Use weight-based seizure treatment, monitor ventilation, and contact base for every patient.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
Base contact is required even if the seizure stops or the patient is not transported.
Support ventilation and airway protection after medication; do not rely on cessation of visible motor activity alone.
Recognize the emergency
Treat ongoing seizure activity or repeated episodes without recovery of consciousness. Turn to the side, protect the airway, and suction when possible.
Status epilepticus includes a seizure longer than 5 minutes or repeated seizures without recovery. Subclinical activity can present with abnormal vital signs, gaze deviation, or a clenched jaw.
Midazolam by weight
Preferred: 0.2 mg/kg IM once, maximum 10 mg.
If IM cannot be delivered or IV/IO is already present: 0.1 mg/kg IN/IV/IO, maximum 5 mg. Repeat once after 3 minutes for continuing or recurrent seizures.
Keep the preferred one-dose IM pathway distinct from the lower-dose alternate-route repeat pathway.
Oxygenation, ventilation & glucose
Monitor SpO₂ and available waveform capnography. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.
Assist with BVM when ETCO₂ is at least 50 mmHg.
Check glucose: treat at or below 60 mg/dL, or use field impression at 60–80 when hypoglycemia is suspected. D10 is 5 mL/kg IV (maximum 250 mL); glucagon 0.5 mg IM if IV cannot be established. The IO dextrose exception requires unconsciousness, glucose below 60, no IV, and no response to glucagon.
Required contact & handoff
Make base contact for every transported and non-transported pediatric seizure patient; pediatric-capable base preferred. Provide ALS escort to the nearest appropriate ERC.
Report weight, seizure duration/pattern, recovery or persistent altered state, glucose, medication route/dose/time, and respiratory response.