3.3 Patient Handoff

A perfect cabin resuscitation can still fail at the door. The receiving team cannot manage what you do not tell them, and they will not hear a twenty-minute narrative in a bay already moving toward the scanner. Patient handoff is a clinical procedure with a structure, a time budget, and a written twin.

Two Handoffs, Two Audiences

Every mission has at least two transfers of information.

Referring provider to flight crew happens at the bedside, in a hallway, or on a highway. Slow down. Ask the questions that will be impossible to reconstruct later. Look at the pumps yourself. Confirm tube depth against the teeth. If the referring story and the monitor disagree, believe the monitor.

Flight crew to receiving team happens on a pad, in a trauma bay, or at a catheterization table. Lead with the threat they must act on in the next ninety seconds, then fill the gaps they ask for. If two receiving voices talk at once, pick the team leader and give one structured report.

A third, quieter handoff is crew to family: who is flying, where you are going, that the receiving team will update them, and that they should not chase the aircraft. Family updates are not optional courtesy. They prevent a second crash in the parking lot and they belong in the record.

SBAR and MIST

Named structures

Use a named structure so the listener can predict the next sentence.

SBAR — Situation, Background, Assessment, Recommendation — is the hospital-native tool. It fits interfacility medical patients, intensive-care transfers, and any report to a receiving attending.

• Situation: who, how old, what is wrong right now, and why they are on your litter.
• Background: relevant history, what the referring team already did, allergies, code status.
• Assessment: your exam, trends, ventilator and drip state, what deteriorated in flight.
• Recommendation: what the receiving team must do next (operating room, scanner, blood bank).

MIST — Mechanism or Medical, Injuries or Illness, Signs, Treatment — is the trauma and EMS-native tool. It fits scene flights and blunt or penetrating injury.

• Mechanism / Medical: ejected at highway speed, or sudden collapse with ST elevation.
• Injuries / Illness: what you found, head to pelvis, including injuries not yet imaged.
• Signs: first and last vital signs, Glasgow Coma Scale trend, saturation, end-tidal carbon dioxide.
• Treatment: airway attempts, chest seals, blood, tranexamic acid, pelvic binder.

You may start with MIST at a trauma bay and finish with two SBAR lines ("code status is full; last tetanus unknown"). The point is structure, not loyalty to an acronym.

What Must Travel With the Patient

Verbal report plus the patient-care report (PCR) should capture the data that changes the next decision. If you remember nothing else, remember this list:

• Allergies and the reaction, not just "NKDA" copied from a stale face sheet.
• Last meal — the receiving anesthesiologist will ask before a midnight operating room.
• Last tetanus on any wound, burn, or open fracture.
• Blood products given — product, number of units, start time, and any reaction.
• Airway attempts — how many, which blade and size, grade of view, tube size and depth, confirmation method, and who intubated.
• Ventilator settings — mode, rate, tidal volume or driving pressure, positive end-expiratory pressure, fraction of inspired oxygen, and the last end-tidal carbon dioxide or blood gas.
• Drip concentrations — drug, micrograms per milliliter, dose in micrograms per kilogram per minute, and the carrier. "Levo at 12" is not a report if one hospital mixes 4 mg in 250 mL and the other mixes 8 mg in 250 mL.
• Neurologic clock — last known well for stroke; time of injury and any lucid interval for traumatic brain injury (TBI).
• Code status and whether a POLST or out-of-hospital DNR is physically on the litter.

Imaging disks, face sheets, and uncrossed type-and-screen tubes are part of the same package. A brilliant verbal report with no paperwork is still an incomplete handoff.

Closed-Loop Communication

Closed-loop communication means the listener repeats the critical content and the speaker confirms it. It is not nodding and it is not "copy." In the aircraft: "Give fentanyl fifty micrograms intravenous now." "Fentanyl fifty micrograms intravenous now." "That is correct." At the receiving door the same loop covers heparin units, drip concentrations, and the assigned destination. Then stop talking so the team can move.

Lead With Actionable Threats

A resus bay is not a conference. Do not dump a twenty-minute narrative. Open with the threat that will kill the patient in the next five minutes:

• ST-elevation myocardial infarction (STEMI): time of first diagnostic electrocardiogram, last known well or symptom onset, what antiplatelet and anticoagulant drugs are already in, whether the patient is in cardiogenic shock, and that the catheterization laboratory is the destination — not the emergency-department hallway.
• Stroke: last known well to the minute, National Institutes of Health Stroke Scale if you have one, glucose, airway status, and whether the receiving team is running a thrombolysis or thrombectomy clock.
• Aortic catastrophe: suspected type A versus ruptured abdominal aneurysm, current blood pressure target you have been holding, access, and blood already given.
• TBI: mechanism, best and last Glasgow Coma Scale, pupil change, whether osmotic therapy was given, ventilator carbon-dioxide target, and whether the patient is herniating now.

After that lead, offer the rest of SBAR or MIST and the written PCR. If the team is already cutting clothes, hand the written report to a scribe and stay for questions. Do not compete with the primary survey. At the referring bedside, interrupt a rambling report the same way: ask first for allergies, last blood products, drip concentrations, and airway history.