What should I do if someone has a seizure in front of me?

Question

What first-aid measures should be taken when someone is having a seizure?

Answer 1

The typical scenario of a seizure is:

1. loss of consciousness
2. uncontrolled movements
3. recovery

The conduct to adopt during each of these phases follows:

During 1. and 2.

The person will fall on the ground if standing and may get hurt, either due to the fall or due to the uncontrolled movements that will follow.

The only things you can (and should) do at that stage are:

• If possible, ease the victim to the floor when falling, without restricting his/her movements. Be careful for yourself. Do not face the person (you could get punched, and even a thin person is very strong in such cases), stand on his/her back.
• Should the victim wear eyeglasses, remove them carefully. If you can, carefully loosen clothes or jewellery around the neck.
• Insert a cushion or some folded clothes under the victim's head. Here again, be careful not being hit and do not restrict the victim's movements.
• Clear the area: remove any object that can be dangerous for the victim.
• Be calm and reassuring for people around. Ask them to stay away from the victim, or to go next room should this happen inside a building. Ask at least one to stay at your disposal in case of need. This may be useful later.
• Monitor how long this phase lasts.
• If you're not aware of the victim's history with seizure, try to find any card or jewellery mentioning it.

There are things you should absolutely avoid doing as they would do way more bad than good:

• DO NOT hold the victim or restrain his/her movements. The victim may hurt him/herself, the only thing you should do is to secure the area as much as you can (see above).
• DO NOT insert anything into the victim's mouth. The victim is NOT going to swallow his/her tongue.
• DO NOT try to make the victim bite anything. No belt, no pencil, nothing. The victim may bite his/her own tongue, you cannot and should not try to prevent that.
• DO NOT move the victim, unless there is an immediate, real, and out-of-control danger.
• DO NOT leave the victim on his/her own. Don't stay too close, though. Be careful for yourself and get ready to do some more securing should this be needed.

During 3.

The victim will not necessarily be aware of what happened, and will need time to recover. He/she might be disoriented/confused, and he/she may have lost urine during the previous phase. You should calmly expect both signs.

There are some do's and don't here, as well:

Do:

• Gently put the victim in recovery position (on a side: video and explanations here).
• As long as the victim has not recovered consciousness, ensure the victim still breathes. To do this, approach your ear to his/her mouth, while looking at his/her chest, for 10 seconds. This allows you to hear the sound of breathing, feel his/her breath, and see the movements of his/her chest. Should you perceive none of these that's a medical emergency (potential cardiac arrest, which is another question¹) - This is quite unlikely to happen but you have to check.
• Without being intrusive, visually check whether urine seems to appear on the person's clothes. Failing to determine this is not a problem.
• During the recovery, speak calmly, be friendly and gentle.
• Once the victim has regained enough consciousness, explain what happened and be reassuring.
• Ask the victim to show his/her tongue, and explain why. He/she can be hurt without knowing.

Depending on what you know or discovered regarding the victim's history with seizure, and depending on the time the previous phase lasted, you may have to call the medical emergency services:

• Should the last phase (1. + 2.) have lasted more than 5 minutes
• Should this be the first time the person has a seizure
• Should the person have stopped breathing
• Should another loss of consciousness occurs
• Should another series of uncontrolled movements occurs
• Should the person remain disoriented after a few minutes of recovery
• Should the person be aggressive/violent
• Should the person be hurt
• Should the person be a pregnant woman
• Should the person ask you to call the emergency services
• Or should you have any doubt, assume you should call the emergency medical services.

When calling the medical emergency services,

• Don't be in a hurry, stay calm.
• Tell your name, phone number, current location,
• Tell this is for a seizure, and tell the victim's gender and age
• Describe the victim's condition, tell what of the above makes you call, tell whether there is a loss of urine or any injury.
• They will guide you. Do whatever they tell you and answer any question.
• Do NOT hang up the phone before instructed to do so

Should no emergency call be needed, offer some help to the person:

• Lead him/her away from any danger, a quiet bench nearby is appropriate should you be outside.
• Offer him/her to call a friend, a relative or a cab.
• In the US, and probably in some other countries, it's illegal to drive within 6 months after having had an unexplained seizure (not caused by eclampsia, hypoxia, head injury, etc.). Should this be the case, you don't have to force the person not to drive, but you can strongly discourage it.

Don't:

• Don't speak fast or act in any way that could frighten the victim. Keep in mind the recovery phase is a slow process during which the victim feels dizzy and confused.
• Don't propose water or food before complete recovery or if you had to call the medical emergency services. In this last case, ask them whether you can propose anything.

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^{1- Being nonresponsive and not breathing triggers the CPR process. It is not described here as it is a question on its own.}

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References:

• Premiers Secours civiques 1 (First-aid guidelines for general public), Ministry of Interior, France
• First-aid for seizures, Centers for Disease Control and Prevention, Atlanta, USA
• What to do when someone has a seizure, the British Epilepsy Action Charity, Leeds, UK