Seizure-A BLS Dispatch

[stcommodore]

So in my system we don't have the units to or practice "dual dispatch." We have about 15 BLS and 35 ALS units and the dispatch protocol goes like this. ALS Dispatches will go to an ALS unit if one is within 2 miles, if not it goes to closest unit. BLS dispatches will go to BLS units within 5mi of a call, if no bls then closest. Trauma runs...closest. Code Blue...Closest and ALS if one is within 2 miles.

Now the topic at hand. Our dispatch protocol states a "ONE seizure, with history of and patient is breathing normally" is a BLS call.

Thoughts? Comments?

[DirteMedic]

Our service practices the same policy. The only caveat is that if the person is still seizing it is a code 3 run and gets ALS. If they are no longer seizing and effectively breathing then it's a code 2 BLS response. It seems to work. The only place we run into an issue is with status seizure and trusting a layman perspective on what "no longer seizing" means. These are areas where a system can get itself into trouble. But honestly nearly every 911 run you make you are basing your dispatch information on layman perspectives.

[stcommodore]

To expand on the topic, "Abdominal Pain" 35 years or older is an ALS dispatch. Now I haven't met many abdominal pains I work up, but I guess its because over the phone abdominal pain can be vauge and acutally be so much more. Would you be ok with "general weakness" being a BLS dispatch? In my urban system I sure am.

[PCP]

In our service it works both ways. If you are working out of a community that has an ALS car and they are not busy, they will be dispatched along with the BLS car. Of course in most places we do not have ALS, so it is up to us to treat and transport the patient. The only places that I can think of here in BC that have an ALS car are: Vancouver, Victoria (multiple ALS cars) Nanaimo has one ALS car, Prince George has one, and Kamloops has one. Other than that it is up to us to deal with any seizures.

I do agree that it is helpful to have an ALS car on scene do to their knowledge and treatment that can do, but I feel confident that as a Primary Care Paramedic that I have knowledge and tools to treat this patient. The biggest thing I feel is that no matter what level of care you are the best patient care is to get them to the hospital.

some questions that need to be asked are why is the patient having seizures? how long have they been seizing for? any hx of seizures in the past? Is there anything I can do for this patient? are they diabetic? drug overdose? if so treat the patient for those and if not, ABC transport!!

To be honest I do not fully understand what tools the ALS crews have to treat a patient that are having seizures? Maybe someone can let me in on the secret!!

[JakeEMTP]

To be honest I do not fully understand what tools the ALS crews have to treat a patient that are having seizures? Maybe someone can let me in on the secret!!

Midazolam, Lorazepam and Diazepam.

We had a pt. 2 weeks ago that was actively seizing when we arrived on scene. We administered 3mg Versed to control the seizures. A FSBS was obtained and found to be 18. We fixed that too. But, it would have been difficult to establish an IV w/o the narcotic controlling the seizure activity.

Edited December 15, 2010 by JakeEMTP

[PCP]

Midazolam, Lorazepam and Diazepam.

We had a pt. 2 weeks ago that was actively seizing when we arrived on scene. We administered 3mg Versed to control the seizures. A FSBS was obtained and found to be 18. We fixed that too. But, it would have been difficult to establish an IV w/o the narcotic controlling the seizure activity.

Oh shoot I should have known that I knew that those are the medications to control seizures, but did not realize that is what the ALS crews will administer. It makes sense that if the patient is not given those medications that it is pretty much impossible to start an IV on patient having seizures. So

So time for another silly question. How does one adminster those certain medications to a actively seizing patient? I thought they are administered through an IV?

So when those medications are administered is there a time line as to how long they control the seizures? Is it possible for a patient to start to have seizures again after the administration of any of those medications?

What does FSBS stand for?

Brian

[JakeEMTP]

Sorry Brian for the use of a perhaps local slang. FSBS is a "Finger Stick Blood Sugar". I used a BGL (Blood Glucose Level) once an a PCR and was told it wasn't an approved abbreviation.

We can administer Versed IM up to 5mg, which we did in this case although a lesser dose due to the pt.'s smaller stature. USUALLY (capitalised for effect), there is a very short time, less than a minute for it to start taking effect. I guess it is possible for the pt. to begin seizing again although I have never seen it in my short career. Perhaps one of the seasoned medics or MD's here could explain.

Edited December 15, 2010 by JakeEMTP

[PCP]

Sorry Brian for the use of a perhaps local slang. FSBS is a "Finger Stick Blood Sugar". I used a BGL (Blood Glucose Level) once an a PCR and was told it wasn't an approved abbreviation.

Hey no problem Jake. I find it funny that using BGL was not approved for abbreviation in your area. Oh well we all have our own abbreviation's. Now I know if I ever see FSBS again I will know what it means.

Thanks for that

[Richard B the EMT]

Hey no problem Jake. I find it funny that using BGL was not approved for abbreviation in your area. Oh well we all have our own abbreviation's. Now I know if I ever see FSBS again I will know what it means.

Thanks for that

...And that, ladies and gentlemen, is why I always ask for us to not use abbreviations, or follow with a translation, as some abbreviations are not universal.

Some of us have had THAT patient threatening to sue for calling them an SOB, when what we meant was the patient had Shortness Of Breath!

[Bieber]

To be honest, I wouldn't be comfortable transporting a post-seizure patient BLS. I've always made them code yellow, meaning they get the monitor and an IV, and several times I've been thankful for it when they started seizing on me again.