Statewide Emergency Medical Services Protocols for Status Epilepticus Management

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 recomme...

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Bibliographic Details
Published inAnnals of neurology Vol. 89; no. 3; pp. 604 - 609
Main Authors Han, Ethan J., Chuck, Carlin C., Martin, Thomas J., Madsen, Tracy E., Claassen, Jan, Reznik, Michael E.
Format Journal Article
LanguageEnglish
Published Hoboken, USA John Wiley & Sons, Inc 01.03.2021
Wiley Subscription Services, Inc
Subjects
Administration, Intranasal
Administration, Rectal
Adult
Algorithms
Anticonvulsants - administration & dosage
Anticonvulsants - therapeutic use
Benzodiazepines
Benzodiazepines - administration & dosage
Benzodiazepines - therapeutic use
Child
Cross-Sectional Studies
Diazepam
Diazepam - administration & dosage
Diazepam - therapeutic use
Emergency Medical Services
Emergency services
Epilepsy
Humans
Injections, Intramuscular
Injections, Intravenous
Intravenous administration
Levetiracetam - administration & dosage
Levetiracetam - therapeutic use
Lorazepam
Lorazepam - administration & dosage
Lorazepam - therapeutic use
Midazolam
Midazolam - administration & dosage
Midazolam - therapeutic use
Pediatrics
Phenobarbital - administration & dosage
Phenobarbital - therapeutic use
Practice Guidelines as Topic
Rectum
Seizures
Status Epilepticus - diagnosis
Status Epilepticus - drug therapy
United States
United States
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Summary: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
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0364-5134
1531-8249
DOI:10.1002/ana.25989