Emergency medication

Buccal midazolam is a Schedule 3/Class C controlled drug, as are some other types of anti-seizure medication. 

Each UK nation has guidance on the management of controlled drugs in schools, click here for more information. 

Buccal midazolam is the most commonly used emergency medication for seizures.  Buccal midazolam is usually prescribed in pre-prepared oral syringes with no needles.  It’s administered into the buccal cavity between the cheek and gum. It’s absorbed through the cheek cells and doesn’t need to be swallowed, but won’t cause any harm if it is. Each young person is prescribed the correct dose for their age. The medication should only be given exactly as prescribed.  

Midazolam is likely to cause drowsiness, sedation and short-term memory loss.  It may also cause breathing difficulties. Although this is unlikely if the correct dose is given, because of this risk, it’s recommended that you call for an ambulance when you’ve administered midazolam to a young person. Always follow instructions from your Epilepsy team, and ensure you call 999 if its your child’s first dose.

Diazepam was the main emergency medication for seizures a few years ago and is still used for some young people.  It has to be administered rectally. It’s usually prescribed in pre-prepared rectal tubes of different strengths. Each young person is prescribed the correct dose for their weight. The medication should only be given exactly as prescribed.  Diazepam can cause drowsiness and sedation, headaches, unsteadiness, dizziness and confusion.  It may also cause breathing difficulties. Although this is unlikely if the correct dose is given, because of this risk, it’s recommended that you call for an ambulance when you’ve administered diazepam to a young person. Diazepam is carried by paramedics.

Paraldehyde is sometimes used as an emergency medication for seizures. It’s usually given rectally.  It’s only prescribed in specific circumstances and should only be given by trained staff. It helps to stabilise electrical activity in the brain and unlike midazolam and diazepam, it does not affect breathing.  It has a sedative effect, so young people usually sleep after they’ve been given it.  

If a young person with epilepsy has a vagus nerve stimulation (VNS) implant, you can activate the device by swiping the special VNS therapy magnet over the device for about a second at the onset of a seizure. 

Find out more about vagus nerve stimulation. 

It’s important to keep a record of when emergency medication has been given. This record should be kept with the medication. 

Download the ‘Record of the use of emergency medication’ 

Emergency medication should only be given by someone who has been trained to do so. Selected staff at your school must, therefore, have appropriate face-to-face training on the correct procedures for administering emergency medication. Guidance has been published on training for professionals to administer buccal midazolam in community settings. You’ll need to agree which staff members are willing to be trained to administer emergency medication.  You should make sure that enough staff members are trained to cover staff absences. Training can be done as part of an INSET day, at a staff meeting or in a dedicated session with the selected members of staff.  The school nurse may be able to deliver this training. Or you can contact the young person’s epilepsy specialist nurse and arrange for them to do it. 

The names of staff trained to give the emergency medication need to be included in the young person’s IHP. 

All members of staff who have contact with, and responsibility for, a young person with epilepsy should know which members of staff are trained to give emergency medication. They should also know where the following are kept: 

• The emergency medication 
• The ‘Recording the use of emergency medication’ form 

All of this information should be recorded in the young person’s Individual Healthcare Plan.  

All medication must be stored in a safe place where young people cannot see or gain access to it.  It should not, however, be locked away, as it needs to be readily available for the young person at all times.  When the young person with epilepsy takes part in sporting activities or goes on any off-site visits, a designated trained staff member should accompany the young person and carry the emergency medication and the IHP with emergency protocol. 

Your school should also consider whether it may be appropriate for a young person with epilepsy to carry their emergency medication with them.  Trained staff would still need to administer the medication in an emergency situation. Your school should only accept prescribed medicines that are: 

• Within use-by date 
• Clearly and correctly labelled, with instructions for administration, dosage and storage 
• Provided in the original container as dispensed by a pharmacist  

It’s important to check the expiry date regularly and, if the emergency medication is out of date, you should contact the parents and ask them for a new supply.