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

Understanding Seizures: Prevalence and Types

Seizures are more common than many people realize. Approximately 1 in 10 individuals may experience a seizure during their lifetime. This statistic underscores the importance of being prepared to assist someone during or after a seizure event.

There are various types of seizures, with the most recognizable being the generalized tonic-clonic seizure, formerly known as a grand mal seizure. During this type of seizure, a person may:

• Cry out unexpectedly
• Fall to the ground
• Experience shaking or jerking movements
• Become unaware of their surroundings

While tonic-clonic seizures are often what people associate with epilepsy, it’s crucial to understand that seizures can manifest in various ways. Familiarizing yourself with different seizure types can help you respond appropriately in any situation.

Recognizing a Seizure Emergency: When to Call 911

Most seizures do not require emergency medical attention. However, certain circumstances warrant immediate professional intervention. You should call 911 if:

• The person has never experienced a seizure before
• The individual 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 individual has a pre-existing health condition such as diabetes, heart disease, or is pregnant

How can you determine if a seizure has lasted longer than 5 minutes? It’s essential to time the seizure from the moment it begins. Use a watch, phone, or clock to keep track of the duration accurately.

Step-by-Step Seizure First Aid: Ensuring Safety and Comfort

When assisting someone experiencing a seizure, follow these general steps to ensure their safety and comfort:

1. Stay with the person until the seizure ends and they are fully alert
2. Help the individual sit in a safe place once the seizure concludes
3. Explain what happened in simple terms when they are able to communicate
4. Offer comfort and speak in a calm, reassuring manner
5. Check for a medical bracelet or other emergency information
6. Maintain a calm environment for yourself and others present
7. Offer to call a taxi or assist in arranging safe transportation home

For generalized tonic-clonic seizures specifically, additional steps include:

1. Gently easing the person to the floor
2. Turning them onto their side to aid breathing
3. Removing nearby hard or sharp objects to prevent injury
4. Placing a soft, flat object like a folded jacket under their head
5. Removing eyeglasses and loosening any restrictive clothing around the neck

Seizure First Aid Don’ts: Avoiding Common Mistakes

Knowing what not to do during a seizure is equally important for ensuring the person’s safety. Avoid these common mistakes:

• Do not restrain the person or attempt to stop their movements
• Never put anything in the person’s mouth, as this can cause dental or jaw injuries
• Avoid attempting mouth-to-mouth resuscitation, as breathing typically resumes naturally after a seizure
• Refrain from offering food or water until the person is fully alert and cognizant

Why should you never put anything in a person’s mouth during a seizure? Contrary to popular belief, it’s physically impossible for someone to swallow their tongue during a seizure. Attempting to prevent this non-existent risk can lead to serious injuries.

Post-Seizure Care: Supporting Recovery and Ensuring Well-being

After a seizure has ended, your role in providing care continues. Here are some steps to support the person’s recovery:

1. Allow the individual to rest if they feel tired
2. Ensure they are breathing normally
3. Calmly orient them to their surroundings
4. Check for any injuries that may have occurred during the seizure
5. Stay with them until they are fully alert and able to communicate clearly
6. Offer to contact a family member or friend if needed

How long does it typically take for someone to recover after a seizure? Recovery time can vary greatly depending on the type and intensity of the seizure, ranging from a few minutes to several hours.

Rescue Treatments: Understanding “As Needed” Medicines for Epilepsy

For individuals with epilepsy, healthcare providers may prescribe “as needed” or rescue medicines. These treatments are designed to be used in specific situations to quickly stop seizures and prevent emergencies.

Characteristics of an ideal rescue medicine include:

• Ease of use
• Quick action
• Safety with minimal side effects
• High efficacy

It’s crucial to understand that rescue medicines do not replace daily seizure medications or emergency medical care when necessary. They serve as an additional tool in managing epilepsy effectively.

Types of Rescue Treatments

Rescue treatments for epilepsy can come in various forms:

• Oral medications
• Nasal sprays
• Rectal gels
• Intramuscular injections

For those with implanted devices like vagus nerve stimulators, using a magnet to activate the device during a seizure can also serve as a form of rescue treatment.

Developing a Seizure Action Plan: Preparedness is Key

A seizure action plan is a personalized document that outlines steps to be taken during and after a seizure. This plan is typically developed in collaboration with a healthcare provider and should include:

1. Description of typical seizure types and durations
2. Specific first aid instructions
3. When to administer rescue medications, if prescribed
4. Emergency contact information
5. Circumstances that warrant calling 911

Why is having a seizure action plan important? A well-crafted plan ensures that caregivers, family members, and friends know exactly how to respond during a seizure emergency, potentially improving outcomes and reducing anxiety.

Epilepsy Education and Training: Empowering Communities

Epilepsy education and training programs play a crucial role in improving seizure response and overall care for individuals with epilepsy. These programs are designed for various groups, including:

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

Such training programs aim to increase awareness, reduce stigma, and improve the quality of care for people with epilepsy in various settings.

Resources for Further Learning

Several organizations offer resources and tools to enhance epilepsy awareness and first aid skills:

• The American Red Cross First Aid App provides instant access to step-by-step first aid advice, including guidance for seizures and epilepsy
• The Epilepsy Foundation offers comprehensive information on seizure first aid and safety
• Mental Health First Aid Training programs can help individuals recognize mental health crises and connect people to appropriate care

How can these resources benefit the general public? By increasing knowledge and confidence in handling seizure emergencies, these tools can lead to better outcomes and reduced stigma for individuals with epilepsy.

Living with Epilepsy: Management Strategies and Support

For individuals diagnosed with epilepsy, effective management extends beyond seizure first aid. Key aspects of living well with epilepsy include:

1. Adhering to prescribed medication regimens
2. Regular check-ups with healthcare providers
3. Identifying and managing seizure triggers
4. Maintaining a healthy lifestyle with adequate sleep and stress management
5. Educating family, friends, and colleagues about epilepsy and seizure first aid
6. Considering alternative therapies like dietary changes or neurostimulation devices in consultation with healthcare providers

What role does self-advocacy play in epilepsy management? Being an informed and active participant in one’s own care can lead to better treatment outcomes and improved quality of life.

Support Networks and Resources

Living with epilepsy can be challenging, but numerous support networks and resources are available:

• Local epilepsy support groups
• Online forums and communities
• Epilepsy Foundation helplines
• Vocational rehabilitation services
• Mental health professionals specializing in chronic conditions

These resources can provide emotional support, practical advice, and a sense of community for individuals navigating life with epilepsy.

Advancing Epilepsy Research: Hope for the Future

Ongoing research in epilepsy aims to improve understanding, diagnosis, and treatment of this complex neurological disorder. Current areas of focus include:

• Developing more targeted and effective medications
• Exploring gene therapies for genetic forms of epilepsy
• Improving brain imaging techniques for better diagnosis and treatment planning
• Investigating the potential of neurostimulation devices
• Studying the impact of lifestyle factors on seizure control

How might advances in epilepsy research impact seizure first aid in the future? As our understanding of epilepsy grows and new treatments emerge, first aid protocols may evolve to incorporate these advancements, potentially leading to more effective emergency responses.

Participating in Epilepsy Research

Individuals with epilepsy and their families can contribute to advancing research by:

1. Participating in clinical trials
2. Sharing their experiences through patient registries
3. Supporting epilepsy research foundations
4. Advocating for increased funding for epilepsy research

These contributions play a vital role in driving progress towards better treatments and, ultimately, a cure for epilepsy.

Epilepsy Awareness: Breaking Stigma and Promoting Understanding

Despite its prevalence, epilepsy remains misunderstood by many, leading to stigma and discrimination. Increasing public awareness is crucial for creating a more inclusive and supportive society for individuals with epilepsy.

Key aspects of epilepsy awareness include:

• Educating the public about the diverse manifestations of seizures
• Dispelling myths and misconceptions about epilepsy
• Promoting inclusive practices in schools and workplaces
• Encouraging open dialogue about epilepsy to reduce fear and stigma
• Highlighting the achievements of individuals living with epilepsy

How can increased awareness impact the lives of people with epilepsy? Greater understanding can lead to improved social support, better accommodation in various settings, and reduced barriers to employment and education.

Epilepsy Awareness Campaigns and Events

Various organizations and initiatives work to promote epilepsy awareness:

• Purple Day (March 26): An international day for epilepsy awareness
• National Epilepsy Awareness Month (November in the United States)
• Wear Purple for Epilepsy campaigns
• Community education programs in schools and workplaces
• Social media campaigns sharing personal stories and facts about epilepsy

These efforts collectively contribute to a more informed and empathetic society, improving the lives of individuals with epilepsy and their families.

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

On this page:

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.