The most important thing you can do for someone having a seizure is stay with them, protect them from injury, and time how long it lasts. Most seizures end on their own within one to three minutes and don’t require emergency medical care. Your job isn’t to stop the seizure. It’s to keep the person safe until it passes.
Immediate Steps During a Seizure
Stay calm and stay close. If the person looks like they’re about to fall, gently ease them to the ground. Clear the area around them of anything hard or sharp that could cause injury. Place something soft and flat under their head, like a folded jacket or sweater. Remove their eyeglasses and loosen any ties, scarves, or tight collars that could restrict breathing.
Turn them gently onto one side with their mouth pointing toward the ground. This keeps the airway clear so saliva or vomit can drain instead of pooling in the throat. Start timing the seizure as soon as you can. If it lasts longer than 5 minutes, call 911 immediately.
Check whether they’re wearing a medical alert bracelet or necklace. It may list a seizure condition, medications, or emergency contacts that will help paramedics if they arrive.
What Not to Do
Don’t put anything in the person’s mouth. This is one of the most persistent myths in seizure first aid. It is anatomically impossible to swallow your tongue during a seizure. Placing a wallet, spoon, or finger between someone’s teeth can break their jaw, crack teeth, or injure you. Don’t hold the person down or try to restrain their movements either. Restraining someone mid-seizure can cause muscle tears, dislocated joints, or fractures for both of you.
Don’t attempt mouth-to-mouth breathing while the seizure is happening. People almost always start breathing again on their own once it stops. And don’t offer food or water until the person is fully awake and alert, because they could choke.
When to Call 911
Not every seizure requires an ambulance, but certain situations do. Call 911 if:
- The seizure lasts longer than 5 minutes
- The person doesn’t regain consciousness after it ends
- A second seizure follows shortly after the first
- The person is pregnant, has diabetes, or has a known heart condition
- The seizure happens in water
- The person has never had a seizure before
- They are injured during the seizure
- They have trouble breathing after the seizure stops
A seizure lasting 5 minutes or longer is considered a medical emergency because prolonged seizure activity can cause brain damage. When continuous or rapidly repeating seizures stretch to 30 minutes, the condition is called status epilepticus. It carries a high mortality rate and requires immediate hospital treatment.
What Happens After the Seizure Ends
When the shaking stops, the person enters a recovery phase that can last anywhere from a few minutes to an hour or more. During this time they may be confused, drowsy, or disoriented. Some people feel embarrassed or frightened. Others can’t remember what happened.
Keep them on their side in the recovery position: the arm closest to the ground extended at a right angle with palm up, the opposite hand resting against their cheek, and the top leg bent at the knee to keep them stable. Gently tilt the head back slightly to open the airway. Stay with them, speak calmly, and tell them what happened when they’re ready to hear it. Help them sit up in a safe place once they’re alert.
If you suspect a spinal injury (from a hard fall, for example), don’t move the person. Keep their head and neck still and wait for emergency services.
Rescue Medications for Known Seizure Conditions
Some people with epilepsy or other seizure disorders carry prescribed rescue medications designed to stop a prolonged seizure before it becomes an emergency. These are typically fast-acting sedatives available as a nasal spray or a gel applied rectally. If you’re a caregiver, family member, or close friend of someone with a seizure condition, ask them (or their doctor) whether they have a rescue medication, where it’s kept, and how to administer it. These medications are specifically meant for seizures lasting longer than a set number of minutes, which varies by prescription.
What Happens at the Hospital
After a first-time seizure, a medical team will run several tests to figure out what triggered it and whether it’s likely to happen again. A neurological exam checks behavior, coordination, and reflexes. Blood tests look at blood sugar levels, signs of infection, and electrolyte balance (the salts in your body that regulate fluids and nerve signaling). An EEG records electrical activity in the brain through small sensors placed on the scalp; certain patterns can indicate whether future seizures are likely.
In some cases, imaging like an MRI gives a detailed look at the brain’s structure to rule out tumors, bleeding, or other abnormalities. If an infection like meningitis is suspected, a spinal tap may be done to test the fluid surrounding the brain and spinal cord. Not everyone needs every test. What gets ordered depends on the circumstances of the seizure and the person’s medical history.
Seizures That Look Different Than You’d Expect
When most people picture a seizure, they imagine someone falling to the ground and convulsing. That’s a generalized tonic-clonic seizure (sometimes still called a grand mal), and it’s what the first aid steps above are mainly designed for. But many seizures look nothing like that. Some cause a person to stare blankly for 10 to 30 seconds, unresponsive to voices or touch. Others produce repetitive movements like lip-smacking, hand rubbing, or picking at clothing. A person might seem confused, wander aimlessly, or say things that don’t make sense.
The first aid basics still apply for these less dramatic seizures: stay with the person, guide them away from danger (traffic, stairs, sharp objects), don’t restrain them, and time the episode. Speak gently and wait for it to pass. They may not realize anything happened once it’s over, so calmly explain what you saw.