Attack One responds to an evening call for a child seizing. It’s a short response time: The patient is on the front ramp of the station, and the report comes from someone who walked in the front door. The concerned individual, a man in his 40s, leads the crew out the door to a van parked on the front concrete. One crew member runs to get pediatric equipment. In the backseat is a very large “child,” actively seizing.
“How old is this young man?” asks the paramedic.
“Twenty-one,” says the older man, who identifies himself as the patient’s father.
The paramedic squeezes into the back of the car but finds too little room to work—the patient will have to be moved out of the car for evaluation and treatment. Colleagues from the station all come out to the front ramp, grab a stretcher and backboard and struggle to move the still-seizing patient out of the backseat.
They quickly get him onto a backboard and on the stretcher, and the crew applies oxygen and begins to evaluate him. The tonic-clonic movements continue. They open his mouth with an oral airway. The paramedic peels the long sleeve off the patient’s arm and searches for a vein to start a line. “Everyone, let’s make sure we watch the blood and secretions,” she advises. “And let’s get masks for everyone on the crew.”
The EMTs look at each other with confusion but follow the orders. They notice that the paramedic has stopped looking for a vein and is questioning the father. “How long has he been seizing?” she asks. “Has he been ill recently? What kind of medical problems does he have?”
The father answers: “He’s been seizing for about 5 minutes. It started as we drove to the hospital—he said he was sick and needed to go. He hasn’t said he was sick until today. I don’t think he has any medical problems, but he doesn’t talk much about it. He lives by himself in an apartment but came home a day ago because he said he wanted to return to the house with his mom and me.”
The paramedic grabs the drug box and finds the midazolam in the locked compartment. She loads the syringe with a dose, then places a small atomizer device on the end and sprays the medicine into the patient’s right nostril. The medic looks at both arms and the man’s neck. She checks the vital signs herself and places her bare forearm on his forehead. She carefully listens to his chest. Within moments he stops seizing and is somnolent. His breathing is assisted with 100% oxygen.
“Sir, we’re going to take your son to the hospital down the street,” the medic tells the father. “Please proceed safely there, not following the ambulance. Your son has stopped having a seizure and will not wake up for a little while. We’ll let the emergency department staff explain the testing and treatment he’ll need. We will be using our lights and siren but driving safely to the hospital.”
Saying very little, she quickly directs the crew to load up the patient, and they proceed rapidly to the hospital. She insists every crew member in the back of the ambulance don a mask, goggles, gown and gloves.
The ED is advised of the patient en route, and the physician and nurses are also in protective wear on EMS arrival. They transfer the patient onto the ED cart and switch the bag-valve mask apparatus over to their oxygen source. The patient’s eyes are now opening on occasion. The staff works quickly to undress the patient, and after an unsuccessful attempt to find an IV site in an arm, the physician inserts a line into a large vein in the patient’s neck.
The EMT crew members are interested in hearing about the paramedic’s decisions after she’d examined the patient so quickly. Once they are in a private area, away from the patient’s family, she explains: