*7.1.2 DMIST*

Another common structured patient handoff technique is the MIST or DMIST tool. Unlike SBAR, where there has not been extensive study of prehospital use, MIST has been studied in multiple centers, including the Southwest Texas Regional Advisory Council, which published one of the largest studies of its use involving over 100 prehospital clinicians pre and post implementation. The overwhelming results of the implementation show that all involved felt that communication between the hospital and prehospital team improved [31]. In 2019, the Commonwealth of Pennsylvania implemented the use of DMIST statewide with a small modification, adding the D for demographics at the beginning [32]. To this point, there has not been comprehensive patient outcome data on this tool.

1.*Demographics*: Age, gender, and weight (as appropriate). This is intended to be simple and for the whole team's knowledge. Information, such as an address, date of birth, and phone number, can be exchanged after transfer of care with hospital registration staff.


*Example: This is a 24yo M unrestrained driver frontal impact MVC, car vs tree. He was unconscious at the scene, with an obvious head injury, bruising of the chest wall with crepitus, and bruising of the abdomen. He has obvious lower extremity deformity. His GCS was 3, HR 120, BP 100/50, RR 6, and SATs 80%. He was emergently intubated with no medications for airway protection and his SATs improved to the 90s. He became hypotensive in the 70s following intubation and underwent bilateral chest decompression with an improvement of SpO2 to 100% and BP to 108/62. He has two bilateral 16g IVs in the AC. Received 1000mg TXA at 1002 hours. He received no other medications from us, including any sedative post intubation. We splinted his lower extremity and maintained a cervical collar with c-spine precautions for the duration of the extrication and transport. Any questions?*

One part to note about many systems that have implemented the DMIST structured handoff is the "EMS timeout," where the trauma team takes 30 seconds of no action to listen to the EMS clinicians uninterrupted. This time-out can occur upon arrival in the trauma bay while still on the EMS stretcher for the stable patient or after critical interventions have occurred in the unstable trauma patient.

These two examples represent potential methods of content delivery, and it would be perfectly acceptable to formulate alternative handoff communication algorithms, which meet the needs of the individual or EMS agency. Whatever style is adopted, ensure that the skill is practiced and utilized with every patient, and its implementation occurs in partnership with the receiving hospitals. This ensures that in highstress situations, the report becomes automatic and easy to deliver, without loss of information leading to adverse patient outcomes. Studies continue to show that this is a high-risk area that needs continuous improvement [33].
