Approaches to Seizure First Aid and Debunking Common Misconceptions

Today we will explore the basics of seizure first aid, and ensuring that any misconceptions surrounding seizure first aid are addressed and clarified further. Whilst first aid in itself is a very common topic, I've come to realise that first aid specific to managing seizures is not so the case. Understanding seizure first aid is extremely vital in helping people of all ages both physically, mentally and emotionally, and could definitely save a life.

Who requires seizure first aid?

Seizure first aid can be provided for anyone who experiences a seizure. This can be due to epilepsy, individuals with known seizure disorder or in individuals who have just experienced a seizure for the first time.

Seizure first aid can differ slightly depending on the type of seizure experienced, whether it is a Tonic-clonic seizure, Atonic (drop) seizure, Absence seizure or even a Myoclonic seizure.

To find out about the different seizure types and their respective symptoms, you can refer to my previous newsletter edition here .

What SHOULD you do during a seizure?

It is important to understand exactly what a person experiencing a seizure requires to ensure that they are safe and protected, and to maximise their recovery experience.

Key things to do when a person experiences a seizure include:

1) STAYING with the patient

Ensure that you remain with the patient during the whole duration of the seizure until they are awake and alert, and that you time their seizure.

It is important to remain calm whilst staying with the patient.

It would also be useful to check for a medical ID, as it would provide insight into:

1. the potential cause of their seizure (i.e. they may be epileptic)
2. any emergency medication they require in an event of a seizure (e.g. Epi-pen)
3. an emergency contact number to someone who can be contacted to support the patient.

2) Keep the person SAFE

It is important to keep the person experiencing the seizure safe from any harm, such as keeping them away from the road. Attempt to slowly move or guide them away from harm.

3) CUSHION their head

Place a pillow or something soft under the person's head. This is crucial to prevent head injury, especially if the patient is experiencing a tonic-clonic seizure where they could be jerking their head, causing their head to bang against the floor or nearby objects.

4) Turn the person to their SIDE (recovery position)

You should perform this step if the person is NOT awake nor aware. This ensures that:

1. the person doesn't choke during their seizure, as the person might vomit, drool, or have difficulty managing saliva.
2. the airway remains open, making it easier for the person to breathe once the seizure stops. It also prevents the tongue from blocking the airway.

Also make sure to loosen tight clothes around the neck, to allow sufficient breathing for the patient.

5) Reassure the patient after their seizure

Seizures are incredibly daunting, and so it is important that the patient not only is physically safe, but also emotionally.

For people with myoclonic seizures, due to them being extremely quick, you may be limited to what help to provide, however, reassurance can be incredibly helpful. Check more about how to support those with myoclonic seizures here .

6) If someone is experiencing a FOCAL or ABSENCE seizure, guide them away from danger (such as roads, train tracks)

Read more about how to support those with focal seizures here .

Read more about how to support those with absence seizures here.

7) Call the ambulance

Call 999 (if based in the UK) or 911 (if based in the US) if:

1. the seizure continues for more than 5 minutes, or the person could be experiencing Status Epilepticus
2. the person goes into another seizure without regaining consciousness in between
3. the person has trouble breathing during or after a seizure
4. the person is injured, pregnant or sick.
5. the person has never experienced a seizure before
6. the seizure occurs in water

Below is a video highlighting what you should do if a person experiences a seizure:

How to help someone experiencing a seizure in a wheelchair

1. Put the brakes of the wheelchair on
2. Fasten the seatbelt if available. If there is no seatbelt, then gently support the person so they don't fall off the wheelchair.
3. Let them experience their seizure on their wheelchair, unless their Seizure Care Plan says otherwise.
4. Time the seizure
5. Cushion their head
6. Check for a Medical ID

What NOT to do during a seizure

There are a number of misconceptions surrounding seizure first aid, which are important to be addressed, including:

1) Do NOT restrain a patient

Restraining a patient experiencing a seizure can pose harm on both the patient, and yourself. Some seizures can cause involuntary, vigorous movements, and restraining those movements can lead to muscle strains, fractures, or joint dislocations for the person experiencing the seizure.

Restraining a patient during their seizure can also increase their stress, even though they are not conscious of the restraint at the time.

What to do instead:

1. Stay calm, and keep the area around the patient safe by moving away and sharp or hard objects
2. Time the seizure
3. Cushion the head
4. Turn the patient onto their side into a recovery position after the jerking stops
5. Stay with the patient

2) Do NOT put objects in their mouth

It is a myth that people swallow their tongue and (as a result) choke during a seizure, and hence people believe that an object should be placed in the patient's mouth to prevent choking. This belief is incorrect. It is physically impossible to swallow your tongue during a seizure.

Why shouldn't we put objects in the person's mouth? The person could choke on the object placed in their mouth and/or experience damage to the jaw, teeth or soft tissues in the mouth. You could also get hurt as trying to insert something in their mouth could result in you getting bitten. The jaw muscles are extremely stiff and strong during a seizure, and the person has no control over them.

What to do instead:

1. If the patient specifically requires emergency medication, then this is the only exception.
2. Turn the patient onto their side into a recovery position after the jerking stops to prevent them from choking.

Useful Posters

Below are useful posters to simplify the key steps involved in seizure first aid.

Takeaway

Seizure first aid is not only about knowing what to do—it's about getting rid of common myths and understanding how to keep someone safe in the moment. By staying calm, protecting the person from harm, and ensuring their airway remains open, you can make a huge difference in their recovery. Remember, there’s no need to restrain them or put anything in their mouth. Instead, focus on providing a safe, supportive environment and being there for them physically and emotionally. Seizures can be frightening, but with the right knowledge and action, you can help someone get through it safely. Every action counts—and you could save a life.

References

Epilepsy Action. (2024). First aid. [online] Available at: https://www.epilepsy.org.uk/info/first-aid [Accessed 20 Sep. 2024].

Epilepsy Action. (2024). Seizures in a wheelchair. [online] Available at: https://www.epilepsy.org.uk/info/first-aid/seizures-in-a-wheelchair [Accessed 20 Sep. 2024].

Epilepsy Foundation Health Communications (2020). Seizure First Aid Resources. [online] Epilepsy Foundation. Available at: https://www.epilepsy.com/tools-resources/forms-resources/first-aid [Accessed 20 Sep. 2024].