A paramedic hands over a patient to the ED: does the team take in what they know?

What the paramedic knows from the scene

A paramedic brings more to the ED than the latest set of measurements. They have seen the patient at the scene and know the sequence of changes in their condition, what interventions were performed and how they responded to treatment during transport. They may also remember what the patient said at home, before their condition or ability to speak changed. That timeline may not be apparent from the first assessment on arrival, so it is worth stating explicitly rather than reporting only current vital signs. Information from witnesses should be distinguished from the paramedic’s own observations and marked as needing confirmation. Taking in this knowledge does not mean uncritically accepting every interpretation the paramedic offers. It means the ED team hears what happened earlier and can factor it into the patient’s ongoing assessment.

Verbal reports and documentation

A bedside report and written documentation serve different purposes. What the team needs to know before responsibility for the patient changes hands—especially an urgent change in condition—should be said aloud. Other details can be passed on in the documentation, but it is worth checking that the key figures match what was said. An observation of 83 handovers at a single center in Israel found discrepancies between verbally and visually communicated information. A survey of 103 staff members at the same center also found differences in perspective between paramedics and ED staff. This suggests agreeing locally on what must be said at the bedside and what can be recorded instead. The study does not, however, establish the effectiveness of any particular checklist.

Who is listening

Even a well-structured report will not help if no one is clearly designated to receive it. When several patients arrive at once, it is worth identifying someone to listen to the paramedic and then confirm the most important information in their own words. When critical details are being passed on, a parallel team conversation can drown out news of a change in condition or an intervention, so those details need a brief window of attention. The paramedic’s professional status should not take the place of assessing the substance of their observations. Staff can ask about the source or significance of information without dismissing it simply because it came from outside the ED. Designating a recipient addresses an organizational problem; taking the report seriously addresses the separate issue of recognizing what someone who was with the patient earlier knows.

Asking about unclear information

An unclear point in a report is a reason to ask a question, not immediately to dispute someone’s competence. The recipient can ask when a symptom appeared, establish whether an account came from the patient, a witness or the paramedic, and clarify what was done before arrival. This makes it easier to distinguish missing information from differing interpretations of the same event. One useful question might be: “Which observation from the scene should change our plan for the next five minutes?” It does not predetermine the answer; it steers the conversation toward decisions. At the end, both sides benefit from briefly confirming the shared plan for the first few minutes. The paramedic then knows what was understood, and the ED team knows what still needs checking.

Conditions in the ED

The ED can be noisy and rushed, with reports happening at the same time. In those conditions, even an important statement may not reach the person making the decision, although the paramedic said it clearly. A brief reporting structure helps prioritize the key message, but it cannot replace a moment when someone is actually able to hear it. Even when the department is busy, it is worth pausing parallel conversations for the most important information and checking who received it. If the report is interrupted, a significant change in condition should be repeated to the appropriate recipient. When no recipient has been designated, lost information cannot be blamed solely on the person giving the report. This is also about how the team organizes its work, not just how concisely the paramedic speaks.

Completing the handover

Handover is complete only when it is clear who has taken over the patient’s care. The paramedic should hear that the report has been received, and the recipient can identify which details still need verification. It is also worth naming any issue that needs monitoring after the ambulance crew leaves, so that an important change in condition does not remain only part of an earlier conversation. This way of closing a handover is a proposed practice, not a finding from a test of a specific format. The observation of 83 handovers and survey of 103 staff at one center in Israel help identify information loss and differences in perspective. They cannot quantify any reduction in mortality following a change in reporting practice or demonstrate the effectiveness of proposed digital tools. A local approach to confirming receipt therefore needs to fit how that ED works.

Improving the shared process

The shared process can be improved by checking which report fields are regularly left blank and which questions help both sides fill the gaps. Exercises based on real scenarios should cover not only what the paramedic says but also how the recipient responds. When reviewing an event, it is worth establishing separately whether information was communicated and whether ED staff had the opportunity to hear it. A mixed-methods review of research on paramedics’ situational awareness offers a broader view, bringing together individual, team, system and contextual perspectives. It does not, however, establish a single, universal effect of training. Handover assessment should therefore not come down to one staff member’s memory; it should also consider how people worked together and the conditions in which decisions were made.

What happens to a paramedic’s knowledge between the ambulance and the ED? This article distinguishes the structure of a report from how it is received, and shows how to close a handover by confirming who has taken responsibility.

Empatyzer in preparing for patient handover to the ED

When a paramedic arrives at the ED, staff may be handling several tasks at once, and the report can easily be interrupted at the crucial moment. In a conversation with Em, the paramedic can prepare a concise timeline of changes in the patient’s condition, practice saying it aloud and prepare a sentence for repeating information missed after an interruption. They can also practice responding calmly to a question about missing details rather than treating it as a challenge to their knowledge. Team mode helps prepare shared handover language across professions, while comparison with a chosen person can help tailor how a question about an unclear point is asked. Micro-lessons can provide reminders to confirm receipt of the most important information. This preparation concerns the conversation between people: it does not replace documentation, designating someone to receive the report or checking the patient’s condition. Nor does the cited observation provide grounds for attributing improved treatment outcomes to Empatyzer.