title: Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1).
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  A regional ambulance service within the National Health Service in England.
  
  
  METHODS
  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.
authors.affiliation: Academic Unit of Primary Medical Care, The University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield, UK.
authors.forename: Jon M
authors.identifier: http://orcid.org/0000-0002-1361-2714
authors.initials: JM
authors.lastname: Dickson
authors.affiliation: The Medical School, The University of Sheffield, Sheffield, UK.
authors.forename: Louise H
authors.initials: LH
authors.lastname: Taylor
authors.affiliation: Research and Development, Yorkshire Ambulance Service NHS Trust, Wakefield, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Shewan
authors.affiliation: Emergency Operations Centre, Yorkshire Ambulance Service NHS Trust, Wakefield, UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Baldwin
authors.affiliation: Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grünewald
authors.affiliation: Academic Neurology Unit, The University of Sheffield, Sheffield, UK.
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D000552:Ambulances; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012640:Seizures / Q000628:therapy*; D006113:United Kingdom; D055815:Young Adult
keywords: ACCIDENT & EMERGENCY MEDICINE; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; NEUROLOGY