A seizure is a sudden, uncontrolled electrical disturbance in the brain that temporarily alters a person’s consciousness, behavior, or movements. While most seizures resolve on their own without lasting harm, certain circumstances require immediate professional intervention. The rescuer’s priority is to protect the person from injury during the episode. They must also time the duration of the event to determine the need for a 911 call.
Immediate First Aid During the Seizure
The initial moments of a seizure focus entirely on physical safety. As soon as the seizure begins, the rescuer should start timing the event, as the duration is the most significant factor in determining the need for emergency services.
The most pressing first aid action is to clear the immediate area of any hard, sharp, or hot objects that could cause injury during the involuntary movements of a convulsive seizure. Gently easing the person to the floor if they are standing or sitting can prevent a dangerous fall. Once the person is on the ground, the rescuer must place something soft and flat, like a folded jacket or cushion, under their head to protect it from repeated impact.
It is necessary to avoid two common but harmful actions: attempting to restrict the person’s movements and placing anything inside their mouth. Restraining the body can result in broken bones or other musculoskeletal injuries, as the muscle contractions are extremely powerful. Similarly, placing an object in the mouth can lead to chipped teeth, jaw injury, or obstructed breathing.
After the convulsive movements stop, or if the person is drooling or vomiting, the rescuer should carefully roll them onto their side into the recovery position. This action helps to keep the airway clear, allowing saliva or other fluids to drain away and reducing the risk of aspiration. Loosening any tight clothing around the neck, such as a tie or collar, further aids in ensuring unobstructed breathing.
Specific Criteria for Calling Emergency Services
The decision to call 911 is based on specific, high-risk conditions that indicate a potential for severe or lasting harm. The most definitive trigger for an emergency call is a seizure that lasts five minutes or longer, a condition referred to as status epilepticus. Once the five-minute mark is reached, the seizure is unlikely to stop spontaneously, and the risk of permanent brain damage or death increases significantly.
Emergency services must also be activated if the person experiences a second seizure immediately following the first without fully regaining consciousness. This rapid succession of events indicates a failure of the brain’s electrical activity to stabilize. Furthermore, a first-time seizure warrants an immediate emergency call because the underlying cause is unknown and may be a serious medical event like a stroke or head injury.
Other circumstances that demand immediate professional help include a seizure that occurs in water, which carries a high risk of drowning, or if the person is known to have a pre-existing medical condition such as diabetes or pregnancy. If the person has sustained a significant injury during the fall or convulsion, such as a head trauma or a possible broken bone, 911 should be called regardless of the seizure’s duration. Similarly, if the person is experiencing difficulty breathing or appears to be choking after the rhythmic jerking has ceased, or if they remain unconscious for an extended period, it signals a life-threatening complication.
When 911 is Typically Not Required
In many instances, emergency medical services are not necessary, particularly when the person is known to have a pre-diagnosed seizure disorder like epilepsy. Most seizures are brief, resolving on their own within one to three minutes, and are usually not medical emergencies. If the seizure is typical for the person and shorter than five minutes, the rescuer’s role shifts to monitoring and post-ictal care rather than escalation.
Once the seizure movements have stopped, the person enters the post-ictal phase, a period of recovery during which they may be confused, drowsy, or disoriented. This phase can last from a few minutes up to several hours as the brain’s electrical activity returns to its baseline state. During this time, the rescuer should stay with the person, speak calmly, and offer gentle reassurance as they gradually regain awareness of their surroundings.
The rescuer should guide the person to a quiet, safe place to rest and recover. It is important to avoid offering food or drink until they are fully alert, as they may choke due to lingering confusion. The primary non-emergency response involves continuous monitoring and offering to contact a family member or friend to help them get home safely.