EMS providers identified themselves as advocates for their patients during the challenging EMS-to-ED handoffs. Providers identified normative challenges they encounter in their communications with hospital staff, and features of EMS and hospital protocols that either facilitate or undermine effective handoffs from the out-of-hospital environment to the ED. They identified 4 key potential ways to improve the structure and process of the handoff: (1) communicate directly with the ED provider responsible for the patient’s care; (2) increase interdisciplinary feedback, transparency, and shared understanding of scope of practice between out-of-hospital and hospital-based providers; (3) standardize some (but not all) aspects of the handoff; and (4) harness technology to close gaps in information exchange.