Epilepsy for EMS

At some point in their lives, one person in 10 will experience a seizure. By age 75, 3% will have epilepsy. So if you, as an EMS provider, haven't encountered an epileptic or seizure patient to this point in your career, rest assured--you probably will.

It is among the missions of the Epilepsy Foundation to help prepare public-safety responders for that. To that end, the foundation is preparing an educational program for EMS much like one it previously did for law enforcement. A trio of foundation representatives described the program to a large crowd at EMS EXPO 2010, held September 27-October 1 in Dallas, TX.

The problem they're trying to educate folks about is a big one: around three million Americans suffer seizures, amounting to $15.5 billion a year in healthcare costs. And the differences between seizures and epilepsy, and full and partial seizures, are not always well understood.

Seizures occur when brief surges of electrical activity affect part or all of the brain. They can last from a few seconds to a few minutes, and have symptoms that range from convulsions and loss of consciousness to blank staring, lip smacking or jerking of the extremities. When a person has two or more unprovoked seizures, they are considered to have epilepsy.

There are various types of seizures, and sufferers may experience more than one, depending on which part and how much of the brain is affected. Seizures may be classified as generalized (absence, atonic, tonic-clonic, myoclonic), partial (simple and complex), nonepileptic or status epilepticus. Further classification into syndromes encompasses characteristics like the type of seizure; typical EEG recordings; clinical features such as behavior during the seizure; the expected course of the disorder; precipitating features; expected response to treatment; and genetic factors.

While causes of seizures often aren't identifiable, they have been known to include head injuries, brain tumors, genetic conditions, lead poisoning, prebirth brain-development problems, and infections like meningitis or encephalitis. Triggers may include failure to take prescribed medication, substance ingestion, hormone fluctuations, stress, sleep patterns and photosensitivity.

A Seizing EMS Patient

For a generalized seizure patient encountered by EMS, a top priority should be to avoid inappropriate restraint. Partial seizures are even trickier, as patients may be assumed to have altered mental status as a result of drug or alcohol use. Complex partial seizures can cloud a sufferer's awareness, block normal communication, and produce a variety of undirected, involuntary and unorganized movements (e.g., vacant stare, fumbling with the hands, picking at clothing, twitching mouth or face).

With a suspected seizure, check for a medical identification card or bracelet that indicates that the wearer has epilepsy. Family members or bystanders may also have this information. A sufferer may also have a vagus nerve stimulator, an implanted device that sends electric impulses to the vagus nerve in the neck via a lead wire implanted under the skin to stop seizures. Know that seizure activity may affect speech, consciousness and movement so severely that a person cannot respond or interact normally during a seizure or just after. Address the patient in a non-threatening way, and guide them away from hazards or into a secluded area. Questions to ask family or bystanders include when the event started, if the person was acting strangely beforehand and if they've had such episodes before.

With ongoing generalized tonic-clonic (grand mal) convulsions, move hazardous objects out of the way, place something soft and flat under the head, loosen any clothing that could impede breathing (ties, scarves, etc.), remove glasses and turn the patient on their side. Do not place anything in the mouth.

With complex partial seizures, speak calmly and reassuringly. Do not grab or restrain the victim, but shepherd them gently away from crowds and hazards. Remember that behavior that may appear threatening is actually involuntary.

The average person's seizure will end after a minute or two, followed by a period of confusion, then slow return of full awareness. Unless a seizure is quickly followed by another one, breathing is impaired or consciousness does not return, there is usually no need for transport. Patients should be transported if they have no idea or there's no other way to determine if they're having a first-time seizure or have epilepsy. First-time seizers may have underlying medical problems that require emergency care.

The Epilepsy Foundation's EMS program was developed over the last year and pilot-tested through 16 foundation affiliates. For more, see the foundation's website.