When someone near you has a seizure, the most important things you can do are keep them safe from injury, turn them on their side, and stay with them until it’s over. 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 protect the person while their brain resets.
What to Do During the Seizure
If someone collapses and their body stiffens or begins jerking, start by noting the time. Knowing how long the seizure lasts is one of the most useful pieces of information you can provide later. Then focus on making the area safe: ease them to the ground if they’re standing, move furniture or sharp objects away, and place something soft (a jacket, a bag) under their head.
Gently roll the person onto their side. This is called the recovery position, and it keeps their airway clear by letting saliva or vomit drain from the mouth instead of blocking their throat. Loosen anything tight around their neck, like a tie or buttoned collar. Stay calm, stay close, and let the seizure run its course.
What Not to Do
Two instincts people commonly have are both dangerous. Do not hold the person down or try to restrain their movements. Their muscles are contracting involuntarily, and fighting against that can cause injuries to both of you, including dislocated joints or torn muscles. Do not put anything in their mouth. People cannot swallow their tongue during a seizure. Placing a wallet, spoon, or fingers between their teeth risks breaking teeth, cutting gums, or getting your fingers bitten.
Don’t try to give them water or food, and don’t attempt CPR while the seizure is happening. Their breathing may sound irregular or pause briefly, but it typically resumes once the seizure ends.
When to Call 911
Most seizures don’t need an ambulance, but several situations do. Call 911 if:
- The seizure lasts longer than 5 minutes. A seizure that continues past this point is a medical emergency called status epilepticus. The brain can be damaged if it isn’t stopped with medication.
- A second seizure follows quickly without the person fully waking up in between.
- They have trouble breathing or don’t wake up after the jerking stops.
- They were injured during the seizure, such as a head strike on the ground.
- The seizure happened in water (pool, bathtub, lake).
- It’s their first seizure ever, or you don’t know whether they have a seizure disorder.
- The person is pregnant or has diabetes and has lost consciousness.
If you’re unsure whether to call, call. Dispatchers can help you assess the situation over the phone.
Seizures in Water
A seizure in a pool, bathtub, or open water is always life-threatening because of the drowning risk. If you can do so safely, support the person’s head above the water line and move them toward shallow water or the pool’s edge. Call for a lifeguard or anyone nearby to help. Once they’re out of the water, place them in the recovery position, cushion their head, and keep them warm. Do not restrain them or put anything in their mouth.
Not All Seizures Look the Same
The dramatic, full-body convulsions most people picture are called tonic-clonic seizures, but seizures can also be subtle. Some cause a person to stare blankly and stop responding for 10 to 30 seconds. Others cause repetitive movements like lip smacking, fumbling with clothing, or wandering aimlessly while appearing confused. These are focal seizures, and the person may have no idea what’s happening.
For these less obvious seizures, the response is simpler: stay with the person, gently guide them away from hazards (traffic, stairs, hot stoves), speak calmly, and don’t grab or shout at them. They may not understand you or be able to respond. Once the episode passes, they’ll likely be confused and need a moment to reorient.
What Happens After the Seizure Ends
The minutes and sometimes hours following a seizure are called the postictal phase, and they can be disorienting. The person may feel exhausted, confused, emotional, or have a headache. Some people don’t remember the seizure at all and may be frightened to find themselves on the ground surrounded by strangers.
Speak in a calm, reassuring voice. Tell them who you are, where they are, and what happened. Don’t overwhelm them with questions right away. Help them sit up when they’re ready, and stay until they’re fully alert. Many people need to rest for the remainder of the day after a seizure and should avoid driving or strenuous activity.
If They Have a Seizure Action Plan
People with diagnosed epilepsy sometimes carry a medical ID bracelet or a seizure action plan, a document from their doctor outlining exactly what to do. Some have prescribed rescue medications, typically a nasal spray or a gel placed between the cheek and gum, that a trained caregiver can give if a seizure lasts beyond a certain time. If you’re a caregiver, family member, or close friend of someone with epilepsy, ask them in advance whether they carry rescue medication and how to use it. Their neurologist will set a specific time threshold (often around the 3- to 5-minute mark) at which the medication should be given.
Some people also have an implanted nerve stimulator in the chest. A special magnet, often worn on the wrist, can be slowly swiped over the device at the start of a seizure and repeated once a minute for a total of three swipes. If the person has one of these, their family or regular caregivers will typically know.
What to Write Down for Their Doctor
If you witness a seizure, the details you record can be more useful than you’d expect. Doctors rely heavily on eyewitness accounts because the person experiencing the seizure usually remembers nothing. Try to note:
- What time it started and stopped (even an estimate helps)
- What the movements looked like: stiffening, jerking, one side more than the other
- What the person was doing right before (talking, sleeping, exercising)
- Eye position: rolled up, turned to one side, staring
- Whether they responded to their name or to touch
- How they acted afterward: confused, sleepy, able to speak
If you can safely do so without stepping away from the person, recording a short video on your phone is one of the most valuable things you can give their medical team. It allows a neurologist to see the seizure type directly rather than relying on a verbal description.