1. EMS Kay Vonderschmidt

2. EMS IM midazolam usage • Before RAMPART did your EMS agencies use midazolam? • No use of midazolam • IV use only • IM use (per medical director) • Other (IN?)

3. Midazolam other • Does your EMS system use midazolam via: • Intranasal? • Intrabuccal? • None of the above • All of the above

4. Midazolam dosages • If your EMS system uses midazolam, what is the dosage prior to RAMPART • IV/IO/IM 2mg dosages repeatable – up to 8mg or more • IV/IO/IM 5mg dosage repeatable up to 10mg • IV/IO/IM other • IN other

5. Other benzo’s • Does your EMS system use other benzo’s for seizures? • Yes • No

6. Discussion • How quickly did the seizure stop vs. transport time? • Does transport time factor positively in the seizure being stopped and remain stopped prior to arrival at ED? • What was the average transport time for the study? (Termination of sz was 3.3 min for IM) • Did transport time factor into repeat doses? • How many people stopped sz in field but sz again in ED vs. their transport time?

7. Discussion • Post RAMPART what should we recommend when it comes to IM administration? • EMS IM usage? (no autoinjectors yet- needs FDA approval) • EMS IM doses • What dose, repeat doses, etc • Adult vs. pedi dosages

8. Discussion • Alternative therapy? • Midazolam IN and/or intrabuccal? Alternative medications? diazepam? lorazepam?

9. Discussions • Are we concerned about an increase in field intubations with the use of midazolam? • Have there been any other studies using benzo’s in the field that includes EMS intubations to compare to?

10. Discussion • How do we present the findings effectively so that a change in practice will occur? • Conferences • Addition to books (AMLS, etc) • White paper • Other ideas

11. Questions