An Emergency Medical Services to Emergency Department Checklist for Handoff of Cardiac Arrest: A Modified Delphi Approach

Objectives: Effective communication during handoffs between emergency medical services (EMS) and emergency department (ED) personnel is a critical step in out-of-hospital cardiac arrest (OHCA) care. No handoff tool has been specifically designed for OHCA, in which timely and accurate transfer of information can substantially affect patient care. This study aimed to develop a standardized checklist for OHCA handoffs based on expert consensus using a modified Delphi approach. Methods: A panel of experts from EMS and the ED were recruited to rate the importance of 17 preidentified communication items derived from video reviews of OHCA handoffs. Experts completed 2 rounds of identical surveys, followed by participation in a focus group. Participants were asked to rate the importance of each item from 1 to 10 and the timing of when items should be communicated (ie, first, second, or third part of the handoff). The focus group further refined the checklist, finalizing the key elements to be included during a 90-minute virtual session via unanimous consensus. Results: Eleven experts were approached, 10 completed surveys, and 7 participated in the focus group. The expert panel developed a 13-item checklist (patient age, location/cause of arrest, witnessed arrest, estimated downtime, bystander cardiopulmonary resuscitation, initial rhythm, most recent rhythm, episodes of return of spontaneous circulation, defibrillation attempts, airway type, vascular access, medications administered, and code status). Witnessed arrest, bystander cardiopulmonary resuscitation, and estimated downtime were prioritized for the first part of handoff communication. Conclusion: This study developed a concise, expert-driven checklist for OHCA handoffs to improve communication between EMS and ED.