- Administer high flow oxygen. (See Oxygen Administration)
- Apply end-tidal capnography
- Protect patient from injury while patient is seizing. DO NOT RESTRAIN PATIENT. DO NOT FORCE A BITE STICK INTO THE PATIENT'S MOUTH. Determine the duration of the seizure. Observe the type of seizure activity and what part(s) of the body it affects.
- Initiate transport.
- Adult patients who are no longer post-ictal may request not to be transported. You should consult with the hospital for authorization not to transport. (See Non-Transported Patient Protocol)
Continuous seizure activity for longer than 3 minutes or
two or more consecutive seizures without regaining consciousness.
Focal seizure activity meeting the above criteria should also be considered status epilepticus
- Assist ventilations and apply end-tidal capnography if available. (See Airway Management Protocol)
- Contact receiving facility for further orders if ALS is not on scene. Request advanced life support.
- Perform Blood Glucose analysis if available. If hypoglycemic, follow hypoglycemia BLS protocol in “Altered Level of Consciousness”.
- Apply the cardiac monitor and pulse oximeter
- Administer midazolam using IM/IN route FIRST:
- If patient ≥ 50 kg, administer 10 mg IM/IN
- If patient < 50 kg, administer 5 mg IM/IN
- Perform blood glucose analysis. If blood glucose < 60 mg/dL, refer to hypoglycemia protocol in “Altered Level of Consciousness”.
- If seizure continues for 5 minutes after initial administration of midazolam, then administer midazolam IM, IN, IO or IV:
- Administer 5 mg IM/IN or 2.5 mg IV/IO
- The EMS Administered maximum cumulative dose should not exceed 15mg total via all routes. Contact the receiving facility for further instructions or additional dosing if needed.
Note: Patient must be placed on nasal waveform capnography.
If the patient is pregnant in the 3rd trimester, administer 4 grams magnesium IVP over at least 4 minutes