Stay with the person, keep them safe from their surroundings, and time the seizure. Those three actions are the core of seizure first aid, and most seizures end on their own within one to three minutes without any medical intervention. Your job isn’t to stop the seizure. It’s to protect the person from injury until it passes, then help them recover afterward.
What to Do During a Convulsive Seizure
A convulsive (tonic-clonic) seizure is the type most people picture: the person’s muscles stiffen, they fall, and their body jerks rhythmically. It happens because abnormal electrical activity fires across both halves of the brain simultaneously, temporarily hijacking normal muscle control. It looks alarming, but here’s exactly what to do:
- Ease them to the ground if they’re standing or sitting in a chair. Don’t try to catch them mid-fall in a way that puts you at risk of injury.
- Turn them gently onto one side with their mouth pointing toward the ground. This keeps saliva from blocking their airway and helps them breathe.
- Clear the area around them. Push away furniture, sharp objects, anything they could hit during involuntary movements.
- Place something soft and flat under their head, like a folded jacket or sweater.
- Remove their glasses and loosen anything tight around the neck, such as a tie or buttoned collar.
- Start timing the seizure immediately. Check a clock or use your phone. The duration matters for deciding whether to call emergency services.
Once you’ve done these things, stay close and wait. Most convulsive seizures last under three minutes. The person cannot hear you or respond during this time, but your presence matters for what comes after.
What You Should Never Do
Two instincts are common during seizures, and both are dangerous.
First, do not put anything in the person’s mouth. Not a wallet, not a spoon, not your fingers. The old idea that someone might swallow their tongue during a seizure is a myth. It’s physically impossible. Forcing an object between clenched jaws can break teeth, injure the jaw, or create a choking hazard by blocking the airway.
Second, do not hold the person down or try to restrain their movements. Restraining someone mid-seizure does nothing to shorten it and can sprain or break bones. It can also make the person more confused, agitated, or aggressive once the seizure ends. Let the movements happen. Your role is to protect the space around them, not to control their body.
If the Seizure Happens in Water
A seizure in a pool, bathtub, or ocean is a medical emergency regardless of how short it is. Support the person’s head above water and tilt it back to keep the airway clear. Once the jerking stops, remove them from the water. If you’re in the ocean or surf, get them out immediately, even during active convulsions, with help from others if possible. Flotation devices can help.
Once the person is on dry ground, place them on their side and check their breathing. Call emergency services even if they seem fine, because they may have inhaled water. If they are not breathing, begin CPR.
When to Call Emergency Services
Not every seizure requires an ambulance. Many people with epilepsy have seizures that resolve on their own and follow a familiar pattern. But call 911 (or your local emergency number) if any of the following apply:
- The seizure lasts longer than 5 minutes. This is the critical threshold. A prolonged seizure, called status epilepticus, can cause brain damage and requires emergency medication.
- It’s the person’s first seizure, or you don’t know whether they have a seizure disorder.
- They’ve injured themselves during the fall or convulsions.
- They have trouble breathing after the seizure stops.
- A second seizure follows immediately without the person regaining awareness in between.
- The person is pregnant.
- The seizure happened in water.
If you know the person has epilepsy, another useful guideline is whether the seizure lasts more than two minutes longer than their typical episodes. That’s a sign something different is happening.
How to Help After the Seizure Ends
When the convulsions stop, the person enters a recovery phase where the brain is working intensely to restore normal electrical activity. This period can last anywhere from a few minutes to over an hour. The person may be confused, drowsy, disoriented, or emotional. Some people don’t remember where they are or what just happened. Others feel exhausted or have a headache.
If they aren’t already on their side, roll them into what’s called the recovery position: place the arm nearest to you at a right angle with the palm up, put the back of their other hand against their cheek, then pull the far knee up and gently roll them toward you. Their bent leg in front of them keeps them stable. Tilt the chin slightly back to open the airway and check that nothing (like food) is blocking their mouth.
If the person is pregnant, roll them onto their left side specifically. This protects blood flow to the baby.
Stay with them and speak calmly. Tell them who you are, where they are, and what happened. Don’t offer food or water until they’re fully alert, since swallowing reflexes may not be reliable yet. Don’t rush them to stand up. Let them set the pace of recovery. Many people feel embarrassed after a seizure in public, so keeping the situation low-key and clearing away bystanders can help.
Helping During a Non-Convulsive Seizure
Not all seizures involve falling and jerking. Some cause a person to stare blankly, stop responding, fidget with their hands, smack their lips, or wander aimlessly. These focal seizures with impaired awareness look less dramatic but still leave the person unable to understand what’s happening around them.
The approach is simpler but just as important: stay with them, gently guide them away from hazards like traffic, stairs, or sharp objects, and speak calmly. Don’t grab or restrain them. Don’t shout or try to snap them out of it. The seizure will run its course, usually within a couple of minutes. Afterward, the same postictal confusion can follow, so stay nearby, explain what happened, and give them time to reorient.
If the person doesn’t return to full awareness, or if a non-convulsive seizure transitions into a convulsive one, follow the same emergency guidelines: get them to the ground safely and call for help if it continues beyond five minutes.