Intervention:
- The intervention evaluated was the prehospital administration of ketamine as a second line agent following initial treatment with midazolam for convulsive status epilepticus.
- All patients included initially received midazolam, administered either intramuscularly, intravenously, or intranasally, consistent with EMS protocols for status epilepticus.
- If seizures persisted after the second dose of midazolam, paramedics could administer ketamine as the next agent after the new protocol was adopted.
- The ketamine was administered at a dose of 100mg IV, based on EMS protocol, and only via the IV route.
Comparator:
- There was no true control group in the traditional sense, as this was a before and after retrospective cohort study, not a randomized trial. The comparator group consisted of patients treated prior to June 2017 under the older EMS protocol, which recommended two doses of midazolam alone for ongoing convulsive seizures. These patients received no ketamine. In contrast, patients treated after June 2017 fell under a revised protocol, which added ketamine as a third-line agent following two doses of midazolam.
- Thus, the comparison reflects differences between two time-based treatment protocols, rather than a contemporaneous control group.
