Question: Just would like clarification that we "must" attempt an IV on all seizure patients first before moving on to either IM, IN, Buccal. The chart is written in this order. I feel that attempting IV's on a lot of our seizure patients could very easily pose a safety hazard on ourselves and others in the field. Thanks.

 Terrific question. Without a doubt, initiating an IV on a seizing patient is not only risky, it is technically very challenging. While the preferred (and likely most effective) route is IV (especially if one is already in place when a patient seizes for instance a second time), other options are available and no, strictly speaking, a paramedic does not "have" to start an IV prior to moving ahead with other routes of administration.

On page 11 of your handbook in the preamble section it states: "When more than one route of drug administration is listed, the order of preference for route administration is from left to right. Clinical circumstances for each case should determine the final route chosen."

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