Handover of ambulance patients in the Emergency Department

The Protocol for the handover of ambulance patients in the Emergency Department outlines a standardised Ambulance handover¹ process to support:

• Safe and timely transfer of individuals arriving by ambulance to the Emergency
• Department (referred to in this protocol as “Ambulance Handover”).
• Consistent and accurate recording of information to support broader ambulance-related performance oversight across health services, the Department of Health (the department) and Ambulance Victoria (AV).
• It replaces the previous Protocol for the clinical handover of ambulance patients in the ED (June 2014).

Preliminaries

Definitions and related reporting requirements referenced throughout this protocol align with the department's current Victorian Emergency Minimum Dataset (VEMD) Manual 2025-26. In the event of any inconsistency, the VEMD Manual 2025-26 or later versions, as appropriate, will take precedence

Who should use this protocol?

This protocol should be used by ED clinicians and ambulance paramedics as a protocol for the clinical handover and physical transfer of patients arriving by ambulance in the ED.

Health service and Ambulance Victoria (AV) executive staff are responsible for ensuring this protocol is applied at each respective health service as outlined in the annual Policy and Funding Guidelines for health services.

Why it matters

A standardised Ambulance Handover process enhances patient safety by ensuring consistent transfer of critical information, leading to better patient outcomes, timely care, improved staff collaboration, and increased paramedic availability.

Additionally, inconsistent reporting masks performance inefficiencies that increase the likelihood of adverse events and limit the ability to improve processes and support better patient care.

Achieving safe clinical ambulance handovers

Effective handovers involve the consistent exchange and accurate recording of information that is concise and structured according to a handover tool to provide high-quality patient care and reduce adverse events.²

Ambulance paramedics and hospital staff have a shared responsibility for ensuring effective and high-quality communication of relevant clinical information at clinical handover.

A process map infographic has been developed to assist clinicians and paramedics in working through each step of the clinical ambulance handover process.

Key responsibilities

The following outlines the shared responsibility between ambulance paramedics and emergency staff in ensuring effective, high-quality communication of relevant clinical information when patient care responsibility is transferred.

Health Services

Ambulance Victoria

IMIST – AMBO clinical handover model

Many models of clinical handover (sometimes referred to as structured handover tools) exist in Victoria, nationally, and internationally. The IMIST-AMBO model is a standardised model used by many Victorian health services and AV when communicating clinical handover of ambulance patients in the ED.

The IMIST-AMBO model should be followed during clinical handover of ambulance patients in the ED irrespective of IT systems in place at health services.

Recording and reporting Ambulance Handover times

Ambulance at Destination and Ambulance Handover Complete

'Ambulance at Destination'³ will be recorded by both ED staff and paramedics. This time represents the point in which the ambulance is parked in hospital waiting bay with engine off and paramedics activate the arrival button on their Mobile Data Terminal (MDT) to commence the Ambulance Handover process with ED staff.⁴

‘Ambulance Handover Complete’⁵ time will be recorded by the ED nurse in the Electronic Medical Record (EMR). This time represents the agreed point between the Ambulance Victoria (AV) paramedic and ED clinician when the following steps are complete:⁶

• Clinical information has been given to the ED clinician; and
• The patient has been moved from the ambulance stretcher to the hospital bed, care area or waiting room.

Both the agreed 'Ambulance at Destination' and 'Ambulance Handover Complete' time is entered into the Victorian Ambulance Clinical Information System (VACIS) and the ED information system for reporting into the VEMD.

The department's reporting processes use the VEMD as the single point of reference for health service reporting, performance management and data analysis. ED clinicians and paramedics are required to both agree on 'Ambulance Handover Complete' times to ensure data remains consistent and accurate.

If there are any concerns with material discrepancies between data sources, please reach out to Performance Improvement via performance.improvement@health.vic.gov.au

Acknowledgements

The Victorian Department of Health would like to acknowledge the valuable work of New South Wales Health and New South Wales Ambulance in developing the IMIST-AMBO handover model.

NSW Health and NSW Ambulance have approved the use of the model for clinical handover in the Protocol for the clinical handover of ambulance patients in the ED for the Victorian Health system.

Footnotes

1.Extracted from VEMD Manual 2025-26, Section 2: Concepts and derived item definitions accessed on 4 July 2026. Note that this excludes Ambulance Clearing Time.

2. Dawson, King and Grantham, et al, Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient, Emergency Medicine Australasia (2013) 25, 393–405.

3. Extracted from VEMD Manual 2025-26, Section 2: Concepts and derived item definitions accessed on 4th July 2026

4.Situations that are not considered Ambulance at Destination time:

• Ambulance has a visual on the hospital premise but not yet arrived at the waiting bay (too early).
• Paramedic arrived on foot at ED triage desk (too late).

5. Extracted from VEMD Manual 2025-26, Section 2: Concepts and derived item definitions accessed on 4th July 2026

6. Refer to the VEMD Manual 2025-26 for examples of case studies, including what is not included.

7. Australian Commission on Safety and Quality in Health Care (ACSQHC), National Safety and Quality Service Standards (Sec Edition), Page 75, Sydney, 2021.

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This protocol is also available for download