Just Remember To Breathe... The Resus Handover
Author: Crawford Nicholson- Paramedic, Scottish Ambulance Service
As we all know, communication between ambulance and ED staff, nursing and medics, is a crucial element of a successful patient journey. The vast majority of times this will consist of the relaxed, yet professional transfer of all relevant key information gained in the pre-hospital environment. Here, ambulance staff play a key role in providing the “gaps in the story” which would normally be told by close family members / carers.
The normal triage climate allows for the development of great working relationships that can last for years and often develop into deeper, long-lasting friendships between two groups of people who share that unique, emergency medicine sense of humour plus the experience of the “warts and all” side of life.
However, not all patients give us the chance for a relaxed, calm, tranquil handover.
This other group of patients, are really not well, and for a huge variety of reasons, don’t fit the simple, casual triage handover. They are destined to go down a different path, directly into the resus room. Now the game changes, and time is critical.
For more recently qualified staff, this can initially be quite daunting and you can feel under significant pressure - to get things right, to help your colleagues, to look as though you know what you’re doing (really don’t stress about this one, everyone has been there) and ultimately do whatever is best for the patient. Sometimes it can be tough, depending on the call, the situation, and the patient, not to mention other external factors that might be added just to make this already stressful situation tougher (such as the ongoing gang fight, multiple vehicle RTC, or simply a nightmare extrication from a home or a field in the middle of the night - the list goes on..)
The key to all of this is simple, just remember to breathe.
Part 1 – The Standby Call
As the name suggests, this call allows the ED to get everything sorted and in place for the arrival of your patient, everything is on standby. It is baseline information which allows for all the appropriate support to be organised, from calling in a trauma team to organising specialist stroke doctors. All this information is close at hand, it just requires a small amount of focus and it sets everything up for you. It consists of;
Specific Injury / Illness
- Heart rate
- Respiratory rate
- Blood Pressure
Any further relevant clinical information / treatment – (patient intubated, chest decompression, etc.)
But the heart is racing, adrenaline is flowing, and it’s easy to miss things. So once you have collected all the information required, write it down in the order you want to send it. Dial the standby code for the ED, and breathe. The radio will answer, another deep breath and just take your time and clearly pass the message. Slow is smooth, smooth is fast. That’s it done.
Part 2—The Resus Handover
This can be the part some ambulance staff feel the most anxious about (despite the resus team being a friendly bunch). It can be daunting, especially if you have called in a serious trauma patient - when you open those resus doors there might be 10 people focused entirely on your every word. The senior clinician (normally a paramedic, but may be a technician) will always take over clinical responsibility, travel with the patient and deliver a handover to medical staff on arrival at the ED. This is great for recently qualified staff, right up until the day they find themselves in the senior role, and all of a sudden everything shifts and they’re responsible for the handover. This is where the real anxiety can begin. However, again, the key is just remember to breathe.
You will have all the relevant information, it’s simply just about organising it into a system that works for you and the receiving ED resus team. The system we use is a hands off IMIST/AMBO handover, however some departments use SBAR (Situation, Background, Asssessment, Recommendation). The key to this, is the 10 seconds between leaving the vehicle and stopping the trolley bed in the resus cubicle. That’s when you can consolidate, formulate and simply work out what you want to say, just before those doors open. Most departments like to handover the patient before moving them from the ambulance trolley, unless the patient is in cardiac arrest, or requires any time critical life-saving interventions.
Next, just breathe, slow is smooth, smooth is fast.
I -Identify the patient, age
M -Mechanism / medical complaint
I -Injuries / Information related to complaint
S -Signs / Symptoms
T -Treatment (intubation, drugs, IV access etc.) & Trends (improvement / deterioration)
The Resus team may have further questions, 99% of which you will already know the answer to from your time with the patient, so don’t worry. And actually sometimes you won’t, but don’t worry about that either.
It’s time to transfer the patient over, and now complete the handover. Breathe again.
B -Background medical history
O -Other information – social input (carers) or family input
- Living arrangements
- Cigarettes / alcohol / recreational drug use
- Review of systems (obviously not always possible)
- Previous admissions / similar presentations
- Anything else relevant
And breathe, that’s it done.
Now, I’d love to say that with over a decade of experience of handing over in resus, that’s exactly how it goes every time. But that’s just not true. It’s very easy to get caught up in the heat of a situation, and forget to take those all-important long gulps of air. There are still times when the resus lead is screaming “Stop, stop, stop! How fast do you think I can write?” but that’s ok, as next time will be better.
Just remember to breathe....
And Some science....
Getting the handover right takes a bit of practice, and both the pre-hospital team and resus team need to be onboard, and listening. Handovers where the whole team are hands off and listen feel the most effective. But is there an evidence base?