If someone near you is having a seizure, your main job is to keep them safe until it stops. Most seizures end on their own within one to three minutes and don’t require emergency medical care. Stay calm, protect them from injury, and time the seizure. If it lasts longer than five minutes, call 911.
Step-by-Step First Aid for a Seizure
These steps apply to the most recognizable type of seizure, where a person loses consciousness and their body stiffens or jerks (sometimes called a grand mal or tonic-clonic seizure):
- Ease them to the ground if they appear to be falling, and lower them gently.
- Turn them onto one side with their mouth pointing toward the ground. This keeps the airway clear so saliva or vomit doesn’t block breathing.
- Clear the area around them. Push away furniture, sharp objects, or anything they could hit.
- Cushion their head with something soft and flat, like a folded jacket or sweater.
- Remove eyeglasses and loosen anything tight around the neck, such as a tie or buttoned collar.
- Start timing the seizure immediately. Pull out your phone and note when it started. This single detail is critical for deciding whether to call for help.
Stay with the person the entire time. When the jerking stops, they’ll likely be confused, exhausted, or disoriented. Speak calmly, tell them what happened, and stay nearby until they’re fully alert.
What Not to Do
The most persistent myth about seizures is that a person can swallow their tongue. This is anatomically impossible. The tongue is anchored to the floor of the mouth and cannot be swallowed during a seizure or at any other time. Despite this, the idea has circulated since the 19th century and still shows up in movies and TV.
Never put anything in the person’s mouth, whether that’s a wallet, a spoon, your fingers, or anything else. Forcing an object between clenched teeth can break teeth, cut gums, injure the jaw, or cause the person to choke. It also puts your own fingers at serious risk of being bitten.
Do not hold the person down or try to stop their movements. Restraining someone mid-seizure won’t shorten it and can cause muscle tears, joint injuries, or fractures. Do not attempt CPR while the seizure is happening. Breathing may look irregular or pause briefly during a convulsive seizure, but it typically resumes once the seizure ends. Do not offer food or water until the person is fully conscious and alert.
When to Call 911
Most seizures resolve without emergency intervention. But certain situations require immediate medical help:
- The seizure lasts longer than five minutes. A convulsive seizure that continues beyond five minutes is classified as a medical emergency called status epilepticus. The previous threshold used to be 30 minutes, but medical guidelines revised this in 2012 because brain injury risk begins well before that point.
- It’s the person’s first seizure or you don’t know whether they have a seizure disorder.
- A second seizure follows without the person regaining consciousness between them.
- The person is pregnant, has diabetes, or has a known heart condition.
- The seizure happens in water (more on this below).
- The person is injured during the seizure, or they don’t start breathing normally after it ends.
If you know the person has epilepsy and a prescribed rescue medication, this is when it may be used. Nasal spray versions of seizure-stopping medications are now available and designed for caregivers to administer outside a hospital. One is approved for people 12 and older, another for those 6 and older. These are prescribed in advance by a neurologist, typically for people who experience seizure clusters, meaning multiple seizures within a short period that differ from their usual pattern. If the person has a seizure action plan, follow it.
Seizures in Water
A seizure in a pool, bathtub, lake, or any body of water is always an emergency. Drowning can happen in seconds, even in shallow water. Support the person’s head above the surface and get them out of the water as quickly as possible. Once on solid ground, check whether they’re breathing. If not, begin CPR right away and call an ambulance.
Even if the person seems fully recovered afterward, they need a medical evaluation. Inhaling even a small amount of water during a seizure can damage the lungs or heart in ways that aren’t immediately obvious.
Not All Seizures Look the Same
Some seizures don’t involve dramatic convulsions at all. A person might stare blankly for 10 to 30 seconds, smack their lips, pick at their clothing, wander aimlessly, or mumble words that don’t make sense. They may seem awake but won’t respond normally to your voice or touch. These are sometimes called focal or absence seizures.
The first aid approach is similar but gentler. Stay close, guide them away from hazards like traffic, stairs, or hot stoves, and don’t grab or restrain them. Speak calmly and wait for it to pass. Don’t assume they’re drunk, on drugs, or being uncooperative. After the episode, they may not remember it at all.
What to Write Down for the Doctor
If you witness someone’s seizure, the details you observe are extremely valuable to their medical team. Doctors rely on eyewitness accounts because the person having the seizure rarely remembers what happened. The most useful information is what you noticed at the very beginning, since early symptoms offer clues about where the seizure started in the brain.
Try to note:
- The date, time, and duration of the seizure.
- What the person was doing right before it started.
- What their body did: stiffening, jerking, head turning to one side, eye rolling, lip smacking, chewing motions, wandering, falling.
- Which body parts were involved and whether movements started on one side and spread.
- Their level of awareness: could they hear you, respond to their name, speak clearly?
- What recovery looked like: how long it took for them to become alert, whether they were confused or sleepy, whether they could speak normally.
- Any possible triggers: missed medication, poor sleep, alcohol use, emotional stress, flashing lights, illness, or a recent change in medication.
Recording a video on your phone, if you can do so without leaving the person unattended, gives the doctor something no written description can match. Even a few seconds of footage can help distinguish between seizure types and guide treatment decisions.