**7. Transfer of care**

Communication skills are crucial for patient safety yet transfer of vital information from EMS clinician to receiving facility personnel is often noted as a source of medical error. It is not only what is communicated between clinicians, but how the information is delivered that affects patient safety. Transfer of care is such a critical juncture for patient safety that in 2013 the National Association of EMS Physicians (NAEMSP) and the American College of Emergency Physicians (ACEP) published a joint physician statement (along with three other key organizations) outlining the importance of this time and highlighting key elements to ensure patient safety when this occurs [29].

## **7.1 Structured Handoff**

In addition to patient demographics, essential information, such as history of present illness, vital signs, interventions, responses to the interventions, and results of any diagnostic testing such as ECG's and point of care laboratory results, should be clearly conveyed to the receiving clinician. In order to prevent information loss in high-acuity situations, a standardized approach to handoff should be developed and routinely used, whether by the EMS clinician or the employing agency itself. There are many different forms of structured handoffs, but two of the more common are SBAR and DMIST (**Table 2**).
