Seizure First Aid

Generalized Tonic-Clonic Seizures – Formally known as a grand mal seizure, this is a convulsive seizure affecting the whole body. The seizure may start with a crying out. The person falls, becomes unconscious and his body stiffens, followed by jerking motions. The person slowly regains consciousness but is tired and confused. The seizure usually lasts 2-4 minutes. What you can do: 1. Look for medical ID. Protect from nearby hazards. Loosen ties or shirt collars. Protect head from injury. Turn on side and keep airway clear. Reassure when consciousness returns.  2. If single seizure lasted less than 5 minutes, ask if hospital evaluation is wanted. If multiple seizures, or if one seizure lasts longer than 5 minutes, call an ambulance. If person is pregnant, injured or diabetic, call for aid at once.

Absence Seizures Formally called “petit mal,” it is the most common in children. There is no aura before the seizure. The seizure consists of brief loss of consciousness (10-20 seconds). Staring and blinking is associated with this type of seizure, dozens or even hundreds may occur each day. They may be mistaken for day dreaming. What you can do: 1. No first aid is necessary but if this is the first observation of this seizure(s), medical evaluation should be recommended. 2. Report instructions that were missed, be reassuring.

Simple Partial Seizures Jerking may begin in one area of the body, can’t be stopped but patient is awake and aware. Sometimes spreads to become convulsive seizure. Patient experiences distorted environment, may see or hear things that aren’t there, may feel unexplained emotions. May also have nausea. What you can do: 1. No first aid is necessary unless seizure becomes convulsive, then provide first aid as indicated above. No other immediate action is needed other than reassurance and emotional support. Medical evaluation should be recommended.

Complex Partial Seizures Formally known as “psychomotor” or “temporal lobe” seizure. It is accompanied by an aura or “warning.” During the seizure, a person may have a glassy stare give no response, move aimlessly, make lip smacking or chewing motions, may appear intoxicated, drugged or psychotic. There may be struggle or fighting of restraint. What you can do: 1. Speak calmly and reassuringly to patient and others. 2. Guide safely away from obvious hazards. 3. Stay with person until they are completely aware of environment and offer to help person get home or to their destination.

First Aid

Think of 3 key areas of seizure first aid.

• Care and Comfort First Aid:  General first aid for all seizure types to keep someone safe.

• Tailoring First Aid: Specific steps for different seizure types.

• Responding to Seizures: Interventions for out of hospital use: First aid steps to help stop or shorten a seizure or prevent an emergency situation. This may involve giving a rescue treatment (often called “as needed” medicine or treatment) that has been recommended by your health care team. The rescue treatments described here can be given by non-medical people who are not in a hospital setting. They are intended for use by anyone (the person with seizures, family member or other observer) who has been trained in their use. These therapies can be given anywhere in the community. A hospital or medical setting is not needed when these are given in the manner described.

Use this section to learn what to do and how to give seizure first aid to someone having a seizure. Then develop a Seizure Response Plan which will help others follow these same steps.

Reading what to do is not the same as learning how to do it. Make sure you practice seizure first aid by developing ‘seizure drills’ for you and your family.  It is critical that you and anyone who may be with you during a seizure know what to do and how to give these treatments correctly and safely.

General First Aid for All Seizure Types

The first line of response when a person has a seizure is to provide general care and comfort and keep the person safe.  The information here relates to all types of seizures. What to do in specific situations or for different seizure types is listed in the following pages. Remember that for the majority of seizures, basic seizure first aid is all that may be needed.

Always Stay With the Person Until the Seizure Is Over 

• Seizures can be unpredictable and it’s hard to tell how long they may last or what will occur during them. Some may start with minor symptoms, but lead to a loss of consciousness or fall. Other seizures may be brief and end in seconds.
• Injury can occur during or after a seizure, requiring help from other people.

Pay Attention to the Length of the Seizure

• Look at your watch and time the seizure – from beginning to the end of the active seizure.
• Time how long it takes for the person to recover and return to their usual activity.
• If the active seizure lasts longer than the person’s typical events, call for help.
• Know when to give ‘as needed’ or rescue treatments, if prescribed, and when to call for emergency help.

Stay Calm, Most Seizures Only Last a Few Minutes

• A person’s response to seizures can affect how other people act. If the first person remains calm, it will help others stay calm too.
• Talk calmly and reassuringly to the person during and after the seizure – it will help as they recover from the seizure.

Prevent Injury by Moving Nearby Objects Out of the Way 

• Remove sharp objects.
• If you can’t move surrounding objects or a person is wandering or confused, help steer them clear of dangerous situations, for example away from traffic, train or subway platforms, heights, or sharp objects.

Make the Person as Comfortable as Possible

• Help them sit down in a safe place.
• If they are at risk of falling, call for help and lay them down on the floor.
• Support the person’s head to prevent it from hitting the floor.

Keep Onlookers Away

• Once the situation is under control, encourage people to step back and give the person some room. Waking up to a crowd can be embarrassing and confusing for a person after a seizure.
• Ask someone to stay nearby in case further help is needed.

Do Not Forcibly Hold the Person Down

• Trying to stop movements or forcibly holding a person down doesn’t stop a seizure. Restraining a person can lead to injuries and make the person more confused, agitated or aggressive. People don’t fight on purpose during a seizure. Yet if they are restrained when they are confused, they may respond aggressively.
• If a person tries to walk around, let them walk in a safe, enclosed area if possible.

Do Not Put Anything in the Person’s Mouth!

• Jaw and face muscles may tighten during a seizure, causing the person to bite down. If this happens when something is in the mouth, the person may break and swallow the object or break their teeth!
• Don’t worry – a person can’t swallow their tongue during a seizure.

Make Sure Their Breathing is Okay

• If the person is lying down, turn them on their side, with their mouth pointing to the ground. This prevents saliva from blocking their airway and helps the person breathe more easily.
• During a convulsive or tonic-clonic seizure, it may look like the person has stopped breathing. This happens when the chest muscles tighten during the tonic phase of a seizure. As this part of a seizure ends, the muscles will relax and breathing will resume normally.
• Rescue breathing or CPR is generally not needed during these seizure-induced changes in a person’s breathing.

Do not Give Water, Pills, or Food by Mouth Unless the Person is Fully Alert

• If a person is not fully awake or aware of what is going on, they might not swallow correctly.  Food, liquid or pills could go into the lungs instead of the stomach if they try to drink or eat at this time.
• If a person appears to be choking, turn them on their side and call for help. If they are not able to cough and clear their air passages on their own or are having breathing difficulties, call 911 immediately.

Call for Emergency Medical Help When

• A seizure lasts 5 minutes or longer.
• One seizure occurs right after another without the person regaining consciousness or coming to between seizures.
• Seizures occur closer together than usual for that person.
• Breathing becomes difficult or the person appears to be choking.
• The seizure occurs in water.
• Injury may have occurred.
• The person asks for medical help.

Be Sensitive and Supportive, and Ask Others to Do the Same

• Seizures can be frightening for the person having one, as well as for others. People may feel embarrassed or confused about what happened. Keep this in mind as the person wakes up.
• Reassure the person that they are safe.
• Once they are alert and able to communicate, tell them what happened in very simple terms.
• Offer to stay with the person until they are ready to go back to normal activity or call someone to stay with them.

Tailoring First Aid Plans

What happens during a seizure may vary from one person to the next. The type of first aid needed can be tailored to what happens during the seizure and the person’s safety. It helps to think about whether the person’s alertness or awareness is affected, and if any physical movements occur that can place them at risk of injury.

Seizures Without Any Change in Awareness

Some people may remain fully awake and alert during a seizure and remember everything that occurs. For example, awareness is not affected during simple partial or myoclonic seizures. During these types of seizures, pay particular attention to the following:

• Usually you don’t need to do anything.
• Stay calm and reassure the person they are safe.
• If the person is frightened or anxious, encourage them to take slow deep breaths or do something that is calming or relaxing.
• Stay with the person until the seizure is over. Make sure that they are fully aware of what is going on before they are left alone.

Seizures with Altered Awareness

Sometimes people may look awake during a seizure, but they really are not aware of part or all of what is going on around them. They may not remember what happens during the seizure or have difficulty talking about it during or after it. The person may walk around during the seizure, but not be in control of where they are going, and they may not be able to protect themselves. These seizure behaviors may be seen with complex partial seizures or clusters of absence seizures. During these episodes, in addition to basic first aid, pay particular attention to the following:

• If the person has a warning before they lose awareness, help them to a safe place.
• Stay with the person and don’t let them wander away. Let them walk in an enclosed area if possible.
• Keep the person away from sharp objects or dangerous places.
• If the person tries to run or is in a dangerous situation, call for help and hold them back if needed to keep them out of danger.
• Do not assume that they can talk or that they can hear you and follow instructions. Assure them they are safe and repeat instructions on what they should do next.
• Make sure that they are alert, oriented and safe after the event before they are left alone.
• Time the seizure – these types of seizures are usually longer than convulsions or tonic clonic seizures. It may be hard to tell when the seizure ended and when the recovery period begins and ends.
• If the seizure turns into a convulsive seizure, follow first aid steps for tonic-clonic seizures.

Seizures with Loss of Consciousness

Some types of seizures can affect a person’s awareness completely – they may be considered ‘unconscious’. They are not able to talk, are not aware of what is going on around them, and may not realize what occurred afterwards. If they have a warning at the start of the seizure, they may be able to get to a safe place – otherwise they are at risk for injury during and after the seizure. Follow the steps for care and comfort first aid with attention to the following:

• Watch how long the seizure lasts – call for emergency medical help if a generalized seizure lasts 5 minutes or longer.
• Protect the person from injury but don’t restrain their movements.
• Watch their breathing – turn them on the side to help keep the airway open. If breathing problems occur, call 911.
• Don’t put anything in their mouth.
• Know when to call for emergency help.
• Stay with the person after the seizure until they are aware and safe.

First Aid for Seizures in Special Circumstances

A seizure in water – If a seizure occurs in water, this person should be supported in the water with the head tilted so his face and head stay above the surface. He should be removed from the water as quickly as possible with the head in this position. He should be examined once on dry land.

A seizure on public transportation – Ease the person across a double or triple seat. Turn him on his side, and follow the same steps as indicated above. If he wishes to do so, there is no reason why a person who has fully recovered from a seizure cannot complete the trip to his destination.

Is an Emergency Room visit needed?
An uncomplicated convulsive seizure in someone who has epilepsy is not a medical emergency, even though it looks like one. It stops naturally after a few minutes without ill effects. The average person is able to continue with his normal activities after a rest period, and may need only limited assistance or no assistance at all, in getting home.

There are several medical conditions other than epilepsy, however, that can cause seizures. These require immediate medical attention and include:

• Diabetes
• Brain infections
• Heat exhaustion
• Pregnancy
• Poisoning
• Hypoglycemia
• High fever
• Head injury

Call for emergency help if:

• A seizure lasts 5 minutes or longer.
• One seizure occurs right after another without the person regaining consciousness or coming to between seizures.
• Seizures occur closer together than usual for that person.
• Breathing becomes difficult or the person appears to be choking.
• The seizure occurs in water.
• Injury may have occurred.
• The person asks for medical help.