Ventilator handoff report: document what the next team needs when a ventilated adult changes hands

A ventilator handoff report is what the outgoing crew says and writes down when a mechanically ventilated adult changes hands. It names the airway and how it was confirmed, the settings running now, the patient’s own values measured against their baseline, every change made and the reason for it, sedation scored rather than described, and whatever is still unresolved. It applies to adult patients only, and the form it takes belongs to the receiving facility’s process and the crew’s own agency protocol, not to this page. It is the last stage of the post-intubation ventilator workflow this report closes.

This order is a common structure, not a protocol. Your agency’s own format and the receiving facility’s process govern what you actually say and write.

What the handoff report carries

A handoff report carries three layers: the airway, the machine, and how the patient has responded over time, plus every change made along the way. Settings without the patient are half the story, which is why NASEMSO’s own documentation elements separate the two.

The numbers handed over tend to be the numbers that stay on. In a retrospective review of 380 mechanically ventilated adults transported to one academic center by a critical care transport program, 30% were receiving a tidal volume above 8 mL/kg predicted body weight at transfer, and the handoff tidal volume correlated strongly with the ICU tidal volume (r = 0.7); patients on high volumes in transport were more likely to be on high volumes in the ICU up to 12 hours after admission (Roginski et al., Air Med J 2022). That is an association in one cohort, not a guarantee.

What should be included in a ventilator handoff report?

Name the patient and why they were intubated, the airway and how it was confirmed, the settings, the values against baseline, changes, events, a sedation score, and what is still open.

Report the vent settings with the numbers behind them

State the mode as volume or pressure targeted, not just the letters on the display: “AC” alone is half an answer. Give the tidal volume in mL and in mL/kg of ideal body weight, with the height and sex it came from so the team can check the math; ideal body weight is predicted from sex and height, never from actual weight. Report the set rate and the total rate, read together, because breaths the patient triggers above the set rate raise the total. Give PEEP and FiO2 with their trend, not just the current value. Compare peak inspiratory pressure against this patient’s own baseline, and report a plateau pressure, if one was measured, with the PEEP in force; NASEMSO’s list omits plateau, which is why it has to be said out loud when one exists. No pressure number belongs on this page as a ceiling or a target: those live on the pages built for them.

Report sedation as a score, not an adjective

Name what is running, when it was last given, and a score on the RASS scale. NASEMSO calls for RASS “or similar scale” and names no target level, and this page prints none either: -4 stays deep sedation, never relabeled to fit a transport story.

Document the airway at transfer of care: tube, depth, cuff, confirmation

The handoff itself is a high-risk moment for the tube. Transfer of care “involves significant patient movement and represents a high-risk event for [unplanned extubation]” (Kwong et al., Prehosp Emerg Care 2025), and one paramedic service raised verbal confirmation of tube position with ED staff at transfer from a 74% baseline to 90% or better, a gain that held after its interventions ended. NASEMSO’s own performance measure is built around the same moment: the tube “verified in proper position upon turnover to receiving facility,” and its documentation list calls for the capnograph at transfer. Report the depth at the teeth or gum line as a recorded number, and report the last endotracheal cuff pressure reading and when it was taken. If an exhaled volume that has drifted from baseline is part of this patient’s story, say so instead of leaving it as a footnote.

Give the vent handoff in a fixed order

Pick one order and use it every time, so nothing depends on memory under load. IMIST-AMBO, SBAR (or its ISBAR variant), and MIST are all names in active use, and this page ranks none of them: in one simulation trial of paramedic-to-trauma-team handovers comparing two structured formats, the format itself was not what separated a good handover from a poor one (Cowan et al., Can J Surg 2023). What separated them was confidence, a clear summary, and no interruptions, and the same trial found that moving the patient to the bed before the handover added activity that got in the way of communication. Whichever structure the agency runs, the vent block, the airway, the settings, the values against baseline, the changes, the sedation score, slots in under treatment and trends, said before the move whenever the room allows it.

1. 1Who and why

2. The vent block

   1. 2Airway
   2. 3Settings
   3. 4Values vs baseline
   4. 5Changes and events
   5. 6Sedation
3. 7Open issues

How do you give report on a ventilated patient?

Inside whatever structure the agency uses, say the airway, the settings, the patient’s values against baseline, the changes, and the sedation score, in that order, then read the numbers back so the receiving team can confirm them.

Write the handoff down: the record the next team reads

The verbal report is the part that gets lost. At one level I trauma center, 69.6% of 473 verbally transmitted elements across 96 trauma handovers made it into the trauma team’s chart, and prehospital hypotension was recorded in just 10 of 28 times it was said aloud (Carter et al., Prehosp Emerg Care 2009). At one urban academic ED, a complete set of vital signs was passed on in only 57% of 90 handoffs of critically ill and injured patients (Goldberg et al., Prehosp Emerg Care 2017). The written record shows the patient’s values at baseline and at transfer, not one snapshot; NASEMSO calls it “baseline and repeated.” Write down which ventilator alarms fired and why, and treat the pre-move checks that feed this report as the record before it. When each item gets written down during the call is the earlier stage’s subject, not this one.

Rows come from NASEMSO’s own Key Documentation Elements for an intubated adult on a ventilator. Empty cells are intentional: this is a card to fill in, and your agency’s own patient care report, not this page, governs what actually gets recorded.

Transfer of care: what to ask before the crew leaves

For the team taking over: ask for anything from the table above that did not make it into the verbal report. Confirm the capnography waveform on your own monitor before the delivering crew clears, the exact moment NASEMSO’s own performance measure is built around. Read the settings back before signing for the patient. Checking a sending facility’s settings before you leave, on the other end of an interfacility transport, is its own page; this section is about receiving the report, not verifying it against the machine.

After the handoff: close the loop

Quality management runs the same direction as the handoff: bidirectional information sharing between agencies and receiving facilities, with outcome information shared back to the agency and the clinicians who ran the call (Vithalani et al., Prehosp Emerg Care 2022). The app cannot see any of that; it runs the same arithmetic every time from the inputs it is given. A share button on the results screen sends a PNG of the whole results column, the inputs, ideal body weight, the calculated rate, tidal volume and minute ventilation, and the RSI doses, through the phone’s share sheet, carrying the app version and “Estimate only · Not medical advice · Verify before use.” It is a reference calculation, not a treatment record and not part of the patient record; the patient in front of the receiving team, and their own protocol, govern the numbers, and the report is how that gets said out loud.

Sources

1. National Association of State EMS Officials. National Model EMS Clinical Guidelines, Version 3.0. March 2022. Airway Management and Mechanical Ventilation (Invasive) sections. https://nasemso.org/wp-content/uploads/National-Model-EMS-Clinical-Guidelines_2022.pdf
2. Roginski MA, Burney CP, Husson EG, Harper KR, Atchinson PRA, Munson JC. Influence of Critical Care Transport Ventilator Management on Intensive Care Unit Care. Air Medical Journal. 2022;41(1):96-102. PMID: 35248352. https://pubmed.ncbi.nlm.nih.gov/35248352/
3. Kwong JL, Bourn S, Hillier M, Merko M, Grass AJ, Ednie T, Verbeek PR. A Quality Improvement Initiative to Increase Confirmation of Prehospital Endotracheal Tube Placement at Emergency Department Transfer of Care. Prehospital Emergency Care. 2025;29(3):252-258. PMID: 38861683. https://pubmed.ncbi.nlm.nih.gov/38861683/
4. Carter AJ, Davis KA, Evans LV, Cone DC. Information loss in emergency medical services handover of trauma patients. Prehospital Emergency Care. 2009;13(3):280-285. PMID: 19499462. https://pubmed.ncbi.nlm.nih.gov/19499462/
5. Goldberg SA, Porat A, Strother CG, Lim NQ, Wijeratne HR, Sanchez G, Munjal KG. Quantitative Analysis of the Content of EMS Handoff of Critically Ill and Injured Patients to the Emergency Department. Prehospital Emergency Care. 2017;21(1):14-17. PMID: 27420753. https://pubmed.ncbi.nlm.nih.gov/27420753/
6. Iedema R, Ball C, Daly B, Young J, Green T, Middleton PM, Foster-Curry C, Jones M, Hoy S, Comerford D. Design and trial of a new ambulance-to-emergency department handover protocol: ‘IMIST-AMBO’. BMJ Quality & Safety. 2012;21(8):627-633. PMID: 22626739. https://pubmed.ncbi.nlm.nih.gov/22626739/
7. Vithalani V, Sondheim S, Cornelius A, Gonzales J, Mercer MP, Burton B, Redlener M. Quality Management of Prehospital Airway Programs: An NAEMSP Position Statement and Resource Document. Prehospital Emergency Care. 2022;26(sup1):14-22. PMID: 35001828. https://pubmed.ncbi.nlm.nih.gov/35001828/
8. Cowan S, Murphy P, Kim M, Mador B, Chang E, Kabaroff A, North E, Cameron C, Verhoeff K, Widder S. Paramedic to trauma team verbal handover optimization - a complex interaction. Canadian Journal of Surgery. 2023;66(3):E290-E297. PMID: 37225244. https://www.canjsurg.ca/content/66/3/E290
9. Joint Trauma System. Mechanical Ventilation Basics. Clinical Practice Guideline ID 92. 9 April 2025. https://jts.health.mil/assets/docs/cpgs/Mechnical_Ventilation_Basics_09_Apr_2025_ID92_v1.1.pdf
10. Institute for Healthcare Improvement. SBAR Tool: Situation-Background-Assessment-Recommendation. https://www.ihi.org/library/tools/sbar-tool-situation-background-assessment-recommendation