Seizure Due To Overdose

Brett Patterson

Brett Patterson

Best Practices

Brett Patterson

Hello Brett,

I was wondering if you could please answer a few questions for me. I was talking with one of our QA coordinators about a situation in which we received a call about a patient seizing as a result of an overdose. What protocol would you go to? Secondly, please explain the rationalization for 12-C-6 (OVERDOSE/POISONING (ingestion). There aren’t any PDIs to give Narcan on Protocol 12: Convulsions/Seizures, so how would you get 12-C-6? I hope my question makes sense.

Thanks for your time,

Susi Marsan

Communications Training Coordinator

Grady Emergency Medical Services

Atlanta, Georgia, USA


Your question makes sense.

We added the seizure code to Protocol 12 for cases where the caller does not offer the cause of the seizure until being questioned. In other words, the Chief Complaint is seizure, and the fact that OVERDOSE/POISONING was involved was “discovered” later, much like abnormal breathing might be discovered on Protocol 26: Sick Person (Specific Diagnosis). If this happens, the EMD has the code available and can provide seizure instructions, then use the Target Tool if narcotics are involved and Narcan is available.

If both OVERDOSE/POISONING and seizure are known at Case Entry, Protocol 23: Overdose/Poisoning (Ingestion) is appropriate for scene safety, and Narcan and the Target Tool can be used to provide some seizure instructions. This is even more relevant in MPDS® v13.1 where significant changes have been made to Protocol 23 due to the prevalence of very strong and dangerous synthetic narcotics.

Hope that answers your question.


Brett Patterson

Academics & Standards Associate

Chair, Medical Council of Standards

International Academies of Emergency Dispatch®

Awesome, Brett, thanks so much for your help. It makes perfect sense what you said, and I will certainly pass it on.



We have a question regarding Protocol 26. When the caller statement includes "confused," "lethargic," or similar, is it still necessary to ask "Is s/he completely alert?" or is this considered obvious and the calltaker can immediately select "confused" or "lethargic" from the drop-down list? Any additional direction/feedback is appreciated.

Jeanne Shadaram

Lead Communications Training Officer

Lee Control/Lee County Public Safety

Fort Myers, Florida, USA

Hi Jeanne:

While answering the completely alert Key Question as “no” based on a caller’s previous description is completely appropriate, the ALTERED LEVEL OF CONSCIOUSNESS list was never meant to universally imply a not alert status. For example, if a caller previously told me that a patient was semi-conscious, I would not even ask the Key Question; I would consider the answer obvious. However, lethargic is obviously not an equivalent to semi-conscious, and I would ask the question for a reportedly lethargic patient.

So, the short answer to your question is that the completely alert Key Question should be asked unless it is obvious that the patient is not alert.

It is also important that EMDs understand the history and function of the ALTERED LEVEL OF CONSCIOUSNESS list on this Protocol. Here’s a link to a related article to help you with this: iaedjournal.org/safety-net-protocol-26/

Please let me know if you have any additional questions.