First aid for generalized seizures: modern approaches and opportunities for improvement

Background. Generalized seizures are often complicated by life-threatening health problems (such as airway obstruction, suppressed respiration and severe injuries) or observed as a manifestation of sudden cardiac arrest that determines a need for rapid recognition and management of the problem. Since immediate arrival of emergency medical service (EMS) specialists to a victim is impossible in most cases, first aid (FA) provision by immediate witnesses of seizures is of paramount importance for preventing death.

Objective: to analyze modern principles and approaches to FA provision for generalized seizures, to study existing organizational framework and to identify areas for improving the organization of FA provision for seizures, as well as to develop a draft domestic algorithm for distant consultation of untrained witnesses by emergency dispatchers on FA provision in generalized seizures.

Material and methods. The analysis was carried out for international and national guidelines on FA, domestic and foreign scientific publications corresponding to the study topic, as well as normative legal acts regulating FA provision in Russia, foreign sets of protocols for EMS dispatchers containing instructions on FA in seizures intended for remote (by telephone) provision to witnesses of the incidents.

Results. Based on the analysis of international and national guidelines on FA and existing dispatch protocols, taking into account the methodological recommendations approved by the Ministry of Health of Russia that determine general principles for receiving requests from the public by EMS dispatchers, the draft universal Russian-language algorithm for dispatcher interrogation and instruction of incident witnesses on FA provision for generalized seizures was developed. A need to modernize the domestic regulatory framework in terms of including seizures in the list of conditions for which FA should be provided, and officially approve the sequence and rules on FA provision for seizures was substantiated.

Conclusion. In Russia, the organization of FA provision for generalized seizures is not optimal and requires improvement. The effect of prompt involvement of untrained witnesses of seizures in the process of providing aid is expected to be ensured by introducing a practice of consulting incident witnesses on FA provision by emergency dispatchers over the telephone. The developed universal dispatch algorithm, after its discussion and testing, could act as one of the basic components of the domestic program for FA distance support.

1. Kornegay J. Seizures and status epilepticus in adults. In: Tintinalli J.E., Ma O.J., Yealy D.M., et al. (Eds.) Tintinalli's emergency medicine: a comprehensive study guide. 9th ed. New York, NY: McGrawl-Hill Education; 2020: 1153–9.

2. International Guidelines 2000 for CPR and ECC. Part 5: New guidelines for first aid. Circulation. 2000; 102 (Suppl. 1): I-77–85. https://doi.org/10.1161/circ.102.suppl_1.I-77.

3. Martindale J.L., Goldstein J.N., Pallin D.J. Emergency department seizure epidemiology. Emerg Med Clin North Am. 2011; 29 (1): 15–27. https://doi.org/10.1016/j.emc.2010.08.002.

4. Michael G.E., O'Connor R.E. The diagnosis and management of seizures and status epilepticus in the prehospital setting. Emerg Med Clin North Am. 2011; 29 (1): 29–39. https://doi.org/10.1016/j.emc.2010.08.003.

5. Kirby S., Sadler R.M. Injury and death as a result of seizures. Epilepsia. 1995; 36 (1): 25–8. https://doi.org/10.1111/j.1528-1157.1995.tb01660.x.

6. Huff J.S., Morris D.L., Kothari R.U., et al. Emergency department management of patients with seizures: a multicenter study. Acad Emerg Med. 2001; 8 (6): 622–8. https://doi.org/10.1111/j.1553-2712.2001.tb00175.x.

7. Silverman E.C., Sporer K.A., Lemieux J.M., et al. Prehospital care for the adult and pediatric seizure patient: current evidence-based recommendations. West J Emerg Med. 2017; 18 (3): 419–36. https://doi.org/10.5811/westjem.2016.12.32066.

8. Langan Y., Nashef L., Sander J.W. Sudden unexpected death in epilepsy: a series of witnessed deaths. J Neurol Neurosurg Psychiatry. 2000; 68 (2): 211–3. https://doi.org/10.1136/jnnp.68.2.211.

9. Sveinsson O., Andersson T., Carlsson S., Tomson T. Circumstances of SUDEP: a nationwide population-based case series. Epilepsia. 2018; 59 (5): 1074–82. https://doi.org/10.1111/epi.14079.

10. Murasaka K., Takada K., Yamashita A., et al. Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: an observational study. Resusc Plus. 2021; 8: 100168. https://doi.org/10.1016/j.resplu.2021.100168.

11. International Federation of Red Cross and Red Crescent Societies. Red Cross Red Crescent Networks. International first aid resuscitation and education guidelines 2020. Available at: https://www.globalfirstaidcentre.org/wp-content/uploads/2021/02/EN_GFARC_GUIDELINES_2020.pdf (accessed 27.12.2022).

12. Kobau R., Zack M.M. Knowledge of and familiarity with epilepsy in U.S. adults: results from the 2017 ConsumerStyles Online Panel Survey. Epilepsy Behav. 2021; 114 (Pt. A): 107535. https://doi.org/10.1016/j.yebeh.2020.107535.

13. Al-Dosary A.S., AlGhamdi F.M., Almutairi B.F., et al. Public awareness of first-aid management of seizures in Saudi Arabia. Epilepsy Behav. 2022; 129: 108634. https://doi.org/10.1016/j.yebeh.2022.108634.

14. Berhe T., Yihun B., Abebe E., Abera H. Knowledge, attitude, and practice about epilepsy among teachers at Ethio-National School, Addis Ababa, Ethiopia. Epilepsy Behav. 2017; 70 (Pt. A): 150–3. https://doi.org/10.1016/j.yebeh.2017.02.009.

15. Adal O., Abebe A. First aid knowledge and practice toward students with epileptic seizure among governmental high school teachers in Addis Ababa, Ethiopia: cross-sectional study. Epilepsy Behav. 2022; 134: 108767. https://doi.org/10.1016/j.yebeh.2022.108767.

16. Martino T., Lalla A., Carapelle E., et al. First-aid management of tonicclonic seizures among healthcare personnel: a survey by the Apulian section of the Italian League Against Epilepsy. Epilepsy Behav. 2018; 80: 321–5. https://doi.org/10.1016/j.yebeh.2017.11.017.

17. Nishina Y., Yoshioka S.I. A survey of epilepsy-related knowledge, attitudes and practices of home healthcare nurses in the San-in Region of Japan. Yonago Acta Med. 2018; 61 (1): 19–26. https://doi.org/10.33160/yam.2018.03.003.

18. Asadi-Pooya A.A., Hosseini S.A., Hashemizadeh Fard Haghighi L., Asadi-Pooya H. Seizure first aid for people with epilepsy: opinions and knowledge of caregivers and healthcare professionals. Seizure. 2022; 102: 1–5. https://doi.org/10.1016/j.seizure.2022.09.007.

19. Kucherenko V., Garkavi A., Kavalersky M. First aid readiness in the population at a road traffic accident. Vrach. 2009; 12: 82 (in Russ.).

20. Dezhurny L.I., Lysenko K.I., Baturin D.I. The role of unprofessional emergency aid to a victim in avoiding untimely death in Russia. Social Aspects of Population Health. 2011; 2: 21 (in Russ.).

21. Birkun A.A., Kosova Y.A. Public opinion on community basic cardiopulmonary resuscitation training: a survey of inhabitants of the Crimean Peninsula. Russian Sklifosovsky Journal "Emergency Medical Care". 2018; 7 (4): 311–8 (in Russ.). https://doi.org/10.23934/22239022-2018-7-4-311-318.

22. Baranov A.V. Organization of first aid in the Arkhangelsk Region. Russian Sklifosovsky Journal "Emergency Medical Care". 2020; 9 (2): 259–63 (in Russ.). https://doi.org/10.23934/2223-9022-2020-9-2-259-263.

23. Birkun A.A., Frolova L.P., Buglak G.N., Olefirenko S.S. Out-of-hospital cardiac arrest in the Republic of Crimea: analysis of epidemiology and practice of care. Russian Sklifosovsky Journal "Emergency Medical Care". 2020; 9 (3): 338–47 (in Russ.). https://doi.org/10.23934/22239022-2020-9-3-338-347.

24. Zhuravlev S.V., Kolodkin A.A., Maksimov D.A., et al. The organization of registration of rate, capacity and effectiveness of first aid measures. Problems of Social Hygiene, Public Health and History of Medicine. Russian Journal. 2020; 28 (4): 616–20 (in Russ.). https://doi.org/10.32687/0869-866X-2020-28-4-616-620.

25. Birkun A. Dataset of comparative analysis of emergency medical services' dispatcher pre-arrival instructions and provisions of national/ international guidelines on first aid in generalized seizures. Mendeley Data. 2022; V1. https://doi.org/10.17632/jv9db33x5d.1.

26. Australian and New Zealand Resuscitation Council. Guideline 9.2.4. First aid management of a seizure. 2014. Available at: https://resus. org.au/download/9_2_medical/guideline-9-2-4-nov-14.pdf (accessed 27.12.2022).

27. American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 14: First aid. Circulation. 2005; 112 (24 Suppl.): IV-196–203. https://doi.org/10.1161/CIRCULATIONAHA.105.166575.

28. Markenson D., Ferguson J.D., Chameides L., et al. Part 17: First aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2010; 122 (18 Suppl. 3): S934–46. https://doi.org/10.1161/CIRCULATIONAHA.110.971150.

29. Zarisfi F., Pek J.H., Oh J.H.H., et al. Singapore First Aid Guidelines 2021. Singapore Med J. 2021; 62 (8): 427–32. https://doi.org/10.11622/smedj.2021112.

30. International Federation of Red Cross and Red Crescent Societies. International first aid and resuscitation guidelines 2016. Available at: https://www.globalfirstaidcentre.org/wp-content/uploads/2020/11/First-Aid-2016-Guidelines_EN.pdf (accessed 27.12.2022).

31. Olasveengen T.M., Semeraro F., Ristagno G., et al. European Resuscitation Council Guidelines 2021: basic life support. Resuscitation. 2021; 161: 98–114. https://doi.org/10.1016/j.resuscitation.2021.02.009.

32. Canadian Red Cross. First aid, resuscitation, and education guidelines: 2020 clinical and education updates for Canada. Available at: https://www.redcross.ca/crc/documents/Training-and-Certification/FirstAid-Tips-and-Resources/CRC_FA_Guidelines_E_EN_20201130.pdf (accessed 27.12.2022).

33. Order of the Ministry of Health and Social Development of the RF of 04.05.2012 No. 477n “On approval of the list of conditions for which first aid is provided and the list of first aid measures”. Available at: https://base.garant.ru/70178292/ (in Russ.) (accessed 27.12.2022).

34. Draft Law No. 466977-7 “On amendments to Article 31 of the Federal Law ‘On the basics of public health protection in the Russian Federation’ ”. Available at: https://sozd.duma.gov.ru/bill/466977-7 (in Russ.) (accessed 27.12.2022).

35. Nikolaou N., Dainty K.N., Couper K., et al. A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children. Resuscitation. 2019; 138: 82–105. https://doi.org/10.1016/j.resuscitation.2019.02.035.

36. Fukushima H., Bolstad F. Telephone CPR: current status, challenges, and future perspectives. Open Access Emerg Med. 2020; 12: 193–200. https://doi.org/10.2147/OAEM.S259700.

37. Eberhard K.E., Linderoth G., Gregers M.C.T., et al. Impact of dispatcherassisted cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest: a systematic review. Scand J Trauma Resusc Emerg Med. 2021; 29 (1): 70. https://doi.org/10.1186/s13049-021-00875-5.

38. Wise S.L., Freeman C.L., Edemekong P.F. EMS pre-arrival instructions. Treasure Island (FL): StatPearls Publishing; 2022.

39. Bagnenko S.F., Plavunov N.F., Minnullin I.P., et al. General principles for receiving calls from the population arriving at the station (department) of ambulance, and determining the reason for calling an ambulance. Guidelines. Saint Petersburg; 2018: 21 pp. (in Russ.).

40. Birkun A.A. Dispatcher-assisted cardiopulmonary resuscitation – an efficient way for improving survival after out-ofhospital cardiac arrest. Emergency Medical Care. 2018; 19 (4): 10–6 (in Russ.). https://doi.org/10.24884/2072-6716-2018-19-4-10-16.

41. Birkun A.A., Dezhurny L.I. Dispatcher assistance in out-of-hospital cardiac arrest: approaches for diagnosing cardiac arrest by telephone. Russian Sklifosovsky Journal "Emergency Medical Care". 2019; 8 (1): 60–7 (in Russ.). https://doi.org/10.23934/2223-9022-2019-8-1-60-67.

42. Birkun A.A., Dezhurny L.I. Chest pain: a review of current principles and approaches to first aid. Russian Journal of Cardiology. 2022; 27 (11): 5200 (in Russ.). https://doi.org/10.15829/1560-4071-2022-5200.