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Example: Standard Operating 

Procedure (SOP) for Patient Handoff

between a Healthcare Facility and a 

Transporting Ambulance 

Drafted by Alexander Isakov, MD, MPH, in collaboration with the EMS Biosafety Transport 

Consortium (Emory University/Grady EMS, University of Nebraska Medical Center/Omaha Fire 

Department, US Department of State/Office of Operational Medicine, NIH Div. of Fire and Rescue 

Services/NIH Div. of Occupational Health and Safety, Fire Dept. of New York, Phoenix Air Group, 

American Medical Response)

Purpose 

This document provides guidance to facilitate planning for and execution of patient handoff

between personnel at a fixed facility (hospital or clinic) and the transporting ambulance agency. 

Information is presented in a chronological format and is provided at a level of detail that will 

afford local planners and operators the flexibility to develop procedures that are suitable for 

their environment. References from peer-reviewed literature are included and provide greater 

detail as articulated by the authors.

The following key assumptions are being made:

 All healthcare workers (hospital and out-of-hospital) who are involved will have received 

education and training and demonstrated the necessary competencies for management 

of patients with serious communicable diseases.

 Healthcare facilities and transporting ambulance agencies have procedures for the 

management of patients with serious communicable diseases.

 Facilities and transporting ambulance agencies are conducting tabletop and operational

exercises that test and refine procedures for the transfer of patients.

 This guidance complements other CDC guidance for management of patients with 

serious communicable diseases.

_____________________________

Mobilizing for patient transport

 Notify responsible parties, including sending facility, receiving facility, transporting 

ambulance agency, public health authority, emergency management agency, law 

enforcement, and (if applicable) aviation and hazardous materials management and

disposal.

o Establish a communications plan that identifies all points of contact and 

distribute it to all parties to facilitate communication.

o All parties should consider notifying their public affairs official.
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o Discuss methods of notification, as radio and other non-secure methods of 

communication may be monitored by the media or the public.

 Communicate to all parties the patient’s risk of exposure to Ebola and clinical condition.

o Communicate whether the patient will be ambulatory or non-ambulatory.

 Confirm transporting ambulance personnel and receiving facility personnel have 

appropriate personal protective equipment (PPE) ensembles (they may be different 

depending on mission requirements and patient condition).

 Confirm and communicate with the designated point of contact at each facility the 

location for transition of patient care at point of origin and destination – this location 

will likely be pre-determined by facilities and chosen in order to minimize environmental 

exposure at the facility and prevent exposure of unprotected staff, patients, and visitors.

 Confirm and communicate location for donning and doffing of PPE for transporting 

ambulance personnel and ambulance decontamination and disinfection.

o Affirm appropriate supervision for the doffing of ambulance personnel. Hospital 

PPE and doffing protocols may be different and therefore supervision may need 

to be specific to the ambulance crews involved.

o Personnel doffing and ambulance decontamination locations must be prepared 

to manage regulated waste.

 Determine the need for additional security with sending and receiving facility security, 

as well as local, county, state public safety and law enforcement personnel both during

transport and at the healthcare facilities.

Preparing for transfer of patient and patient care

Sending facility

 Maintain appropriate infection control posture while managing patient.

 Determine appropriate level of personnel to accompany patient during transfer.

 Provide management of volume depletion and nausea/vomiting as much as possible to 

facilitate event-free transport.

 Be prepared to communicate with transport agency directly to provide up-to-date 

patient status and facilitate patient transfer.

 Advise transporting ambulance agency about any patient belongings that may 

accompany patient.

 Determine and communicate whether patient is ambulatory or will require a stretcher 

transport.

 Obtain vital signs immediately before transfer of care to share with transport team.

 As mutually agreed upon with transporting ambulance agency and just prior to their 

arrival, have patient apply barrier garments with the goal of limiting exposure of 

transport team or vehicle (e.g., as tolerated), including footed impermeable suit, 

surgical mask, and gloves for ambulatory patient, or impervious sheets and surgical 

mask for non-ambulatory patient, and adult undergarment, as needed.

 Communicate transport plan to family and friends of patient, as appropriate.

 Provide written patient care report (PCR) that includes signs and symptoms and care 

rendered. Provide PCR to transporting ambulance agency in a manner that assures it is 

contamination-free.
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 Ensure patient’s property is secured and documented appropriately (assume property is 

contaminated).

 Transfer patient care and any belongings to transport team.

 Follow facility SOPs for mission completion, which may include disinfection of exposed 

environmental surfaces, etc.

Transporting ambulance provider

Before transport

 Ensure transportation readiness:

o Confirm that receiving facility is ready for patient arrival.

o Confirm patient’s condition and level of personnel required to accompany 

patient during transfer.

o Confirm whether additional passengers are being transported (family, etc.).

o Confirm location for decontamination and disinfection of ambulance and 

doffing of ambulance transport personnel PPE. Confirm hospital (or contracted 

service) is prepared to handle contaminated waste.

o Communicate with designated emergency management officials and coordinate 

with the agency that will be providing security as required for the mission. 

o Confirm that all agencies involved in patient transport have access to secure 

communications.

o Ensure procedures have been implemented to limit contamination of 

ambulance environmental surfaces (isolation of driver compartment, draping, 

etc.).

o Ensure adequate inventory of supplies and appropriately-sized PPE for the 

personnel who are assigned to the transport mission.

 Barrier drapes and tape for transport vehicle as indicated

 PPE ensemble – correct size suits, back-up PPE for possible breach, 

charged batteries if using powered air-purifying respirator (PAPR), etc.

 Supplies for decontamination and disinfection – U.S. Environmental 

Protection Agency (EPA)-registered hospital disinfectant wipes effective 

against the known or suspected pathogen, hand disinfectant, a “spill kit” 

(household bleach, absorbent towels and appropriate water-tight 

container to secure gross contamination), etc.

 Supplies for waste collection – biohazard bags, autoclave bags

o Ensure appropriate medical director (or appropriate person providing medical 

oversight) is immediately available throughout the transport.

o Hold mission briefing for transport team to review:

 Purpose and team primary contacts

 Transport provider health check

 Patient history and condition

 Infection control posture – ambulance configuration and personnel PPE

 Team member (paramedic, EMT, driver, supervisor/safety officer, EMS 

physician, etc.) roles and responsibilities, including supervision of

donning and doffing procedures, etc.

 Relevant clinical care guidelines including appropriateness of 

interventions or invasive procedures

 Transportation of patient samples and medication, if applicable
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 Transfer of paper or electronic ambulance patient care records in a way 

that avoids contaminating the receiving facility

 Decontamination and disinfection procedure

 Waste collection and mission recovery

 Post-mission surveillance

 Special considerations – transfer of patient across state borders, 

deterioration of patient condition in transit, vehicle malfunction and 

other contingencies, etc.

 Media discipline

During transport

 Communicate with sending facility for patient updates and to confirm patient transfer 

location.

 Contact sending facility to verify patient management steps have been taken to 

facilitate event-free transport and reduce risk of exposure.

 Depart for patient location and provide estimated time of arrival (ETA) for ambulance at

sending facility.

 Communicate with designated point of contact at each facility the arrival of transporting 

ambulance at sending and receiving facilities.

 Observe donning of PPE and when ready, proceed to make patient contact (only the 

minimum number of providers necessary to manage the patient should be present).

 Conduct brief patient assessment to determine patient’s stability, “dry” or “wet”

symptoms, and need for intervention before and/or during patient transport. Clearly 

define appropriate interventions for patient deterioration/decompensation. Consider 

minimizing patient contact. For example, consider not obtaining vital signs if patient is 

“dry,” has no visual evidence of distress or shock, and transport time is not prolonged.

 Transport patient in impervious suit if ambulatory, or in impervious sheets if nonambulatory and stretcher-bound, as tolerated.

 Consider any patient belongings to be contaminated, which are typically bagged, 

labeled, and transported with the patient in the patient compartment.

 Any documents provided by sending facility should be free of contamination. When in 

doubt, consider them contaminated and package as appropriate for transport by 

ambulance personnel.

 Report patient’s condition and ETA to receiving facility to facilitate their readiness to 

receive patient from transport agency immediately upon arrival, thus avoiding PPEinduced fatigue/dehydration for patient, ambulance crew and/or receiving staff. 

Upon arrival

 Confirm arrival with receiving facility and specific route of travel within facility before 

debarking ambulance with patient.

 Transport patient to designated location in receiving facility – via the most direct route 

to isolation unit – ambulatory vs. stretcher.

 Ensure route of travel is secure.

 Transfer patient care to receiving facility team as arranged (and exercised).

 Return to ambulance and proceed to designated decontamination/disinfection station.

 Disinfect ambulance per SOP.

 Ambulance transport personnel doff PPE under supervision of qualified personnel 

(transport agency PPE ensemble and SOP may differ from hospital).
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 Have appropriately trained personnel package waste from ambulance transport.

 Transfer waste to hospital or appropriate agency as previously arranged and in 

accordance with applicable regulations.

 Secure mission, debrief providers, and initiate post-mission surveillance as indicated.

Receiving facility

 Ensure isolation unit is ready to receive patient.

 Prepare arrival site and route of entry to isolation unit – ambulatory vs. stretcher 

transport.

 Communicate with ambulance transport agency regarding readiness to receive patient, 

route of entry, and location of patient transfer.

 Confirm location for ambulance decontamination/disinfection and personnel doffing of 

PPE.

 Consider need for security on route of intra-facility patient transport (e.g., from 

ambulance entrance to the designated ward or unit) and/or in decontamination area (if 

on hospital premises).

 Prepare to receive biohazard waste from transporting ambulance agency and facilitate

waste management.

 Inform appropriate public health, emergency management, and public safety authorities 

on arrival of patient.

 Communicate any diagnostic test results to transporting ambulance agency as 

appropriate to inform need for continuing post-mission surveillance of ambulance 

providers (EMTs, paramedics, etc.).
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References

1. Isakov A, Jamison A, Miles W, Ribner B. Safe management of patients with serious 

communicable diseases: recent experience with Ebola virus. Ann Int Med 2014 Dec 

2;161(11):829-30.

2. Lowe, J.J., Jelden, K.C., Schenarts, P.J., Rupp, L.E., Hawes, K.J., Tysor, B.M., Swansinger, 

R.G., Schweldhelm, S.S., Smith, P.W., Gibbs, S.G. Considerations for Safe EMS Transport 

of Patients Infected with Ebola Virus. Prehospital Emergency Care. 2015; 19(2):179-183.

3. Coignard-Biehler H, Isakov A, Stephenson J. Pre-hospital transportation in western 

countries for Ebola patients, comparison of guidelines. Intensive Care Med. 2015; 41(8): 

1472–1476.

4. Isakov A, Miles W, Gibbs S, Lowe J, Jamison A, Swansiger R. Transport and management 

of patients with confirmed or suspected Ebola virus disease. Ann of Emerg Med. 2015;

66(3):297-305.

5. Swansiger, R.G., Walters, W.A., Isakov, A.P., Gibbs, S.G., Lowe, J.J. 2014. 

BioContainment Ground Transport Standard Operating Procedures. Office of Medical 

Services Operational Medicine. United States Department of State.