Background According to the Joint Commission, communication breakdowns are estimated to contribute to 80% of medical errors. Recent studies have challenged the typical belief that patient handoffs between physicians in the transfer of care are safe and effective, and that handoffs between experienced providers are better than those between trainees. Handoff communication is a skill that requires training and practice, and despite being a regular and frequent occurrence, poor communication during patient handoffs remains a major contributor to medical errors. This points to likely deficits in the common practices of medical training and education. Patient handovers of poor and insufficient quality are characterized by errors and omissions of critical information, a lack of standardization in the structure of the report, and the absence of closed-loop communication, i.e. readback. As a remaining challenge, it is more difficult to define precisely which nonarbitrary elements of communication contribute to a “good” patient handover, and to determine the quality thresholds necessary to distinguish expert, acceptable, and unacceptable levels of performance. Methods Researchers at the Uniformed Services University of the Health Sciences (USUHS) completed semi-structured interviews with enlisted medical providers about their firsthand experience in delivering and receiving patient handovers in tactical combat environments at or near the point of injury. Participants were asked what they feel is necessary for a successful patient handover, as well as questions about acceptable information omissions, barriers or obstacles to successful handover, and the role of communication in successful handovers. Purposive and snowball sampling methods were used to identify participants from various lines of military service. Inclusion in the study required that participants had prior experience in patient handovers at the point of injury to receiving emergency medical evacuation teams (MEDVAC), from MEDVAC to an advance trauma management site (Role 2), and/or from a Role 2 to a military treatment facility (MTF/Role 3). All interviews were recorded and transcribed. A conceptual content analysis was conducted to determine the presence and meaning of words, concepts, and themes within the interview data. Summary These firsthand accounts provide insight from experienced personnel, enabling us to determine an operationalizable definition of what makes a handover successful and to create a grading scale suitable for application in training exercises in the classroom or in the field, promoting constructive feedback, more accurate assessment of learner ability, and improvements in the identification of specific deficits in performance. Interview data specifically illuminated the importance of training as well as training deficiencies, the importance of shared meanings, and the barriers that these personnel in patient handover, from physical noise to the difficulty in completing reporting requirements.