So, as we left it yesterday, we were just coming to the transport decision.
Thanks for all of the comments, they have been really interesting to read and seem to be mostly polarised into the two options of taking in the RR car or getting an ambulance to transport the patient.
My decision was to take her and mum up to the hospital in the car. My rationale for this was based on my relatively unremarkable findings on examination, the previous history of a febrile convulsion along with the information gained from the nursery worker which seemed to point to a febrile cause of the seizure. She had been cooled down now and as I explained to the mother, the reason for transport was more to do with need to look into the possible source of the pyrexia rather than the treatment of the convulsion itself.
As I would be transporting in the car, I like to have my patient report form completed before I leave, so I spent some time documenting my assessment, findings and decision. All in all, I had been on scene for about 30 minutes with nothing concerning happening to the child during that time. I was happy to take in the car and that is what I did.
Mum was still concerned and fretting about what had happened, she was obviously shaken by the whole thing, which was another factor in my decision for hospital assessment, to reassure the mother. As I drove up to the hospital, she kept on saying
“Are you sure that she is ok?”
“She seems to be sleepy, is that ok?”
I reassured her all the time that it was all normal for a child who may have had a fit. She will be tired and it is okay for her to have a little sleep on the way up.
About 5 minutes after leaving the scene and about 15 minutes away from the hospital, I hear…
“Oh my God!, ITS HAPPENING AGAIN !”
I glance in the rear view mirror and see mum, panic stricken, with her daughter lying in her lap, in the throws of definite Grand Mal seizure. Oh Crap!!
“Its ok, everything is ok. It will pass, just keep doing what you are doing. Support her in your arms and make sure she doesn’t hurt herself whilst she is moving”
I said that in the best calm and reassuring voice that I have.
“I’m just going to pull over for a second and come and check on her, ok?”
I moved to the back seat of the car and could see that she was still fitting. I place a 100% Oxygen mask on her and considered my options.
I have enough equipment with me to handle the fit if it continues, that isn’t an immediate issue. However, I don’t want to be sitting at the side of the road hoping that it will pass. Ideally she should be moving towards the hospital, just in case the fit continues.
I get on the radio
“Medic999 to Red Base”
“Yeah, further to this case …….., the patient is now fitting in the back of the car. Could you tell me the location of the nearest available vehicle please, Cat ‘A’ response”
“Nearest vehicle is at the hospital, ETA approximately 10 minutes”
I was hoping that one of my stations vehicles would be on station, as they would have been only 3 minutes away, however, Sods law works again!
By the time all of this happened, I looked back at the girl and she had now stopped the seizure activity and was now post ictal. At least I didn’t have to medicate her to stop the fit!
But, I now have a history of 2 fits in 40 minutes, this time with no evidence of a febrile cause. She still didn’t feel hot to touch and her blood sugar was normal. I am now concerned that she may fit again, and possibly move into status epilecticus.
And we are back to another dilemma…
You are stuck at the side of the road, 15 minutes from hospital (10 mins with lights and sirens). The closest ambulance is 10 minutes away. The patient has stopped fitting but now you are more than a little bit worried…..
What’s your next move, what would you do?