1. Administer high flow oxygen. (See Oxygen Administration)

  3. Apply end-tidal capnography

  5. 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.


Not in Status Seizures


  1. Initiate transport.

    1. 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)


Status Seizures


Criteria: 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




  1. Assist ventilations and apply end-tidal capnography if available. (See Airway Management Protocol)

  3. Contact receiving facility for further orders if ALS is not on scene. Request advanced life support.

  5. Perform Blood Glucose analysis if available. If hypoglycemic, follow hypoglycemia BLS protocol in “Altered Level of Consciousness”.




  1. Apply the cardiac monitor and pulse oximeter

  3. Administer midazolam using IM/IN route FIRST:

    1. If patient ≥ 50 kg, administer 10 mg IM/IN
    2. If patient < 50 kg, administer 5 mg IM/IN


  5. Perform blood glucose analysis. If blood glucose < 60 mg/dL, refer to hypoglycemia protocol in “Altered Level of Consciousness”.

  7. If seizure continues for 5 minutes after initial administration of midazolam, then administer midazolam IM, IN, IO or IV:

    1. Administer 5 mg IM/IN or 2.5 mg IV/IO


  9. 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


Adult Status Epilepticus