Ambulance care of prolonged convulsive seizures - a survey
BACKGROUND AND OBJECTIVES: In the UK, there are clear guidelines for paramedics on how to treat patients presenting with prolonged convulsive seizures. Despite this, paramedics have reported feeling unsure about determining the severity of seizures and often rely on senior paramedic experience as opposed to published guidelines. To determine individual paramedic action in this scenario, a questionnaire was developed. The responses were then compared to national guidelines to determine whether there were any significant differences.
METHODS: An anonymous online questionnaire comprising of ten questions was created via an online survey tool in December 2016. All responses were automatically saved by the tool and then analysed by May 2017. A volunteer sample of 138 paramedics from seven ambulance services across the UK chose to complete the questionnaire after being informed about it by their ambulance service.
RESULTS: Paramedics who completed the questionnaire mostly acted in concordance with UK guidelines, although when regarding more complex seizure management, there were some responses which differed from the guidelines significantly. Many paramedics offered suggestions on how to improve ambulance care of patients presenting in this way, with the most frequent suggestion being the stocking of buccal midazolam, alongside undertaking more training, improving the clarity of ambulance clinical practice guidelines and being provided with more information about the patients. Buccal midazolam was also considered the easiest route of anticonvulsant administration for patients of all ages.
DISCUSSION AND CONCLUSIONS: In this sample, paramedics seldom had midazolam available to use, and practice varied with regard to which medication to use and when at various stages during the treatment of prolonged convulsive seizures. More needs to be done, such as exploring the possibility of stocking buccal midazolam in ambulances, to ensure optimal patient management and outcomes to reduce the incidence of status epilepticus and keep people with prolonged seizures out of hospital.
