How to Assist a Seizure

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A Definitive Guide to Assisting Someone Having a Seizure

Witnessing a seizure can be a frightening experience, both for the person having it and for those around them. The sudden loss of control, the erratic movements, and the potential for injury can leave bystanders feeling helpless and unsure of how to react. However, understanding how to properly assist someone during and after a seizure is crucial. Your calm and informed actions can significantly impact the individual’s safety and well-being. This comprehensive guide will provide you with the knowledge and actionable steps needed to confidently and effectively help someone experiencing a seizure. We will delve into various types of seizures, the immediate actions to take, post-seizure care, and essential considerations to ensure the best possible outcome.

Understanding Seizures: More Than Just Convulsions

Before we dive into assistance, it’s vital to grasp what a seizure truly is. A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in behavior, movements, feelings, or levels of consciousness. Not all seizures involve dramatic convulsions. In fact, there’s a wide spectrum of seizure types, each with its own characteristics. Recognizing these differences can help you better assess the situation and provide appropriate care.

Generalized Seizures

These seizures involve both sides of the brain from the outset.

  • Tonic-Clonic Seizures (Grand Mal): This is perhaps the most recognized type. It typically involves two phases:
    • Tonic Phase: The person’s muscles suddenly stiffen, causing them to fall to the ground. Their back arches, and they may cry out as air is forced past their vocal cords. Breathing may temporarily stop, and their skin might turn bluish. This phase usually lasts for 10-20 seconds.

    • Clonic Phase: Rhythmic jerking movements of the arms and legs begin. The person may bite their tongue or cheek, and saliva may mix with air, appearing as foam around the mouth. Bladder or bowel control may be lost. This phase typically lasts for a few minutes, though it can vary.

  • Absence Seizures (Petit Mal): These are more common in children but can occur at any age. They involve brief, sudden lapses of consciousness, often appearing as staring spells. The person may blink rapidly or make slight chewing movements. They usually last only a few seconds and the person is often unaware they’ve had one.

  • Myoclonic Seizures: These involve sudden, brief jerks or twitches of a muscle or group of muscles. They are often described as brief “shocks” or “jumps.” The person usually remains conscious.

  • Atonic Seizures (Drop Attacks): These cause a sudden loss of muscle tone, leading to a sudden collapse or drop to the ground. The person remains conscious during the fall but immediately regains consciousness once on the ground.

  • Tonic Seizures: Similar to the tonic phase of a tonic-clonic seizure, these involve a sudden stiffening of muscles, often causing a fall.

Focal (Partial) Seizures

These seizures originate in one specific area of the brain. The symptoms depend on the part of the brain affected.

  • Focal Aware Seizures (Simple Partial Seizures): The person remains fully conscious and aware of their surroundings during the seizure. Symptoms can include:
    • Motor symptoms: Jerking or stiffening of a limb, head turning, eye deviation.

    • Sensory symptoms: Tingling, numbness, visual disturbances (flashing lights), olfactory hallucinations (smelling something not there).

    • Autonomic symptoms: Changes in heart rate, breathing, or stomach sensations.

    • Psychic symptoms: Feelings of déjà vu, fear, or joy.

  • Focal Impaired Awareness Seizures (Complex Partial Seizures): The person’s consciousness is impaired or altered. They may appear confused or dazed and engage in automatisms (repetitive, non-purposeful movements) such as:

    • Lip-smacking, chewing, swallowing.

    • Fumbling with clothes.

    • Wandering aimlessly.

    • Repeating words or phrases.

    • Picking at objects. The person will typically have no memory of the seizure.

Unclassified Seizures

Some seizures don’t fit neatly into the generalized or focal categories, or there may not be enough information to classify them.

Understanding these different types is the first step in providing effective assistance. Your response will need to be tailored to the specific type of seizure observed, especially regarding consciousness and mobility.

Immediate Action: What to Do During a Seizure

Your primary goal during a seizure is to keep the person safe and prevent injury. Remain calm, as your composure will help you think clearly and act effectively.

For Tonic-Clonic Seizures (and other seizures involving loss of consciousness/collapse):

  1. Stay Calm and Time the Seizure: This is paramount. Panicking won’t help. Immediately note the time the seizure begins. This information is vital for emergency medical services and for tracking the seizure’s duration, which is a key indicator of its severity. A seizure lasting longer than 5 minutes, or multiple seizures without full recovery in between, constitutes a medical emergency.
    • Concrete Example: You see someone suddenly collapse and begin shaking. Immediately glance at your watch or phone and make a mental note: “Okay, it’s 3:15 PM.”
  2. Ease the Person to the Floor if They Are Standing or Sitting Precariously: Gently guide them down if possible, ensuring a soft landing. If they are already on the floor, leave them there. Do not try to hold them upright or restrict their movements.
    • Concrete Example: A colleague at their desk suddenly goes rigid and starts to fall. You quickly step forward and gently guide their shoulder, helping them slide from their chair to the carpeted floor rather than crashing down.
  3. Protect Their Head: Place something soft and flat under their head to cushion it from impact with the hard surface. This could be a folded jacket, a pillow, a backpack, or even your hands if nothing else is available. This prevents serious head injuries from repeated bumping during the clonic phase.
    • Concrete Example: A person is convulsing on a concrete sidewalk. You quickly remove your rolled-up jacket and carefully slide it under their head, ensuring it’s not obstructing their breathing.
  4. Clear the Area Around Them: Move any objects that could cause injury if the person hits them during their movements. This includes furniture, sharp objects, hot liquids, or anything else that could be a hazard. Create a safe perimeter.
    • Concrete Example: Someone collapses in a kitchen. You swiftly move a nearby chair, kick away a fallen pot, and ensure there are no broken dishes within their flailing reach.
  5. Loosen Anything Around Their Neck: If the person is wearing a tight tie, scarf, or collar, gently loosen it to ensure their breathing is not restricted. This helps maintain an open airway.
    • Concrete Example: An individual is wearing a tightly knotted tie. You carefully unbutton the top button of their shirt and loosen the tie, ensuring it’s not constricting their neck.
  6. Turn Them Gently Onto Their Side (Recovery Position) IF Possible and Safe: Once the tonic phase has passed and the clonic (jerking) movements have started, or if there is frothing at the mouth, gently roll the person onto their side. This helps to prevent them from choking on saliva, vomit, or blood (if they have bitten their tongue/cheek) and keeps their airway clear. Do not force them onto their side if it’s difficult or they are resisting. Prioritize head protection.
    • Concrete Example: After a minute of convulsions, you notice some frothing at the person’s mouth. You gently place one hand on their shoulder and the other on their hip, and carefully roll them onto their side, ensuring their head is still cushioned.
  7. Do NOT Put Anything in Their Mouth: This is a critical point. Do not attempt to force anything into their mouth, including your fingers, a spoon, or a wallet. People having seizures cannot swallow their tongue. Attempting to force something into their mouth can cause serious injury to their teeth, jaws, or your fingers, and could obstruct their airway.
    • Concrete Example: A well-meaning bystander reaches for a spoon. You calmly but firmly say, “Please don’t put anything in their mouth. They won’t swallow their tongue, and that could hurt them.”
  8. Do NOT Restrain Their Movements: Do not try to hold them down or stop their movements. This will not stop the seizure and can cause injuries like fractures or dislocations to both you and the person seizing. Let the seizure run its course.
    • Concrete Example: A family member instinctively tries to hold down their loved one’s flailing arm. You gently explain, “It’s safer to let them move. Holding them down could cause an injury.”
  9. Stay with the Person Until the Seizure Ends and They Are Fully Recovered: Do not leave them alone. They will be confused and disoriented immediately after the seizure. Your presence provides comfort and ensures their safety during this vulnerable period.
    • Concrete Example: You remain by the person’s side, even after the shaking stops, speaking softly and reassuringly until they begin to respond coherently.

When to Call for Emergency Medical Assistance (911/115 in Vietnam):

While most seizures are not life-threatening, certain situations warrant immediate medical attention. Call emergency services if:

  • The seizure lasts longer than 5 minutes. This is a medical emergency known as status epilepticus, which can cause brain damage if not treated promptly.

  • The person has multiple seizures without regaining consciousness between them. This also falls under status epilepticus.

  • The person is pregnant.

  • The person has never had a seizure before. This requires medical evaluation to determine the cause.

  • The person is injured during the seizure. (e.g., a bad fall, head injury, broken bones).

  • The seizure occurs in water. (e.g., swimming pool, bathtub).

  • The person has difficulty breathing or stops breathing after the seizure.

  • The person does not regain consciousness or normal breathing shortly after the seizure.

  • The person has underlying health conditions that could be exacerbated by the seizure. (e.g., heart condition, diabetes).

  • The person has a medical alert bracelet indicating a specific condition that requires immediate attention.

    • Concrete Example: The seizure you are witnessing has gone on for four minutes. You get your phone ready. At the five-minute mark, you immediately dial 115 (or 911 in other regions) and provide concise details to the dispatcher.

For Absence Seizures and Focal Aware/Impaired Awareness Seizures:

While these seizures don’t involve grand convulsions, they still require your attention to ensure the person’s safety and well-being.

  • Stay with the Person: Do not leave them alone.

  • Speak Calmly and Reassuringly: If they are responsive, try to orient them.

  • Guide Them Away from Danger: If they are wandering or engaged in automatisms, gently guide them away from traffic, stairs, hot stoves, or any other hazards. Do not grab or restrain them forcefully, as this can confuse or agitate them.

    • Concrete Example: Someone in a supermarket aisle suddenly stares blankly, and starts picking at their shirt. You gently place a hand on their arm and softly say, “Are you okay? Let’s move away from the display here.”
  • Do Not Interfere with Their Movements (Unless Dangerous): Allow them to complete their automatisms unless they are causing harm.

  • Explain What Happened Afterwards: Once the seizure has passed and they are fully aware, gently explain what occurred, as they may have no memory of the event.

    • Concrete Example: After a brief staring spell, your friend asks, “What just happened?” You calmly respond, “You seemed to zone out for a few seconds there, just a little blank stare. Are you feeling alright now?”

Post-Seizure Care: Guiding Them Through Recovery

Once the seizure has ended, the person will likely be confused, disoriented, and fatigued. This post-ictal (after seizure) phase can last for minutes to hours. Your continued support is essential.

  1. Reassure Them Calmly: Speak in a calm, soothing voice. Tell them they are safe and that the seizure is over. They may be scared, embarrassed, or confused. Your voice can be a grounding presence.
    • Concrete Example: As the person regains consciousness, you gently say, “It’s okay. You’ve had a seizure, and it’s over now. You’re safe.”
  2. Help Them Sit Up or Lie Down Comfortably: Once they are more alert, assist them into a comfortable position. If they are on their side, you can help them gently sit up or remain lying down if they prefer.
    • Concrete Example: The person is still on their side, groaning softly. You ask, “Would you like to stay like this, or can I help you sit up a little?”
  3. Check for Injuries: Carefully and gently check them for any cuts, bruises, or other injuries that may have occurred during the seizure, especially to the head, arms, and legs. If you find any, treat them as you would any other injury, or call for medical help if severe.
    • Concrete Example: You notice a small scrape on their elbow from where they hit the floor. You gently suggest, “You have a little scrape here. Would you like a bandage?”
  4. Offer to Help Them to a Quieter, Safer Place: Bright lights, loud noises, and crowds can be overwhelming after a seizure. If possible, help them move to a more private, quiet area where they can rest and recover.
    • Concrete Example: You are in a busy mall. You offer, “Would you like to move to that quieter bench over there, away from all the noise, so you can rest?”
  5. Do Not Offer Food or Drink Immediately: The person may still be disoriented, and their swallowing reflex might not be fully returned. Wait until they are fully alert and coherent before offering sips of water.
    • Concrete Example: The person asks for water. You say, “Let’s wait just a few more minutes until you’re feeling a bit more awake, then I can get you some water.”
  6. Allow Them to Rest: The post-ictal phase often involves significant fatigue. Allow them to rest as much as they need. They may even fall asleep.

  7. Gather Information (If Appropriate): If you know the person, or if they are able to communicate, ask if they have a medical ID or if there’s anything you should know about their condition. Offer to contact a family member, friend, or emergency contact.

    • Concrete Example: Once the person seems more alert, you gently ask, “Is there someone I can call for you? Do you have an emergency contact?”
  8. Provide Privacy: While you need to stay with them, avoid drawing unnecessary attention to them. Ask curious bystanders to give them space.
    • Concrete Example: A small crowd is gathering. You politely but firmly say, “Please give them some space. They need to recover quietly.”
  9. Offer Ongoing Support: Continue to check on them periodically, ensuring they are recovering well. Offer to stay with them until a family member arrives or they feel well enough to be left alone.
    • Concrete Example: You remain seated nearby, occasionally asking, “How are you feeling now? Do you need anything?”

Essential Considerations and Proactive Measures

Beyond the immediate actions, there are broader considerations and proactive steps you can take to be better prepared and ensure optimal assistance.

Education and Awareness

  • Learn About Seizures: The more you understand about different seizure types and their manifestations, the better equipped you’ll be to respond appropriately. This guide is a starting point, but consider further resources from epilepsy foundations.

  • Recognize Early Warning Signs (Auras): Some people experience an “aura” before a seizure, which can be a distinct sensation, smell, visual disturbance, or feeling. If you know someone who experiences auras, ask them what their aura feels like so you can potentially help them find a safe place before a seizure begins.

    • Concrete Example: Your friend tells you they sometimes smell burnt toast before a seizure. If they suddenly comment on a phantom burnt toast smell, you can calmly say, “Okay, let’s get you to a safe spot, maybe lie down over here.”
  • Know Individual Seizure Plans: If you regularly interact with someone who has epilepsy, ask them or their caregiver about their individual seizure action plan. This plan often outlines specific instructions, medications, and emergency contacts.
    • Concrete Example: A child in your care has a school seizure action plan. You review it to know their typical seizure presentation, whether they need rescue medication, and who to call.

Preparedness

  • First Aid Kit: While not specific to seizures, having a basic first aid kit available is always good for treating minor injuries that may occur during a seizure.

  • Medical ID Bracelets/Information: Encourage individuals with epilepsy to wear a medical ID bracelet or carry an information card. This can provide crucial details to first responders, such as their condition, medications, and emergency contacts.

  • Epilepsy-Friendly Environments: In a home or workplace setting where someone with epilepsy spends a lot of time, consider making the environment safer by:

    • Padding sharp furniture corners.

    • Securing rugs to prevent slips.

    • Keeping pathways clear.

    • Ensuring good lighting.

Debriefing and Support

  • Encourage Medical Follow-Up: After any seizure, especially a first one or one that was prolonged/unusual, encourage the person to follow up with their doctor.

  • Offer Emotional Support: Having a seizure can be emotionally distressing. The person may feel vulnerable, embarrassed, or anxious. Offer a listening ear and reassurance. Validate their feelings.

    • Concrete Example: After the person has recovered, you say, “It’s completely understandable to feel shaken up after something like that. Take your time, and please know it’s not your fault.”
  • Educate Others (With Permission): If the person is comfortable, you can gently educate other bystanders about what happened, dispelling myths and promoting understanding.
    • Concrete Example: A bystander comments, “Oh my goodness, they swallowed their tongue!” With the person’s consent, you can calmly explain, “Actually, that’s a common misconception. People don’t swallow their tongues during seizures, but it’s important to keep their airway clear.”

Dispelling Common Myths

  • Myth: You can swallow your tongue during a seizure.
    • Reality: It’s physically impossible to swallow your tongue. The tongue is attached to the back of the mouth.
  • Myth: You should put something in a person’s mouth to prevent them from biting their tongue.
    • Reality: This is extremely dangerous. It can break teeth, damage the jaw, and cause the person to choke. Tongue bites during seizures are often unavoidable but are usually minor and heal quickly.
  • Myth: You should restrain a person having a seizure.
    • Reality: Restraining someone can cause serious injury to both the person seizing and the helper.
  • Myth: Seizures are always violent and involve shaking.
    • Reality: As discussed, there are many types of seizures, and many do not involve convulsions.
  • Myth: People with epilepsy are mentally ill or less intelligent.
    • Reality: Epilepsy is a neurological condition, not a mental illness. Intelligence levels in people with epilepsy vary just like in the general population.

Conclusion

Assisting someone having a seizure is an act of compassion and practical support. By understanding the different types of seizures, knowing the immediate actions to take, providing careful post-seizure care, and committing to ongoing awareness and education, you can make a profound difference. Your calm presence, quick thinking, and adherence to these guidelines will ensure the safety and dignity of the individual experiencing the seizure. While the experience can be daunting, remember that most seizures are brief and resolve on their own. Your informed actions can transform a potentially dangerous situation into one where the person is protected, respected, and supported through a vulnerable moment.