Statewide Emergency Medical Services Protocols for Status Epilepticus Management

Abstract

Although seizures are common in prehospital settings, standardized emergency medical services (EMS) treatment algorithms do not exist nationally. We examined nationwide variability in status epilepticus treatment by analyzing 33 publicly available statewide EMS protocols. All adult protocols recommend intravenous benzodiazepines (midazolam, n = 33; lorazepam, n = 23; diazepam, n = 24), 30 recommend intramuscular benzodiazepines (midazolam, n = 30; lorazepam, n = 8; diazepam, n = 3), and 27 recommend intranasal benzodiazepines (midazolam, n = 27; lorazepam, n = 3); pediatric protocols also frequently recommend rectal diazepam (n = 14). Recommended dosages vary widely, and first‐ and second‐line agents are designated in only 18 and 2 states, respectively. Given this degree of variability, standardized national EMS guidelines are needed. ANN NEUROL 2021;89:604–609

First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study

“…Equally, a recent randomized controlled trial has shown that intubation after 2 of 12 established SE is independent of baseline characteristics and early neurologic recovery, though it is strongly associated with site-specific practice pattern variation [8]. Additionally, a recent study showed high variability of SE treatment in EMS algorithms in the US [9]. The systematic priority-based emergency assessment of Airway, Breathing, Circulation, Disability, and Exposure (i.e., ABCDE approach) is the standard examination of critically ill patients as recommended by international organizations [10,11].…”