What to do after a seizure: why contacting base matters

What is the appropriate action for a patient who is postictal after an active seizure?

• A. Monitor vital signs
• B. Administer oxygen
• C. Contact base
• D. Transport immediately

Answer: (C)

In the context of a patient who is postictal after an active seizure, the most appropriate action involves ensuring the patient's well-being before making decisions about their ongoing care or transport. While contacting base may be a vital step in managing the patient's overall care, it is crucial to first assess the patient's immediate needs, such as monitoring vital signs and possibly administering oxygen if the situation warrants it. After a seizure, patients can exhibit confusion, lethargy, and other symptoms due to the postictal state. Monitoring vital signs is critical to ensure the patient is stable and does not have any additional complications. Additionally, if the patient's oxygen levels are low, providing supplemental oxygen is important for their recovery. Immediate transport might not be necessary if the patient is safe and stable; however, if there are concerns about their condition, contacting base for guidance is appropriate. Therefore, while contacting base is a step in the management of the patient's care, the emphasis should be placed on first assessing and stabilizing the patient, which includes monitoring vital signs and addressing any immediate needs before deciding on transport or further interventions.

Outline

• Opening vignette: a seizure ends, the scene quiets, and questions begin.

• Section 1: What happens after a seizure (the postictal state) and why calm, steady action matters.

• Section 2: A practical sequence for Los Angeles County EMS responders

• Safety and initial checks

• Airway, breathing, circulation, and monitoring

• Oxygen and glucose considerations

• Protecting the patient and avoiding common missteps

• When to contact base and why it matters

• Transport decisions and documentation

• Section 3: Why “contact base” is the right move—and how it fits with patient-centered care

• Section 4: Quick, usable takeaways you can reference

• Closing: thoughtful care over rushing to conclusions

Postictal Pause: What to do when a seizure ends

Let me explain something simple but crucial: after a seizure stops, a patient isn’t automatically back to normal. There’s a quiet, groggy period called the postictal state. Confusion, drowsiness, and disorientation aren’t rare. The body is recovering from the exertion, the brain is sorting things out, and oxygen levels can dip as the patient slowly reorients. This is a moment when steady, methodical care matters more than speed.

In Los Angeles County, as in many well-organized EMS systems, responders are taught to treat the patient with care first and to connect with medical oversight as a part of that care. The key idea isn’t to rush to a transport decision based on the seizure alone. It’s to stabilize, assess, and communicate—ensuring the patient’s safety while arranging the next steps with guidance from a physician at the base hospital.

A practical sequence for responders in the field

Safety first, always. The scene should be calm and free of hazards. Gently guide the patient away from furniture or objects that could cause injury during the seizure, and after the episode, avoid forcing anything into the mouth. A common but important misstep is to assume every postictal patient is instantly ready for a brisk ride to the hospital. In reality, many people recover enough to be monitored at the scene, with a plan guided by medical control.

Airway, breathing, circulation – the core triad. Start with a quick check: is the patient talking? Are they breathing normally, or is there labored breathing or blue-tinged lips? If oxygen saturation is dropping or the patient looks short of breath, supplemental oxygen is appropriate. A simple nasal cannula might do, but if breathing is seriously compromised or the patient is unresponsive, a bag-valve-mask setup becomes necessary. The idea is to keep the airway open and ensure adequate oxygen delivery during the recovery window.

Vital signs and a postictal snapshot. Monitor heart rate, blood pressure, respiratory rate, and oxygen saturation continuously. A mental status check is equally important: is the patient oriented, able to follow simple commands, or responding with only partial responses? This isn’t just data collection; it’s about catching red flags early. If there’s any sign of persistent confusion, severe weakness, unequal pupils, or ongoing breathing difficulty, you’re likely looking at a situation that benefits from closer medical oversight sooner rather than later.

Glucose check and other quick labs. Hypoglycemia can mimic or confound seizure activity. If a glucometer is available, a quick finger-stick check is a smart move. If glucose is low, treat according to local protocols. If glucose is high or normal and the patient remains atypical, you still treat the vital signs and exam findings with medical control in the loop.

Oxygen, but with judgment. Oxygen is a friend when the patient isn’t perfusing well or when SpO2 is below a safe threshold. If the patient is comfortable and SpO2 sits in the normal range, you might not escalate oxygen therapy. The goal is to tailor treatment to the patient’s needs, not to apply oxygen regardless of the situation.

Protect from injury, don’t restrain unnecessarily. It’s natural for a patient to thrash during a seizure, but once the episode stops, it’s important to protect the patient from further harm. Loose clothing can stay on; do not attempt to restrain limbs unless there’s an immediate risk of injury. Reassure the patient with a calm, steady voice as they regain awareness.

The moment to contact base: why it’s the right move

Here’s the thing: even when the patient seems to be stabilizing, contacting base (the medical control physician or the base hospital) early in the process is prudent. Why? Because postictal care isn’t always straightforward. The physician at the base hospital can give orders on several fronts—whether to continue monitoring on scene, whether to administer additional medications if the patient isn’t returning to baseline, or whether transport is indicated based on the overall clinical picture.

Contacting base isn’t a sign of weakness or indecision. It’s part of careful patient management. It helps ensure you’re aligned with the patient’s best interests, especially when the situation isn’t crystal clear. In Los Angeles County, EMS providers use medical control to guide non-emergency transport decisions, additional treatments, and the timing of transport. That collaboration keeps the patient safer and helps the EMS team make decisions with professional support behind them.

When is transport appropriate? How to decide thoughtfully

Transport decisions in the postictal period aren’t automatic. If vitals are stable, the patient is awake enough to answer questions, and there are no new concerning findings, some teams may opt for monitoring on scene for a time before deciding on transport. If the patient has ongoing confusion, lethargy that doesn’t improve, continuous abnormal breathing patterns, or a suspected complication (such as head injury from a fall), transport is more likely to be appropriate. In any case, the base hospital’s guidance shapes what happens next.

Documentation matters. Clear notes about the timing of the seizure, the postictal state, vitals at arrival and throughout care, the patient’s orientation, glucose results, oxygen use, and decisions about transport are essential. Good documentation isn’t just bureaucracy; it’s a map for the next clinician who might treat the patient, and it supports consistent, patient-centered care across the system.

A quick, usable checklist you can hold onto

• Scene safety and patient protection: keep the area clear; protect from injury.

• Postictal assessment: check responsiveness, airway, breathing, circulation; monitor mental status.

• Vital signs monitoring: record pulse, BP, respirations, SpO2 continuously.

• Oxygen as indicated: titrate to keep SpO2 in an acceptable range.

• Glucose check (if available): treat accordingly.

• Avoid routine restraints; communicate with the patient to reorient and reassure.

• Contact base early for orders and guidance.

• Decide on transport based on stability, findings, and base guidance.

• Document thoroughly and accurately.

Real-world flavor: what this looks like on the ground

Imagine a quiet afternoon in a busy Los Angeles neighborhood. A neighbor reports someone had a seizure, now waking up feeling foggy and disoriented. The EMS crew steps in, keeps the scene calm, and uses a pulse oximeter to check oxygen levels. The patient isn’t fully oriented, so the crew asks simple questions, checks the glucose with a reader, and keeps the patient on a comfortable side position to reduce the risk of choking on secretions. The oxygen is tentatively increased because the SpO2 flickers around the low 90s. Then, before packing up, the lead medic calls base to confirm the next steps. The physician on the other end agrees that continuous monitoring is the wise path for now, with transport arranged if the patient doesn’t improve in the next 10–15 minutes or if new symptoms arise.

Slight digression: how this fits into broader care

This approach isn’t just about one patient in a single moment. It’s about a system that values clarity, patient safety, and teamwork. Medical oversight ensures that decisions about care are not made in a vacuum. It also helps standardize how postictal patients are managed across different scenes—from a quiet residential street in Studio City to a bustling ER in downtown LA. The shared goal is simply this: keep people safe, calm fears, and connect them with the care they’ll need as they move forward.

Common questions that pop up (and straightforward answers)

• Do I always call base after a seizure? Not always, but it’s wise to contact base when the patient’s status is uncertain or when you’re deciding on transport. It helps ensure you have guidance tailored to the situation.

• Should I give oxygen to every postictal patient? Not automatically. Use oxygen if SpO2 is low or if there are signs of breathing difficulty. Otherwise, monitor and reassess.

• Is transport always necessary? No. If the patient stabilizes and there are no new concerns, on-scene monitoring with a plan for transfer if things worsen can be appropriate, especially when base hospital guidance supports it.

• What about possible underlying issues? Postictal states can highlight other problems—head injury, infection, metabolic disturbances. A clinician at base can help you decide what to test or treat.

Closing thoughts: thoughtful care over quick conclusions

In the end, the aim is simple and human: help the person recover from a seizure with careful, informed steps. Monitor, support, reassess, and reach out to a medical professional for guidance. Contacting base isn’t a sign of hesitation; it’s a responsible bridge to continued care. When you combine solid on-scene assessment with clear communication to medical control, you’re choosing the path that keeps patients safer and more comfortable during a vulnerable moment.

If you ever find yourself facing a postictal patient, remember the rhythm of care: assess, stabilize, monitor, communicate, and decide with medical oversight. The result is not just a protocol followed—it’s a calm, patient-centered response that respects the person in front of you, right here in Los Angeles County.