Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines. (January 2015)

• Record Type: Journal Article
• Authors: Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A.; Parkinson, Martin; Dickson, Jon M.
• Is Part Of: Seizure. Volume 24(2015)
• Page Start: 82
• Page End: 87
• Publication Date: 2015-01
• Subjects: TIA transient ischaemic attack -- UK United Kingdom -- ALS advance life support -- ED Emergency Department -- PWE people with epilepsy -- QoL quality of life -- SE status epilepticus -- JRCALC Joint Royal Colleges Ambulance Liaison Committee -- ABCD airway breathing circulation disability -- IV intravenous -- PR per rectum -- USA United States of America -- ECG electrocardiogram -- ECA emergency care assistant -- EEG electroencephalography -- IM intramuscular -- IN intranasal -- AEDs automatic external defibrillators -- NEAD non-epileptic attack disorder; Seizure -- Status epilepticus -- Pre-hospital -- Advanced life support -- Benzodiazepines -- Hospital admissions; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2014.09.002
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: We summarise the UK Ambulance Service guidelines for seizure management. We review the research literature on the pre-hospital management of seizures. Much of current practice is drawn from generic advanced life support principles. Benzodiazepines are effective but we cannot conclude on a preferred preparation. More research is needed to improve pre-hospital care for people after a seizure. Abstract: Purpose: Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Methods: Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Results: Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. Conclusion: The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated.