Prehospital seizure management: Triage criteria for the advanced life support rescue team

Abarbanell, Neal Robert

doi:10.1016/0735-6757(93)90126-v

Cited by 12 publications

(9 citation statements)

References 11 publications

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“…28 In one study, those who were conscious with normal or rapidly improving neurological status, had normal vital signs and showed no signs of serious injury or illness did not receive ALS interventions. Paramedics successfully identified 173 out of 230 patients who did not require ALS care, with only one participant subsequently deteriorating, while 57 out of 58 patients received appropriately indicated ALS.…”

Section: Initial Assessment and Resuscitationmentioning

confidence: 98%

“…Paramedics successfully identified 173 out of 230 patients who did not require ALS care, with only one participant subsequently deteriorating, while 57 out of 58 patients received appropriately indicated ALS. 28 Providing the correct level of care is important in improving scene times and allowing for a more efficient use of services. However, this study employed separate dispatch teams for patients requiring ALS and those that did not, which is less applicable to systems which do not use a two tiered approach.…”

Section: Initial Assessment and Resuscitationmentioning

confidence: 99%

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Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines

Osborne

Taylor

Reuber

et al. 2015

Seizure

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The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated.

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Section: Initial Assessment and Resuscitationmentioning

confidence: 98%

Section: Initial Assessment and Resuscitationmentioning

confidence: 99%

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines

Osborne

Taylor

Reuber

et al. 2015

Seizure

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“…A recent retrospective study of the out-ofhospital care of seizure patients found that 75% of the patients presenting with seizure activity might be safely triaged to non-advanced life support transport after evaluation by paramedics. 3 Those conclusions remain to be validated in a prospective study; the challenge remains to predict all patients who might need advanced life support during transport.…”

Section: Emsmentioning

confidence: 99%

Emergency Department Management of Patients with Seizures: A Multicenter Study

Huff

Morris

Kothari

et al. 2001

Academic Emergency Medicine

124

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Abstract. Objectives: Patients with seizure disorders are common in the emergency department (ED), yet little is known regarding the management of these patients. This study was performed to define the frequency of patients with seizure disorders in the ED patient population and to determine possible seizure etiologies, characteristics of diagnostic activities, treatments, and dispositions. Methods: Twelve EDs monitored all patients with a chief complaint related to seizure disorders presenting over 18.25 days (5% of the calender year) in late 1997. Retrospective chart review was used to gather specific data regarding these consecutive cases. Results: Of the 31,508 patients who presented to these 12 EDs during the study period, 368 (1.2%) had complaints related to seizures. Three hundred sixty-two charts were available for analysis and make up the study population. Two hundred fifty-seven (71%) utilized emergency medical services (EMS) for transport and care. Advanced care, including intravenous access, laboratory work, cardiac monitoring, or oxygen administration, was utilized in 304 (84%) patients. Antiepileptic drugs were given in 199 (55%) patients. Ethanol withdrawal or low antiepileptic drug levels were implicated as contributing factors in 177 (49%) of patients. New-onset seizures were thought to be present in 94 (26%) patients. Status epilepticus occurred in only 21 (6%) patients. Ninety-eight (27%) of all patients were admitted to the hospital. Conclusions: Patients with presenting complaints related to seizures are frequent in the ED population and make considerable demands on EMS and ED resources. Six percent of patients with seizure-related presentations were in status epilepticus and more than a fourth of all patients required hospitalization. P ATIENTS with seizures and presenting complaints related to seizure disorders are frequent in the emergency department (ED) population, but little is known of their demands on emergency medical services (EMS) and ED resources. The acuity of problems ranges from status epilepticus to requests for medication refills. Surprisingly, little research has been performed on seizure disorders in the emergency patient population; one study describes this population from the perspective of a single ED. This study was undertaken to determine the frequency of patients with a chief complaint related to seizures at a broad range of institutions and to determine characteristics of clinical care provided, including diagnostic tests, treatment actions, and disposition. Investigators were instructed to cast a wide net to capture all patients with presenting complaints related to seizures or a seizure disorder. The widest spectrum of patient presentations was to be included for study, ranging from active seizures to requests for medication refills. The project was a descriptive study providing a snapshot in time of seizure care in diverse EDs. To the best of our knowledge, this is the only multicenter study to date that attempts to describe the needs of patients with seizures in...

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“…We are aware of one study that prospectively examined the ability of paramedics to determine that patients do not need transport, 14 and one examining the safety of a set of triage criteria for determining whether seizure patients require ALS or can be safely triaged to BLS, 15 but have found none that examined the ability of the BLS provider to determine when ALS is not needed. From a system standpoint, Key and colleagues in Houston's urban fire-based EMS system published three abstracts showing the safety of sending BLS-FR units without an ambulance to automated medical alarms 16,17 and certain motor vehicle accidents when the 911 caller is unable to provide any useful information about the accident.…”

Section: Discussionmentioning

confidence: 99%