Epilepsy awareness and emergency rescue training: Ignorance is bliss!

Status epilepticus (SE) has a high mortality rate and is associated with complications such as neurological deficit and cognitive decline. Buccal midazolam is the recommended emergency rescue medication in the UK to reduce the duration of a seizure and SE. It should be administered by an appropriately trained person. There are agreed guidelines on training standards for its administration in the UK produced by the Joint Epilepsy Council of the United Kingdom and Ireland. Training should provide an overview of epilepsy to facilitate safe, person-centered care and appropriate administration of rescue medication to people with epilepsy (PWE). Unfortunately the current guidelines do not assure satisfactory practice. An investigation was conducted to quantify the nature and degree of the problem in Cornwall, UK (population 550,000). To address the identified inconsistencies, a web-based test was developed using a focus group of experts and stakeholders. Over 800 carers for PWE took the test at different intervals of its development. A consistent 20% failure rate was noted. Over 90% of participants felt it kept PWE safer. The test was incorporated into routine clinical practice and has contributed to reduction of primary epilepsy deaths. The e-test is a cost-effective solution to help harmonize practices across different settings and can be easily adopted by other countries.