EMS Transfer of Care/Handoff Note (Emergency Department)

Patient: [Full name and DOB / Temporary alias with estimated age/sex and encounter identifiers]

ED Arrival: [Date and time]

EMS Agency/Unit: [Agency name], [Unit identifier], [BLS / ALS / CCT / Air]

Receiving Clinician(s): [Name(s) and role(s) of RN and/or MD/APP who accepted report]

Transfer of Care Time: [Time receiving clinician assumed responsibility]

(This is an EMS handoff summary for immediate ED care; refer to the full EMS Patient Care Report for comprehensive documentation.)

(Prefix statements with information source as appropriate: "Per EMS:", "Per patient:", "Per family:", "Per facility paperwork:", or "Observed in ED on arrival:". For critical items—airway status, allergies, treatments given, vitals, onset/LKW—explicitly document unknown/not obtained rather than leaving blank.)

Quick Summary

Illness Severity: [Unstable/Critical / Watcher / Stable] (If Watcher or Unstable/Critical, include the primary reason in parentheses.)

Chief Concern: [Plain-language complaint with onset time or last known well; include dispatch impression if different]

Patient Summary: [One sentence: age/sex, key high-risk comorbidity if relevant, presentation with mechanism or onset, and current status]

Mechanism / Medical Complaint

[Mechanism of injury details or medical complaint chronology] (For trauma: restraints/helmet use, intrusion/extrication, speed estimate, ejection, fall height, weapon type, or exposure details as relevant. For medical: symptom onset, progression, triggers, last normal, and associated symptoms. Include time anchors with exact times when available; label estimates as approximate.)

Key Findings

(Include only findings that materially change immediate ED management. Omit non-pertinent categories.)

• Neuro: [GCS with components or AVPU; focal deficits; pupils; baseline vs current if known]
• Respiratory: [Airway patency; work of breathing; breath sounds; oxygenation status; airway device if present]
• Cardiovascular: [Perfusion; pulses; capillary refill; skin signs; rhythm interpretation; signs of shock]
• Trauma/MSK: [Identified/suspected injuries; deformities; immobilization status; hemorrhage control status]
• Skin: [Color; temperature; diaphoresis; rashes; burns; wounds]

Vitals Trend

(Time-stamped list with at minimum the first and most recent sets. Include rhythm interpretation and ETCO2 if monitored/ventilated.)

• [Time] - HR: [value], BP: [value], RR: [value], SpO2: [value% on room air / on O2 with device and flow], Temp: [value / not obtained], Pain: [0–10 / not obtained], Glucose: [value / not obtained]
• [Time] - HR: [value], BP: [value], RR: [value], SpO2: [value% on room air / on O2 with device and flow], Temp: [value / not obtained], Pain: [0–10 / not obtained], Glucose: [value / not obtained]

(If no vital signs were obtained, document "No prehospital vital signs available" with reason.)

Prehospital Treatments

(List interventions chronologically. For medications: name, dose, route, time, indication, response/adverse effects. For procedures: airway management with device/size/confirmation, vascular access with site/gauge/fluids, cardiac interventions with energies/times/ROSC, trauma care with tourniquet location and application time.)

• [Time] - [Intervention with relevant details] - [Response/adverse effects]
• [Time] - [Intervention with relevant details] - [Response/adverse effects]

(If no treatments given: "No prehospital medications or procedures beyond monitoring and transport.")

Background

Allergies: [Allergy list / NKDA / Unknown] (If unknown, state reason.)

Home Medications: [Relevant medications, prioritizing anticoagulants/antiplatelets, insulin/hypoglycemics, seizure meds, beta blockers, opioids/sedatives / Unknown]

PMH/PSH: [Pertinent medical and surgical history] (Include pregnancy status and code status/advance directives if known.)

Diagnostics

• POC tests: [Test name]: [value] at [time]
• 12-lead ECG: [Obtained / Not obtained] at [time]; [EMS interpretation]. [Location of ECG artifact or access method]

Pending Concerns / Action List

• [Task or recheck for ED] (e.g., repeat BP, reassess neuro exam, confirm tourniquet time)
• [Contingency/what to watch for] (e.g., airway swelling risk, recurrent hypoglycemia, re-narcosis)
• [Unresolved discrepancies or uncertainties] (e.g., conflicting histories, unclear ingestion timing)

(If none: "No additional EMS pending concerns reported.")

Transfer Attestation

Verbal report received by [name(s) and role(s)] at [time]. [Receiver had opportunity to ask questions / Barrier to questions: active resuscitation or other reason].

Full EMS PCR: [pending / available]. Access: [paper copy provided / electronic portal / attached media].

Cardiac Arrest / Post-ROSC Addendum

(Include only for cardiac arrest patients.)

• Arrest: [Witnessed / Unwitnessed / Unknown]; Bystander CPR: [Yes / No / Unknown]
• Initial rhythm: [VF / VT / PEA / Asystole]; Defibrillations: [times and energies]
• Airway: [BVM / SGA type/size / ETT size/depth]; Confirmation: [capnography ETCO2 value, auscultation]
• Medications: [Drug, dose, route, time for each]
• ROSC: [time(s)]; Estimated downtime: [duration with uncertainty noted]; Current status: [hemodynamics/sedation/temperature management]

Stroke Addendum

(Include only for stroke alerts.)

• Last Known Well: [date/time / unknown] (Include information source.)
• Glucose: [value] at [time]
• Neurological findings: [Focal deficits]; Stroke scale: [scale name and score if performed]
• Anticoagulant/antiplatelet status: [medications / none / unknown]
• Stroke alert pre-notified: [Yes / No] at [time]

Trauma Addendum (MIST)

(Include only for significant trauma.)

• Mechanism: [Concise mechanism details with times]
• Injuries: [Identified or suspected injuries]
• Signs: [Most recent vital signs and GCS]
• Treatments: [Key prehospital interventions with times, including hemorrhage control]

Behavioral Health / Restraint Addendum

(Include only when chemical or physical restraints were used.)

• Risk/Behavior: [Threat to self/others; agitation level; suspected substances or contributing conditions]
• Restraints: [Type; application time; patient position; monitoring approach]
• Sedating medications: [Drug, dose, route, time, response]
• Safety checks: [Skin/circulation checks; airway/breathing monitoring]