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What should I do if someone appears to be having a major seizure?
Non-convulsive seizures
A seizure in water
A seizure on an airplane
A seizure on a bus
How will I know if the person having the seizure needs to go to an A&E department?
If you have never seen an epileptic seizure taking place, the first time (or even subsequent times) can be a worrying experience, particularly if you are unfamiliar with what to do. As a result, knowing some basic first aid will benefit both the person having the seizure and you.
What should I do if someone appears to be having a major seizure?
At the start of a major seizure, the person may cry out. They will then usually stiffen and fall to the floor, where their arms and legs may jerk or twitch. In the event of such a seizure, here are some basic first aid points:
Keep calm
Clear a space around the person, moving objects away that might be harmful
If there are other people around, explain what you are doing, reassure them if necessary and keep them away from the person having the seizure
Try and make the person as comfortable as possible by for example, placing a cushion under their head to prevent head or facial injury
Loosen any tight neckwear and remove spectacles and high heel shoes if worn
Do not place anything in their mouth at any stage
Do not attempt to rouse them and only move them if they are in a dangerous location, such as at the top of stairs or on a road
Be aware that during the seizure, the person may go blue in the face. There is nothing you can do about this until the seizure is over
At the end of the seizure, the twitching/jerking will stop. The person usually takes a deep breath, the blue colour goes and they slowly wake up. They may be confused and may not know where they are for a short while afterwards. They may also have soiled themselves. At this point, you should:
Stay with the person and talk to them quietly. Explain what has happened and reassure them
Do not try to wake them up, let them come to in their own time
Do not give them anything to drink until you are sure that they are fully awake.
Be aware that you do not need to send for an ambulance unless one seizure runs into another, the person has not woken up after five minutes, they are having trouble breathing or they are injured.
If at the end of a seizure, the person remains blue or is struggling for breath:
Put your fingers under the angles of their jaw and lift it forward
Gently put your fingers into their mouth and check that their dentures or tongue are not blocking the back of the throat. However do not do this while they are having a seizure
Roll the person onto their side and tilt the chin upwards.
If nothing has so far worked, mouth-to-mouth resuscitation may be required. However this will not be necessary very often.
Non-convulsive seizures
During a non-convulsive seizure, the person may seem blank and will not be able to speak or answer questions normally. They may act in an odd way, for example chewing or smacking their lips, they may say odd, unexpected things or they may fiddle with their clothes.
A person having a minor seizure may even appear drunk or drugged. This may come on suddenly and last only a short time (a few minutes). During this kind of seizure, you should:
Gently protect the person from obvious dangers, such as if they are wandering near a busy road
Keep other people away from them
Talk to the person quietly
Remember they may be dazed when they come around
Very rarely, the person may become agitated. If this happens, do not obstruct the person. Instead wait nearby, observe closely and only intervene if necessary
Do not try to stop the seizure, you will not succeed
Do not send for an ambulance unless the seizure lasts a long time, i.e. more than five minutes, where that is not usual for the person or if their pattern is unknown. (Some people may have a card that states how long it takes for them to wake up)
Stay with the person until you are sure they have come to properly and can get home safely.
Be aware however, at the end of a minor seizure, it is not unusual for a person to then have a major seizure.
A seizure in water
If a seizure occurs in water, the person should be supported in the water with the head tilted so their face and head stay above the water. The person should be removed from the water as quickly as possible with the head in this position.
Once on dry land, the person should be examined and if they are not breathing, artificial respiration will need to take place immediately.
Anyone who has a seizure in the water should be taken to an A&E department for a careful medical check-up, even if they appear to be fully recovered afterwards. Heart or lung damage from ingestion of water is a possible hazard in such cases.
A seizure on an airplane
If the plane is not full, passengers beside the person having the seizure may be moved to other seats. If possible, the seat arms should be folded upwards, so that the person can be helped to lie across two or more seats. The head and body should be turned to one side.
Once consciousness has fully returned, the person can be helped into a resting position in a single reclining seat.
If there are no empty seats elsewhere in the place, the seat in which the person is sitting should be reclined. Once the rigidity phase has passed, they should be turned gently to one side in the seat.
Pillows or blankets can be arranged so that the head does not hit any unpadded areas of the plane. However care should be taken that the angle at which the person is sitting is such that their airway stays clear and breathing is unobstructed.
A seizure on a bus
Ease the person gently across a double seat. Turn the person on their side and follow the same steps as above (on an airplane).
If the person has fully recovered, there is no reason why they cannot stay on the bus until they arrive at their destination.
How will I know if the person having the seizure needs to go to an A&E department?
Even though it may look like one, an uncomplicated convulsive seizure is not a medical emergency. It stops naturally after a few minutes and the person suffers no ill effects. In fact, the average person with epilepsy is able to go about his/her business after a rest period and may only need limited assistance, or no assistance at all, in getting home.
There is no need to call an ambulance if the person:
Has ID jewellery or a card that states they have epilepsy
And the seizure does not last longer than five minutes
And if consciousness returns without further incident
And there are no signs of injury, physical distress or pregnancy
If however the person’s seizures last longer than five minutes or their seizures run into each other for more than five minutes, i.e. they do not get the chance to come around before another seizure occurs, then an ambulance should be called. If the person is having problems breathing or has injured themselves during their seizure, an ambulance should also be called.
You should also be aware that there are several medical conditions other than epilepsy that can cause seizures. These require immediate medical attention and include:
Diabetes
Poisoning
Brain infections
Hypoglycaemia
Heat exhaustion, high fever
Pregnancy
Head injury
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