Which route is commonly used for benzodiazepine administration in pediatric febrile seizures in EMS?

• A. Intranasal midazolam is commonly used.
• B. Intravenous only.
• C. Oral only.
• D. Subcutaneous.

Answer: (A)

In prehospital pediatric febrile seizures, the goal is to stop the seizure quickly with minimal distress and without delaying care. Intranasal midazolam fits that goal best because it is absorbed rapidly through the nasal mucosa, delivering quick control of the seizure without needing to establish IV access. The needle-free, easy administration is especially advantageous when the child is actively seizing or anxious, making IV placement difficult or time-consuming.

Other routes have drawbacks in this setting. Intravenous administration, while effective, requires obtaining venous access during an active seizure, which can take time and increase stress for the child. Oral administration has slower onset and can be unreliable if the child is vomiting or uncooperative. Subcutaneous dosing can be variable in onset and is less commonly used in many EMS protocols.

A typical intranasal midazolam dose is about 0.2 mg/kg (up to around 5 mg), delivered with a nasal atomizer to ensure rapid absorption. This combination of rapid effect, ease of use, and noninvasiveness explains why this route is the commonly chosen option in EMS for pediatric febrile seizures.