Prehospital seizure management: triage criteria for the advanced life support rescue team

The present study was completed to establish advanced life support (ALS) versus non-ALS triage criteria for use by ALS prehospital personnel when faced with the seizure patient, in the hope of more efficient use of ALS rescue teams. Preselected triage criteria for acuity of care based on neurological condition, vital signs, and concomitant illness/injury were tested against retrospective data (paramedic run reports) collected on 230 patients. Triage criteria sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) were determined with a 95% confidence interval (CI). Point estimate of use/need of care was noted. ALS interventions were instituted in 58 patients (25%). In 57 of these cases, indication for and ALS intervention, were established on initial patient assessment (SENS, 98.28; 95% CI, 90.76 to 99.96). Of 173 patients requiring no ALS intervention on initial assessment, only 1 (0.58%) developed complications warranting ALS therapy during the course of prehospital care (SPEC, 100.00; 95% CI, 100.00 to 99.99; PPV, 100.00; 95% CI, 100.00 to 94.63; NPV, 99.42; 95% CI, 96.82 to 99.99). No inappropriate use, point estimate (PE) [(0)/(172) (0.00% to 0.01%)] or unmet need, PE [(0)/(58) (0.00% to 5.16%)] of care was noted. The data presented in this study suggest that given similar field times, after initial patient assessment by ALS personnel, it is reasonable and safe to triage seizure patients who do not require ALS intervention to non-ALS rescue teams for continuation of care and transportation.