Cross-sectional Study Of The Prehospital Management Of Adult Patients With A Suspected Seizure (Epic1)

Authors: Jon M Dickson, Louise H Taylor, Jane Shewan, Trevor Baldwin, Richard A Grünewald, Markus Reuber

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.

Citation: Jon M Dickson, Louise H Taylor, Jane Shewan, Trevor Baldwin, Richard A Grünewald, Markus Reuber
Cross-sectional Study Of The Prehospital Management Of Adult Patients With A Suspected Seizure (Epic1)
BMJ Open 2016;6:e010573 doi:10.1136/bmjopen-2015-010573

Received: 16 November 2015 Revised: 23 December 2015 Accepted: 14 January 2016 Published: 23 February 2016

Copyright: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:http://creativecommons.org/licenses/by/4.0/

Acknowledgments:

Many thanks to Peter Mortimer who provided invaluable input throughout the research especially during retrieval and anonymisation of the PRFs.

Funding:

This research received no specific grants from any funding agency in the public, commercial or not-for-profit sectors. JMD's salary is funded by the NIHR.

Competing interests:

JMD has received a research grant from UCB Pharma Limited for research into emergency care of seizures.

Ethics approval: This service evaluation was approved by the Clinical Governance Group of YAS and the University of Sheffield ethics committee (project number SMBRER285).

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