A seizure occurring while a person is in the water presents an immediate, life-threatening emergency due to the high risk of drowning and pulmonary aspiration. In an aquatic environment, the loss of consciousness and muscle control leaves the individual unable to protect their airway. The inhalation of even a small volume of water can trigger severe respiratory complications, making rapid, calm, and informed action necessary to preserve life. The immediate priority is to prevent water from entering the lungs while preparing for the safest possible removal from the water.
Immediate Response and Preventing Drowning
The first step in any rescue scenario is to ensure rescuer safety; only a strong, capable swimmer should enter the water to assist, especially in conditions like strong currents or rough seas. Once you reach the person, your sole objective while the seizure activity is still occurring is to maintain an open airway by keeping their head and face above the water surface. This act prevents the aspiration of water into the lungs, which is the most dangerous consequence of a seizure in this setting.
You should gently support the person’s head with a tilt to ensure the face is completely clear of the water. Do not attempt to restrain the person or stop the seizure movements, as this can cause injury to both the person seizing and the rescuer. The involuntary muscle contractions, known as convulsions, are temporary and will run their course naturally. Your focus must remain on the stabilization of the airway until the convulsing ceases.
If the person is in a contained area like a pool, gently guide them away from the edges to prevent injury from striking against the hard surface during the seizure. Immediately call out to others nearby to alert a lifeguard or to have someone call local emergency services, such as 911. Having another person aware of the situation allows for coordinated effort and ensures professional help is on the way while you maintain the stabilization of the airway.
Safe Extraction from the Water
Once the active, jerking movements of the seizure have stopped, the individual should be removed from the water as quickly and smoothly as possible. If the seizure is happening in open water, immediate removal is recommended, even if the seizure activity has not completely ceased, due to the difficulty of maintaining safe airway stabilization in an uncontained environment. Flotation devices, if readily available, can assist with the support and removal of an unresponsive person.
The physical act of moving the person requires careful, controlled movements to avoid causing further injury, particularly to the head or neck. For a larger person, it may be most practical to guide them gently toward the shallowest end of the pool or the nearest stable edge. If a backboard or other specialized rescue equipment is available, trained personnel should utilize it to ensure spinal alignment during the extraction process.
The person should be placed on a pool deck, dock, or other stable ground immediately upon removal. This surface must be clear of objects that could impede the next steps of assessment and care. The smooth, controlled removal minimizes the risk of secondary injuries that can occur when moving a limp, post-seizure individual.
Post-Seizure Care and Emergency Services
As soon as the person is on dry land, assess their breathing and circulation. If the person is unresponsive but breathing, they must be immediately rolled into the recovery position, on their side with the head slightly tilted back.
The recovery position is an important measure because it allows any inhaled water, vomit, or saliva to drain freely from the mouth, preventing further aspiration after removal. You should then cover the person with a blanket or dry towels, especially if they have been in cold water, to help combat hypothermia.
Calling emergency medical services (EMS) is mandatory for any seizure that occurs in water. Even if the person appears to recover quickly and is breathing normally, there is a substantial risk that they have inhaled water, which can lead to secondary drowning or pulmonary edema hours later. Professional medical evaluation is necessary to check for signs of water inhalation, lung damage, or heart issues.
If the person is not breathing and has no pulse upon removal from the water, you must immediately begin Cardiopulmonary Resuscitation (CPR). The protocol emphasizes rescue breaths combined with chest compressions. Continue CPR until professional help arrives, or until the person shows definitive signs of life, such as breathing. While waiting for EMS, continue to monitor the person’s level of consciousness, breathing rate, and skin color, providing any information about the seizure’s duration and the person’s condition to the arriving paramedics.