A seizure is the result of a sudden, uncontrolled electrical disturbance within the brain that temporarily affects a person’s movement, behavior, or consciousness. The immediate objective of first aid during this event is to shield the individual from self-inflicted harm or environmental injury. Most seizures conclude within a few minutes, making the bystander’s role one of protection and observation until the event resolves naturally.
Protecting the Individual During the Event
The initial response to a convulsive seizure focuses on ensuring the person’s immediate environment is safe. Gently ease the person to the floor if they are standing or sitting, allowing the movements to occur without the risk of a hard fall. Move away any hard, sharp, or hot objects, such as furniture, lamps, or debris, that the person might strike during the uncontrolled muscular activity.
It is helpful to place a soft, flat item, like a folded jacket or towel, beneath the person’s head for cushioning. This simple action helps prevent trauma to the skull and neck from repeated impact against the ground. Loosen any tight clothing around the neck, such as a tie or collar, to assist with breathing once the convulsions subside. Time the seizure from the moment it begins, as this information is important for medical professionals.
Placing the Person in the Recovery Position
The most important action following the initial safety measures is turning the person onto their side, which is known as the recovery position. This position is the direct answer to protecting the airway and should be done gently either during the seizure if fluid is in the mouth, or immediately after the convulsions have stopped. Placing the person on their side uses gravity to allow saliva, mucus, or any possible vomit to drain out of the mouth, rather than being inhaled into the lungs (aspiration).
To achieve a stable recovery position, kneel beside the person and extend the arm nearest to you at a right angle, bent at the elbow with the palm up. Bring the person’s opposite hand across their chest and place the back of their hand against the cheek nearest to you, using your hand to support the head. With your other arm, reach over and bend the leg farthest from you at the knee, placing the foot flat on the floor for leverage. Gently pull the bent knee towards you to roll the person onto their side, making the bent leg the primary support. Once positioned, slightly tilt the head back by lifting the chin to ensure the airway is fully open.
Critical Actions to Avoid
Knowing what actions to avoid is just as important as knowing what to do, as certain interventions can cause harm. Never attempt to restrain the person or hold them down to stop the convulsive movements. Seizure movements are involuntary muscle contractions, and forcefully restricting them can result in fractures, sprains, or soft tissue injury.
A common misconception is the need to place an object in the person’s mouth to prevent them from swallowing their tongue. The tongue is a muscle attached at the back of the mouth, making it impossible to swallow, and attempting to force anything between the teeth can lead to broken teeth, jaw injury, or severe injury to the helper’s fingers. Do not offer the person any food, water, or medication until they are completely awake and fully alert.
Knowing When to Seek Emergency Help
Most seizures resolve on their own, and emergency medical services are not always necessary. However, certain situations indicate a potential medical emergency and require an immediate call to 911 or the local emergency number.
Professional assistance is needed if any of the following occur:
- The seizure lasts longer than five minutes.
- One seizure is immediately followed by a second without the person regaining consciousness between events.
- The person has difficulty breathing after the seizure has stopped.
- Call emergency services if the person has sustained a significant injury during the seizure, such as a head wound, or if the seizure occurs in water.
- Seeking help is also advised if the person is pregnant, has diabetes, or if this is the person’s first-ever seizure.