Push Dose EMS

On this episode, Dr. Heintz and Andrew Olson examine decision-making capacity and the balance between patient autonomy and safe care when patients decline treatment or transport. The episode offers practical approaches to communication barriers, reassessment, medical control, documentation, and connecting patients with additional resources.

MCOEM Decline of Care or Transport Guideline: https://app.eolasmedical.com/spaces/landing/null?spaceId=EOLAS%23ORG%23milwaukee-county-ems%2376ce0e89-37b9-48db-8edf-6605d13f4ad7&fileId=FILE%234d124dfa-820b-4527-bf3f-243c851bdb41&origin=section

Email Mike: [email protected]

Milwaukee County EMS reviews its 2025 STEMI data and opportunities to improve recognition, activation, and scene times. Dr. Rago and Andrew Olson discuss difficult ECGs, STEMI mimics, early notification, and the importance of treating the patient—not just the tracing.

Milwaukee County OEM EMS Activity Dashboard:

https://county.milwaukee.gov/EN/Office-of-Emergency-Management/EMS/Data-Analytics/EMS-Activity

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Meet Milwaukee County EMS’s newest fellows, Dr. Hanna Heintz and Dr. Cierra Rago, and learn about their backgrounds, roles, and goals for the year ahead. They discuss the value of relationships between EMS physicians and field clinicians—and share a few strong opinions about caffeine, diltiazem, and the best way to say hello.

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In this episode of Push Dose EMS, Shane Hughes and Dr. Tom Grawey discuss how to recognize and manage the peri-arrest patient before they progress to cardiac arrest. The conversation challenges the traditional rapid transport mindset and focuses on early identification, treating the underlying cause, and making patient movement safer through deliberate, meaningful interventions.

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This episode takes a one-year look at Milwaukee County’s prehospital whole blood program, exploring how it was built, implemented, and refined across a complex EMS system. Dr. Amy Stasik, Dr. Tom Engel, and Dan Pojar share key lessons learned, clinical impact, and opportunities for improvement - from patient recognition to system coordination.

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In this episode of Push Dose EMS, Dr. Mitch Byrd and Quality Assurance Manager Matt Pinsoneault break down what QA/QI means in modern EMS. The discussion highlights Milwaukee County’s shift toward a just culture, focusing on learning, system design, and provider engagement rather than blame, and emphasizes how documentation and clinician involvement drive meaningful change and better patient outcomes.

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Email Matt: [email protected]

Email MCOEM EMS Quality: [email protected] 

Milwaukee County CQIP Submission Form: CQIP Case Submission - OEM EMS

Check out the Milwaukee County EMS Continuous Quality Improvement Program: 

https://county.milwaukee.gov/files/county/emergency-management/EMS-/Standards-of-Care/Continuous-Quality-Improvement-Program-2024-070124.pdf 

Every call generates data, but what actually happens to it? This month, we take a behind-the-scenes look at how EMS documentation fuels system performance, research, and operational decisions across Milwaukee County. Learn how your charting shapes dashboards, deployment strategy, and quality improvement efforts. 

Email Mike: [email protected]

Email Milwaukee County Data Analytics Team: [email protected] 

EMS Activities Dashboard: https://county.milwaukee.gov/EN/Office-of-Emergency-Management/EMS/Data-Analytics/EMS-Activity

Hospital Diversions Dashboard: https://county.milwaukee.gov/EN/Office-of-Emergency-Management/EMS/Data-Analytics/Hospital-Diversions 

Cardiac Arrest Dashboard: https://county.milwaukee.gov/EN/Office-of-Emergency-Management/EMS/Data-Analytics/Cardiac-Arrest 

Overdose Dashboard: https://county.milwaukee.gov/EN/Office-of-Emergency-Management/EMS/Data-Analytics/Overdose

EMS Stroke Dashboard: https://county.milwaukee.gov/EN/Office-of-Emergency-Management/EMS/Data-Analytics/EMSStrokeDashboard

Pediatric 911 encounters account for just over 5% of Milwaukee County EMS calls, but they require disciplined assessment and rapid recognition.  In this episode, we discuss assessment pearls, talk about common emergencies in the pediatric population, and take a look at our current pediatric EMS study, the Pedi-PART Trial.

Email Mike: [email protected]

Pedi-PART SOAR Card Reference:

https://county.milwaukee.gov/files/county/emergency-management/EMS-/Numbered-Notices/NN-24-04-Pedi-PART-Study-w-SOAR-Cards.pdf

Ramgopal S, Elmer J, Escajeda J, Martin-Gill C. Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients. J Pediatr. 2018 Aug;199:200-205.e6. doi: 10.1016/j.jpeds.2018.03.069. Epub 2018 May 11. PMID: 29759850; PMCID: PMC7073459.

This episode explores postpartum hemorrhage and what EMS providers need to know for early recognition and effective prehospital management. With insight from Dr. Rachel Harrison and Dr. Amy Stasik, we review the 4 Ts, updated guidelines, and whole blood considerations. 

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NAEMSP OB Emergency Guidelines:

Now Available: New EMS Obstetric Emergency Guidelines - NAEMSP

NAEMSP Postpartum Hemorrhage Guideline:

Postpartum Hemorrhage

A challenging Oak Creek call with seizure activity, head trauma, and a late DNR highlights decision-making in the gray zone of EMS. The crew reflects on airway management and ethics to strengthen clinical judgment in the field.

Email Mike: [email protected]

Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C., Mullins, T., & Sherrill, D. (2017). The effect of combined out-of-hospital hypotension and hypoxia on mortality in major traumatic brain injury. Annals of Emergency Medicine, 69(1), 62–72. https://doi.org/10.1016/j.annemergmed.2016.08.007