A seizure is a temporary, uncontrolled disturbance of the electrical activity in the brain that causes changes in awareness, movement, or behavior. Most seizures end naturally within a few minutes, meaning not every episode requires a trip to the emergency room. Knowing the specific indicators that turn a common medical event into a life-threatening emergency is necessary for making a quick, informed decision. This guide outlines the criteria for when to call emergency medical services (EMS) and what steps to take until professional help arrives.
Immediate Indicators for Emergency Intervention
The most significant trigger for immediate intervention is seizure duration, defined by a five-minute threshold. A seizure lasting longer than five minutes, or multiple seizures occurring without the person fully regaining consciousness between them, is defined as Status Epilepticus (SE). This prolonged electrical activity is a medical emergency because it can lead to irreversible brain injury or death if not treated quickly. Early intervention with anti-seizure medication is necessary to stop the episode and minimize damage.
Immediate emergency transport is necessary if the seizure is a person’s first-ever event. A first seizure requires an urgent diagnostic workup in the hospital to identify the underlying cause, which could range from a temporary illness to a serious neurological condition. Similarly, if the person has an established epilepsy diagnosis but experiences a seizure that is a marked change from their usual pattern or duration, they should receive emergency care.
Underlying health conditions increase the risk associated with any seizure, warranting immediate EMS involvement. If the person is pregnant, has diabetes, or has a known heart condition, a seizure can destabilize these systems quickly. For instance, a diabetic seizure may signal dangerously low blood sugar, which requires rapid medical correction.
Any signs of respiratory distress or difficulty breathing during or immediately following the seizure are a reason to call for help. Signs of cyanosis, such as a bluish tint to the lips or fingernails, indicate insufficient oxygen delivery to the tissues. If the person sustains a significant head injury or other trauma during the fall or convulsion, they need emergency evaluation for internal injuries or concussion.
Safe Home Management and Follow-Up
For individuals with an established diagnosis of epilepsy, a seizure may not require a hospital visit, provided the event is typical for them. Most seizures end spontaneously within 30 seconds to two or three minutes. If the seizure is short, and the person returns quickly to their normal state of awareness (their post-ictal baseline), emergency intervention is often not necessary.
The decision to manage the situation at home hinges on the person’s established Seizure Action Plan, provided by their neurologist. This plan details the specific seizure type, typical duration, and when to administer prescribed rescue medications, if available. In these non-emergency scenarios, the priority shifts from calling 911 to ensuring a safe recovery period and arranging follow-up with their medical team.
Even when the seizure is short and recovery is quick, a discussion with the primary care physician or neurologist is necessary the next business day. This applies if there are minor injuries, a cluster of seizures closer together than usual, or if the person is experiencing new or worsening medication side effects. These changes may indicate the need for an adjustment to their treatment plan to better control the frequency of future events. This proactive communication supports long-term seizure management.
What to Do While the Seizure is Happening
The first action a bystander must take is to note the exact start time of the seizure. Timing the event with a watch or phone is necessary because the five-minute mark is the point at which a seizure becomes a medical emergency. Simultaneously, the immediate surroundings must be assessed for anything that could cause injury during the involuntary movements.
The next step is to clear the area of any hard, sharp, or hot objects that the person might strike. Gently placing something soft and flat, like a folded jacket or towel, underneath the person’s head can cushion against repeated impact with the floor. Loosening any tight clothing around the neck, such as a tie or collar, helps ensure the airway is not restricted.
Once the environment is secured, the person should be turned gently onto their side into the recovery position. This positioning is necessary to keep the airway clear and prevent aspiration of saliva or stomach contents. After the seizure movements have stopped, remain with the person until they are fully alert and aware of their surroundings.
Never attempt to restrain the person or hold them down, as this can cause musculoskeletal injuries like broken bones or dislocated joints. Do not put anything into the person’s mouth, including fingers or objects, as this can cause dental damage or obstruct the airway. The belief that a person can swallow their tongue is a myth; the tongue may fall back, but the side-lying position manages this risk.