The FEBSTAT study investigators reviewed the charts of 199 patients with FSE, age 1 month to 6 years, recruited from multiple centers from 2002 to 2010. More than one AED was required to terminate FSE in 140 patients (70%). Median time from seizure onset to first AED administered by emergency medical services (EMS) or emergency department (ED) was 30 min. Mean seizure duration was 81 min for subjects who received AED prior to arrival at ED and 95 min for those who did not (p = 0.1). Median time from the first dose of AED to the end of seizure was 38 min. Initial dose of lorazepam or diazepam was suboptimal in 32 (19%) of 166 patients. Respiratory support was required by 95 subjects (48%). Median seizure duration in the respiratory support group was 83 min whereas for the nonrespiratory support group, seizure duration was 58 min (p < 0.001). Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration. A standard prehospital treatment protocol is recommended with education of EMS responders. [2]

COMMENTARY. EMS care of children participating in FEBSTAT studies varied considerably, some being allowed to administer treatment only when ordered by an ED physician. Delay in AED administration may lead to prolonged FSE and an associated increased risk of respiratory distress. Early treatment of seizures with benzodiazepines does not increase the need for prehospital or ED intubation and respiratory support [1] but rather, results in shorter total seizure duration [2].