The most important thing you can do when someone is having a seizure is stay calm, keep them safe from injury, and let the seizure run its course. Most seizures end on their own within one to three minutes and don’t require emergency medical care. Your job isn’t to stop the seizure. It’s to protect the person until it passes, then help them recover afterward.
What to Do During a Convulsive Seizure
When someone drops to the ground and their body stiffens or shakes, this is a tonic-clonic seizure, the type most people picture when they think of seizures. Here’s what to do, step by step:
- Ease them to the ground if they’re standing or sitting, and place something soft (a jacket, a folded sweater) under their head.
- Clear the area around them. Push away furniture, sharp objects, or anything they could strike during involuntary movements.
- Turn them gently onto their side. This keeps the airway clear so saliva or vomit can drain rather than pooling in the throat. Roll them as a unit rather than twisting their body.
- Loosen anything tight around the neck, like a tie, scarf, or buttoned collar.
- Time the seizure. Check a clock or start a timer on your phone the moment you notice it. This information matters if medical help is needed.
- Stay with them until the seizure ends and they’re fully awake.
Things You Should Never Do
Two instincts almost everyone has during a seizure are wrong: holding the person down and putting something in their mouth. Restraining someone during a seizure will not stop or slow it down. It’s more likely to agitate them or cause injury to both of you.
It is physically impossible to swallow your tongue. Placing a wallet, spoon, or anything else between someone’s teeth can break their teeth, injure their jaw, or hurt your fingers, because the person cannot control their muscle movements. Don’t attempt mouth-to-mouth breathing during the seizure either. Normal breathing typically resumes once the convulsions stop.
Helping with Non-Convulsive Seizures
Not all seizures involve falling and shaking. During a focal impaired awareness seizure, the person may look blank, smack their lips, fidget with their clothing, or wander around in a confused state. They may appear partially conscious but unable to respond normally to you.
Your role here is quieter but just as important. Stay nearby and gently guide them away from hazards: traffic, stairs, hot surfaces, bodies of water, or sharp equipment. Speak calmly and in simple, reassuring phrases. Some people can hear during these seizures even if they can’t respond. Don’t yell, grab them, or try to physically force them to stop moving unless they’re about to walk into immediate danger. They may react unpredictably to sudden emotional or physical stimulation.
When to Call 911
A seizure lasting longer than 5 minutes is a medical emergency. Call 911 right away. You should also call emergency services if:
- A second seizure follows closely after the first one.
- The person has trouble breathing or doesn’t wake up after the seizure ends.
- They’re injured during the seizure.
- The seizure happens in water.
- This is their first seizure ever.
- The person is pregnant.
- The person has diabetes and loses consciousness.
If you know someone has epilepsy and has seizures regularly, a single seizure that follows their usual pattern and lasts under 5 minutes often doesn’t require an ambulance. But any seizure that looks different from their typical episodes, or that comes with new or more severe symptoms, warrants emergency attention.
What to Do After the Seizure Ends
The minutes and hours following a seizure can be almost as disorienting as the seizure itself. This recovery phase, called the postictal state, commonly involves confusion, exhaustion, headache, muscle soreness, and difficulty speaking. Some people don’t remember what happened or where they are.
Once the convulsions stop, keep the person on their side and check that they’re breathing normally. Stay with them as they come to. Speak in a calm, quiet voice and tell them who you are, where they are, and what happened. Don’t crowd them or bombard them with questions. Many people feel embarrassed or frightened after a seizure, so a steady, reassuring presence helps more than you might expect.
The person may need to spend the rest of the day resting and avoiding anything mentally or physically demanding. A simple over-the-counter pain reliever can help with the headache that often follows. If postictal symptoms like confusion or weakness last longer than a day, that’s worth a visit to a healthcare provider.
Seizures in Water
A seizure in a pool, bathtub, or open water is one of the most dangerous scenarios. Support the person’s head above the surface with their face tilted upward and get them out of the water as quickly as possible. Once on dry ground, check whether they’re breathing. If they’re not, begin CPR immediately and call an ambulance.
Even if the person seems fully recovered afterward, they need a medical evaluation. Inhaling even a small amount of water can cause damage to the lungs or heart that isn’t immediately obvious.
Helping a Child with a Febrile Seizure
Young children sometimes have seizures triggered by a rapid spike in body temperature, usually during an illness. These febrile seizures are frightening to watch but are typically brief and not harmful on their own. The same core rules apply: protect the child from injury, place them on their side, don’t restrain them, and don’t put anything in their mouth.
All first-time febrile seizures need medical attention. Even if your child recovers quickly and seems fine, a healthcare provider should evaluate them to rule out underlying causes. If your child has a history of febrile seizures, their pediatrician can give you a personalized plan for managing future episodes, including when you do and don’t need to seek emergency care.
Preparing If Someone You Know Has Epilepsy
If you live with, work with, or regularly spend time with someone who has epilepsy, a little preparation goes a long way. Ask them directly what their seizures look like and what kind of help they prefer. Some people carry medical ID bracelets or cards with specific instructions. Knowing their typical seizure pattern helps you recognize when something is different and genuinely warrants a 911 call versus when you can simply keep them safe and wait it out.
Keep their environment as hazard-free as practical. Padding sharp furniture corners, avoiding locks on bathroom doors, and swimming only with a buddy who knows what to do are small changes that reduce risk significantly. Having a phone timer ready and knowing the 5-minute rule for calling emergency services puts you in a position to act quickly and confidently when it matters.