FIRST AID FOR SEIZURES
SAFETY COMMON SENSE
Handling any type of seizure involves one simple principle: to protect the person from harm until full awareness returns.
When providing seizure first aid for generalized tonic-clonic (grand mal) seizures, these are the key things to remember:
- Keep calm and reassure other people who may be nearby.
- Don’t hold the person down or try to stop his movements.
- Time the seizure with your watch. If the seizure itself (not including the recovery time) last longer than 5 minutes call for medical attention. If the person comes in and out of continuous seizures call for immediate medical attention.
- Clear the area around the person of anything hard or sharp.
- Loosen ties or anything around the neck that may make breathing difficult.
- Put something flat and soft, like a folded jacket, under the head.
- Turn him or her gently onto one side. This will help keep the airway clear.
- Do not try to force the mouth open with any hard implement or with fingers. A person having a seizure CANNOT swallow his tongue. Efforts to hold the tongue down can injure teeth or jaw.
- Don’t attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.
- Stay with the person until the seizure ends naturally.
- Be friendly and reassuring as consciousness returns.
- Offer to call a taxi, friend or relative to help the person get home if he seems confused or unable to get home by himself.
Myth: A person having a seizure can swallow his tongue.
Fact: Efforts to hold the tongue down or putting something in the mouth can hurt the tooth or jaw.
Myth: People with epilepsy are dangerous or possessed by the devil.
Fact: Epilepsy is a neurologic disorder, and it is rare that someone having a seizure will harm another person.
Myth: You should hold a person down while he’s having a seizure.
Fact: You should make sure the area near the person is safe and that there is nothing hard or sharp.
Myth: You should perform artificial respiration.
Fact: Artificial respiration is only needed if the person does not start breathing after the seizure has stopped.
Is it necessary to call 911?
An un-complicated generalized tonic-clonic (grand mal) seizure in someone who has epilepsy is not a medical emergency, even though it looks like one. It stops naturally after a few minutes without ill effects. The average person is able to continue his business after a rest period and may need only limited assistance, or no assistance at all, in getting home. In other circumstances, an ambulance should be called.
When these conditions exist, immediate medical attention is necessary
- Diabetes
- Brain infections
- Heat exhaustion
- Pregnancy
- Poisoning
- Hypoglycemia (low blood sugar levels)
- High fever
- Head injury
- The seizure has happened in water.
- There’s no medical I.D. and no way of knowing whether the seizure is caused by epilepsy.
- The person is pregnant, injured, or diabetic.
- The seizure continues for more than five minutes.
- A second seizure starts shortly after the first has ended.
- Consciousness does not start to return after the shaking has stopped
FAQs for First Aid and Seizures
First Aid for Seizures - Convulsive and Non-Convulsive
First Aid For Convulsive Seizures
In a generalized tonic-clonic seizure the whole brain is affecting from the beginning. In (a, at right) there is a cry and loss of consciousness, arms flex up then extend in (b) and remain rigid (the tonic phase) for a few seconds. A series of jerking movements take place (the clonic phase) as muscles contract and relax together. In (c) the jerking is slowing down and will eventually stop. In (d) the man has been placed on his side to aid breathing and to keep the airway clear.
During a generalized tonic-clonic seizure, the person suddenly falls to the ground and has a convulsive seizure. It is essential to protect him or her from injury. Cradle the head or place something soft under it, a towel or your hand, for example. Remove all dangerous objects. A bystander can do nothing to prevent or terminate an attack. At the end of the seizure, make sure the mouth is cleared of food and saliva by turning the person on his or her side to provide an open airway and allow fluids to drain. If the person assisting remains calm, the person having the seizure will be reassured when he or she regains consciousness.
Breathing almost always resumes spontaneously after a convulsive seizure. Failure to resume breathing signals a complication of the seizure such as a blocked airway, heart attack or severe head or neck injury. In these unusual circumstances, CPR must start immediately. If repeated seizures occur, or if a single seizure lasts longer than five minutes, the person should be taken to a medical facility immediately. Prolonged or repeated seizures may suggest status epilepticus (nonstop seizures), which requires emergency medical treatment
First Aid For Non-Convulsive Seizures
You don’t have to do anything if a person has brief periods of staring or shaking of the limbs. If someone has the kind of seizure that produces a dazed state and automatic behavior, the best thing to do is:
- Watch the person carefully and explain to others what is happening. Often people who don’t recognize this kind of behavior as a seizure think that the dazed person is drunk or on drugs.
- Speak quietly and calmly in a friendly way.
- Guide the person gently away from any danger, such as a steep flight of steps, a busy highway, or a hot stove.
- Stay with the person until full consciousness returns, and offer help in returning home.
NOTE:
Don’t grab hold, however, unless some immediate danger threatens. People having this kind of seizure are on “automatic pilot” so far as their movements are concerned. Instinct may make them struggle or lash out at the person who is trying to hold them.
First Aid for Seizures - Special Locations and Circumstances
A Seizure in Water
If a seizure occurs in water, the person should be supported in the water with the head tilted so his face and head stay above the surface. He or she should be removed from the water as quickly as possible with the head in this position. Once on dry land, he should be examined and, if he is not breathing, artificial respiration should be begun at once. Anyone who has a seizure in water should be taken to an emergency room for a careful medical checkup, even if he or she appears to be fully recovered afterward. Heart or lung damage from ingestion of water is a possible hazard in such cases.
A Seizure in an Airplane
If the plane is not filled, and if the seat arms can be folded up, passengers to the left and/or right of the affected person may be reassigned to other seats, so that the person having the seizure can be helped to lie across two or more seats with head and body turned on 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, the seat in which the person is sitting can be reclined, and, once the rigidity phase has passed, he can be turned gently while in the seat so that he is leaning towards one side.
Pillows or blankets can be arranged so that the head doesn’t hit unpadded areas of the plane. However, care should be taken that the angle at which the person is sitting is such that his airway stays clear and breathing is unobstructed.
A Seizure on a Bus
Head Injury During a Seizure
If the person hits his or her head while falling, his or her post-seizure condition should be carefully monitored. Although sleepiness and confusion are natural consequences of a seizure, it should always be possible to rouse the person without difficulty. A person who fails to return to consciousness after a seizure needs further medical assessment. If head injury is a possibility, the person should be closely observed for the following signs:
- Difficulty in maintaining consciousness (an observer should try to waken the person at 20-minute intervals)
- Vomiting
- Vision problems
- Excessive sleepiness two hours or more after the seizure (unless, of course, the seizure has occurred late in the day and the person’s usual bedtime is approaching)
If any of these signs are observed, or if the patient has a persistent headache after a rest period, unconsciousness with failure to respond, unequal pupil size or excessively dilated pupils, or weakness of the limbs, immediate medical attention is essential.
First Aid for Seizures - Managing Prolonged Seizures
Managing Prolonged Seizures in Children
Special Circumstances
Managing Prolonged or Cluster Seizures
Prolonged or clustered seizures sometimes develop into non-stop seizures, a condition called status epilepticus.
Status Epilepticus
Status epilepticus is a medical emergency. It requires hospital treatment to bring the seizures under control. If your child has had episodes of non-stop seizures that had to be treated in the emergency room, you will want to have a plan of action ready in case they occur again.
Managing Status Epilepticus
Ask the doctor if there are any new treatments you can use at home or school to stop a seizure from developing into status.Call an ambulance. Do not attempt to transport an actively seizuring child in your car unless an ambulance is not available.Be aware of where the nearest hospital is, how long it takes to get there. If you live a long way from the hospital, you may plan to call earlier than you would if it were closer. If there are several hospitals nearby, ask your doctor in advance which one to call.Consider arranging for standing orders prepared by the doctor to be kept in the emergency room so the seizure can be managed as your doctor directs. Ask for a copy for yourself if you and your child travel out of town.
Leave detailed written instructions with babysitters or adult caregivers. If you have been instructed in the use of in-home therapy, make sure that a responsible caregiver also receives instruction.
Fortunately, most seizures, even those that are prolonged, end without injury. The important thing is to work with your doctor so that you have a plan to follow when they occur.
Managing Partial Seizures
A child who has partial seizures that affect his emotions or sense of the world around him may be intensely frightened by the episodes. One little girl who had partial seizures in the area of the brain that controls vision (the occipital lobe) would “see” blobs of color that looked like monsters, a terrifying experience. Children with this type of epilepsy need lots of reassurance — and an adult who keeps track of how often the seizures occur. If they become prolonged and frequent, emergency treatment may be necessary.
Managing complex partial seizures requires gentle monitoring during the seizure, keeping hazards out of the way, reassuring the child in a calm voice, and keeping track of how long the seizure lasts.
Prolonged confusion and clusters of complex partial seizures may also require at home therapy as prescribed, or emergency treatment.
First Aid for Seizures - Childcare
For the “Babysitter” – What Child Care Providers Should Know
While you may never have to manage a seizure in a child with epilepsy, knowing what to do can make a big difference if a seizure does occur. In most cases, all you need to do is a few very simple things to keep the child safe until the seizure ends on its own. Sometimes, you don’t have to do much of anything at all. Little staring spells last only a few seconds and then the child goes back to what he was doing before. He or she may not even know a seizure happened.
If a child jerks or falls suddenly because of a seizure, all you have to do is help him up, see if he hurt himself, and comfort him if he’s upset.
If a child seems dazed and confused and wanders around looking half asleep, stay with her and talk to her quietly and calmly. Guide her gently away from anything that could hurt her (like stairs, a stove, or a hot radiator). Comfort her as she slowly comes out of it.
If a child suddenly cries out, falls, stiffens and shakes, you still don’t have to do much. A few simple steps will keep him or her safe for the minute or two the seizure usually lasts.
- First, clear everything out of the way.
- Don’t hold the child down or try to stop the jerking.
- Put something flat and soft under the child’s head.
- Make sure there’s nothing tight around his neck that could interfere with breathing.
- Check your watch so you’ll know how long the seizure lasts.
- Turn the child gently onto one side so he or she doesn’t choke.
- Don’t try to open his mouth.
- Don’t try to put anything in his mouth.
- Don’t try to give him or her anything to drink during the seizure.
- Comfort the child as she starts to wake up afterward. Help her get cleaned up if she wet or soiled herself during the seizure.
Some children are exhausted after a seizure like this and need to sleep. Some are confused or cranky for a while. Others can go back quite quickly to what they were doing before. The parents will tell you what to expect.
When the Babysitter Should call 911
Should you call the rescue squad if a child has a seizure in which he falls and shakes?
Yes, if the parents have asked you to call.
No, if the seizure ends without any problems and the child is back to normal afterward.
The average seizure in a child who has epilepsy is not a medical emergency. It ends naturally by itself. But every rule has an exception or two, and that’s true of epilepsy as well.
There are a few times, fortunately quite rare when you should call for emergency medical assistance.
- When a seizure doesn’t show any signs of stopping after five minutes.
- When the seizure happened in water and there’s any chance that the child inhaled or swallowed a lot of water.
- When a child doesn’t come round or isn’t breathing properly afterward.
- When a child vomits during the seizure and then doesn’t come round or isn’t breathing properly afterward.
- When another seizure starts soon after the first one.
- When an unexpected seizure happens in a child who does not have epilepsy.
If a child has prolonged seizures (longer than 5 minutes) or has clusters of seizures, the doctor may have prescribed some special medicine that can be given. However, that is something that the parents will discuss with you, and you will need training in how to apply it.
First Aid for Seizures - Seniors with Seizures
Handling Convulsions in an Older Person
- Ease the person having the seizure into a reclining position on the floor or flat surface.
- Put something soft and flat under the head.
- Turn him or her gently on to one side to prevent choking and keep the airway clear.
- If the person having the seizure is seated, turn gently to one side so any fluids drain away from the mouth.
- Don’t try to force anything into the mouth. Seizures do not cause people to swallow their tongues.
- Don’t try to give fluids or medicine until the seizure is completely over and the person is fully alert again.
- Don’t try to restrain the jerking movements. Muscles contract with force during seizures. Applying restraint could cause tears in the muscle or even break a bone, especially in elderly people whose bones may be fragile.
Responding to Confusion in an Older Person
Confusion may occur during a complex partial seizure or during the recovery period after other types of seizures. In either case, the same basic rules apply:
- Remove anything from the area that might cause injury or could be a hazard to someone who is temporarily unaware of where he is or what he’s doing.
- Don’t try to restrain an older person who is wandering and confused during a complex partial seizure. If danger threatens, guide gently away.
- People may be quite agitated during these episodes. Trying to restrain them, or grabbing hold, is likely to make the agitation worse and may trigger an aggressive response.
- Be reassuring, comforting and calm as awareness returns. If confusion persists, get a medical evaluation.
Warning Signs
Most seizures, even in elderly people with other health problems, end naturally without any special treatment. Although emergency medical assistance should be obtained when someone has a first seizure, subsequent seizures usually do not require special treatment.
However, it is always possible for more serious problems to develop. Here are a few ways to spot them:
- Watch the time. If the convulsive shaking and jerking of a tonic-clonic seizure lasts longer than five minutes or starts up again shortly afterward, call an ambulance or follow specific instructions from the doctor on in-home care. Non-stop seizures, which doctors call status epilepticus, are quite dangerous for elderly people. Prompt medical care is needed.
- Check for secondary injuries. Seniors who have seizures may break bones, so special care should be taken to find out if there’s any unusual pain following a seizure. Headaches are quite common, but a severe headache after a seizure in someone who doesn’t usually have them should be checked out.
- Call for help if breathing is labored following the seizure, if there is chest pain or unusual pain of any kind, or if consciousness does not return after a few minutes.
- Be aware that periods of confusion lasting more than one hour associated with seizures may signal that something is seriously wrong.
If an older person with a seizure disorder who does not have a mental impairment seems to slip in and out of a confused or agitated state with few intervals of normal awareness, you may be seeing another kind of continuous seizure activity. This, too, should be evaluated at a hospital.
Special Circumstances
If you are living with an older person with seizures who has other medical problems, check with the doctor about how he or she wants you to respond when a seizure happens.
Find out whether the doctor wants to be notified every time or just in certain circumstances.
Ask whether or when you should call an ambulance; and if there are any special warning signals that you should be on the lookout for.
