When a seizure ends, the rescuer’s role shifts from physical protection to ensuring safety and recovery during the postictal state. This period is marked by altered consciousness, often including confusion, disorientation, and exhaustion, as the brain recovers from the intense electrical activity. The actions taken focus on maintaining a clear airway and providing supportive care until the person regains baseline awareness.
Immediate Post-Seizure Positioning
The most pressing concern once a seizure has stopped is ensuring a patent airway and preventing aspiration. Saliva or stomach contents can pool in the mouth, and the relaxed tongue may obstruct the throat. The immediate action is to gently roll the person onto their side into the recovery position.
This lateral position uses gravity to drain fluids away from the airway and out of the mouth. It also prevents the tongue from blocking the upper airway. While rolling them, support the head and neck to prevent undue strain.
Quickly survey the surroundings for hazards before or immediately after positioning. Remove any sharp objects from the area, and loosen any tight clothing around the neck that could impede breathing. Keep the person in this safe, quiet position while assessment steps are taken.
Assessing Breathing and Responsiveness
Once the person is safely positioned, assess their physical state. The first priority is confirming they are breathing adequately, as respiratory dysfunction is a potential complication after a seizure. Respiration should quickly return to a more normal pattern.
Check for the rise and fall of the chest, listen for air movement, and feel for breath. If the person is breathing, monitor the rate and depth to ensure effectiveness. Next, assess their level of consciousness, noting if they respond to voice or touch.
Confusion and sluggishness are expected, as the postictal state can last minutes to hours. While they are still unresponsive or confused, perform a rapid, non-invasive check for obvious injuries sustained during the seizure. Focus on visible trauma, such as cuts or broken teeth, that may require immediate medical attention.
Providing Comfort and Reorientation
After physical safety checks, address the person’s psychological state. As they emerge from postictal confusion, they may be disoriented, scared, or embarrassed, and may not remember the event. Speak in a calm, quiet, and reassuring voice to help ground them.
Explain simply what happened, such as, “You had a seizure, and it has stopped now.” Allow them time to recover without rushing them to move, as they may feel fatigue or have a headache. Offer a blanket if they are cold, and maintain a quiet environment to reduce sensory overload.
Do not offer anything to eat or drink until the person is fully alert and can swallow safely, preventing a choking risk. Stay with them until their confusion has fully passed and they are aware of their surroundings and can communicate clearly.
Criteria for Emergency Medical Services
While most seizures end without the need for emergency services, specific situations require an immediate call to 911 or a local emergency number. The most time-sensitive criterion is a seizure that lasts five minutes or longer, or if a second seizure begins immediately after the first without the person fully regaining consciousness. These situations indicate a serious medical emergency.
Other serious signs necessitate an emergency call:
When to Call 911
- The person has trouble breathing or waking up after the seizure stops.
- The seizure occurred in water.
- The person is pregnant or has known diabetes and is unconscious.
- A significant injury, such as head trauma, was sustained.
- This is the person’s first-ever seizure.
- Persistent confusion or unconsciousness lasts five to ten minutes or more after the seizure ends.
Gathering details about the seizure duration and the person’s actions before and after provides valuable information for the arriving medical team.