MED-02 — Lesson 6 of 6
Patient Care Handoff Report
Translating field assessment into a structured verbal and written report
Why Handoff Quality Matters
Medical errors and patient deterioration after handoff are well-documented in civilian emergency medicine — and they are even more likely in austere environments where receiving providers have less information, less equipment, and less time. A poor verbal handoff wastes precious evacuation time. Missing medication information causes dangerous treatment decisions downstream.
Your job is to package your field assessment into a format that transfers instantly, clearly, and completely to whoever takes over care.
MIST: The Standard Field Handoff
MIST is the standard field handoff format used in TCCC and tactical emergency medicine. It is brief, structured, and designed for noisy, high-stress environments where attention is limited. Use MIST for verbal handoff to rescue personnel, EMS, or trauma teams.
MIST at a Glance
MIST is brief and structured, designed for noisy, high-stress handoffs where the receiving provider’s attention is limited.
Practice delivering MIST in 60-90 seconds. It should be memorizable and repeatable. Write key details on a glove or cuff in the field. A printed MIST card from the companion workbook makes this easier in austere conditions.
Sample MIST Report
35M Abdominal Pain, Wilderness Setting, Day 3
M — Mechanism / Medical Complaint: 35-year-old male. Medical complaint — progressive abdominal pain beginning approximately 18 hours ago. No trauma. No other group members affected.
I — Injuries / Illness Identified: Suspected appendicitis. Pain migrated from periumbilical to right lower quadrant. Guarding on palpation of RLQ. Anorexia — no appetite last 12 hours. Mild nausea.
S — Signs and Symptoms: Alert and oriented. HR approximately 98, RR 18, skin warm and dry. Pain 7/10, constant, worsens with movement. Low-grade fever estimated (no thermometer). ALLERGIES: PCN — hives.
T — Treatment Administered: NPO since 12:00 (6 hours). Ibuprofen held as of 12:00 — 400mg x 2 doses taken earlier with minimal effect. IV/fluids not available. No antibiotics administered. Patient assisted to litter — cannot bear exertion without pain increase.
SBAR: For Medical Consultation or Relay
SBAR (Situation, Background, Assessment, Recommendation) is used when you need to consult with a medical professional by radio, satellite phone, or relay — giving them enough information to advise treatment or evacuation decisions from a distance.
- S — Situation: Who are you, who is your patient, what is the current problem?
- B — Background: Age, sex, relevant past medical history, medications, allergies. Events leading up.
- A — Assessment: What do you think is happening? OPQRST summary. Vital signs trends. Severity and trajectory.
- R — Recommendation: What do you need? Advice on treatment? Permission to administer a medication? Evacuation guidance? Be specific about what you are asking.
Written Patient Care Handoff
In prolonged care situations, a written record accompanies the patient from point of injury through every handoff. This prevents information loss when multiple providers are involved, when verbal communication is difficult, or when the patient is unconscious and cannot verify their own history.
The written record should include: patient demographics, SAMPLE findings (all six elements), OPQRST findings for each complaint, vital signs with timestamps, treatments given with doses and times, and assessment of trajectory (improving, stable, worsening).
Allergies must appear on every written record, prominently. A medication allergy that is not communicated at handoff is a preventable death. If nothing else is documented, document allergies and current medications.
Blank Patient Care Handoff Template
Complete one form per patient at point of care
Patient Information: Name / Callsign: _____________ | Age: ___ | Sex: ___ | Weight (approx): ___
Date / Time of Initial Assessment: Date: _____________ | Time: _____________
Chief Complaint: _____________________________________________________________
ALLERGIES (required): _____________________________________________________________
Medications: _____________________________________________________________
Past Medical History: _____________________________________________________________
OPQRST Summary: O: ________ | P: ________ | Q: ________ | R: ________ | S: __/10 | T: ________
Last Intake: Food: _____________ | Fluid: _____________ | Time: _____________
Vital Signs (with timestamps): Time | HR | RR | BP | Temp | LOC | Pain
_______ | ___ | ___ | _____ | _____ | ___ | ___
_______ | ___ | ___ | _____ | _____ | ___ | ___
Treatment Given: Medication / Intervention | Dose | Route | Time
_________________________________ | _____ | _____ | _____
Trajectory at Handoff: ☐ Improving ☐ Stable ☐ Worsening ☐ Unstable
Handoff Provider: Your name / callsign: _____________ | Time of handoff: _____________
Connecting to Other MED Series Courses
- MED-05: MEDEVAC Request — The MIST format you learned here directly populates the MEDEVAC request format. Your S (Signs and Symptoms) becomes the casualty status line; your T (Treatments) informs the medical support requirement line.
- MED-06: Patient Care Documentation — Covers formal documentation including the TCCC Card (DD Form 1380), Patient Care Report (PCR), and digital/electronic documentation options.
- MED-08: CASREP — When reporting casualties to leadership or command, SAMPLE and OPQRST data populate the CASREP format for situational awareness and resource requests.
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