title: Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.
abstract: OBJECTIVE
  Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based.
  
  
  METHODS
  Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies.
  
  
  RESULTS
  Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration.
  
  
  CONCLUSIONS
  The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated.
authors.affiliation: Academic Unit of Primary Medical Care, The Medical School, The University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, South Yorkshire, United Kingdom. Electronic address: a.osborne@doctors.org.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Osborne
authors.affiliation: Academic Unit of Primary Medical Care, The Medical School, The University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, South Yorkshire, United Kingdom. Electronic address: LTaylor5@sheffield.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Taylor
authors.affiliation: Academic Neurology Unit, The University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, South Yorkshire, United Kingdom. Electronic address: m.reuber@sheffield.ac.uk.
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
authors.affiliation: Academic Neurology Unit, The University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, South Yorkshire, United Kingdom. Electronic address: r.a.grunewald@sheffield.ac.uk.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grünewald
authors.affiliation: Yorkshire Ambulance Service NHS Trust, Springhill 2, Brindley Way, Wakefield 41 Business Park, Wakefield WF2 0XQ, West Yorkshire, United Kingdom. Electronic address: Martin.Parkinson@yas.nhs.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Parkinson
authors.affiliation: Academic Unit of Primary Medical Care, The Medical School, The University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, South Yorkshire, United Kingdom. Electronic address: j.m.dickson@sheffield.ac.uk.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Dickson
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D019468:Disease Management; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D012640:Seizures / Q000628:therapy*; D006113:United Kingdom
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines
keywords: Advanced life support; Benzodiazepines; Hospital admissions; Pre-hospital; Seizure; Status epilepticus