How to recognize a seizure emergency. When to call 911 during a seizure. What are the proper steps for seizure first aid. How to keep a person safe during a seizure. What should you avoid doing during a seizure. How to use rescue treatments for epilepsy.

Understanding Seizures: Frequency and Types

Seizures are more common than many people realize. Approximately 1 in 10 individuals may experience a seizure during their lifetime. This prevalence underscores the importance of understanding proper seizure first aid techniques.

There are various types of seizures, each presenting differently. The most widely recognized is the generalized tonic-clonic seizure, formerly known as a grand mal seizure. During this type of episode, the person may cry out, fall, shake or jerk, and become unaware of their surroundings.

How frequently do seizures occur in the general population?

Studies indicate that about 10% of people will have at least one seizure in their lifetime. This statistic highlights the importance of public awareness and preparedness for potential seizure situations.

Recognizing Seizure Emergencies: When to Call 911

While most seizures do not require emergency medical attention, certain situations warrant immediate professional intervention. It’s crucial to recognize these scenarios to ensure the safety of the person experiencing the seizure.

In which situations should you call emergency services during a seizure?

Call 911 if any of the following conditions are present:

• It’s the person’s first seizure
• The person has difficulty breathing or regaining consciousness after the seizure
• The seizure lasts longer than 5 minutes
• Another seizure occurs shortly after the first one
• The person sustains an injury during the seizure
• The seizure happens in water
• The person has a pre-existing health condition such as diabetes, heart disease, or is pregnant

Essential Steps for Seizure First Aid

Knowing how to respond during a seizure can significantly impact the safety and well-being of the person experiencing it. Here are the general steps to follow for any type of seizure:

1. Stay with the person until the seizure ends and they are fully awake.
2. Help the person sit in a safe place once the seizure concludes.
3. Communicate what happened in simple terms when they are alert and able to understand.
4. Offer comfort and speak calmly to the person.
5. Check for any medical identification, such as a bracelet or emergency information card.
6. Maintain a calm environment for yourself and others present.
7. Offer to call a taxi or assist in arranging safe transportation home.

How long should you stay with a person after their seizure ends?

It’s important to remain with the person until they are fully conscious and aware of their surroundings. This period can vary but typically lasts several minutes after the seizure has stopped.

Specific First Aid for Tonic-Clonic Seizures

Tonic-clonic seizures, characterized by loss of consciousness and convulsions, require specific first aid measures to ensure the person’s safety:

• Gently ease the person to the floor
• Turn them onto their side to aid breathing
• Clear the surrounding area of hard or sharp objects
• Place a soft, flat item like a folded jacket under their head
• Remove eyeglasses if present
• Loosen any tight clothing around the neck
• Time the duration of the seizure

Why is it important to turn a person onto their side during a seizure?

Turning the person onto their side, known as the recovery position, helps maintain an open airway and allows any fluids to drain from the mouth, reducing the risk of choking.

Common Misconceptions and Actions to Avoid

Understanding what not to do during a seizure is equally important as knowing the correct first aid procedures. Many well-intentioned actions can actually cause harm or complicate the situation.

What actions should be avoided during a seizure?

Never attempt the following during a seizure:

• Restraining the person or trying to stop their movements
• Putting anything in the person’s mouth
• Attempting mouth-to-mouth resuscitation
• Offering food or water until the person is fully alert

These actions can lead to injury, interfere with breathing, or pose choking hazards. It’s a common myth that a person can swallow their tongue during a seizure – this is physically impossible.

Rescue Treatments and Medications for Epilepsy

For individuals with epilepsy, healthcare providers may prescribe rescue treatments or “as needed” medications to manage seizures and prevent emergencies.

What are the characteristics of an ideal rescue medication?

An effective rescue treatment should be:

1. Easy to administer
2. Fast-acting
3. Safe with minimal side effects
4. Highly effective in stopping seizures

These medications aim to quickly halt seizures and prevent the need for emergency room visits. However, it’s crucial to understand that rescue treatments do not replace daily anti-epileptic medications or emergency medical care in true emergencies.

Can rescue treatments completely replace emergency medical care?

No, rescue treatments are not a substitute for emergency medical care. While they can help manage seizures and potentially prevent some emergencies, severe or prolonged seizures still require immediate professional medical attention.

Specialized Devices for Seizure Management

Some individuals with epilepsy use implanted devices as part of their treatment plan. One such device is the vagus nerve stimulator (VNS).

How does a vagus nerve stimulator work as a rescue treatment?

A VNS device is implanted under the skin in the chest area and connected to the vagus nerve in the neck. During a seizure, the patient or a caregiver can swipe a magnet over the device generator. This action triggers an extra dose of stimulation, which may help stop or shorten the seizure.

This form of rescue treatment can be particularly useful for people whose seizures are not well-controlled by medications alone. However, it’s important to note that VNS is not suitable for all types of epilepsy and requires careful evaluation by a neurologist.

Training and Resources for Seizure First Aid

Given the prevalence of seizures, it’s beneficial for the general public and specific professional groups to receive training in seizure first aid and epilepsy management.

What resources are available for learning about seizure first aid?

Several organizations offer valuable resources and training programs:

• The American Red Cross provides a free app with step-by-step first aid advice, including guidance for seizures and epilepsy.
• The Epilepsy Foundation offers comprehensive information on seizure first aid and safety protocols.
• Mental Health First Aid Training programs can help individuals recognize mental health crises, including those related to epilepsy.

Additionally, specialized training programs are available for various professional groups, including:

• School staff
• First responders and law enforcement
• Older adult caregivers
• Mental health professionals
• Childcare providers

These training programs aim to increase awareness, reduce stigma, and improve the quality of care for individuals with epilepsy across different settings.

How can increased public awareness impact the lives of people with epilepsy?

Greater public understanding of seizure first aid can significantly improve outcomes for people with epilepsy. It can lead to:

• Faster and more appropriate responses during seizure emergencies
• Reduced risk of injury during seizures
• Decreased stigma and discrimination in social and professional settings
• Improved overall quality of life for individuals living with epilepsy

By fostering a more informed and empathetic society, we can create safer environments for those affected by epilepsy and seizure disorders.

Developing a Comprehensive Seizure Action Plan

For individuals diagnosed with epilepsy, creating a detailed seizure action plan in collaboration with their healthcare provider is crucial. This plan serves as a roadmap for managing seizures and potential emergencies.

What key elements should a seizure action plan include?

An effective seizure action plan typically contains:

• Basic personal and medical information
• Description of typical seizure types and frequency
• List of current medications and dosages
• Step-by-step instructions for seizure first aid
• Guidelines for when to administer rescue medications
• Criteria for seeking emergency medical care
• Contact information for healthcare providers and emergency contacts

This plan should be regularly reviewed and updated to reflect any changes in the individual’s condition or treatment regimen. It’s also important to share this plan with family members, caregivers, and relevant personnel in work or school environments.

How often should a seizure action plan be reviewed and updated?

It’s recommended to review and update the seizure action plan at least annually or more frequently if there are significant changes in seizure patterns, medications, or overall health status. Regular check-ins with the healthcare provider can help ensure the plan remains current and effective.

By maintaining an up-to-date seizure action plan, individuals with epilepsy can feel more confident in managing their condition and empower those around them to provide appropriate assistance when needed.

Seizure First Aid | Epilepsy

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About 1 out of 10 people may have a seizure during his or her lifetime. That means seizures are common, and one day you might need to help someone during or after a seizure.

Learn what you can do to keep that person safe until the seizure stops by itself.

About 1 out of 10 people may have a seizure during his or her lifetime.

Seizures do not usually require emergency medical attention. Only call 911 if one or more of these are true:

• The person has never had a seizure before.
• The person has difficulty breathing or waking after the seizure.
• The seizure lasts longer than 5 minutes.
• The person has another seizure soon after the first one.
• The person is hurt during the seizure.
• The seizure happens in water.
• The person has a health condition like diabetes, heart disease, or is pregnant.

Stay with the person until the seizure ends and he or she is fully awake.

There are many types of seizures. Most seizures end in a few minutes.

These are general steps to help someone who is having any type seizure:

• Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms.
• Comfort the person and speak calmly.
• Check to see if the person is wearing a medical bracelet or other emergency information.
• Keep yourself and other people calm.
• Offer to call a taxi or another person to make sure the person gets home safely.

When most people think of a seizure, they think of a generalized tonic-clonic seizure, also called a grand mal seizure. In this type of seizure, the person may cry out, fall, shake or jerk, and become unaware of what’s going on around them.

Here are things you can do to help someone who is having this type of seizure:

• Ease the person to the floor.
• Turn the person gently onto one side. This will help the person breathe.
• Clear the area around the person of anything hard or sharp. This can prevent injury.
• Put something soft and flat, like a folded jacket, under his or her head.
• Remove eyeglasses.
• Loosen ties or anything around the neck that may make it hard to breathe.
• Time the seizure. Call 911 if the seizure lasts longer than 5 minutes.

Knowing what NOT to do is important for keeping a person safe during or after a seizure.

Never do any of the following things

• Do not hold the person down or try to stop his or her movements.
• Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
• Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure.
• Do not offer the person water or food until he or she is fully alert.

• American Red Cross First Aid Appexternal icon Download the free Red Cross app for instant access to step-by-step first aid advice, including advice about seizures and epilepsy.
• Epilepsy Foundation Seizure First Aid and Safetyexternal icon Learn more about how to respond to seizures safely.
• Mental Health First Aid Trainingexternal icon  This evidence-based program can help people recognize mental health crises and learn how to connect a person to mental health care.

• Types of Seizures Learn about the different types of seizures.
• Managing Epilepsy Learn what you can do to manage your epilepsy.
• Fast Facts Find out about epilepsy in the United States, such as how many people have epilepsy.

Epilepsy and seizure training programs for professionals including

• School staff.
• First responders and law enforcement.
• Older adult caregivers.
• Mental health professionals.
• Childcare providers.

Learn more about Training for Professionals.

Using Epilepsy Rescue Treatments | Epilepsy Foundation

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Talk with your healthcare provider about your seizure action plan and whether you need a rescue medicine.

What are “as needed” or rescue medicines?

“As needed” medicines are only given in specific situations. Some people also call them “rescue treatments.”

• The ideal rescue medicine (1) is easy to use, (2) works quickly, (3) is safe with little to no side effects, and (4) works well.
• The goal is to stop seizures quickly to prevent emergency situations. Hopefully this will prevent you from needing an emergency room. However, rescue medicines do NOT take the place of emergency medical care. If a true medical emergency happens, get emergency medical help right away.
• If medications are prescribed as rescue treatments, they do NOT take the place of daily seizure medications. Most people who have epilepsy are prescribed other medications that they take on a regular basis.
• People who have certain implanted devices for the treatment of epilepsy (such as a vagus nerve stimulator) can use a magnet to swipe over the device generator at the time of the seizure. This is also a form of rescue treatment.

What types of medicines can be used as a rescue treatment?

The most common type of rescue medicines are from a group of medicines called benzodiazepines. These medications get into the bloodstream quickly, to start working in the brain quickly.

• Benzodiazepines are available in several different forms. Depending on the specific benzodiazepine they can be
  • Swallowed in pill form (oral)
  • Placed under the tongue to dissolve (sublingual)
  • Placed between the cheek and the gum to dissolve (buccal)
  • Given via a gel through the anus (rectal)
  • Sprayed up the nose (nasal)
• In a hospital setting, other forms of benzodiazepines can be given by an injection directly into the bloodstream vein or injected into a muscle.
• The names of benzodiazepines that are most commonly used as rescue medications include diazepam, lorazepam, clonazepam, and midazolam.
  • The availability of these medicines in different forms and how they are used may vary from country to country.
  • Also, the brand names of these medications can change depending on the form it is given.
• In the United States, the U.S. Food and Drug Administration (FDA) has approved several medications for out-of-hospital use for the treatment of acute repetitive seizures or clusters.
  • Diastat^® – a diazepam rectal gel
  • Nayzilam^® – a midazolam nasal spray
  • Valtoco^® – a diazepam nasal spray
  • Other medications are commonly used for out-of-hospital rescue treatment but have not yet been approved by the FDA.

How do I choose the right rescue treatment for me?

• Choosing whether you need a rescue medication, and which medication to choose, should be done during a discussion with your healthcare provider about a seizure action plan. The action plan should involves more than just a taking medication and include seizure first aid and when emergency help is needed.
• Things to consider when talking to your healthcare provider:
  • How fast will it work?
  • How will I take it? (mouth, nose, etc…)
  • How easy is it to use?
  • What are the side effects?
  • How much does it cost?
• Some people who remain awake and alert may be able to swallow a pill such as lorazepam or diazepam.
• Other people who are not alert may need to be given a form that can be given under the tongue (sublingual), between the cheek and gum (buccally), or sprayed into a nostril (nasal spray).
  • People who are not able to take these forms can use rectal diazepam; however this is most often prescribed for children.

When should I use my rescue medicine?

Since seizure emergencies are not common, some people with epilepsy will not need to use any treatment other than their daily amount of seizure medicine. However, sometimes seizures occur in a different pattern that is more often or more severe. Several names have used to describe these patterns, such as seizure clusters and acute repetitive seizures. Stopping seizures early in these situations is the key to preventing a seizure emergency.

• There is no one-size-fits-all when it comes to rescue medicines. Since each person’s seizures are different, their seizure action plan and rescue medicine plan should be made specifically for them.
• When discussing with your health care provider, you should have a good understanding of your typical pattern of seizures and be able to recognize when seizures are not typical for you.
• As part of being prepared, ask your healthcare provider if “as needed” medicines are right for you and develop a clear plan with your provider about when they should be used.

General situations when rescue medicines may be recommended:

• Seizures occur that are different than your usual type or pattern.
• Seizures last longer than typical events.
• Seizure occur more frequently than usual
• Seizure clusters are different than usual – for example when more occur than normal or in a shorter period of time.
• Seizures occur at high-risk times – for example, during medicine changes or when sick.

Webinar Recording

Rescue Therapies for Children and Adults

Having a seizure action plan is essential for people living with epilepsy, their families, caregivers, classmates, and colleagues. A good seizure action plan includes information about what to do in the event of a seizure emergency. Watch the video for a discussion with Dr. Lawrence Hirsch and Registered Nurse Nancy Santilli about the latest options in rescue therapies for children and adults.

Webinar recorded on September 1, 2022

Learn More

• Understanding Seizures and Emergencies
• Responding to Seizures
• FDA News: Nayzilam (midazolam) Nasal Spray Approved for Seizure Clusters
• FDA News: Valtoco (diazepam) Nasal Spray Approved as Rescue Therapy for Seizures
• Innovations for Rescue Medications
• Six Questions to Help Decide Whether Your Child Should Have Acute Rescue Medications for Breakthrough Seizures

Authored By:

Matthew Hoerth MD

Patty Obsorne Shafer RN, MN

on Sunday, April 14, 2019

Reviewed By:

Elaine Wirrell MD

on Tuesday, April 14, 2020

First aid for epilepsy in humans.

What to do in case of an epileptic attack

First aid in case of an epileptic attack, as a rule, is provided to a person by those people who happened to be next to him at that moment. First of all, if you become a witness to an attack, you must call an ambulance so that the sick patient can receive the help of a qualified specialist. In addition, there are a number of simple rules that help to protect the patient during an attack before the ambulance arrives. You can turn to videos on the websites of professional medical communities, which in a popular way introduce how you can help a person with an epileptic seizure, whether an adult or a child.

An attack in an adult patient may begin with an “aura”, he anticipates loss of consciousness and convulsions and can inform others about this, the patient should lie on a bed or on the ground, away from traumatic objects, loosen his tie (if any).2

Immediately, without waiting for the arrival of a doctor, a child who has symptoms of “aura” should be placed on a flat surface (bed or floor), unbuttoned and loosened tight clothing, especially at the throat, to clear the airways. First aid for epilepsy in children, if an attack occurs outside the home, is to move the child to a safe place (away from water, traffic, sharp objects and corners), put something soft under his head, for example, a folded jacket . Remember that in the event of an attack, it is imperative to call an ambulance. It is necessary to protect the patient from injury, especially from head injury.6

If a convulsive attack in an adult or child occurs suddenly, and the patient does not anticipate it and cannot protect himself from injury, then first aid measures are taken after the onset of the attack. During an attack, the patient is not recommended to be transferred, except in cases where he may be in danger, for example, on the roadway, near the fire, on the stairs or in the water.

One of the standards in emergency care is to immediately put the victim in a comfortable position. With increased salivation and vomiting, the patient should be placed on his side so that he does not choke. This should be done gently, without using force. Before the arrival of doctors, you need to observe the patient. Do not try to keep the patient, limiting his movements. A dangerous complication of an attack – retraction of the tongue – occurs, as a rule, in the case of the position of the head face up with the head thrown back. Therefore, in no case should the position of throwing the head back be allowed! There is no need to try to open the patient’s mouth, even if the tongue is bitten, as this can lead to injury to the teeth, oral mucosa, upper and lower jaws, and the tongue itself. Among the urgent measures often mentioned is the need to lay an object between the teeth of the patient in order to prevent biting, which should never be done. Biting the tongue occurs at the very beginning of the attack. If the patient bit his tongue or cheek, then the injury has already occurred. Further attempts to open the mouth to avoid injury to the oral mucosa are useless and even dangerous.4

It is necessary to wait for the attack to end, being next to the patient and carefully observing his condition, in order to correctly and fully describe the manifestations of the attack to the doctor after the arrival of the ambulance. It is very important to note the time when the attack began, since the duration of the attack or series of attacks is very important for the attending physician. After an attack, as a rule, the patient feels weak, exhausted, or falls asleep. In this case, it is not necessary to disturb him in order to allow the nerve cells exhausted from the attack to recover. The standard of behavior of a person who happened to be close to the patient during an attack is to remain nearby and wait until the period of post-attack confusion (if any develops) ends and consciousness is fully restored. along with inappropriate behavior, aggressive actions towards others can also be noted. In such cases, it is important to remain calm and composed and try to provoke him to react as little as possible.3

When providing first aid for epilepsy in adults, do not pour water on the patient to “bring him to his senses”, do artificial respiration. It is also not recommended to try to wake the patient after an attack by shaking, tapping, inhaling pungent odors, or using any other methods. .

Seizures are often short-lived (several seconds or minutes) and end on their own. However, with prolonged seizures or seizures following one after another without recovery of consciousness, there is a threat of developing status epilepticus, and, in addition to providing emergency care, doctors should be immediately called for further hospitalization if necessary.7

It is important to remember the need to provide timely assistance for epilepsy and obtaining expert advice on how to act in an emergency, depending on the individual situation of the patient.

INTERNATIONAL LEAGUE OF ANTIEPILEPTIC RECOMMENDATIONS7

• 1. Voronkova K.V., Petrukhin A.S., Pylaeva O.A., Kholin A.A. Epilepsy is curable! Recommendations for patients and their relatives. Moscow, publishing house “Litterra” 2010. 176 p.
• 2. Karpova V. I., Krushinskaya N.S., Mukhin K.Yu. Epilepsy. Story. Diagnostics. Practice. Treatment. Tips for patients. Moscow, System Solutions, 2011. 224 p.
• 3. Mukhin K.Yu., Mironov M.B., Petrukhin A.S. epileptic syndromes. Diagnostics and therapy. Guide for doctors. Moscow, System Solutions, 2014. 376 p.
• 4. Devinsky O., Epilepsy. Patient and family guide. Demos Medical Publishing. 2008. 394 p.
• 5. Michalovska-Karlova E.P. journal Epilepsy.Medi.ru – No. 7, 2012. www.epilepsy.medi.ru Date of access – 11/28/2014.
• 6. Tikholaz T.V. journal Epilepsy.Medi.ru – No. 8, 2012 www.epilepsy.medi.ru Accessed 28.