General Approach to All Patients


Basic Life Support

  • Supplemental 100% oxygen if active seizures
  • Nasal cannula is sufficient if no active seizures and no respiratory signs or symptoms
  • Protect patient from injury

Advanced Life Support

  • Full ALS Assessment and Treatment
  • Blood glucose measurement
    • If < 70 mg/dL, treat per Altered Mental Status/Hypoglycemia Protocol
  • For active seizures do NOT delay treatment to obtain intravenous access, begin with IM dose unless IV is already established
  • Administer Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg IV
    • If seizures continue or re-occur repeat Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg IV; wait at least 5 minutes from initial dose
  • If hypoxic seizures, drug induced seizures, seizures from head trauma, stroke or eclampsia suspected treat as above and refer to appropriate protocol for further care
  • If patient becomes combative or agitated in the post-ictal state (after seizure resolution)
    • Apply physical restraints as needed to ensure patient/crew safety (only as directed in Behavioral Emergencies protocol)
    • If chemical restraints are required:
      • Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg IV (total maximum dose including treatment for seizures is 10 mg IM/intranasal or 5 mg IV)
      • Do NOT treat with Ziprasidone (Geodon), use is contraindicated in these patients
      • Contact Medical Control for further orders

Diazepam rectal gel (Diastat®)

Some patients with a diagnosed seizure disorder will have their own Diazepam rectal gel (Diastat®) prescribed by their physician. When available, Diastat can be given if no IV is available. Use the patients prescribed dose or refer to the table below. If an IV is readily available, Midazolam (Versed) is the preferred medication.

For patients > 12 years old (0.2mg/kg)
Weight Dose
(kg) (lbs) (mg)
14-27 30-60 5
28-50 61-111 10
51-75 112-166 15
76-111 167-244 20