Management of Prehospital Seizure Patients by Paramedics

Abstract

Background. Seizure patients are frequently encountered in the prehospital environment andhave the potential to need advanced interventions, though the utility of advanced life support (ALS) interventions in many of these patients has not been proven. Objective. Our goals were to assess the management of prehospital seizure patients by paramedics in an urban EMS system with an existing ALS-based prehospital seizure protocol andto assess characteristics andshort-term outcomes that may aid in addressing the utility of specific ALS interventions. Methods. This was a retrospective study of 97 EMS cases with the chief complaint of seizure. Prehospital records were reviewed for patient andevent characteristics, including past seizure history, seizure timing, level of consciousness, on-scene andtransport times, andEMS interventions. Emergency department (ED) records were reviewed for recurrence of seizure activity, ED evaluation, anddisposition. Data were analyzed using descriptive statistics andStudent t-test. Results. Of 87 patients meeting the protocol inclusion criteria for all ALS interventions, 11 (12.6%) received cardiac monitoring, 55 (63.2%) had intravenous (IV) access attempted, and56 (64.4%) had blood glucose determination. Average on-scene time was 5.9 minutes longer if IV access was attempted (p = 0.001), though transport times were not significantly different (11.6 versus 11.3 minutes, respectively; p = 0.851). Additional seizure activity occurred in the prehospital and/or ED settings in 28 patients (28.9% of all cases), including 17 in the prehospital setting and15 in the ED. Diazepam was administered by EMS for half of the eight (8.2%) patients who had seizures lasting more than 1 minute, while the remainder had seizures that were focal or spontaneously resolved. Conclusion. This study showed a lower-than-anticipated level of compliance with an ALS-based prehospital seizure protocol, though patient-specific care appeared appropriate. Prehospital seizure patients have the potential for seizure recurrence andmay benefit from focused ALS interventions, but their heterogeneity makes uniform protocols difficult to develop andfollow.