Response and Call-to-Hospital Intervals for Seizure-Related EMS Encounters in Shiraz, Iran: A Retrospective Observational Study
Journal of Practical Emergency Medicine,
Vol. 13 No. 1 (2026),
1 January 2026
,
Page e15
https://doi.org/10.22037/jpem.v13i1.47441
Abstract
Background: Status epilepticus is a time-sensitive neurologic emergency in which delayed treatment may reduce responsiveness to benzodiazepines and increase the risk of treatment refractoriness and adverse outcomes. We evaluated emergency medical services (EMS) call-to-scene response and call-to-hospital intervals among transported seizure-related EMS encounters in Shiraz, Iran.
Methods: We conducted a retrospective observational study of routinely recorded EMS data from 21 March 2022 through 20 March 2023. Calls containing the keyword “seizure” in the caller’s chief complaint, the initial telephone diagnosis, or the final on-scene EMS diagnosis were identified. Seizure-related EMS calls that resulted in hospital transport were included, and the transported EMS encounter was the unit of analysis. EMS response interval was defined as EMS arrival at the scene minus call time, and the call-to-hospital interval as hospital arrival minus call time. The proportions of encounters with EMS arrival within 10 minutes and hospital arrival within 30 minutes were reported as descriptive timing thresholds rather than guideline-based treatment targets. Numerical variables were summarized according to distribution, categorical variables as counts and percentages, and 95% confidence intervals (CIs) for proportions using the Wilson score method.
Results: Among 3,063 seizure-related EMS calls, 1,092 (35.7%) resulted in hospital transport and were included. Mean EMS response interval was 15.9 minutes (SD, 7.8; range, 3.7–67.8). EMS units arrived within 10 minutes of the emergency call for 221 encounters (20.2%; 95% CI, 18.0%–22.7%). Median call-to-hospital interval was 53.9 minutes (IQR, 23.9; range, 12.3–197.1). No transported encounter reached a hospital within 10 minutes of the call, and 27 encounters (2.5%; 95% CI, 1.7%–3.6%) reached a hospital within 30 minutes. Prehospital benzodiazepine treatment was recorded in 214 encounters (19.6%).
Conclusion: Among transported seizure-related EMS encounters, call-to-scene and call-to-hospital intervals were substantial. Because the available timestamps were anchored to the emergency call rather than seizure onset, these findings should not be interpreted as direct measures of status epilepticus treatment delay or guideline adherence. They quantify real-world operational intervals relevant to time-sensitive seizure care.
- Epilepsy
- seizure
- Emergency treatment
- Emergency Medical Services
- Prehospital Care
- Response Time
How to Cite
References
1. Trinka E, Leitinger M. Management of Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus. Continuum (Minneap Minn). 2022;28(2):559-602 PubMed PMID:35393970.
2. Naylor DE. In the fast lane: Receptor trafficking during sta-tus epilepticus. Epilepsia Open. 2023;8 Suppl 1(Suppl 1): S35-s65. Epub 20230320 PubMed PMID:36861477; Pub-Med Central PMCID: PMC10173858.
3. Huang T-H, Lai M-C, Chen Y-S, Huang C-W. The Roles of Glutamate Receptors and Their Antagonists in Status Epilep-ticus, Refractory Status Epilepticus, and Super-Refractory Status Epilepticus. Biomedicines. 2023;11(3):686 PubMed PMID:36979664.
4. Kellinghaus C, Rossetti AO, Trinka E, Lang N, May TW, Un-terberger I, et al. Sustained Effort Network for treatment of Status Epilepticus (SENSE) - A multicenter prospective ob-servational registry. Epilepsy Behav. 2019;101(Pt B):106553. Epub 20191104 PubMed PMID:31699661.
5. Farjoud Kouhanjani M, Shafie’ei M, Hashemi B, Farazdaghi M, Asadi-Pooya AA. Clinical outcomes and healthcare costs in status epilepticus: A multivariable analysis from a tertiary center in a resource-limited setting. Epilepsy Behav. 2025;164:110259 PubMed PMID:39823745.
6. Weant KA, Gregory H. Optimizing Status Epilepticus Man-agement in the Emergency Department: It's About Time. Adv Emerg Nurs J. 2023;45(1):11-22 PubMed PMID:36757741.
7. Morgan LA, Hrachovec JB, Goodkin HP. Pediatric Status Ep-ilepticus: Treat Early and Avoid Delays. Paediatr Drugs. 2023;25(4):411-24 PubMed PMID:37178271.
8. Kämppi L, Mustonen H, Soinila S. Analysis of the delay components in the treatment of status epilepticus. Neurocrit Care. 2013;19(1):10-8 PubMed PMID:23817962.
9. Kämppi L, Mustonen H, Soinila S. Factors related to delays in pre-hospital management of status epilepticus. Neurocrit Care. 2015;22(1):93-104 PubMed PMID:25052156.
10. Bhattarai HK, Bhusal S, Barone-Adesi F, Hubloue I. Pre-hospital Emergency Care in Low- and Middle-Income Coun-tries: A Systematic Review. Prehosp Disaster Med. 2023;38(4):495-512. Epub 20230726 PubMed PMID:37492946; PubMed Central PMCID: PMC10445116.
11. Asadi-Pooya AA, Nazari M, Mirzaei Damabi N. Effects of the international economic sanctions on access to medicine of the Iranian people: A systematic review. J Clin Pharm Ther. 2022;47(12):1945-1951 PubMed PMID:36401156.
12. Asadi-Pooya AA, Azizimalamiri R, Badv RS, Yarali B, Asadollahi M, Homayoun M, et al. Impacts of the internation-al economic sanctions on Iranian patients with epilepsy. Epi-lepsy Behav. 2019;95:166-168 PubMed PMID:31063932.
13. World Health Organization. Intersectoral global action plan on epilepsy and other neurological disorders 2022–2031. Geneva: World Health Organization;2023. ISBN:9789240076624.
14. Colla M, Santos GD, Oliveira GA, de Vasconcelos RBB. Am-bulance response time in a Brazilian emergency medical ser-vice. Socioecon Plann Sci. 2023;85:101434.
15. Jana A, Sarkar A, Parmar V, Saunik S. Examining district-level disparity and determinants of timeliness of emergency medical services in Maharashtra, India. Sci Rep. 2023;13(1):21239. Epub 20231201 PubMed PMID:38040797; PubMed Central PMCID: PMC10692338.
16. Mell HK, Mumma SN, Hiestand B, Carr BG, Holland T, Stopyra J. Emergency Medical Services Response Times in Rural, Suburban, and Urban Areas. JAMA Surg. 2017;152(10):983-4 PubMed PMID:28724118; PubMed Central PMCID: PMC5831456.
17. Gaínza-Lein M, Fernández IS, Ulate-Campos A, Lod-denkemper T, Ostendorf AP. Timing in the treatment of sta-tus epilepticus: From basics to the clinic. Seizure. 2019;68:22-30.
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