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Seizures in the Field: BLS Priorities, Benzodiazepines, and Ketamine

Seizure management starts with the basics—and demands a clear plan when the seizure won’t stop. In this episode of the Pre-Hospital Paradigm Podcast, Scott, AJ, Wes, and Dr. John Hilt discuss prehospital seizure assessment, treatment decisions, and the role of ketamine in their local 2026 protocol for seizures that persist despite benzodiazepines.

The conversation connects field experience with emergency department care, emphasizing airway support, a thorough history, and the importance of looking beyond the dispatch label.

In this episode:

• BLS comes first. The team emphasizes patient protection, airway positioning, oxygenation, and ventilation as foundational parts of seizure care.

• Recognizing status epilepticus. Discussion covers prolonged seizures and repeated seizures without a return to baseline, including how witness accounts and dispatch information help establish the timeline.

• Looking beyond “seizure.” Seizure-like activity can accompany cardiac arrest. The hosts discuss avoiding assumptions and assessing what is actually happening.

• Getting a useful description. Which body parts moved? Was the patient responsive? Did the activity stop? Clear observations help the receiving team understand the event.

• Checking blood glucose. The crew highlights glucose assessment as a critical step in identifying a treatable cause of altered mental status or seizures.

• Benzodiazepines and medication history. Topics include administration routes, reassessment, and accounting for rescue medications given by family members before EMS arrives.

• Ketamine for persistent seizures. The team explains why their system added ketamine as an option after benzodiazepines fail, how its mechanism differs, and why available medications shape prehospital treatment choices.

• Monitoring after medication. Capnography, pulse oximetry, continued reassessment, and readiness to support ventilation remain central to the discussion.

• Other causes and similar presentations. The hosts explore eclampsia, stroke, head injury, intracranial infection, toxic exposures, and pediatric febrile seizures.

Why the local protocol matters

The hosts describe how their system introduces new treatment options through training and medical control consultation. Ketamine’s place in their field protocol reflects the medications already available to crews and differs from the treatment sequence discussed for the hospital setting. Medication choices, dosing, and authorization requirements are specific to the local protocol.

The handoff starts with the story

A useful report includes when the episode began, what witnesses saw, whether the patient returned to baseline, prior seizure history, prescribed medications, and any treatment given before EMS arrival. The team also discusses asking about recent illness, fever, trauma, and possible exposures.

Key takeaway

Strong seizure care combines basic life support, timely recognition of persistent seizure activity, and a careful search for the cause. As the hosts emphasize throughout the episode: get the story, reassess, and avoid anchoring on a single explanation.

Related listening: The podcast’s discussions on BLS before ALS and stroke assessment