Arora VM, Eastment MC, Bethea ED, Farnan JM, Friedman ES Participation and experience of third-year medical students in handoffs: time to sign out?. J Gen Intern Med. 2013; 28:(8)994-8

Carter AJ, Davis KA, Evans LV, Cone DC Information loss in emergency medical services handover of trauma patients. Prehosp Emerg Care. 2009; 13:(3)280-5

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Iedema R, Ball C, Daly B Design and trial of a new ambulance-to-emergency department handover protocol: ‘IMIST-AMBO’. BMJ Qual Saf. 2012; 21:(8)627-33

Kohn LT, Corrigan JM, Donaldson MS To Err Is Human: Building a Safer Health System.Washington, DC: National Academy Press; 2000

Patterson ES, Roth EM, Woods DD, Chow R, Gomes JO Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual Health Care. 2004; 16:(2)125-32

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Evaluation of a paramedic student patient hand-off curriculum using simulation

02 June 2016
Volume 6 · Issue 2



Even though patient handoffs are at high risk for errors and adverse events, there is not a standardised approach to how these should be taught to paramedic students. The goal of this study was to evaluate the feasibility and effectiveness of implementing a lecture-based training involving the IMIST-AMBO mnemonic in paramedic education.


Paramedic students were randomised into a control group of standard national paramedicine curriculum and an intervention group who received an additional EMS patient handover lecture including IMIST-AMBO protocol. Outcomes were measured through simulation exercises, with learners randomised to either a low-fidelity tabletop or high-fidelity mannequin-based session.


There were three paramedic student teams in each arm of the study. There were no statistical differences in the reporting of any of the IMIST-AMBO components or the total number reported between the control and the intervention group. The intervention group took significantly longer to give their patient handoff: 78.2 s versus 49.2 s.


The formal education on patient handoffs was successfully implemented. There was a trend toward more data being reported in the intervention group but this came at the cost of a significantly longer report.


We were able to successfully implement formal education on patient handoffs but the small size of the study limited the ability to evaluate its effectiveness. Patient handoffs are a high-risk area in medicine and more studies are needed to determine the most effective way to teach this to paramedic students.

Emergency medical service (EMS) providers handoff approximately 28 million patients every year in the United States (Federal Interagency Committee on Emergency Medical Services, 2012). A patient handoff refers to the transfer of information, through either physical or mental process, from one healthcare provider to the next (Patterson et al, 2004). Inaccuracies in this critical and unavoidable process contribute to the 44 000 to 98 000 deaths that occur every year due to medical errors (Kohn et al, 2000). In a recent study, 98% of survey participants from two large urban medical schools reported witnessing an error in a written handoff and 64% of those same participants witnessed an error due to a verbal handoff (Arora et al, 2013). While at high risk for communication errors and adverse events, patient handoff education has not been formally addressed in primary EMS education. The National Standard Curriculum makes mention of an oral report only once in its 962 pages by stating: ‘The paramedic must also be able to accurately report orally and in writing, all relevant patient data’ (Stoy and Margolis, 1998). Absent from the text is a standardised approach to how this should be accomplished.

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