Abstracts

The emergency outpatient management of seizures varies significantly among EMS providers, depending on established protocols and levels of training/experience. To establish the clinical care provided by a highly trained EMS unit we reviewed records of the Richmond Ambulance Authority (RAA)., The RAA is an all Advanced Life Support service operating in an urban environment. Using a dynamic deployment method matching resources to demand, they field up to 22 units within Richmond. In 2005 31,100 patients were transported including 1,159 seizures. All seizure related calls were reviewed. Of the 1,159 calls there were 539 unique social security numbers. Transports per person ranged from 1 (67%) to 17 (0.2%). Diazepam (IV) is the recommended 1^st line therapy. IV attempts on pediatric ([lt]15 years) and adult ([gt]15years) patients that required medication were compared., Priority 1 calls averaged 40 minutes from dispatched time to arrival at the emergency department(ED). The average time from the scene to the ED was 7 minutes. Of the 1,159 seizure calls, 625 patients (54%) were transported to the ED; 85 patients (13.6% of those transported) were under the age of 15. The success rate for starting an IV on seizure patients requiring diazepam was 62% on the 1^st attempt, 16% on the second attempt and 19% on the 3^rd attempt. In 3% of seizing patients an IV could not be established. There was no difference between adult and pediatric IV success rate., Rapid IV access is not always possible in patients who are actively seizing. Alternative forms of anticonvulsant treatment need to be available for EMS.,