Seizure Assessment in the Field
Seizures are caused by abnormal electrical activity in the brain. They can range from brief absence seizures to prolonged tonic-clonic episodes. The NREMT expects EMTs to manage seizure patients safely, protect the airway in the postictal period, and identify life-threatening seizure emergencies.
Types of Seizures
Generalized Tonic-Clonic (Grand Mal)
The most dramatic seizure type. The tonic phase involves rigid muscle contraction lasting 10-30 seconds. The clonic phase involves rhythmic jerking movements lasting 30-60 seconds. The patient is unconscious throughout. Post-seizure, the patient enters a postictal state characterized by confusion, drowsiness, headache, and sometimes combativeness. The postictal period may last minutes to hours.
Absence (Petit Mal)
Brief episodes (5-30 seconds) of staring and unresponsiveness, often without motor activity. Most common in children. May be mistaken for daydreaming. The patient returns to normal immediately after the episode.
Focal (Partial) Seizures
Start in one area of the brain. Simple focal seizures preserve consciousness (the patient is aware of jerking or sensory changes). Complex focal seizures alter consciousness (the patient may perform repetitive, purposeless movements called automatisms).
Status Epilepticus
Status epilepticus is a life-threatening emergency defined as a seizure lasting longer than 5 minutes or two or more seizures without return to baseline consciousness between them. This is a true emergency because prolonged seizure activity causes brain damage, hyperthermia, metabolic acidosis, and can lead to death.
EMT management: Maintain airway (suction as needed), high-flow oxygen, protect from injury, time the seizure, rapid transport. This patient needs IV benzodiazepines, which are outside EMT scope.
EMT Seizure Management
During the Seizure
- Protect the patient from injury: move furniture, place padding under the head
- Do NOT restrain the patient or put anything in their mouth
- Time the seizure duration
- Note what the seizure looks like (where it starts, what movements occur)
After the Seizure (Postictal Phase)
- Position on the side (recovery position) to protect the airway
- Suction if needed
- Assess for injuries sustained during the seizure (tongue lacerations, shoulder dislocations, vertebral fractures)
- Check blood glucose (hypoglycemia can cause seizures)
- Provide oxygen and monitor airway
- Speak calmly and reassure the patient as they regain consciousness
Common Seizure Causes
- Epilepsy (most common cause in adults with seizure history)
- Medication non-compliance (missed anti-seizure medication)
- Hypoglycemia
- Head trauma
- Stroke
- Drug/alcohol withdrawal
- Eclampsia (seizures in pregnancy)
- Febrile seizures in children (fever-induced, typically benign in children 6 months to 5 years)
- Brain tumors or infections
Key NREMT Points
- Never restrain a seizing patient or force anything between their teeth
- The airway is the primary concern in the postictal period
- Always check blood glucose in any altered mental status patient
- First-time seizures in adults always warrant transport and hospital evaluation
- Febrile seizures in children are usually benign but still require evaluation to rule out serious infection