A seizure is a sudden, uncontrolled electrical disturbance that occurs in the brain, causing temporary changes in movement, behavior, or consciousness. During a convulsive seizure, the brain’s neurons fire abnormally and rapidly, leading to involuntary muscle stiffening and jerking movements known as a tonic-clonic seizure. The most important rule of first aid for this type of episode is to never attempt to physically hold down or restrain the person. Understanding the biological forces at play explains why this instinctual reaction is counterproductive and potentially harmful.
The Physical Dangers of Restraint
Trying to restrain someone during a convulsive seizure does not stop the underlying electrical storm in the brain, which must simply run its course. The movements observed are involuntary muscle contractions driven by intense, disorganized neural activity. Fighting against this powerful force places the person at significant risk of severe orthopedic injury. The risk of bone fractures, particularly in the arms, legs, and spine, increases substantially when external force is applied against the body’s spasmodic movements. Joint dislocations, especially in the shoulder, are a serious concern as the muscles contract with extreme force against the resistance of the restraint. Forcefully limiting the natural movement can lead to muscle tearing and internal tissue damage, which would not have occurred otherwise. The person may also become agitated or confused if they sense they are being held down, potentially injuring the person attempting to help them.
Immediate Safety Actions During a Seizure
Since the seizure movements cannot be stopped, the focus of first aid must shift entirely to protecting the person from the environment and preventing secondary injuries. Gently ease the person to the floor if they are not already down, allowing the convulsions to occur safely.
Safety Checklist
- Quickly clear away any hard, sharp, or hot objects that the person could hit during the episode.
- Place something soft and flat, such as a folded jacket or a cushion, underneath their head to protect it from repeated impact with the ground.
- Loosen any tight clothing around the neck, like a tie or collar, to ensure clear and easy breathing.
- Never place anything into the person’s mouth, as this can cause tooth damage, jaw injury, or block the airway.
Care and Observation Following the Convulsions
Once the rhythmic jerking movements have completely stopped, the active seizure phase is over, and the person will likely enter the post-ictal state. At this point, gently roll the person onto their side, which is known as the recovery position. This action allows any saliva or vomit to drain from the mouth, preventing the fluid from entering the lungs and keeping the airway clear. The post-ictal phase is characterized by confusion, drowsiness, and disorientation, as the brain recovers from the massive electrical discharge. Remain with the person as they slowly regain full awareness and speak to them calmly and reassuringly. Do not offer any food, water, or medication until they are fully alert and able to swallow normally.
When to Seek Emergency Medical Help
Most seizures resolve spontaneously within one to three minutes and do not require emergency medical intervention. However, certain circumstances demand an immediate call to 911 or local emergency services. A seizure lasting five minutes or longer is considered a medical emergency, known as status epilepticus, and requires urgent professional treatment. You should also call for emergency help if a second seizure begins before the person has fully recovered from the first, or if they are having difficulty breathing after the movements stop. Other urgent indicators include the person being injured during the episode, the seizure occurring in water, or if the person is pregnant, has diabetes, or has never had a seizure before. If you are unsure of the person’s medical history, contacting emergency services is always the appropriate course of action.