METHODS: An online cross-sectional survey and modified Delphi study was conducted among healthcare professionals across Malaysia from 22 March to 31 August 2024. A modified Delphi process was used to develop a consensus from existing literature, with two Delphi rounds assessing the relevance, clarity, and importance of each question. Consensus was achieved if 90 % or more participants agreed.

RESULTS: Among 137 responses, 89.1 % of healthcare professionals were aware of rescue medications. However, only 62.0 % recognized the superior absorption and bioavailability of IM midazolam over rectal diazepam, and 78.1 % were aware of its efficacy in terminating seizures. Of those (69.3 %) involved in SE management, 29.5 % (n = 28) were engaged in prehospital management of SE. Only 35.7 % (n = 10) reported that prehospital personnel were permitted to use IM midazolam for SE management and all required physician endorsement. Notably, 78.9 % of participants reported that 25 % or fewer patients with SE were treated with IM midazolam. The main barriers include unfamiliarity (64.2 %) and lack of protocols (62.1 %). A strong consensus was reached on the recommendation of IM midazolam as a first-line treatment for SE management.