Seizure First Aid

Reviewed by: HU Medical Review Board | Last reviewed: November 2021

Knowing how to help someone with epilepsy during a seizure can be the difference between life and death. While most seizures end on their own without serious harm, some seizures are life-threatening emergencies.

Understanding how to respond to a seizure will give you the knowledge and confidence to support and care for the person having a seizure. You should learn the actions to take to keep a person safe, and how to observe and record the seizure.1,2

Keep them safe

The first and most important step is to remain calm and keep others around you calm as well. Do your best to talk in a soothing voice to the person having a seizure. Reassure them they are safe, even if you do not know they are aware of you. Check for a medical ID.1,2

Time the seizure as best as you can. If you do not have a watch, use the clock feature on your phone. Timing the seizure is important, as this will determine if you need to call 9-1-1 for help.1

Move harmful or sharp items away. If a crowd gathers, remind others to step back and give the person some room.

Seizures can cause confusion. If they can move, gently guide the person to a safe, quiet spot away from crowds, traffic, or other safety concerns. If there is another person nearby, ask them to stay with you in case you need more help.1

Turn them on their side

If the person is not awake and aware of what is going on, gently lay them down and turn them on their side. Keep their mouth pointed toward the ground. This allows saliva, vomit, and other fluids to drain out if needed.1

If they are having a convulsive seizure, help them lay down and put something soft under their head. Loosen any tight clothing around their neck, and remove glasses.

At times, it might look like the person has stopped breathing if they are convulsing. This is because the muscles in the chest can become stiff during a seizure. Rescue breathing is usually not needed. Continue to stay with them and remain calm.1

If the person is aware of their surroundings, help them to sit and stay in a comfortable position.

Seizure first aid: what NOT to do

Some things may cause more harm, including:1,2

  • Restraining – Do not hold down or restrain the person. You can injure the person having the seizure, or you can be injured.
  • Placing items in the mouth – Do not place a stick, bite block, or other items in the mouth of the person having a seizure. A common myth is that a person having a seizure can "swallow their tongue." This is not true. The muscles in the mouth and jaw tighten during a seizure and can break an object that is placed in the mouth. Or, the object can break their teeth. This can cause an airway emergency. Rescue drugs may be placed inside the mouth if prescribed by their doctor.
  • Performing mouth-to-mouth breathing – People usually start breathing on their own after a seizure.
  • Giving food or water – Avoid giving anything by mouth until they are awake and alert.

When should you call 9-1-1 for an epilepsy seizure?

Knowing when to call 9-1-1 can ensure the person having a seizure gets the emergency medical care they need. Call for help in these situations:1-2

  • Any seizure lasting longer than 5 minutes
  • The person has never had a seizure before
  • A second seizure starts soon after the first one ends
  • The person has trouble breathing after the seizure
  • The person does not return to their normal self after the seizure
  • An injury has occurred
  • The seizure happens in water
  • The person has other health conditions or is pregnant
  • The person asks to be treated by a doctor

Tips for observing and recording

At times, you will not be able to witness events leading up to a seizure. However, observing and recording the seizure is an important part of helping the person with epilepsy. Later, this information can be used to build their seizure action plan.

If someone has accessible seizure rescue medicine prescribed by their doctor (typically a benzodiazepine tablet or nasal spray), they can receive a dose after the seizure. Prescription instructions will describe criteria for administration – for example, give after a generalized seizure lasting longer than 3 minutes. Even if the seizure is short and self-resolved, you should notify your doctor after a seizure because you may need a medicine adjustment or further workup to identify the trigger.

A seizure action plan helps organize seizure information so it is available when it is needed.3

The Epilepsy Foundation offers helpful printable resources to build your seizure action plan and seizure response tools, including:3

  • A seizure action plan template
  • A seizure diary with simple checklist to record behaviors during events
  • A calendar to record the date and type of seizure

For more information, you can print a go-to guide to remind you of what to record and observe during seizures.

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