Management of the seizure patient

[under-dreaming]

Do you always wait for a seizure patient to stop convulsing before loading them on a spine board and putting them in the back of the ambulance? I was just looking it up in my BLS book, and it says that we are to wait until they are finished. Should we wait a long time? What is the wait limit?

I have run on a couple calls involving a seizure patient. The EMT in charge wanted to just load and go even though the patient was still convulsing. The patient had been convulsing for over twenty minutes by the time we arrived (both times, same patient), no harm was done to the patient. Was that the appropriate action?

Any and all information will be of great help. Thanks.

[ERDoc]

This is one of those situations where there is no one-size-fits-all right answer. If you are an ALS crew then stay on the scene and stop the seizure. For a BLS crew it may be more beneficial to the pt to get to the hospital as quickly as possible. However, if you can't move the pt safely while they are having a seizure then it may not be a good idea to do so. But, if they have been seizing too long you may be doing more harm. How is that for an answer?

[DartmouthDave]

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Hello,

I would say 'load and go' if the patient had been seizing for 20 minutes. Any interesting history on this

patient?

D

[under-dreaming]

This is one of those situations where there is no one-size-fits-all right answer. If you are an ALS crew then stay on the scene and stop the seizure. For a BLS crew it may be more beneficial to the pt to get to the hospital as quickly as possible. However, if you can't move the pt safely while they are having a seizure then it may not be a good idea to do so. But, if they have been seizing too long you may be doing more harm. How is that for an answer?

Thanks.

[under-dreaming]

[/font:c235e37f93]

Hello,

I would say 'load and go' if the patient had been seizing for 20 minutes. Any interesting history on this

patient?

D

Well, since you asked, I'll give you what I can.

Like I said, I've run on this pt. twice. I wasn't running the call, so I didn't get much Hx on scene.

30 y/o male pt.

Arrive on scene to find pt. supine on living room floor actively convulsing. Convulsions are mild to moderate. Airway is good.

The EMT running the call (EMT-II) had been there before, so he didn't gather any information whatsoever other than the duration of the seizure.

The pt. was loaded onto the backboard and we carried him out to the ambulance. No vitals on scene, no vitals in the rig (the hospital is just around the corner... not that it justifies cutting corners though). My partner told me to just go ahead and roll-out. When we got to the hospital he threw on a hep-lock just before we took the pt. out of the ambulance. and brought him in.

**Just for the record: I don't really look to this particular EMT as a good example of an effective EMT.**

This patient has a history of seizures. I don't know what is causing them... I don't even know if the hospital does. As you can see, the history is not interesting at all. My biggest concern is that this EMT is creating a habitual response to this patient. And the concern is not for the EMT, it's for the pt. and the family. Because if I find out that he has been dealing with this the wrong way every time, but the family is used to seeing him deal with the pt. in that manner, then they will think that I am doing something strange and wrong when I am the one making pt. contact without this other EMT. It is just something that I have been thinking about.

[Timmy]

That is such poor care! Wait, did I just say care? Why bother calling the ambulance? Just chuck him in the back of the family car and off we go.

Why is ALS not called? Seizures really don't warrant BLS.

[under-dreaming]

That is such poor care! Wait, did I just say care? Why bother calling the ambulance? Just chuck him in the back of the family car and off we go.

Why is ALS not called? Seizures really don't warrant BLS.

Like I said, he is pretty much a bad example all around. The family doesn't know any different though! That's the saddest part.

This is a rural area, and we do not offer service above EMT-III in the fire department (and that has to do with who's on shift). During the day shift, there are two EMT's on duty; at night, only one. One of the off-duty staff or a volunteer answers up at night when there's an ambulance call. The EMT in question works nights at the beginning of the week, I work nights at the end of the week. I just happen to answer up to drive for him from time to time.

If I run on a pt. in cardiac arrest or a GSW or what have you, I can request ALS assistance if the hospitals flight medics are in town, and they can offer assistance. My chief is also a paramedic.

[Arizonaffcep]

This is a rural area, and we do not offer service above EMT-III in the fire department (and that has to do with who's on shift). During the day shift, there are two EMT's on duty; at night, only one. One of the off-duty staff or a volunteer answers up at night when there's an ambulance call. The EMT in question works nights at the beginning of the week, I work nights at the end of the week. I just happen to answer up to drive for him from time to time.

If I run on a pt. in cardiac arrest or a GSW or what have you, I can request ALS assistance if the hospitals flight medics are in town, and they can offer assistance. My chief is also a paramedic.

What is the difference between EMT I, II, and III? Are they ALS? If you call for ALS assistance, and it would take longer for them to reach you vs. "load and go" to the hospital, IMHO, load and go...don't waist time waiting for ALS IF you can get to the hospital faster than ALS can get to you.

[under-dreaming]

EMT-I is NREMT-B; EMT-II can initiate IV, intubate and push some drugs (NREMT-I '85); EMT-III pushes more drugs and higher level cardiac skills(NREMT-I '99). EMT-II and III are considered ALS.

The hospital is within two to five minutes drive from most areas. So yes, load and go is often a very wise decision. Usually additional resources are called upon for moving larger patients or for trauma incidents in colder weather.

[crotchitymedic1986]

There is really no reason to backboard this patient, unless the fell and suffered trauma during the seizure, since this is a known seizure patient (it would be different if he had no history of seizures, or you had no idea what his history is). In this BLS scenario, with you knowing that this patient does tend to have seizures for greater than 20 minutes, I would load and go to the hospital (starting an IV, placing him on highflow O2, and maintaining his airway enroute).