Buccal Midazolam can be used as an anticonvulsant for grand-mal convulsions lasting more than five minutes, as they may not stop spontaneously. Ambulance paramedics and technicians can administer the patient’s own prescribed Midazolam provided they are competent to administer buccal medication and are familiar with midazaolam’s indications, actions and side effects. Those that are not familiar with the use of this medication should use rectal PR or IV diazepam instead. NB if the child continues fitting 10 minutes after their first dose of anticonvulsant, they should receive IV diazepam for any further anticonvulsant treatment. If it is not possible to gain vascular access for the second dose of medication, no further drug treatment should be used, even if this means that the child continues to fit i.e. do not give a second dose of buccal or rectal medication. Where grand-mal convulsion continues ten minutes after the second anticonvulsant, senior medical advice should be sought.