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Tom Grawey

Bio: Tom Grawey is an academic researcher from Medical College of Wisconsin. The author has contributed to research in topics: Medicine & Emergency medical services. The author has an hindex of 1, co-authored 4 publications receiving 12 citations.

Papers
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Journal ArticleDOI
TL;DR: Paramedics identified multiple potential solutions to overcome several barriers to protocol adherence and system improvements to address dose standardization, protocol clarity, simplified controlled substance logistics, and equipment availability.

18 citations

Journal ArticleDOI
TL;DR: Fifty percent of HEMS patients may benefit from PoCUS to evaluate for hypotension in flight, and how commonly the extended focused assessment with sonography in trauma or the rapid ultrasound in shock for medical patients could be used by HEMS is determined.

8 citations

Journal ArticleDOI
TL;DR: Initial and continuing education for airway management must extend beyond a narrow focus on psychomotor skills and task completion to include appreciation of underlying pathophysiology, clinical judgment, and higher-order decision making.

5 citations

Journal ArticleDOI
TL;DR: A comprehensive curriculum for EMS clinicians should align with the vision outlined by EMS Agenda 2050 by addressing the following areas:Public health & epidemiologySocial determinants of healthSocial equity and biasMental & behavioral healthCulture of safety and human factors scienceQuality improvementHealth care business & financeLeadership and change managementEvidence-based practiceEffective communication skills.

4 citations

Journal ArticleDOI
01 Aug 2021
TL;DR: The ED EMS Time as discussed by the authors was developed as an alternative training method to provide a field-type experience within the emergency department (ED) setting, where medical students observe and complete standardized reflections on Online Medical Control radio consultations and EMS to ED patient handoffs.
Abstract: Background Ambulance ride alongs are frequently a critical element of educational programs for learners of prehospital emergency care. We describe a novel alternative to the EMS ride along experience more conducive to COVID-19 restrictions. Methods ?ED EMS Time? was developed as an alternative training method to provide a field-type experience within the emergency department (ED) setting. Over the course of a four hour shift, medical students observe and complete standardized reflections on Online Medical Control radio consultations and EMS to ED patient handoffs. Medical students also interview EMS clinicians to gain insight into prehospital care and the challenges that occur in the field. Experiences are debriefed with an EMS attending. Results Medical students expressed increased knowledge around the challenges and treatment capabilities of EMS through the ED EMS Time experience. They were able to explain what information obtained from the scene was helpful to EMS clinicians. Medical students were able to realize the objectives of ambulance ride time through an emergency department experience designed around EMS. Conclusions ED EMS Time represents a novel approach to teaching medical students the intricacies of prehospital medicine from the confines of the emergency department while avoiding direct patient contact, preserving PPE and limiting COVID-19 exposure.

1 citations


Cited by
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Journal ArticleDOI
TL;DR: This study provides Class III evidence that for patients with status epilepticus, higher doses of midazolam led to a reduced use of rescue therapy without an increased need for ventilatory support.
Abstract: Objective To examine the use of benzodiazepines and the association between low benzodiazepine dose, breakthrough seizures, and respiratory support in patients with status epilepticus. Methods In this cross-sectional analysis of adult patients with status epilepticus treated by an emergency medical services agency from 2013 to 2018, the primary outcome was treatment with a second benzodiazepine dose, an indicator for breakthrough seizure. The secondary outcome was receiving respiratory support. Midazolam was the only benzodiazepine administered. Results Among 2,494 patients with status epilepticus, mean age was 54.0 years and 1,146 (46%) were female. There were 1,537 patients given midazolam at any dose, yielding an administration rate of 62%. No patients received a dose and route consistent with national guidelines. Rescue therapy with a second midazolam dose was required in 282 (18%) patients. Higher midazolam doses were associated with lower odds of rescue therapy (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.7–0.9) and were not associated with increased respiratory support. If anything, higher doses of midazolam were associated with decreased need for respiratory support after adjustment (OR, 0.9; 95% CI, 0.8–1.0). Conclusions An overwhelming majority of patients with status epilepticus did not receive evidence-based benzodiazepine treatment. Higher midazolam doses were associated with reduced use of rescue therapy and there was no evidence of respiratory harm, suggesting that benzodiazepines are withheld without clinical benefit. Classification of evidence This study provides Class III evidence that for patients with status epilepticus, higher doses of midazolam led to a reduced use of rescue therapy without an increased need for ventilatory support.

28 citations

Journal ArticleDOI
TL;DR: Implementation of an evidence-based seizure protocol for EMS increased midazolam administration and future research should focus on optimizing administration of the correct dose of midazlam to improve seizure cessation.

11 citations

01 Jan 2018
TL;DR: In this article, the authors evaluated the efficacy of a Mobile Integrated Health (MIH) led transitional care strategy to reduce acute care utilization and found that inpatient utilization decreased significantly from 140 hospitalizations to 26 post-MIH (83% reduction, p = 0.00).
Abstract: Background: Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. Study objective: To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. Methods: This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90 days before MIH intervention to 90 days after. Results: Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre‐MIH to 26 post‐MIH (83% reduction, p = 0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p = 0.98; observation stays 95 to 106, p = 0.30) Primary care visits increased 15% (p = 0.11). Conclusion: In this pilot before/after study, MIH significantly reduces acute care hospitalizations.

7 citations

Journal ArticleDOI
TL;DR: DAAM is an appropriate tool for EMS clinicians in systems with clear guidelines, sufficient training, and close EMS physician oversight, but should not be used in settings without adequate resources.

6 citations

Journal ArticleDOI
TL;DR: A systematic review of prehospital guidelines published from January 2018 to April 2021, evaluate guideline quality, and identify top-scoring guidelines to facilitate dissemination and educational activities for EMS personnel is presented in this article.

6 citations