Faking seizures?

[paramedicmike]

If this is a concern within the administration and day to day functioning of your school perhaps setting up a meeting with everyone involved to develop a care plan for when this particular student has a seizure is in order. That way everyone is on the same page about what to do the next time it happens. This will also create a list of things that would trigger a call to 911.

Not every seizure patient needs a ride to the emergency room especially if that patient has a known seizure history and doesn't want to go.

MTA: Looks like ERDoc and I were typing our responses at almost the same time.

Edited December 13, 2014 by paramedicmike

[ERDoc]

Great minds think alike.

[Grodo]

I suppose that if I ask for some criteria (when to call EMS), you're going to tell me that it varies from person to person, and I should really be asking the student?

Thing is, if I ask her, I suspect she's going to decide EMS should never be called, unless she's running on half of her blood supply, no longer breathing, or already dead (in which case, why are we even bothering with an ambulance?). She will freely admit that she avoids EMS like the plague; although to be fair, she did once tell a colleague of mine that medical intervention is indicated when a seizure lasts longer than five minutes (something that was echoed in this thread), but "that has never happened with her".

Should we be concerned if her post-ictal period lasts longer than normal, as well? If so, how much longer? Also, I've now read that an ambulance should be called if the person has multiple seizures without waking up in-between. I suppose they mean being post-ictal, and then going straight into another seizure? No jokes about us being too fussy in-between ... And what about two or more seizures within one hour? One of you already said we probably made the right call on Wednesday about that, but from what I've read so far, it doesn't seem like that actually happens very often. Is the fact that it does happen with this person an indication that her seizures might be psychogenic after all?

Gosh, I have so many questions now ...

[paramedicmike]

Gosh, I have so many questions now ...

Please reread what both ERDoc and I posted above.

[Grodo]

OK ... Looks like I'll be trying to organise a meeting with my student's PCP and my boss . Thank you for your time and information!

[paramedicmike]

And with the student. The student needs to be involved in this process, too.

[ERDoc]

We can give you general advice (pretty much what you already posted). The best people to make the decision are the student and her PCP or neurologist. They know her much better than we do.

[mikeymedic1984]

I don't think any of us are saying to call 911 immediately. Not all seizures need to go to the ER, especially in people known to have seizures. You also have to honor the patient's wishes, but keep in mind that you still need to take care of her properly. I think the school needs to have a conversation with her and get in writing a plan for what to do when she has a seizure.

Actually I am saying she should call 911, simply because this is a "school/student" relationship, even though the student is an adult. Should the wost happen, which probably never will, the family's lawyer is going to ask why they chose not to call 911. Just as ER Docs have ordered unnecessary lab work, xrays, and CT Scans, that they knew were a waste of time, we have to protect ourselves from the lawyers. At a minimum, the school should be calling the emergency contact relative every time, on a recorded line, and asking them if they want to come get her or call 911.

[ERDoc]

I disagree. There are plenty of places that have care plans for their students, especially when they are specialized schools that deal with people with chronic diseases. I completely agree that the emergency contact should be notified each time, but good luck getting a recorded line at a school.

[mikeymedic1984]

Thats fine, we can always agree to disagree, but I bet the school's attorney would think differently.