📋

ZMIST Handoff Format

Structured Casualty Transfer — Military & Pre-hospital Standard

Zulu Time of Injury

Time the injury occurred in 24-hour UTC (Zulu) format. Critical for calculating time-sensitive interventions like TXA window (3 hrs) and tourniquet time.

"Injury at Zulu 1347"

TXA windowTourniquet timeAntibiotic timing

Mechanism of Injury

How was the injury caused? Be specific — this predicts injury patterns and guides the receiving team's assessment priorities.

"GSW right thigh, high-velocity, through-and-through"
"Fall from 4 metres onto concrete, landed feet first"
"IED blast, patient was 3 metres from point of detonation"

BlastGSWBluntPenetratingBurn

Injuries Found

All injuries identified during your assessment — both confirmed and suspected. Include mechanism-predicted injuries even if not yet confirmed.

"Tourniquet right mid-thigh, suspected femur fracture. Abrasions to face and chest. No other obvious injuries found — spinal injury not excluded."

ConfirmedSuspectedNot yet excluded

Signs & Vital Signs

Current vital signs at time of handoff. Include AVPU/GCS, pulse, respirations, BP if available, SpO₂, temperature if measured.

"AVPU: Voice. Pulse 110, weak radial. Resps 22. BP 90/60. SpO₂ 96% on air. GCS 13 (E3V4M6). Pale, diaphoretic."

HRBPRRSpO₂AVPU/GCSTemp

Treatment Given

Every intervention performed — with times where relevant. The receiving team needs to know exactly what has and hasn't been done.

"CAT tourniquet right mid-thigh applied Zulu 1349. 500mL Hartmann's IV right AC, running now. TXA 1g IV given Zulu 1352. Morphine 5mg IV Zulu 1354. Oxygen 15L NRB."

Tourniquet timeFluids givenDrugs + doses + timesProcedures

✓ Complete ZMIST example

Z: Injury Zulu 1347
M: GSW right thigh, through-and-through
I: R mid-thigh wound, CAT applied, suspected femur #
S: AVPU-V, HR 110, BP 90/60, RR 22, SpO₂ 96%
T: CAT 1349, 500mL Hartmann's, TXA 1g IV 1352

Train online at medready.io

Training reference only · TCCC / PHTLS standard

Handoff Communication Tips

How to deliver a clear, effective casualty handoff

🔊

State your name and role first. "Medic Johansson, Swedish Army, handing off one casualty." The receiving team needs context before details.

⏱️

Lead with what's time-critical. If the tourniquet was applied 90 minutes ago, say that in the first sentence — not buried in line T.

🚫

Say what you DIDN'T do. "I did not give any analgesia" and "spinal injury not excluded" are as important as what you did.

📣

Ask for read-back on critical details. Tourniquet time, drug doses, and allergy information should be confirmed verbally by the receiving team.

📝

Always accompany with written documentation — field medical card, casualty card, or TCCC card. Verbal handoff is not a substitute for written records.

🏥

MIST vs ZMIST: MIST (Mechanism, Injuries, Signs, Treatment) is the civilian version — same structure, no Zulu time line. Use ZMIST in military/tactical settings.

medready.io — Medical Training Platform

Training reference only