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When medical caregivers transfer patients to another person’s care (a patient handoff), it is essential they effectively communicate the patient’s condition to ensure the best possible health outcomes. Emergency situations caused by mass casualty events (e.g., natural disasters) introduce additional difficulties to handoff procedures such as environmental noise. We created a projected mixed reality simulation of a handoff scenario involving a medical evacuation by air and tested how low, medium, and high levels of helicopter noise affected participants’ handoff experience, handoff performance, and behaviors. Through a human-subjects experimental design study (N = 21), we found that the addition of noise increased participants’ subjective stress and task load, decreased their self-assessed and actual performance, and caused participants to speak louder. Participants also stood closer to the virtual human sending the handoff information when listening to the handoff than they stood to the receiver when relaying the handoff information. We discuss implications for the design of handoff training simulations and avenues for future handoff communication research.