A generalized tonic-clonic seizure, often associated with full-body convulsions and loss of consciousness, is a sudden, uncontrolled event of excessive electrical activity in the brain. The physical movements are involuntary muscle contractions that cannot be stopped by external force. This article provides guidance on seizure first aid, addressing the dangerous misconception that physical restraint is helpful. The correct response focuses on protection and allowing the seizure to run its course naturally.
The Danger of Restraining Limbs
Attempting to restrain the arms, legs, or body of a person experiencing a tonic-clonic seizure is highly dangerous and ineffective. The convulsive movements result from powerful, uninhibited muscle contractions driven by a neurological event. Trying to physically fight this force will not shorten the seizure, which must complete its cycle in the brain.
This external resistance dramatically increases the risk of severe musculoskeletal injuries. Applying pressure can lead to bone fractures, joint dislocations, or serious muscle and ligament tears due to the forceful contractions. Focusing on restraint also distracts the helper from performing protective measures, which are the only safe interventions during the active seizure phase. The goal is to keep the person safe from their surroundings, not to stop the seizure itself.
Essential Steps for Seizure Safety
The correct first aid response centers on protecting the person from environmental hazards while the seizure is occurring. If the person is standing, gently ease them to the ground to prevent a fall. Quickly assess the immediate area for any hard or sharp objects, and move dangerous items away from the person’s head and limbs to create a safety zone.
Placing something soft and flat, such as a folded jacket or small pillow, underneath the person’s head provides a cushion against the hard ground. This helps prevent head injury from the repeated impact of the convulsions. Loosen any tight clothing around the neck, such as a collar or tie, to ensure the person’s breathing is not restricted.
It is helpful to time the seizure from the moment it starts until the movements stop, as this information is important for medical professionals. Once the violent jerking movements have subsided, gently turn the person onto their side. This position, often called the recovery position, helps fluids drain from the mouth, keeping the airway clear and reducing the risk of aspiration.
Post-Seizure Care and Emergency Criteria
The period immediately following the active convulsions is known as the postictal phase, when the brain begins to recover. During this time, the person will likely be confused, disoriented, and drowsy. Staying with the person until they are fully alert and oriented is a necessary part of safe first aid.
Do not offer food, water, or medication by mouth until the person is completely conscious and can swallow safely, as there is a risk of choking. Once they begin to wake up, speak calmly and reassure them, explaining simply what has happened. Allow the person to rest or sleep, as fatigue is a common symptom of the postictal state.
While most seizures end safely on their own, specific criteria mandate an immediate call to 911. Emergency services must be contacted if:
- The seizure lasts continuously for five minutes or longer.
- A second seizure begins immediately after the first one ends.
- The person was injured during the seizure, is pregnant, or has diabetes.
- The seizure occurs in water.
- The person has never had a seizure before.