Trauma Bay Handoff
Objective: Give a short trauma handoff (MIST or IMIST-AMBO) that a surgeon can act on, including times and the one thing that can still kill the patient.
Why This Is Hard
Trauma bays have named this for years: a rambling narrative while the patient is still bleeding. MIST (mechanism, injuries, signs/vitals, treatment) and IMIST-AMBO (identify/age, mechanism, injuries, signs, treatment, then allergies, meds, background, other) exist so a tired trauma team gets the clock, the bleed, and the airway in one pass.
Practice the 30-second version on the way in — not at the foot of the bed.
- One speaker. The attendant who ran the patient talks. Everyone else is quiet unless asked.
- Lead with the thing that can still kill them: “Tourniquet left leg 18:42, BP 88, airway is an SGA (supraglottic airway).”
- Vitals as a trend if you have two sets. One number is a snapshot.
- Written times: tourniquet, needle, last BP, last EtCO₂. Paper beats memory.
- I have a 20-second report
- Mechanism is __
- Tourniquet on at __
- Worst vital is __
Street Sequence
- On the ramp, decide who talks, name the one killer, and say what they need to do in the first 30 seconds.
- Identify age, sex, and name if you have it. Give mechanism in one sentence.
- Name the injuries you found. Give signs: HR, BP, sat, GCS or AVPU, EtCO₂. Give treatment: airway, holes you made, blood products, TXA if given — with times.
- Stop. Answer questions. Do not restart the whole call unless they ask. Then write your chart.
Field Rules
- MIST: Mechanism — Injuries — Signs (vitals) — Treatment. Enough for a trauma bay to start.
- IMIST-AMBO adds Identify and a second half (Allergies, Meds, Background, Other) if they have time. Lead with MIST. AMBO is extra, not a reason to stall the survey.
- Times are treatments: tourniquet on at hh:mm. Needle at hh:mm. Blood started at hh:mm.
- One killer: if you only get 10 seconds, say the thing that is still a problem.
Field Pitfalls
- A five-minute story before the first set of vitals.
- Two medics talking over each other.
- Forgetting the tourniquet time.
- Saving the hypotension for the punchline.
Practice
60-second drill
Partner: 40-year-old, MVC, pelvic binder, left-leg tourniquet 10 minutes ago, last BP 92/60, SGA in, EtCO₂ 32. Give the 20-second MIST. Then they ask “when did the tourniquet go on?”
Related: Trauma Triage & Destination, Massive Hemorrhage Comes First.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ACS Committee on Trauma / field triage communication — the receiving team needs mechanism, physiology, and times — not a novel
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.