This study is interesting because Maryland EMS has a protocol to give Midazolam IM in prehospital setting. The New England journal published on Feb,16, 2012 a double-blind, randomized study comparing IM Midazolam versus IV Lorazepam for children and adults in status epilepticus. The median times to active treatment were 1.2 minutes in the IM-Midazolam group and 4.8 minutes in the intravenous-lorazepam group(make sense due to to longer period of time to get IV access), with corresponding median times from active treatment to cessation of convulsions of 3.3 minutes and 1.6 minutes. Adverse-event rates were similar in the two groups.
The conclusion is in status epilepticus, IM-Midazolam is at least as safe and effective as IV-Lorazepam for prehospital seizure cessation.