In our simulation, the use of medical emergency cognitive aid (MECA) in medical emergency situations significantly reduced failure rates. The use of MECA was widely accepted, and MECA were easy to use.

In a high percentage, stress level of the participants was diminished.

Based on our data, an introduction of MECA at least for the ED, the intensive care unit and the in-hospital emergency response teams could be considered.

Additionally, MECAs could be used beforehand as teaching aids to avoid potentially fatal misinterpretations in an emergency.

Further studies should focus on the transferability to the pre-clinical sector or high-risk in-hospital settings (e.g., catheter laboratory) and their impact on the performance in key aspects (e.g., more benefit and less harm for patients).

MECA may lead to a destructive outcome. Therefore, one of the priorities in MECA/checklist implementations in the future should be how to secure the correct cognitive aid selection for a critical incident.

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