If you are experiencing a medical emergency, contact emergency services immediately: Emergency contacts and medical assistance
Scenario 1 — Seizure in Progress: What Bystanders Must Do
If someone is having a generalised tonic-clonic (GTC) seizure: 1. Stay calm. Most seizures end on their own within 1–3 minutes. 2. Keep them safe. Clear objects away. Do NOT hold them down or restrain them. Do NOT put anything in their mouth. 3. Time the seizure from the first moment — duration matters for deciding whether to call emergency services. 4. Turn them on their side (recovery position) if they are unconscious and breathing, to prevent aspiration. 5. Call emergency services (10177 private / 112 mobile) if: - The seizure lasts more than 5 minutes - A second seizure begins before full consciousness is regained - This is the first seizure the person has ever had - The person is pregnant, injured, or does not regain consciousness within 5 minutes after the seizure stops
Scenario 2 — Status Epilepticus: The Emergency
Status epilepticus (SE) is defined as a seizure lasting more than 5 minutes, or two or more seizures without full recovery in between. It is a neurological emergency. Prolonged SE causes irreversible brain damage and can be fatal.
Go to the emergency room immediately. Do not wait for the seizure to stop on its own if it has lasted 5+ minutes.
In hospital, treatment follows a time-sensitive protocol: - 0–5 min: Benzodiazepine first-line (lorazepam IV or diazepam rectal/IM — first responder or ER) - 5–20 min: IV levetiracetam, sodium valproate, or fosphenytoin if benzodiazepine fails - 20–40 min: Anaesthesia + intubation if refractory — ICU admission
Status epilepticus ICU admission: estimated cost R30,000–R60,000 for a 2–5 day ICU stay.
Pre-Authorisation in an Emergency
When you arrive at the emergency room by ambulance or emergency presentation: 1. Your scheme must cover the emergency — status epilepticus is a PMB emergency. You cannot be turned away from a PMB emergency based on your plan. 2. Call your scheme's 24-hour emergency line (on the back of your medical aid card) within 48 hours of admission to authorise the admission. 3. If you have gap cover, notify your gap insurer as soon as possible — give the admission date, treating neurologist's name and practice number.
What Your Medical Aid Pays For
| Item | Covered? |
|---|---|
| Emergency room assessment | YES — PMB emergency |
| IV medication for status epilepticus | YES — PMB emergency |
| ICU admission for refractory SE | YES — PMB emergency |
| Neurologist consultations in hospital | YES — scheme specialist rate |
| Post-discharge AED medication | YES — CDL chronic benefit |
| EEG (post-event) | YES — CDL diagnostic |
| Specialist shortfall (neurologist above scheme rate) | Gap cover pays |
| ICU specialist shortfall (intensivist) | Gap cover pays |
What Gap Cover Pays For
Neurologists and intensivists commonly bill above scheme rate. In an ICU admission for status epilepticus: - Neurologist daily visits: shortfall R600–R1,500 per visit - Intensivist daily visits: shortfall R500–R1,500 per visit - ICU co-payment (if scheme applies one): gap cover
Gap cover annual overall payment limit (OPL) ~R220,000. For a single status epilepticus ICU admission, the shortfall accumulation is unlikely to reach OPL. If you have repeated hospitalisations in a year (e.g., refractory epilepsy with multiple admissions), OPL becomes relevant.
After the Crisis: Next Steps
- Ensure CDL registration is in place — if not already registered, your GP or neurologist must submit a CDL chronic condition application to your scheme.
- Review your AED regimen — status epilepticus often prompts review of whether current medication and dosing is optimal.
- Update your seizure action plan — share updated first-aid instructions with family, household members, and employer if relevant.
- Driving restriction reset — after a seizure event, the clock on seizure-free driving eligibility typically resets. Consult your neurologist.
- Follow up claims — check that all in-hospital accounts were billed and settled correctly. Escalate disputes to the scheme's dispute resolution process.
Emergency Contacts
- Emergency (private ambulance): 10177 (SA national) | 082 911 (Netcare) | 084 124 (ER24)
- Emergency (public): 10111 (police) | 10177 (ambulance) | 112 (mobile, all networks)
- Epilepsy South Africa: 0860 374 537
- Your scheme's 24-hour line: On the back of your medical aid card
Check your epilepsy cover and gap cover options → AURA check
This page is general information about medical schemes. It is not medical advice: speak to a healthcare professional about your own treatment. Medical aid and gap cover advice is given by Eldon de Waal, a Supervised Representative of Approach Administration (FSP 23579).