Pre-hospital to in-hospital care transitions represent critical junctures where communication failures significantly compromise patient safety and contribute to preventable medical errors. This systematic review examines existing evidence on emergency medical services to nursing handover protocols, their effectiveness in reducing medical errors, and patient safety outcomes, with particular attention to Middle Eastern emergency care contexts. A comprehensive search of peer-reviewed literature identified 37 relevant studies addressing handover communication, standardized protocols, medical error reduction strategies, and patient safety interventions. Findings reveal substantial variability in handover practices globally, with structured communication tools such as SBAR and I-PASS demonstrating measurable improvements in information transfer completeness and error reduction. Middle Eastern emergency care systems face unique challenges including infrastructure limitations, workforce diversity, and inconsistent protocol implementation. Critical gaps persist in culturally adapted handover protocols, context-specific validation studies, and longitudinal outcome assessments within Middle Eastern healthcare environments. This review underscores the urgent need for standardized, evidence-based handover protocols tailored to regional healthcare contexts to enhance patient safety during critical care transitions.