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Objective: To study the efficacy of intramuscular midazolam in treating seizures. Design: On arrival, patients with seizures were treated with intramuscular midazolam, a stopwatch was started, and an intravenous line inserted. If the seizure had not stopped within six minutes, standard intravenous anticonvulsants were given. The time to cessation of the seizure was recorded. Setting: Department of Emergency Medicine, Fremantle Hospital, a busy emergency department (50,000 annual attendances, 18% children) in a general community teaching hospital. Main outcome measure: Time to cessation of fitting. Results: Thirty eight patients aged from 15 months to 89 years, were treated with intramuscular midazolam at an average dose of 0.12mg/kg (range 0.07–0.21mg/kg). The seizures terminated in all but two cases in an average time of 1minute 53 seconds overall (range 15 seconds to 6 minutes 7 seconds). In a subgroup of 15 patients with prolonged seizures of 36 minutes duration on average, the seizures ceased in a mean time of 2 minutes 41 seconds, with one failure. The latter time is likely to represent the true response time of seizures to intramuscular midazolam as some of the short‐lived seizures may have ceased spontaneously. All seven children treated with intramuscular midazolam ceased fitting. There were no adverse side effects in any patient. Conclusion: Midazolam given by intramuscular injection was shown to be rapidly effective for the control of generalised convulsive seizures, focal seizures and status epilepticus in adults and in children. This new therapy has exciting applications in the treatment of seizures in children and in the pre‐hospital setting. 1992 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

The former Portuguese colony of East Timor was forcibly absorbed into the Republic of Indonesia in 1975. An armed East Timorese resistance movement maintained a fight for independence for the next quarter of a century. The Indonesian Government allowed a plebiscite of the population in August 1999, the result of which was strongly in favour of independence. Following the poll, there was an outbreak of extreme violence and the structure of the country was virtually destroyed. The Indonesian Government invited a multinational force to restore order. This report is of the medical work conducted while serving in a multifunction non-government organization in East Timor in the post-conflict environment. The work includes developing a tuberculosis clinic, conducting refugee medicine at the border crossing point and establishing a rudimentary health-care system based on a primary-care model. A background in emergency medicine is very useful in situations such as this, where improvisation becomes a core skill.

Seventy‐five consecutive patients attending the Emergency Department at Fremantle Hospital in status epilepticus were treated with intravenous midazolam. All seizures ceased without other therapy, after an average dose of 0.1 mg/kg midazolam. Seven percent of patients had a further seizure in the Emergency Department, a rate comparable to other anticonvulsants. Midazolam is a safe, effective agent for the treatment of status epilepticus, with possible advantages over currently accepted treatment. 1992 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine