Virtual Training Director: Febrile Seizures

The Virtual Training Director is a column for training officers that utilizes the content of CE articles to help facilitate training sessions. Use or adapt this lesson plan for your organization, its personnel and its local protocols.

ESSENTIAL INFORMATION

Although febrile seizures are usually harmless and have little lasting consequence, they can be considerably stressful to parents who find their child seizing and to EMS professionals responding to a call for a convulsing, not-breathing infant. The causes and consequences of febrile seizures were discussed in the May CE article, along with considerations for assessment and treatment. Treatment depends on the condition of the child when found--seizing or postictal. The general principles of treatment are to reduce core temperature and to administer antipyretics, if trained and authorized, and benzodiazepines only if the child is still seizing.

I have outlined below an interactive training session for participants to review and practice pediatric assessment skills. Before your training session, ask members to read the CE article so they have the necessary knowledge for a productive discussion and practice session. (You can make and distribute copies of any of our articles for education purposes.)

Time needed: 1 to 2 hours

INSTRUCTOR PREPARATION

Before the training program, prepare several scenarios focused on conversations between EMS professionals and parents about the necessity of transport. These discussions should be based on your organization's policies and protocols for treat and release.

CLASSROOM TRAINING OBJECTIVES

• Understand causes of fever
• Differentiate focal and generalized seizures
• Review pediatric assessment components
• Role-play treat-and-release conversations
• Discuss indications for ALS medications.

1. Introduce the training topic of febrile seizure assessment by describing the interactive activity to role-play and document treat-and-release situations related to febrile seizure patients.

2. Review the following concepts from the article. Add additional content as needed, based on your group's knowledge and experience.

• Seizure type: generalized or focal
• Pediatric Assessment Triangle
• Temperature-reduction techniques
• Role of parents in assessment, treatment and transport decision-making
• ALS medications: benzodiazepines and antipyretics.

TEACHING TIP: Ask participants to define these concepts and terms in their own words and give concrete examples.

3. Present five to 10 from-the-door assessments of pediatric patients. Ask the group to decide if the patient is an emergency or no emergency based on the description you provide. Give them information about the child's work of breathing, skin condition and general appearance. This should only be a few sentences of information. For example: You see an infant wrapped in a fleece blanket who is not moving, is breathing rapidly and has a far-off look in his eyes.

TEACHING Tip: Ask participants to develop scenarios from their own experiences and share them with the class.

4. Role-play conversations with parents about treat and release. Select a participant to play the role of the parent and give her a quick briefing on her role. Have another member or members play the role of the EMS crew and discuss with the parent the need for patient transport and/or risks associated with refusal of treatment and transport. Make sure this role-playing activity is congruent with your local policies and protocols. Some potential scenarios:

• Parent of a 16-month-old who just had a seizure with focal characteristics.
• Parent of 2-year-old who has just had a seizure. The child has a history of febrile seizures and is undergoing testing for epilepsy.
• Parent of 3-year-old who has just had a seizure. The parent wonders if she should give the child oral acetaminophen.
• Parent of 9-month-old who has had multiple seizures in the last 24 hours. The child is postictal during assessment.

TEACHING Tip: Ask the role-play observers to complete appropriate paperwork (a treat-and-release form and/or a patient care report narrative) for each of the scenarios. Have a group discussion about the quality of the paperwork.

5. Review of ALS medications. For ALS providers, discuss the pros and cons, administration routes and special considerations for use of benzodiazepines to treat an actively seizing child and administration of an antipyretic medication to a febrile child.

If antipyretic administration is already part of your organization's protocols, review your protocol. If it is not, have a pro-con debate about why acetaminophen would or would not be a good addition to your formulary.

CONCLUSION

Conclude the training session with a 3-5-minute reminder that communicating with parents may be the most difficult aspect of febrile seizures. Remember that good questions lead to good answers. Listen to the information about the seizure provided by parents and caregivers. You may need to provide lots of reassurance and calming.

1.5 hours of CECBEMS-approved CE credit is available for the May article on febrile seizures. Visit RapidCE.com to complete a set of quiz questions and print a CE certificate.

Greg Friese, MS, NREMT-P, is an e-learning designer, podcaster, author, presenter and paramedic. He is also a lead instructor for Wilderness Medical Associates. Read more from him at the EverydayEMSTips.com blog. Connect with Greg at EMSUnited.com, Facebook.com/gfriese OR twitter.com/gfriese.