A seizure is a temporary, uncontrolled electrical disturbance in the brain causing changes in movement, behavior, feeling, or consciousness. Most seizures are short events that resolve spontaneously within a few minutes. The challenge for a witness is determining when this common event becomes a medical emergency requiring immediate intervention. Knowing the criteria for escalating care and proper first aid steps can significantly improve the outcome.
Defining the Immediate Threat: When to Call 911
The distinction between a routine seizure and a medical emergency hinges on duration and associated complications. Emergency Medical Services (EMS) must be contacted immediately if a seizure lasts five minutes or longer, a condition known as status epilepticus. This prolonged activity can lead to brain damage if not medically stopped.
A 911 call is also necessary if the person has a second seizure without fully regaining consciousness between events. Immediate emergency transport is required if the person is injured during the seizure, appears to be choking, or has persistent difficulty breathing after the seizure stops. Seizures occurring in water, such as a pool or bathtub, also require an immediate emergency call.
The threshold for calling 911 should be lower if the person is pregnant or has a known underlying health condition, such as diabetes. Emergency medical attention is also warranted if the seizure is the person’s first-ever event or represents a marked change in pattern for someone with a known seizure disorder. For the general public, calling 911 for transport to an emergency department is the correct protocol, as Rapid Response Teams (RRT) are not a community service.
The Role of Rapid Response Teams in Clinical Settings
A Rapid Response Team (RRT) is an internal hospital system designed to prevent serious medical emergencies within a healthcare facility. This team is composed of specialized clinicians, including ICU nurses, respiratory therapists, and physicians, who respond to signs of patient deterioration. RRTs are activated by the bedside nursing staff for admitted patients, not by the public.
Nurses activate the RRT if a patient with no prior history begins seizing or if a seizure is prolonged and does not respond to initial hospital interventions. The goal is to stabilize the patient, assess the cause, and coordinate with the attending physician to determine if a transfer to a higher level of care is required. The RRT intervenes before a situation escalates to cardiac or respiratory arrest.
Essential Seizure First Aid: Immediate Safety Measures
While determining the need for emergency services, the immediate priority is ensuring the person’s physical safety. The first step is to time the seizure, as duration is the most important information for medical professionals. The immediate area must be cleared of any hard or sharp objects the person could strike during the uncontrolled movements.
If the person is on the ground, place a soft, flat item, like a folded jacket, gently under their head for cushioning. Once the convulsive activity stops, or if the person is vomiting, turn them gently onto their side into the recovery position. This action helps keep the airway clear and reduces the risk of aspiration.
Restrictive clothing around the neck, such as a tie or scarf, should be loosened to aid breathing. Never restrain the person or attempt to put anything into their mouth, as this can cause injury to both the person and the helper.
Post-Seizure Observation and Follow-Up
The period immediately following a seizure is the postictal phase, characterized by confusion, drowsiness, and sometimes a temporary inability to speak or move normally. The caregiver should stay with the person during this time, allowing them to rest and recover safely. Continuous monitoring of their breathing and level of consciousness is necessary until they are fully alert.
Once the person is conscious, perform a basic assessment for minor injuries that may have occurred during the event. Follow-up with a primary care physician or neurologist is warranted, even if 911 was not called, especially if the event was unusual for a known seizure disorder. The physician needs a detailed account of the event, including the seizure’s duration and characteristics of the postictal state, to manage care or begin a diagnostic workup.