By: John Paisley
A Glance in the ER
In an emergency situation, distinguishing between epileptic seizures and nonepileptic seizures poses a significant challenge for healthcare personnel (Lehn et al., 2021). Patients in the pre-ictal stage (warning signs a seizure may occur are present) are able to aid healthcare staff in obtaining important medical information necessary for care, such as: a patient history, medication list, vital signs, physician assessment and additional testing. However, in most cases, patients typically arrive to the ER actively having a seizure or in a post-ictal state through emergency medical transport, limiting obtainable information. This situation can result in potential misdiagnoses and delays in patient care (Webb & Long, 2017).
Emergency Medical Personnel Care
Upon arrival, emergency medical service (EMS) personnel prioritize rapid evaluation and treatment, ensuring patients maintain a clear airway, breathe spontaneously, and circulate their blood without medical intervention (Short & Goldstein, 2022). In cases of active seizures, EMS personnel may also administer antiseizure medications or benzodiazepines (Al Sawaf et al., 2023). Additionally, EMS personnel must gather basic demographic information, such as name, address, date of birth, and gender, following agency and state guidelines (Short & Goldstein, 2022). Most of this information can be found on a person’s identification card/ driver’s license.
Limitations To Patient Medical Information
When EMS agencies are hospital-owned, EMS personnel may have access to healthcare information, using patient demographic information. Yet, many agencies lack a unified electronic medical record (EMR) with their hospital. A unified EMR shares patient information, visit history, allergies, medication list, and more across hospital facilities, aiding in quick access for EMS personnel during patient care. That being said, there are a few issues with a unified EMR.
The merging process of EMRs involve a lengthy timeframe, and rushing this process may lead to documentation errors (Crew & Houser, 2020). Another challenge arises from competition among hospital chains, this can hinder patient information distribution due to non-compatible EMR systems (Torab-Miandoab et al., 2023). Furthermore, if a patient with epilepsy travels to another state or country, the local hospital chain may lack access to their medical records. Lastly, many patients prefer medical records remain private and secure. In the States, this is ensured through the Department of Health and Human Services under the Health Insurance Portability and Accountability Act, commonly known as HIPAA.
Keeping the Healthcare Team Informed
Numerous barriers hinder EMS personnel and ER staff from accessing vital medical records. There are emergency record request options, though; they typically involve lengthy processing times (Born et al., 2023). While limited studies have been performed, those available have shown that patients bringing paper copies of their medical records to the ER reduces medical information retrieval delays and increases information accuracy (Lorsbach et al., 2021).
Providers have noted that multiple paper medical records can result in patients selectively choosing medical records, causing difficulties in determining up-to-date accuracy and validity (Joseph et al., 2023). Patients can resolve this by working with primary care provider to create a personal health record. A personal health record is a condensed form of a patient’s medical record focusing on critical information needed in an emergency. This information may include things such as: medical diagnoses, surgeries, allergies, medication list, emergency contact information, and the name of primary care provider and specialists (Sarwhal & Gupta, 2022). Through patient and healthcare staff cooperation, a concise and accurate personal health record can be maintained for times of emergency.
In the digital age, physical information remains crucial. A form of identification can benefit emergency personnel in patient care; storing a clearly marked personal health record near a patient’s identification can aid emergency personnel in care. Medical identification jewelry, most commonly a medical bracelet, can also be used to notify emergency medical personnel of medical information; however, patients should discuss medical jewelry inscriptions with their primary care provider prior to purchase (Rahman & Sultan, 2017). Lastly, if a patient has a significant other, trusted roommate, or caregiver, a copy of their personal health record can be given to these individual; however, this can increase the potential of personal medical information to be misplaced or seen by unintended viewer. Patients with epilepsy may have difficulties ensuring emergency staff are aware of their medical information. Through these methods patients can ensure emergency staff are well informed during their care.
Resources:
Al Sawaf, A., Arya, K., & Murr, N. (2023). Seizure Precautions. StatPearls: Seizure Precautions. https://www.ncbi.nlm.nih.gov/books/NBK536958/
Born, J., Bohn, A., Kümpers, P., & Juhra, C. (2023). Verfügbarkeit von Patienteninformationen in der Notaufnahme : Wunsch und Wirklichkeit [Availability of patient information in the emergency department : Wish and reality]. Medizinische Klinik, Intensivmedizin und Notfallmedizin, 118(1), 54–61. https://doi.org/10.1007/s00063-021-00881-6
Crew, D., & Houser, S. H. (2020). Overcoming Challenges of Merging Multiple Patient Identification and Matching Systems: A Case Study. Perspectives in Health Information Management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883361/
Garfield, S., Furniss, D., Husson, F., Etkind, M., Williams, M., Norton, J., Ogunleye, D., Jubraj, B., Lakhdari, H., & Franklin, B. D. (2020). How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience. BMJ quality & safety, 29(9), 764–773. https://doi.org/10.1136/bmjqs-2019-010194
Joseph, L., Greenfield, S., Manaseki-Holland, S., T R, L., S, S., Panniyammakal, J., & Lavis, A. (2023). Patients’, carers’ and healthcare providers’ views of patient-held health records in Kerala, India: A qualitative exploratory study. Health expectations: an international journal of public participation in health care and health policy, 26(3), 1081–1095. https://doi.org/10.1111/hex.13721
Lehn, A., Watson, E., Ryan, E. G., Jones, M., Cheah, V., & Dionisio, S. (2021). Psychogenic nonepileptic seizures treated as epileptic seizures in the emergency department. Epilepsia, 62(10), 2416–2425. https://doi.org/10.1111/epi.17038
Lorsbach, M., Gillessen, A., Revering, K., & Juhra, C. (2021). Informationen zur medizinischen Vorgeschichte in der Notaufnahme : Einfluss auf Therapie- und Diagnostikentscheidungen [Information on medical history in the emergency department : Influence on therapy and diagnostic decisions]. Medizinische Klinik, Intensivmedizin und Notfallmedizin, 116(4), 345–352. https://doi.org/10.1007/s00063-020-00661-8
Rahman, S., Walker, D. and Sultan, P. (2017), Medical identification or alert jewellery: an opportunity to save lives or an unreliable hindrance?. Anaesthesia, 72: 1139-1145. https://doi.org/10.1111/anae.13958
Sarwal D, Gupta V. 2022. Personal Health Record. StatPearls: Personal Health Record. https://www.ncbi.nlm.nih.gov/books/NBK557757/
Short, M., & Goldstein, S. (2022). EMS Documentation. StatPearls: EMS Documentation. https://www.ncbi.nlm.nih.gov/books/NBK448107/
Torab-Miandoab, A., Samad-Soltani, T., Jodati, A., & Rezaei-Hachesu, P. (2023). Interoperability of heterogeneous health information systems: a systematic literature review. BMC medical informatics and decision making, 23(1), 18. https://doi.org/10.1186/s12911-023-02115-5
Webb, J., Long, B., & Koyfman, A. (2017). An Emergency Medicine-Focused Review of Seizure Mimics. The Journal of emergency medicine, 52(5), 645–653. https://doi.org/10.1016/j.jemermed.2016.11.002
