Repeat this phrase: Seizure activity in and of itself does not constitute a medical emergency.
Patients who have seizures are often brought to the emergency department by bystanders or EMTs who have the mistaken impression that the individual is in medical crisis. This represents the widespread misunderstanding of seizures pervasive in our society.
Of course, EMS response, lights, sirens and the resultant rubber-necking crowd only serve to embarrass the patient and create an unnecessary ambulance fee.
A seizure is abnormal electrical activity in the brain. Seizures may manifest physically as convulsive activity of the extremities, trunk, head, face and/or tongue. Convulsions are usually jerking movements which may be subtle or strenuous and violent. The neurological activity in the brain IS the seizure; the convulsion is a symptom of the seizure.
Seizures occur for a variety of reasons: Head injury, stroke, brain tumor, excessive drug or alcohol intoxication, fever, prolonged insomnia are all common causes. However, the source of most seizure disorders (>50%) is not known. When a patient suffers seizures for which there is no known cause, the patient is said to have Epilepsy.
Epilepsy has very negative connotations in our society. In her classic, Illness and Its Metaphors, Susan Sontag describes how some diseases in our society are represented by negative images, thoughts, reactions, and stereotypes. Epilepsy is such a disorder; it is often assumed to be associated with mental retardation or inferiority, and physical frailty.
But, in fact, negative attitudes towards people with seizure disorders have very little to do with the disorder or the patient. Mostly, they are the result of the fear and discomfort experienced by witnesses to seizure events.
Epilepsy and other seizure disorders are often treated with pharmacological agents. These medicines attempt to raise the seizure threshold in the brain, thereby inhibiting seizures. This effect is usually achieved at the expense of artificially sedating the brain. Despite proper administration of medications, however, patients may still experience seizures.
So, when are seizures a medical emergency? Seizures are medical emergencies if:
1) the patient injuries him/herself during the seizure
2) the seizure is prolonged (rule of thumb is >20 minutes)
3) the patient experiences apnea during the seizure and does not successfully recover unassisted breathing
4) the patient does not have a known seizure disorder
5) the patient admits to not taking prescribed medications.
Seizures can be debilitating and terrible for the patient, and they can be horrifying for bystanders. But none of these is necessarily a medical emergency. If you witness a seizure, provide basic first aid along with protective and comfort care, but don't call EMS unless one of the above criteria exists. The person with the seizure disorder will appreciate you for it.
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2 comments:
I get the main point, but, err, sorry, I think there is some poor advice there.
Just because most seizures do not correspond to a medical emergency does NOT mean that the seizure in front of you does not correspond to a medical emergency.
Most chest pain does not correlate to MI, but would you advise NOT to call EMS? Or, perhaps closer to home, does the fact that most chest pain does not correlate to MI mean that hospital time frame goals for EKG/IV/MD access are necessary or wastful?
Further, you entirely neglect to mention trauma from falls.
It seems like what you really want to see are less non-emergent seizure patients coming in to your ER via ambulance. (And maybe less on one patient in particular), and more sensitivity for people with seizure disorders.
The second one is more a cultural problem than a medical problem. With regard to the first, doesn't it make more sense train EMS (as opposed to bystanders) to do a better job of differentiating patients in the field?
(And is 18 minutes NOT a prolonged seizure? Really? The rule of thumb in EMS for seizures of unknown etiology--including patients who are unconscious and cannot explain their disorder--is six minutes.)
In fact, no, I didn't neglect trauma from falls. #1 "if the patient injuries themselves" is considered, by me, to be seizure activity that constitutes an emergency. A fall that precedes a seizure would not be considered within any category I described because it is a "fall" not a "seizure".
The fact is, the overwhelming majority of seizures are NOT emergencies, and the possible outcomes are NOT life-threatening. By contrast, chest pain MAY NOT be an emergency, BUT if it IS, the lack of more prompt intervention is (statistically) that much more deadly. Not so with seizures.
As for EMS, the tendency to transport seizure patients (in my opinion) is based more upon the mood of bystanders than medical criteria. Starting with the premise that these seizure episodes don't constitute a medical emergency seems better to me.
Of course, a BLS survey by EMS should determine what is and is not an emergency. But speaking from the end-point (the ER) I can say that we watch more seizure patients sleep than we do save their lives. I wish it were different.
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