A seizure is a temporary, uncontrolled electrical disturbance within the brain that causes changes in behavior, movement, feelings, or awareness. The immediate instruction for anyone witnessing such an event is clear: Do not restrain someone having a seizure. Attempting to physically stop the person’s movements is not only unhelpful but can cause significant harm to the individual experiencing the seizure and the bystander trying to help.
Dangers of Physical Restraint
Restraint is dangerous because the intense, rhythmic movements, such as those seen in a tonic-clonic seizure, are involuntary muscle contractions driven by the brain’s electrical activity. Applying force against these powerful, uncontrolled contractions can result in serious musculoskeletal injuries, including bone fractures, joint dislocations, and muscle tearing.
Physical restraint does nothing to shorten the duration of the seizure, as it is a self-limiting electrical event that must run its course. Forcibly holding a person down can also prevent them from breathing naturally by constricting their chest or blocking their airway, which is a life-threatening complication.
Restraining a person also increases the risk of injury to the bystander, who may be unintentionally struck by flailing limbs. The correct action is to protect the person from their surroundings, not to attempt to control the seizure itself.
Essential Safety Measures During the Seizure
The priority during the active seizure is to protect the person from injury while allowing the episode to resolve naturally. A bystander should immediately clear the area around the person, moving away any sharp, hot, or hard objects that could cause harm. This creates a safe perimeter for the involuntary movements.
If the person is on the ground, gently place something soft and flat underneath their head, such as a folded jacket or cushion, to provide cushioning against repeated impacts. This can help prevent head and neck trauma. Gently loosen any tight clothing around the neck, such as a tie or collar, to help with breathing and circulation.
Check the time when the seizure begins, as the duration is important for medical professionals. Most seizures resolve within one to three minutes, but timing the event helps determine if emergency intervention is necessary. Never place anything in the person’s mouth, as this common misconception can cause broken teeth, jaw injury, or a blocked airway.
Monitoring and Post-Seizure Care
Once the active movements have stopped, the focus shifts to post-seizure care. Gently turn the person onto their side into the recovery position. This prevents aspiration, allowing fluids or saliva to drain and ensuring the airway remains clear.
After positioning the person, check to ensure they are breathing normally. The period immediately following a seizure is the postictal phase, marked by a temporary change in consciousness. This often includes confusion, disorientation, and sleepiness as the brain begins its recovery.
The bystander should remain with the person until they are fully alert and aware of their surroundings. Reassurance is important, as the person may feel frightened or embarrassed. Do not offer food or drink until the person is completely conscious and responsive.
Criteria for Calling Emergency Services
Most seizures are self-limiting events that do not require an ambulance, but certain criteria indicate a need for immediate professional medical intervention. Call 911 or your local emergency number if:
- The seizure lasts five minutes or longer, which is considered a medical emergency (status epilepticus).
- The person does not regain consciousness or has another seizure immediately following the first.
- The person sustained a serious injury, such as a head wound or a fracture.
- The person is pregnant or known to be diabetic.
- The seizure occurred in water, due to the risk of water inhalation.
- This is the person’s first-ever seizure.
- The person has difficulty breathing after the seizure has stopped.
Observing and reporting the exact duration and characteristics of the seizure will provide valuable information to the responding medical team.