Patient Handoff

As an EMT there are typically two phases to handing off a patient to the next level of care - the initial call into the hospital (often called the "Ring Down") and the final transfer when the patient is formally transitioned into the care of the ED.

Ring Down[edit | edit source]

The "Ring Down" is a call to the hospital to which you are transporting a patient. The goal of this communication is to notify the receiving facility of the patient's chief complaint and condition to allow them to prepare appropriate staff and equipment. The report should follow your local EMS protocols but most include the following pertinent data:

• Unit's identification and level of service (ALS or BLS)
• Estimated time of arrival (ETA)
• Patient's age and gender (do not broadcast the patient's name on a radio communication)
• Chief complaint, severity and brief history of present illness
• Pertinent past medical history (major past illness, or relevant chronic illness like diabetes)
• Pertinent scene assessment findings and mechanism of injury (i.e. fall, or motor vehicle accident)
• Patient's mental status
• Brief report of findings of the physical exam including LOC and vital signs (baseline)
• Brief summary of treatment provided
• Patient's response to treatment

Much of this information should already be in your Patient Care Report (PCR) but you are not relaying the entire record - just the most relevant highlights

Key tips:

• Keep the transmission brief
• Speak at a reasonable pace
• Do not use names, the airwaves are public
• Do not provide your opinion, or a diagnosis, or commentary on the patient
• When you are finished transmitting, indicate this by saying "over". Avoid using slang, unapproved abbreviations, or agency specific codes
  • When utilizing "over" and "out" during radio transmission, "over" signifies a turnover of radio traffic to the other side, allowing them to respond to a question or add further information. "Out" signifies the end of the transmission.

Full Hand Off[edit | edit source]

When handing off patient care to the next level of care the goal is efficient, effective and error-free transfer of information along with the patient. For the next healthcare provider team to be effective immediately at handoff, they need to understand:

1. What is the crux of the patient's problem? (Describe the signs and symptoms, not your diagnosis)
2. What (and how serious) is the patient's current state? (ABCs, physical exam results, vital signs, mental status, and trends)
3. What care has already been provided and what effect has it had? (include times administered, and timing of responses)
4. What are the patient's immediate needs? (include pertinent negatives such as medication allergies)

A clear, organized presentation of the data you have questions quickly and efficiently will not just help avoid errors and misunderstandings, it will provide a handoff that allows receiving clinicians to "pick up the ball" and continue progress in patient care rather than spending time with unnecessary questions and clarifications—or, even worse, beginning a patient interview and assessment basically from scratch.

You may use mnemonics such as I-PASS, SBAR, or MIST to structure your report, but it is more important that it be consistently structured than which particular mnemonic you use.

This hand off can occur when giving the patient to the same or higher level of care in the field (BLS to ALS or Fire Department to Ambulance) or in the hospital (Ambulance to RN or MD).

Documentation[edit | edit source]

• "Turnover report given to RN/ALS paramedic/Trauma team/Firefighter, patient care transferred."

Self Assessment[edit | edit source]

Tips and Tricks[edit | edit source]

1. In the early stages of your career, giving a handoff report will feel awkward and may come out stunted. If you want to fix this sooner than later, practice your handoffs or practice gathering all necessary information for every patient, even if you are not the primary caregiver. In the ALS setting, a trauma patient requires a trauma team of 8-10 higher level providers, oftentimes including several doctors. Handoffs to a trauma team should take place in 60 seconds or less and are oftentimes the most difficult part of the trauma call for new paramedics. If you plan on becoming a paramedic, practice your "normal" handoff so that you do not have to think as much during a more critical situation.