Case Studies

Case 6: Presenting at accident and emergency after a prolonged seizure

Mark, a 33-year-old man, was brought into the local accident and emergency (A&E) department via ambulance following an episode of prolonged fitting on a street. By the time he arrived at A&E, he presented with very aggressive behaviour. Mark appeared to be incoherent, uncoordinated and very unstable on his feet. He refused to sit on a trolley or chair and backed himself into a corner of the resuscitation room. Staff were not very clear about how they could safely support him, but an initial assessment did not show any evidence of immediate serious injury or illness.

The A&E staff observed that although initially he appeared to be mute, he became increasingly agitated on overhearing staff discussing his condition. Efforts to calm and reassure Mark were unsuccessful and seemed to add to his obvious distress. Staff observed that he appeared frightened and disorientated. One of the nurses suggested that he might be feeling overwhelmed and suggested that he should be left in the cubicle with just one member of staff to see if that would help calm him. This was reluctantly agreed to and within half an hour, Mark was much calmer and was able to state his name, age and address.

Mark was also able to tell the member of staff that he had epilepsy and a mild learning disability. At the time he did not have any personal belongings with him, and was unable to give details of his medication or general practice (GP). After 5 hours, he was allowed to leave A&E as his condition had significantly improved. He was given a discharge note and asked to give it to his GP and support worker.

• 1. How could this situation be improved?

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  Correct answer: The main issue appears to be a lack of knowledge and understanding of people with a learning disability.

  People with a mild learning disability do not always want to admit they are having difficulties, and this case was compounded by the fact that the young man had no ID or medical details on him at the time of admission.

• 2. What might be the follow-up care?

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  Correct answer: This does not always happen, but one of the nurses wanted to try and prevent such an incident from happening again and after checking with her manager, followed up with Mark a few days later, in person, and was then able to contact his support worker.

  The support worker contacted the Health Liaison Team, who visited the young man and ensured that he visited the GP and had a review of his medication and a referral was made to the consultant in epilepsy. The health liaison nurse ensured that Mark had an accessible health folder to carry with him at all times. His support worker encouraged him to purchase and wear a medic-bracelet outlining his condition and who to contact in an emergency.

• 3. How could the A&E health professionals be educated?

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  Correct answer: The Health Liaison Team also contacted the A&E department to offer training sessions to all staff on supporting people with learning disabilities accessing their services. These sessions were planned over a 6-month period and, following evaluation, were rolled out to all wards and departments in the hospital.

  The sessions proved to be very helpful and enabled the A&E staff to feel more confident in handling future incidences.