So, you’re having a seizure. What do you do?
Well nothing, I guess; you’re having a seizure.
But paramedics can do stuff! And with this brilliant and natural segue, we’re on to Protocol 513 – Seizures.
The ALS protocol for seizures does what it can to diagnose and treat within the confines of the paramedic’s scope of practice. They should be checking a 3-lead for any concerning arrhythmias that may be mimicking as seizure activity, as well as assessing for hypoglycemia that may need to be reversed. Notice that there is a note included that reminds providers to account for a relative hypoglycemia for diabetic patients who may be euglycemic by non-diabetic standards. Similar to other protocols where hypoglycemia is mentioned, ALS will respond by giving dextrose IV/IO or glucagon IM if unable to obtain vascular access.
From here, the protocol discusses benzos, offering separate IV/IO and IM/IN dosing strategies to account for the time and safety concerns that often come with attempting to secure vascular access in a patient that is actively thrashing about. Check the protocol for specifics, but broadly, ALS providers are allowed to administer up to two doses of lorazepam OR up to two doses of diazepam OR a single dose of midazolam by Standing Order. As an OLMC physician, you can authorize repeat doses of any of those as you see fit.
That’s it! Stop the seizure! Don’t forget that benzos will require a Tracking Number (MMC-####), but don’t be alarmed if the crew asks to call back for the number after they’ve controlled the seizure in front of them; they won’t leave you hanging! While you wait for their call back, you can brush up on the protocols at www.nycremsco.org or with the protocol binder!
Dave