests that the checklist program can improve the safety of surgical patients in diverse clinical and economic environments.

Whereas the evidence of improvement in surgical outcomes is substantial and robust, the exact mechanism of improvement is less clear and most likely multifactorial. Use of the checklist involved both changes in systems and changes in the behavior of individual surgical teams. To implement the checklist, all sites had to introduce a formal pause in care during surgery for preoperative team introductions and briefings and postoperative debriefings, team practices that have previously been shown to be associated with improved safety processes and attitude and with a rate of complications and death reduced by as much as 80%. The philosophy of ensuring the correct identity of the patient and site through preoperative site marking, oral confirmation in the operating room, and other measures proved to be new to most of the study hospitals.

In addition, institution of the checklist required changes in systems at three institutions, in order to change the location of administration of antibiotics. Checklist implementation encouraged the administration of antibiotics in the operating room rather than in the preoperative wards, where delays are frequent. The checklist provided additional oral confirmation of appropriate antibiotic use, increasing the adherence rate from 56 to 83%; this intervention alone has been shown to reduce the rate of surgical-site infection by 33 to 88%. Other potentially lifesaving measures were also more likely to be instituted, including an objective airway evaluation and use of pulse oximetry, though the change in these measures was less dramatic. Although the omission of individual steps was still frequent, overall adherence to the subgroup of six safety indicators increased by two thirds. The sum of these individual systemic and behavioral changes could account for the improvements observed.

Another mechanism, however, could be the Hawthorne effect, an improvement in performance due to subjects' knowledge of being observed. The contribution of the Hawthorne effect is difficult to disentangle in this study. The checklist is orally performed by peers and is intentionally designed to create a collective awareness among surgical teams about whether safety processes are being completed. However, their analysis does show that the presence of study personnel in the operating room was not responsible for the change in the rate of complications.

This study has several limitations. The design, involving a comparison of preintervention data with postintervention data and the consecutive recruitment of the two groups of patients from the same operating rooms at the same hospitals, was chosen because it was not possible to randomly assign the use of the checklist to specific operating rooms without significant cross-contamination. One danger of this design is confounding by secular trends. They therefore confined the duration of the study to less than 1 year, since a change in outcomes of the observed magnitude is unlikely to occur in such a short period as a result of secular trends alone. In addition, an evaluation of the American College of Surgeons' National Surgical Quality Improvement Program cohort in the United States during 2007 did not reveal a substantial change in the rate of death and complications. They also found no change in their study groups with regard to the rates of urgent cases, outpatient surgery, or use of general anesthetic, and they found that changes in the case mix had no effect on the significance of the outcomes. Other temporal effects, such as seasonal variation and the timing of surgical training periods, were mitigated, since the study sites are geographically mixed and have different cycles of surgical training. Therefore, it is unlikely that a temporal trend was responsible for the difference they observed between the two groups in this study.

Another limitation of the study is that data collection was restricted to inpatient complications. The effect of the intervention on outpatient complications is not known. This limitation is particularly relevant to patients undergoing outpatient procedures, for whom the collection of outcome data ceased on their discharge from the hospital on the day of the procedure, resulting in an underestimation of the rates of complications. In addition, data collectors were trained in the identification of complications and collection of complications data at the beginning of the study. There may have been a learning curve in the process of collecting the data. However, if this were the case, it is likely that increasing numbers of complications would be identified as the study progressed, which would bias the results in the direction of an underestimation of the effect.

One additional concern is how feasible the checklist intervention might be for other hospitals. Implementation proved neither costly nor lengthy. All sites were able to introduce the checklist over a period of 1 week to 1 month. Only two of the safety measures in the checklist entail the commitment of significant resources: use of pulse oximetry and use of prophylactic antibiotics. Both were available at all the sites, including the low-income sites, before the intervention, although their use was inconsistent.

Surgical complications are a considerable cause of death and disability around the world. They are devastating to patients, costly to health care systems, and often preventable, though their prevention typically requires a change in systems and individual behavior. In this study, a checklist-based program was associated with a significant decline in the rate of complications and death from surgery in a diverse group of institutions around the world. Applied on a global basis, and especially in developing countries like Nigeria, this checklist program has the potential to prevent large numbers of deaths and disabling complications, although further study is needed to determine the precise mechanism and durability of the effect in specific settings.

Adapted from The New England Journal of Medicine.