A seizure is a sudden, uncontrolled electrical disturbance in the brain that temporarily affects a person’s movement, behavior, or level of consciousness. During a tonic-clonic seizure, the body stiffens and jerks due to involuntary muscle contractions. You should never restrain a person’s arms or body during a seizure. Restricting movement will not stop the brain’s electrical activity and introduces a significant risk of physical harm.
The Dangers of Physical Restraint
Attempting to hold down or restrict the movements of a person experiencing a seizure is counterproductive and dangerous. A seizure causes muscles to contract with involuntary force, and trying to overpower this action can lead to serious orthopedic injuries. The resistance against muscle spasms can cause bone fractures, dislocated joints, and severe muscle tears in the seizing person.
Physical restraint does nothing to shorten the duration of the seizure, which is a self-limiting event dictated by the brain’s electrical activity. If the person is partially conscious or becomes aware during the restraint, the experience can be confusing, frightening, and lead to emotional distress. The helper also risks being injured by the person’s forceful, uncontrolled movements.
Essential Safety Steps During a Seizure
Since restraint is unsafe, the primary goal of seizure first aid is to protect the person from injury while the episode runs its course. Immediately begin timing the seizure, as the duration is important medical information. If the person is standing or sitting, gently ease them to the floor to prevent a fall or other trauma.
Clear the area surrounding the person of any harmful objects, such as furniture or sharp items. Move these items out of the way so the person does not strike them during the clonic (jerking) phase. Protecting the head is a priority, so place something soft and flat underneath it, such as a folded jacket, cushion, or your hands.
Gently loosen any tight clothing around the neck, such as a collar or tie, to help ensure clear breathing. Never attempt to place anything in the mouth—including a finger, spoon, or bite stick—as this is extremely dangerous. Inserting an object can injure the person’s jaw, break their teeth, or cause a life-threatening airway obstruction.
Post-Seizure Care and Recovery Positioning
Once the convulsing movements have stopped, the person enters the post-ictal phase. During this recovery period, the person may be confused, drowsy, or unaware of their surroundings. After the shaking subsides, the person should be gently rolled onto their side, known as the recovery position.
This positioning ensures that saliva, mucus, or vomit can drain easily from the mouth, preventing airway blockage. The head and mouth should be angled toward the ground to utilize gravity for drainage. Check to confirm that the person is breathing normally; they usually start breathing on their own again after a seizure.
Stay with the person until they are fully alert and oriented. Speak calmly and reassuringly, explaining what happened once they are able to communicate. It is common for the person to feel exhausted or want to sleep following a seizure, and you should allow them to rest.
When Emergency Medical Services Are Necessary
While most seizures are temporary and resolve without professional medical intervention, certain signs indicate that emergency medical services (EMS) should be called immediately. A seizure that lasts five minutes or longer is known as status epilepticus and requires urgent treatment. Call for help if the person has a second seizure soon after the first, without regaining consciousness in between.
Call EMS if the person has difficulty breathing after the seizure has stopped or if they do not regain consciousness within a few minutes. Also call EMS if the person was injured during the seizure, such as from a fall, or if the seizure occurs in water. If the person is pregnant or has a pre-existing health condition like diabetes or heart disease, emergency medical attention is necessary regardless of the seizure’s duration.