Paramedics Can Safely Treat Patient Seizures in Ambulance

A study has found that patient seizures can be safely and effectively treated by paramedics using benzodiazepine drugs en route to the hospital, rather than waiting for hospital staff to administer the drugs. Conducted by researchers at the University of California, San Francisco (UCSF, USA), the study was published in the August 30, 2001, issue of The New England Journal of Medicine (NEJM).

Quick treatment to stop potentially life-threatening seizures, preferably within 30 minutes of onset, can reduce the likelihood of brain damage. Although some paramedics already administer benzodiazepines, their practice is based on anecdotal evidence, not formal studies, say the researchers. This study is the first to systematically examine the benefits of early drug administration and determine if they outweigh potential serious side effects. Benzodiazepines can cause some people to stop breathing, to breathe too shallowly, and to suffer cardiac complications.

The study involved 205 patients diagnosed with "status epilepticus,” continuous or repeated seizures lasting at least five minutes without recovery of consciousness. About half had seizures as a result of epilepsy and the rest had seizures from causes such as alcohol abuse, adverse drug reactions, stroke, or trauma. Those who had received anti-seizure drugs in the ambulance were far more likely to be free of seizures by the time they reached the hospital than those who remained unmedicated en route. Almost 60% of those given lorazepam were free of seizures upon arrival, while 43% of those given
diazepam were free of seizures, suggesting that lorazepam was more effective. In contrast, only 21% of the unmedicated group were seizure-free on arrival.

"This study will reassure many emergency medical systems (EMS) that treatment with benzodizepines is both safe and effective,” said Brian Alldredge, PharmD, UCSF professor of clinical pharmacy and lead author. "It suggests too that lorazepam is likely to be a better choice than diazepam.”




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