Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1)
Dickson, Jon M. Taylor, Louise H. Shewan, Jane Baldwin, Trevor Grünewald, Richard A. Reuber, Markus
Dickson, Jon M.
Taylor, Louise H.
Shewan, Jane
Baldwin, Trevor
Grünewald, Richard A.
Reuber, Markus
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Abstract
Objectives: Suspected seizures are a common reason
for emergency calls to ambulance services. Prehospital
management of these patients is an important element
of good quality care. The aim of this study, conducted
in a regional ambulance service in the UK, was to
quantify the number of emergency telephone calls for
suspected seizures in adults, the associated costs, and
to describe the patients’ characteristics, their
prehospital management and their immediate
outcomes.
Design: Quantitative cross-sectional study using
routinely collected data and a detailed review of the
clinical records of a consecutive series of adult patients
(≥16 years).
Setting: A regional ambulance service within the
National Health Service in England.
Participants: Cross-sectional data from all 605 481
adult emergency incidents managed by the ambulance
service from 1 April 2012 to 31 March 2013. We
selected a consecutive series of 178 individual
incidents from May 2012 for more detailed analysis
(132 after exclusions and removal of non-seizure
cases).
Results: Suspected seizures made up 3.3% of all
emergency incidents. True medical emergencies
were uncommon but 3.3% had partially occluded
airways, 6.8% had ongoing seizure activity and
59.1% had clinical problems in addition to the
seizure (29.1% involving injury). Emergency vehicles
were dispatched for 97.2% of suspected seizures,
the seizure had terminated on arrival in 93.2% of
incidents, 75% of these patients were transported to
hospital. The estimated emergency management cost
per annum of suspected seizures in the English
ambulance services is £45.2 million (€64.0 million,
$68.6 million).
Conclusions: Many patients with suspected
seizures could potentially be treated more
effectively and at lower cost by modifying
ambulance call handling protocols. The
development of innovative care pathways could
give call handlers and paramedics alternatives to
hospital transportation. Increased adoption of care
plans could reduce 999 calls and could increase
the rates of successful home or community
treatment.
https://bmjopen.bmj.com/content/bmjopen/6/2/e010573.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2015-010573