Seizure-A BLS Dispatch

[firemedic37]

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.

Pt's can start to seize again even after receiving even a large dose of medications. It is not usually seen in the field very often unless you have extended transport times or status epilepticus which can be very difficult to manage outside of the hospital.

Seizures are more complex than just jerking movements and can be life threatening. When pt's don't respond to traditional treatment such was Valium and Versed there are other ways of managing them. The most common method is to RSI, Rapid Sequence Introduction meaning that we sedate and administer paralytics to stop the jerking movement and control the airway (intubate the pt). This does not stop the seizure it just controls the airway. They need anti-epileptic medications in the hospital setting and evaluation by a neurologist.

Another effective way of administering medications to a seizing pt is to administer it inter-nasally (IN) it is very quick and you do not have the risk of being stuck with a dirty needle. It is almost or as effective as IV administration. And there are limited medications that can be given that way but Versed and Valium are approved.

[PCP]

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.

At least your honest about not feeling comfortable about transporting a post-seizure patient and you request for ALS. That to me is also good patient care. You are lucky you have that choice to call for ALS. I don't have a choice I have to feel comfortable about transporting a post-seizure patient as noted before I do not have ALS in my community.

Great job on calling for ALS as I am sure some medics will not call for ALS even if they are not comfortable transporting.

Brian

[uglyEMT]

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

Being BLS I would like to add something, strictly from my perspective is all. I would of course request ALS but if none was available and the patient is post seizure and has a known history of them and has a patent airway with normal resperations I don't see a problem with transporting.

I will explain my reason why. Most folks with a history of seizures usually know their bodies well. They will know when one is coming on and after know if they feel different then the last time. The reason some folks call 911 for a seizure is because they see the person writhing on the graound and panic. So if I get their and ALS is unavailable and I am able to communicate with my patient, they tell me of a history of seizures, possibly have prescriped meds, they have normal respirations, and are post seizure then I dont see a need for anything advanced to be done. Yes I know their can be complications, thus my statment that the patient usually knows afterwards if anything is off. Transport to nearest facility, monitor breathing and vitals, keep an ear out for the patient telling you another might be coming on, and transfer care to the ED.

Now if there wasn't a history or the patient goes status epilictus then yea I wouldn't think about transport unless ALS was available unless a life threatening problem is arising where immediate medical intervention is necessary.

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.

In my response area both would be a BLS response with ALS availablity. If we get there and the "abdominal pain" is present but we find out the patient has eaten a large meal or a new kind of meal and has normal range vitals then we would advise ALS of our findings and if they feel it necessary we will meet enroute. Now we get there and the pain is on the right side, higher up and radiating twords the back, ect then ALS will be called and either meet at scene (depending on their location) or enroute due to high suspition of something major that would be better served by ALS then BLS.

General weakness I would follow the same guidelines as above. If my findings are leading me twords beigin findings then I would ask for advice or just transport but if my findings are leading to something serious then its ALS all the way.

Now this doesn't mean ALS can't release the patient back to my care and I continue transport without them. Just that I would consult them or call them forthwith if I felt it necessary.

A few quick examples..

abdominal pain: 21yr F calls has 8/10 pain. Arrive on scene find her doubled over on her floor. After a brief history find out its cramps from PMS. Non ALS but a transport none-the-less (she insisted)

General weakness: 24yr F calls for weakness. Arrive on scene and she is sitting on the couch. After a breif history find out she is running a 103 fever and fell down the stairs (15 wooden) before calling us. Full spinal precautions due to the fall (actually had decreased PMS in her lower extremities and fixed dialated pupils) ALS dispatched due to the temperature and also the possible closed head injury

So the BLS side is able to make the determination after a breif history if ALS is warrented for the call and not just by dispatch alone. Now if dispatch has the time and asks the right questions sometimes they dispatch both units so that we arrive pretty close to one another to get the patient moving that much quicker.

FYI the area I am in the ALS uses chase trucks and can not transport so a BLS rig is at every call but not necessarily an ALS rig. 4 ALS rigs cover my area (50 sq miles or more) so sometimes they just are not available.

[zippyRN]

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?

breathing normally = not actively seizing ,

hx of seizures = the top 2 diagnoses

-1. someone with a seizure disorder or

- 2. an alcoholic who who is suffering from ETOH deficiency.

if someone is not actively seizing what the treatment from any EMS provider whether first responder or a full blown Field Physician + Paramedic / PHRN ? supportive care and offer transport to the ED to be checked out

end result = none emergent transport for evaluation or discharge at scene depending on service / state protocols / guidelines and patient preference ...

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.

rule out AAA or atypical presentation of acute MI