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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
Maui County Paramedics Association Thursday, February 16, 2012 6:35:35 PM Sounds good, but are there auto injectors where you can adjust the dosage? 
Alan Jump Thursday, February 16, 2012 6:48:33 PM It wouldn't be technically difficult to combine an auto-injector design with adjustable dosage, such as what is available for the Lantus pens. My questions: would they be used frequently enough to justify the cost of such a device, and is the shelf life of benzodiazepene conducive to maintaining a stock of such devices?
Greg Friese Friday, February 17, 2012 6:12:02 AM I wonder about the friends, family, childcare provider, teacher, etc. usage of an auto-injector. I know there is diastat for rectal administration, but an auto-injector could really make it easier for a friend or family member to provide treatment either well before EMS arrival or in lieu of EMS. 
Chris Cannon Friday, February 17, 2012 8:39:44 AM I saw this article yesterday - great stuff! Pair that with our other auto injectors and nasal administration and many meds can now be VERY easily administered.
Rogue Medic Saturday, February 18, 2012 9:21:05 AM It is good that the study was done, but there is no need for paramedics to have auto-injectors.
If paramedics cannot give IM injections, then the problem is with medical oversight, not with the safety of the medication.
" All adults and those children with an estimated body weight of more than 40 kg received either 10 mg of intramuscular midazolam followed by intravenous placebo or intramuscular placebo followed by 4 mg of intravenous lorazepam. In children with an estimated weight of 13 to 40 kg, the active treatment was 5 mg of intramuscular midazolam or 2 mg of intravenous lorazepam."
No real need for adjustable dose.
Most important is that these doses (higher than a lot of doctors are comfortable with - 10 mg adult - 5 mg peds) were VERY SAFE.. 
Bob Sullivan Sunday, February 19, 2012 7:12:13 AM The next step is to compare IM to IN. Now I squirt 5 mg midazolam up patient's noses before looking for a line, and usually the seizure has stopped by the time I get one. 
