Seizure First Aid: Simple First Aid That Can Make a Difference
Updated: 6 hours ago
Seizures in the Community: Simple First Aid That Can Make a Difference
By Garry Perkins, former Paramedic, parent and Founder of Sussex First Aid Courses Ltd
Seeing someone have a seizure for the first time can be frightening. For a parent watching their child, a carer supporting somebody in their care, or a member of the public suddenly faced with a person having a seizure, those first few moments can feel overwhelming.
For me, this subject is also very personal.
Alongside more than 35 years working in emergency care as a paramedic, I have experienced seizures from a parent's perspective. My son Ryan had cerebral palsy and experienced many seizures during his life.
I understand only too well the worry that comes with watching your child have a seizure, wondering whether this one is different, whether it will stop and whether you need emergency help.
It is one of the reasons seizure awareness has always been a subject particularly close to me.
The good news is that seizure first aid does not need to be complicated.
Stay calm. Keep the person safe. Time the seizure. Reassure them. Know when to call for help.
Not Every Seizure Looks the Same
When people hear the word seizure, many immediately picture someone falling unconscious and experiencing strong jerking movements.
That describes a tonic-clonic seizure, but seizures can present in many different ways.
A person may suddenly appear vacant or unresponsive. They may become confused, make repetitive movements, wander, stare, smack their lips or behave in a way that seems unusual. Other seizures can cause brief muscle jerks, changes in sensation or sudden loss of muscle tone.
Some people experience more than one type of seizure.
This is why knowing the individual person and understanding what is normal for them can be incredibly valuable.
Epilepsy Action advises staying with the person, keeping them safe and considering information from medical identification or their individual care plan where available. (Epilepsy Action)
A Seizure Does Not Always Mean Epilepsy
It is also important to understand that a seizure does not automatically mean someone has epilepsy.
Seizures can occur for a number of reasons and may be associated with other medical conditions or situations. These can include brain injury, stroke, problems with blood glucose, infections and a lack of oxygen, among other causes. Children may also experience febrile seizures associated with a high temperature.
So if somebody has a seizure for the first time, they need medical assessment.
Keep Seizure First Aid Simple
When someone is having a tonic-clonic seizure, perhaps the most useful thing a first aider can do initially is remain as calm as possible.
You are unlikely to be able to stop the seizure yourself, but you can protect the person from further harm.
My simple approach is:
Stay with them and start timing the seizure. Note when it begins and, if possible, when it finishes.
Make the area safe. Move chairs, tables, sharp objects or other hazards away from them. Only move the person themselves if they are in immediate danger.
Protect their head. If they are on the floor, place something soft such as a folded coat, jumper or cushion beneath their head. Your hands can also be used gently if nothing else is available.
Loosen tight clothing around the neck if this can be done safely.
Do not restrain them. Allow the seizure to run its course while protecting them from injury.
Never put anything in their mouth. Do not put your fingers, a spoon or any other object between their teeth.
When the jerking has stopped, check their breathing and place them into the recovery position when appropriate.
Stay with them, preserve their dignity and reassure them until they have recovered. Do not give food or drink until they are fully recovered.
These principles are consistent with current NHS seizure first-aid advice. (nhs.uk)
Never Put Anything in Their Mouth
This is worth repeating because it remains one of the most persistent myths surrounding seizures.
Never put anything into the person's mouth.
A person cannot swallow their tongue.
Trying to force something between their teeth may cause damage to their teeth, mouth or jaw and could injure the first aider as well.
Similarly, do not try to physically hold the person's arms or legs still.
Protect — don't restrain.
Talk to Them and Reassure Them
Even when someone appears unresponsive, I encourage first aiders and carers to continue speaking calmly to them.
Tell them that they are safe and that you are staying with them.
When someone begins to recover, they may be frightened, embarrassed or confused. They may not know where they are or what has happened.
A calm, familiar voice can be enormously reassuring.
There is no need for a crowd of people standing over them. Give them space, reduce unnecessary noise and allow them time to recover.
When Should You Call 999?
Many people with established epilepsy do not require an ambulance every time they experience their usual seizure. Their individual care plan may tell family members, carers or colleagues exactly what to do. (nhs.uk)
However, call 999 or 112 for emergency help if the seizure lasts 5 minutes or longer, lasts significantly longer than is normal for that individual, another seizure begins without the person recovering between them, it is their first known seizure, they have difficulty breathing after the seizure, they have been seriously injured, or they are not recovering as expected. If you are concerned for any other reason, call for help. (nhs.uk)
For someone with an established seizure condition, their personalised care or emergency management plan may contain a different threshold based on their normal seizure pattern. Follow that plan where appropriate.
Why Five Minutes Matters
This is an especially important point for first aiders.
Historically, people may have heard prolonged seizures discussed in terms of 20 or 30 minutes.
That is not a reason to wait.
Current NICE guidance treats a convulsive seizure lasting 5 minutes or more as convulsive status epilepticus requiring immediate emergency treatment. (Nice)
Status epilepticus can also occur when someone experiences repeated seizures without regaining consciousness between them.
Five minutes is the important first-aid trigger.
Start your timer as soon as you recognise that a seizure is occurring.
Those few seconds spent checking your watch or phone at the beginning can provide extremely useful information later.
Individual Care Plans Can Make an Enormous Difference
One of my strongest recommendations for somebody with a known seizure condition is to have an up-to-date individual care or emergency management plan.
Every person is different.
One person's normal seizure may last 30 seconds. Another person's may last several minutes. Some people have warning signs before a seizure. Others may experience particular sequences or clusters of seizures.
A good plan can explain what that individual's usual seizures look like, how long they normally last, what first aid they require, when emergency help should be called and whether they have prescribed rescue medication.
That information can be invaluable to family members, carers, schools, workplaces and the ambulance service.
Epilepsy Action also recommends up-to-date care planning for people at risk of prolonged seizures or status epilepticus. (Epilepsy Action)
Emergency Medication and Buccal Midazolam
Some children and adults who are at risk of prolonged seizures may have been prescribed emergency or rescue medication, such as buccal midazolam.
This medication should only be administered in accordance with that person's prescribed emergency management plan by somebody who has received the appropriate training.
The individual plan should clearly identify when medication should be given, the prescribed dose, what should happen afterwards and when the emergency services should be called.
If you are uncertain, call 999.
At Sussex First Aid Courses we strongly believe that carers and staff expected to administer emergency medication should receive practical training rather than simply being handed a written instruction sheet.
What Happens After the Seizure?
After a seizure finishes, the person may enter what is known as the post-ictal phase.
Again, everyone is different.
Some people recover relatively quickly. Others may be extremely tired and want to sleep. They can experience headache, aching muscles, confusion, poor memory, emotional upset or altered behaviour.
Recovery may take considerably longer for some people than others.
This is where good observation becomes important.
Ask yourself:
Is this person's recovery following their normal pattern, or is something different today?
Stay with them.
Check that their breathing is returning to normal.
If they are unconscious but breathing normally, place them in the recovery position and continue to monitor them.
If they are not breathing normally, call 999 and begin CPR.
Protect Their Dignity
Seizures can be a very public and vulnerable experience.
A person may have lost bladder control. They may be disorientated when they wake. They may be embarrassed by what has happened.
Move unnecessary bystanders away.
If appropriate, use a blanket, coat or other item to help preserve their privacy.
Avoid asking lots of questions immediately.
Give them time.
Explain calmly what has happened and reassure them that they are safe.
Epilepsy Action specifically recommends protecting the person's dignity and moving unnecessary bystanders away where appropriate. (Epilepsy Action)
Look for the Red Flags
During and after a seizure, keep observing the whole person rather than concentrating only on the seizure movements.
Be particularly concerned if you notice blue or grey lips, continuing breathing difficulties, repeated seizures, failure to regain consciousness, significant injury, a first-ever seizure, an unusual or prolonged recovery, pregnancy, diabetes or anything else that makes you concerned that this is not the person's normal pattern.
If something doesn't look or feel right, seek urgent medical help.
You do not have to diagnose the cause of the seizure.
As a first aider your role is to recognise, protect, observe and escalate.
A Care Plan Helps When Stress Takes Over
Emergencies affect us all.
Even someone who has received training can find that their thinking changes when the person having the seizure is their own child, partner, relative or somebody they care deeply about.
Human factors matter.
That is another reason written plans are so valuable.
When you are frightened and trying to remember what normally happens at four minutes, whether medication is due at five minutes and when the ambulance needs to be called, a clear care plan gives you something reliable to follow.
I know from both sides — as a paramedic and as a parent — how important that reassurance can be.
First Aid Is About Being There
You don't have to understand every neurological process occurring during a seizure to provide good first aid.
Sometimes the most valuable things you can offer are very simple:
Keep them safe.
Time the seizure.
Don't restrain them.
Don't put anything in their mouth.
Stay with them.
Reassure them.
Know when to call 999.
For somebody experiencing a seizure, having a calm and confident person beside them can make an enormous difference.
And for parents, grandparents, carers, teachers, support workers and members of the community, gaining a little knowledge and practising these skills can replace some of the fear with confidence.
Epilepsy and Seizure Awareness Training
At Sussex First Aid Courses, our Basic Epilepsy and Seizure Awareness Training is designed for people who have responsibility for supporting somebody with epilepsy or seizures at work, at home or within community and voluntary settings.
Our practical and interactive training can include understanding epilepsy and different seizure presentations, recognising and responding to seizures, tonic-clonic seizure first aid, post-ictal care, recognising status epilepticus, individual care plans, risk management, emergency escalation and discussion around prescribed rescue medicines such as buccal midazolam where appropriate.
Most importantly, our aim is to help people feel prepared rather than frightened.
Because when an emergency happens, simple, safe and effective first aid really can make a difference.
About the author
Garry Perkins is a former paramedic with more than 35 years' experience in emergency care, a parent with personal experience of caring for a child who experienced seizures, and the Director and Founder of Sussex First Aid Courses Ltd.
Sussex First Aid Courses provides practical first aid, epilepsy awareness and emergency-care training for families, carers, schools, community organisations, healthcare teams and workplaces across Sussex and surrounding areas.
Sussex First Aid Courses Ltd 0800 069 9931 info@sussexfirstaidcourses.co.uk. www.sussexfirstaidcourses.co.uk
This article provides general first-aid information and does not replace an individual's medical advice, epilepsy care plan, emergency management plan or practical training.
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