There was an item in today's ANN LANDERS column (or was it DEAR ABBY, I
forget?) about a man having [what sounded like probably] a partial complex
seizure in public.  His girlfriend asked bystanders *NOT* to call an ambulance,
said it was an epileptic seizure & that he had them about 6x/day.  Ann Landers
(or Dear Abby, whoever) agreed with the writer that the girlfriend was "a
jackass" and asked what kind of 'friend' would "endanger" a person having a
seizure by not taking him to the hospital.

I believe that this (nationally published) advice is totally incorrect.  If a
person is having his or her **FIRST** seizure, or if he or she is having one
LONG seizure that doesn't stop after several minutes, or one seizure RAPIDLY
following on the heels of the last one, REPEATEDLY, then yes, I agree that an
ambulance ride to the hospital is indicated.  But if a person who already has
been diagnosed with epilepsy has a seizure, and he or she is with an {*filter*}
family member or friend who can see that his or her safety is assured until
they get home, THERE REALLY IS NO REASON TO CALL AN AMBULANCE.  The ambulance
bill and the emergency room bill would be huge, and unnecessary.  The family
member and/or friend probably is much more familiar with what is normal or
usual for that individual, and what is abnormal or unusual and requires
attention or emergency attention.  Finally, an epileptic seizure is not
dangerous to the person having it, except if the seizure occurs while the
person is engaged in a hazardous activity, thus disabling the person from
protecting his or her own (or others') safety (skydiving, surfing, tightrope
walking, flying an airplane, shooting the Falls in a bathtub, etc.).

Just wanted to correct a nationaly published, but incorrect, suggestion.

------------------------

Philosophy Department;Wesleyan University;USA

-*----
In another recent column, Ann Landers attributed "many deaths"
to LSD use.  (In fact, you are *much* less likely to die from
taking LSD than you are from drinking liquor.)

Either she has stopped using a medical consultant, or the
consultant is screwing up royally.

Russell

Yes, I tell this to my seizure patient families also.  Ambulances and ERs
are very dangerous places for seizure patients.  I'm convinced that
more patients are killed by IV Valium that by seizures in this country.  
Certainly there is a lot of morbidity.  Many physicians and EMT don't realize
that Valium is not indicated in a seizure, only in prolonged status
epilepticus, and in the boonies, getting IV Valium for a simple seizure
is almost the rule, rather than the exception.  The EMT system saves people
with trauma and cardiac arrest, but only occassionaly do they do any
good for epileptics, in my experience (I'm sure that is going to get
me some irate letters).  

When I've witnessed a seizure in public, I've also told people not to
call the paramedics if they haven't already done so and the patient
is a known epileptic.  I've also done so in the case of a diabetic
who had a hypoglycemic seizure and looked OK after getting some OJ
and a woman who fainted in a {*filter*}tore while between {*filter*} drawings
of a GTT for hypoglycemia at her Drs. office upstairs.  In the latter
case, they had already called the ambulance, and I spirited her up
to her Dr's office so she could avoid having to argue about going
to the hospital (in that locale, paramedics weren't allowed to
use their judgement about that and were told to transport everyone,
a stupid idea, I think).

The other thing that needs to be corrected is the idea that
some people have that you should put something in the mouth
of the person having a seizure.  Never, never, do that.
The patient could aspirate or injure themselves on the object.
Just move them on their side (so they don't aspirate their secretions)
to the floor away from sharp objects and don't
restrain them.  Wait for the seizure to end.  It's hard for those
not familiar with epilepsy to keep cool since it looks so scary.
This is why often the action oriented housestaff will push Valium
on such patients.  The applicable "pearl" is "first, take your
own pulse".  (Sorry, Ruth, couldn't let you go without a pearl.)

--
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Gordon Banks  N3JXP      | "To the intelligent, life is infinitely mysterious.

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If I have some medical problem (e.g. epileptic fit) that causes someone
to call an ambulance on my behalf, and then after I recover in the
hospital I explain that I never wanted the ambulance called, by what
legal authority is the hospital allowed to bill me for picking me up?

Stephen

CORRECT!

WRONG!  Since people who are already diagnosed with a seizre disorder
are generally medicated to prevent seizures, if would be very prudent
for a person to have another evaluation for the repeated seizure.  People
often need to have there theraputic meds changed as time passes.  Also,
most seizures in seizure disorderpatients are a direct result of
non-compliance with medications.  Since itis unlikely that the "friend"
nor the patient will watn to seek medical care on their own, ambulance
tranport would be indicated.

True, IV Valium is not indicaed for a Sz unless it is status seizures.
As a result, most agencies, including ours are also supplied with
Phenobarbitol.

One ofthe most important treatments for a patient having a seizure is to
protect the patient from being injured.  Sincethere are other problems
which may develop, wither directly or indirectly, as a result of the
seizure, paramedics should evaluate seizure patients.  If they are OK and
don't require transport, they need not transport.  A patient has the right
to refuse transport and can sign AMA.

I think by taking this negative attitude, you are placing the patient
in grave danger.  What if the patient has a syncope as a result of
a slow heart rate, block or other cardiac problem which expereinced
and trainned emergency medical personnel are able to check.  What if her
syncope was as a result of hypotension second to the diuretic she has
recently been perscibed.  What if she has a heart attack, faints and
all you do is give her some OJ.  What are you going to say if she dies?

The point is, there are a number of other things which can be going on
in a patient and we, as paramedics, are trained to take them all into
account totreat patients in the best possible fashion.

This is TRUE, Never place anything in the patients mouth.  Do hole
the patients head to prevent further injury, but do not try to hold
the persons arms, legs down.

-Robert

--

"Why is it a penny for your thoughts, but you always have to put
 in your 2 cents worth? "

CORRECT.  So such persons can phone their neurologist's office to schedule an
appointment when they get home.  

INCORRECT.  At least in the USA, if a person does not want to seek medical care
on his or her own, he or she must be judged incompetent in a court of law
before he or she can be compelled to submit to medical care that he or she does
not want.  Neither bystanders nor EMTs nor police nor ambulance personnel nor ER
physicians are given the power to coerce undesired medical treatment for
competent {*filter*}s.  Only a judge may do that, after a proper legal proceeding.

------------------------

Philosophy Department;Wesleyan University;USA

  (In PA, at least)
        If a person is unable to make a rational, legal decision (ie if a person is
                - a legal minor
                - mentally handicapped
                - unresponsive/unconscious
                - {*filter*} or drug impaired
                - mentally ill/unstable
                NOTE: A _REASONABLE_ attempt must be made to find the person's
                        guardian, if appropriate..
        )
                EMS personel, at least, assume that the person would want "appropriate
                care"  if he or she was able to give consent.   (Implied Consent)

        I'm sure this has been tested many times, but I have used it myself on many
        ocasions without a problem.  People have been upset about an ambulance bill,
        etc, but all have paid..
        I'm sure someone out there will contradict me, so take this for what it is
        worth.,,,

                        -kevin

Most states have laws that allow ambulance companies (usually
municipalities now) to bill you for such services if they were
provided, under the theory that it is not safe to make them
determine whether you wanted it or not.  Similar laws prevent
the good Samaritan who called them from being liable.  The
hospital neither pays the ambulance nor bills you for it.

--
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Gordon Banks  N3JXP      | "To the intelligent, life is infinitely mysterious.

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I don't think this is correct in most states -- if it were, a person
obviously incompetent to refuse treatment, such as a diabetic having
an insulin reaction and acting combative -- could not be treated if
he or she refused treatment (for instance by screaming "leave me alone").

I believe that people who are obviously incompetent can be treated for
imminently lifethreatening problems without a judge's order under the
doctrine of implied consent just as they could be treated if they were
comatose and unable to consent.
--
David Rind

But what if the so-called patient when waking up, let us say, says
"I refuse all care and refuse to pay".

They absolutely, enequivocally, without any doubt, should not pay a penny.

What if the patient has some sort of document on him that says "In case
of seizure, do NOT call medical aid. It will NOT be paid for."?

How could such a bill ever hold up in court? People have a  
constitutional right not to pay for goods and services they did not request.

Doug McDonald

Sorry, but I disagree.  If they are non-compliant, and didn't want
the medical care, taking them to an ER in an ambulance will not likely
improve their compliance, but will run up a goodly bill.  Medication
adjustments should be handled by the patient's physician, not by
someone in an ER who will never see the patient again.  A phone call
to the patient's physician will accomplish more with less expense and
risk than a ride in an ambulance at high speed with siren and flashing
lights.

These are all questions of medical judgement.  It is not appropriate
to always assume some rare and dangerous cause when the common and
obvious one is by far more likely.  Once the patient is up in her
doctor's office, he can run cardiograms or even call an ambulance
if he wants to.  The most valuable thing a doctor can learn is how
to recognize when someone is really sick or not.  Occassionally
you will be wrong.  But probably not as often as someone is injured
by overtreating.

In my judgement, no paramedic I've met is better trained to handle
epilepsy than I am.  They may have the necessary equipment
when I don't, and in the exceedlingly rare cases where intubation
is required may be able to do that better, but that's about it.
--
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Gordon Banks  N3JXP      | "To the intelligent, life is infinitely mysterious.

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Actually, if the physician deems the patient is incompetent, emergency
medical care can be rendered without consent, and the patient restrained
if necessary to provide it.  Patients with head injuries, or who are
delirious from any cause can not wait until a judge convenes a hearing
before getting medical care.  This would include patients who have just
suffered a seizure (almost always temporarily incompetent).  However,
if poor compliance was the problem, it is doubtful that any forced
treatment is going to do any good in the long run unless the patient
can be convinced to cooperate.
--
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Gordon Banks  N3JXP      | "To the intelligent, life is infinitely mysterious.

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