Engine Company EMS: Responding to Seizures

By Michael Morse

A common call for an engine company emergency medical services (EMS) crew is a possible seizure. On arrival, there are several special considerations, which follow:

Scene safety. Often, a person who experiences a seizure can become disoriented or violent.
Patient safety. Seizure activity may result in injury to the patient.
Observers. Family, friends, coworkers, or bystanders who witness the events leading to the 911 call may be upset by what they have witnessed. Sometimes, seizure-like activity is violent; other times, it may be just odd. Often, seizures are fairly uneventful.

Any event resulting in a call to 911 is far from normal. Often, the event that precipitated the 911 call is over prior to our arrival. Our presence does not mitigate the stress and concern that bystanders feel. It is imperative we understand that, although the scene may appear under control and calm, the actual event took place before our arrival.

Although a call for a seizure is common, our findings on arrival are anything but. A common misconception involving a seizure response is the responders expecting their patient to be showing obvious signs of distress. This article will hopefully help firefighters assigned to advanced life support units better understand seizure activity. Seizures present in many different ways; understanding the different presentations of seizure-like activity helps form a treatment plan and a clear, concise radio report.

Seizure-like activity is a dramatic event for the patient and witnesses. Generally, by the time an engine company EMS crew arrives on scene, the worst is over. Loss of consciousness, body stiffening, jerking, and shaking may have happened. The possibility of the patient biting their tongue or cheek also exists. Keep in mind, the events leading up to a 911 call for a seizure were far from peaceful.

Some patients have described their event as being hit by a single volt of electricity, then suddenly jerking into an awake state. Multiple jolts in young children can be called “infantile spasms.” Other seizures present as staring spells; patients may stare off into space for a few moments, then return to normal activity. EMS is often called after these events, and crew members may be told that the patient is having a “pre-seizure.” I have seen patients wander, fumble with clothes, and smack their lips. They appear to be conscious, but unaware of what they are doing. Triggered by fever, febrile seizures typically occur in children aged nine months to five years. Often, they happen within 24 hours of illness or infection. Unusual crying, moaning, and eye rolling are common. Duration can be up to 10 minutes. Shaking and twitching are often seen. Loss of consciousness, vomiting, tongue biting, and difficulty breathing can be expected.

Things to do:

> Determine how long the seizure-like activity lasted.

> Clear the area of sharp and hard items.

> Loosen clothing around the victim’s neck.

> Put something soft behind the head.

> Ensure that nothing is inside the mouth.

> Formulate a clear, concise narrative to relay to the incoming transport unit.

Always follow your local protocols when treating patients who appear to have experienced some type of seizure-like activity. It is not necessary to diagnose the cause of the possible seizure. It is important to have a plan and know how best to describe what happened to the person we were called to treat. People expect medically trained responders to arrive when they call us; every bit of knowledge helps our patients, ourselves and our department.

Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.