Seizure
treatment study: Implications for EMS
Being able to use an auto-injector can simplify the
procedure and speed up the delivery time
By Art Hsieh
Seizures are a common call for EMS systems. Often the physical manifestations
of the seizure activity is over by the time we arrive; rarely do we have to
manage the more serious condition of status epilepticus.
Because of its commonality, we might not consider the impact that seizures
can have upon the patient, long after we managed their acute condition.
An advance like this has the potential to dramatically improve the overall
health of the individual, and possibly reduce the need for emergency
services.
There are also implications for EMS providers as well. It can be a challenge
to administer an intravenous benzodiazepine when the patient is actively
seizing.
Being able to use an auto injector can simplify the procedure and speed up
the delivery time. It might also mean that terminating an active seizure might
become a basic life support procedure. This can improve a system's overall
ability to respond to these common calls.
That time might be some ways off. However, it's another interesting
development in our business that benefits both patients and providers
alike
Study: Injection offers faster help for seizure patients Results probably will change how seizures are treated by paramedics
Link to original information
By Erin Allday
The San Francisco Chronicle
Expert Analysis
Seizure treatment study: Implications
for EMS
By Art Hsieh
Seizures are a common call for EMS systems. Often the
physical manifestations of the seizure activity is over by the time we arrive;
rarely do we have to manage the more serious condition of status
epilepticus.
Because of its commonality, we might not consider the impact
that seizures can have upon the patient, long after we managed their acute
condition.
An advance like this has the potential to dramatically improve
the overall health of the individual, and possibly reduce the need for emergency
services.
|
SAN FRANCISCO — Injecting patients in the thigh with a drug-loaded syringe
is a safe and effective way to stop a seizure in an emergency, according to
results of a national study released Wednesday, a finding that could pave the
way toward making such syringes as widely available as EpiPens used to treat
severe allergic reactions.
The two-year study, published in the New England Journal of Medicine,
concluded that a single stab from an auto-injector was more effective in
stopping a prolonged seizure than the traditional method of inserting an
intravenous line and delivering the drug directly into the bloodstream.
The results probably will change how such seizures, which can be
life-threatening if they're not stopped right away, are treated by paramedics.
But they could have more long-term repercussions if doctors start giving the
auto-injectors to epileptic patients, some of whom have several severe seizures
a year, to use at home, much as people with severe allergies carry epinephrine
syringes with them.
"I don't think we're ready to hand these out at epilepsy clinics for people
to take home right now," said Dr. J. Claude Hemphill, chief of neurology at San
Francisco General Hospital, who led the San Francisco arm of the study. "But
that may be a follow-up some folks want to do."
The U.S. Department of Defense also has taken special interest in the study,
because auto-injectors would be much more convenient than IV drug treatment in a
large-scale bioterrorism attack involving seizure-inducing nerve gas.
"The advantage is you can give it the auto-injection faster," said Dr. Walter
Koroshetz, deputy director of the National Institute of Neurological Disorders
and Stroke. "If you have 100 people simultaneously seizing, no way can you do
all those IVs. But you could just run around and inject everybody for their
seizures."
Seizures are caused by a disruption in the brain's electrical system, and in
most cases they resolve themselves after a minute or so. Roughly 2 percent of
Americans have epilepsy, a condition marked by chronic seizures.
Some seizures, known as status epilepticus or prolonged seizures, can last
several minutes or longer, and they may require drugs to stop them. More than
50,000 people in the United States die from prolonged seizures every year,
either from brain damage due to the seizure itself or from accidents related to
passing out mid-attack.
The study, which was funded primarily by the National Institutes of Health,
involved 79 hospitals nationwide, including several in the Bay Area. More than
4,000 paramedics were trained to participate in the study and 893 patients were
treated.
A drug and a placeboEvery patient was given both the
auto-injector shot, usually to the thigh, and an intravenous injection. But in
half the cases the auto-injector was filled with a placebo, and in the other
half the IV drug was a placebo. Neither patients nor paramedics knew which
treatment was the placebo in any given case.
Researchers found that 73 percent of patients who were given the
auto-injector drug had stopped seizing by the time they reached the emergency
room; 63 percent of patients who got the IV drug were seizure-free.
Patients who were given the auto-injector drug were less likely than the IV
group to be admitted to the hospital after their seizure.
"This auto-injection should be the new standard of care," said Dr. James
Quinn, a professor of surgery and emergency medicine at Stanford who led the
study there. "It's great when you can do a study and it's probably going to
change how we do things."
Although two different drugs were used in the trial - midazolam for the
auto-injector and lorazepam for the intravenous injection - researchers don't
believe that the drugs made a difference in how effective the treatments were.
Rather, they said, the auto-injectors are simply easier to use.
It's much simpler to give a single shot than to try to start an intravenous
line on a patient who is actively convulsing, doctors and paramedics said. In
the study, 42 patients did not receive the intravenous treatment because the
paramedic couldn't start the IV, whereas only five patients didn't receive the
auto-injector shot because the syringe malfunctioned.
"It takes time to set up an IV. You have to find a vein that's going to be
good, you have to isolate the arm and hold it still, you have to clean the arm,
you have to insert the needle," said Judy Klofstad, a paramedic with the San
Francisco Fire Department who participated in the study. "If you're really good,
it can take 2 1/2 minutes."
Paramedics took on average just 20 seconds to use the auto-injector,
according to the study. "You just hold their thigh down, target it, and it can
go right through their clothing, through jeans even," Klofstad said.
Doctors said that because the auto-injection drug causes heavy sedation and
can lead to respiratory problems and low blood pressure, more research is needed
before the syringes are handed out to patients.
But Tiffany Manning, who has epilepsy and suffers a prolonged seizure every
two or three months, said she's excited about someday being able to carry around
an auto-injector. Her doctor at the UCSF epilepsy clinic has prescribed an oral
drug that her parents can give her when she has a seizure, but it can be
time-consuming and difficult to measure out the proper dosage and make sure she
swallows it, she said.
"And when I wake up I have a funny taste in my mouth," said Manning, 30. "My
doctor doesn't prescribe it very often. You can overdose someone on it. ... I'd
rather just have a shot in the leg."
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2012 San Francisco Chronicle
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