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I would be interested on the lists view on this scenario.
An ambulance is called via the 999 system to a 48 y/o male, vomiting blood. The pt is an Iranian national, on a British Army training exercise with regular members of the British Army. When the ambulance arrives there is a delay of approximately 15 mins until the pt is brought to the place where the amb is waiting. On investigation by the amb crew, it is found that the pt has had a seizure about 60 mins earlier and had bitten his tongue, hence the vomiting blood bit.
On further investigation, it is found that the pt has no H/O of fitting. There is no recent history of trauma, D&V, or emotional upset. Pt denies alcohol abuse, and the crew have no reason to suspect otherwise. Pt denies any change in his normal routine, no change in appetite and states he now feels fine, though still a little concerned about what has just happened to him. Communication with the pt is via an interpreter as he speaks little English. Pt denies any pain or discomfort, and is calm and alert.
His VS are BP 130/80, RR 20, MSC x 4, PERLA, BM 8.6 MMoL, PR 120, regular and easy to find radially, his skin temp appears normal, he has no visible injuries other than the bitten tongue which is no longer bleeding. His PR is put down to being concerned at having just had a fit.
The crew decide that as this is the pt's 1st fit and there appears no obvious reason for it, the pt should attend the local A&E dept. It was decided that the pt could be driven to the A&E dept by a British Army seargent with the interpreter. The seargent was given the advice that if the pt should fit again, he should stop the vehicle, protect the pt's airway and head and dial 999. This was agreed by all parties on scene, and the pt was driven to A&E with paperwork provided by the ambulance crew. The ambulance then came clear and was available for further emergency calls.
10-20 mins after presenting at A&E, the pt had a second siezure. Should this pt have been taken to A&E by emergency ambulance? Were the ambulance crew incorrect in their management of the case?
I would be very grateful to hear your view on this.
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