Professional Practice, Communication, and Documentation
Handoffs and paperwork are clinical interventions
Communication failures cause more transport harm than equipment failures. Use a structured handoff - SBAR or I-PASS (Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver) - with a read-back and an explicit invitation for questions. Include allergies, code status, weight, last doses and times of vasoactive drugs, line sites, pending results, and family contact.
Documentation should be contemporaneous, factual, and objective: departure and arrival times, mode, crew, vital sign trends, interventions with responses, changes in condition, and any consent or refusal discussion. "If it wasn't documented, it wasn't done" is harsh but reflects how charts are read later. Correct errors with a single line and initials rather than obliteration.
Legal and professional concepts: EMTALA requires stabilization before transfer, a documented benefit, acceptance by the receiving facility, qualified transport personnel, and transfer of records. Consent, decision-making capacity, refusal, and confidentiality apply in the air and on the road. Practice within your state scope and program protocols, and escalate concerns through the chain of command, including the medical director.
Trap: a question describes a friendly handoff with no read-back; the correct answer usually involves structured communication and confirmation.
Worked example: at shift change, give a 30-second summary, then name the top three things that could kill this patient in the next hour, then ask what questions the receiver has. That single habit catches most handoff errors.