Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff

Abstract

Study objectivesWe aimed to evaluate the duration and frequency of communication between EMS (Emergency Medical Services) and ED (Emergency Department) staff during handoff and the subsequent time to critical cardiac care (rhythm determination, defibrillation) using CA (cardiac arrest) video review. MethodsA single-center retrospective study of video-recorded adult CAs between August 2020 and December 2022 was performed. Two investigators assessed the communication of 17 data points, time intervals, EMS initiation of handoff, and type of EMS agency. Median times from initiation of handoff to first ED rhythm determination and defibrillation were compared between the groups above versus below the median number of data points communicated. ResultsOverall, 95 handoffs were reviewed. The handoff was initiated in a median of 2 seconds (interquartile range (IQR) 0–10) after arrival. EMS initiated handoff in 65 (69.2%) patients. The median number of data points communicated was 9 and median duration was 66 seconds (IQR 50–100). Age, location of arrest, estimated down time, and medications administered were communicated > 80% of the time, initial rhythm 79%, and bystander cardiopulmonary resuscitation and witnessed arrest < 50%. The median times from initiation of handoff to first ED rhythm determination and defibrillation were 188 (IQR 106–256) and 392 (IQR 247–725) seconds, though not statistically different between handoffs with <9 vs. ≥9 data points communicated (p > 0.40). ConclusionThere is no standardization for handoff reports from EMS to ED staff for CA patients. Using video review, we demonstrated the variable communication during handoff. Improvements to this process could reduce the time to critical cardiac care interventions.