Responding to Seizures Safely

Seeing someone have a seizure can be frightening, especially when the person suddenly falls, becomes stiff or has jerking movements. The most helpful response is usually calm, practical and focused on preventing injury. A seizure often ends on its own, but the person may need urgent medical attention depending on its duration, cause and surrounding circumstances.

This guide explains how to give basic first aid during and after a seizure. It is not a substitute for professional medical care or a personal seizure-management plan. If you are unsure whether the situation is an emergency, seek medical help.

What is a seizure?

A seizure is a sudden burst of abnormal electrical activity in the brain. It can affect movement, awareness, sensation, behaviour or bodily functions. Not all seizures look the same. Some involve full-body shaking and loss of consciousness, while others may appear as staring, unusual movements, confusion, sudden falls or brief periods of unresponsiveness.

During a convulsive seizure, the person may become stiff, fall to the ground and then experience rhythmic jerking. They may drool, make unusual sounds, lose bladder control or change colour briefly. Afterwards, they may be sleepy, confused, confused about where they are, or have a headache and aching muscles. These changes can be alarming, but they are common during recovery.

A seizure may happen in someone with epilepsy, but it can also have other causes, including low blood sugar, a head injury, infection, stroke, poisoning, withdrawal from alcohol or certain medicines, or complications during pregnancy. A first seizure should be assessed by a healthcare professional.

The priorities of seizure first aid

First aid has three main goals:

• Protect the person from injury without restraining them.
• Help maintain an open airway and monitor breathing after the movements stop.
• Recognise situations that require urgent medical attention.

You do not need to diagnose the seizure or stop the movements. In most cases, your role is to make the area safer, observe what happens and stay with the person until they recover or professional help arrives.

What to do during a seizure

1. Stay calm and note the time

Take a breath and look at the surroundings. Start timing the seizure as soon as possible. People often overestimate how long a seizure lasts, so using a phone stopwatch or observing a clock is useful. The duration is important information for healthcare professionals and helps you recognise when emergency services are needed.

2. Protect the person from nearby hazards

If the person is standing or sitting, guide them gently to the floor if you can do so safely. Move hard, sharp or hot objects away from them. Cushion the head with a folded jacket, towel or another soft item. Remove glasses if this can be done without forcing the person’s head or limbs.

If the seizure occurs near traffic, open water, fire, machinery, electricity or a height, prioritise safety. Move the person only as much as necessary to remove an immediate danger. Do not put yourself at risk while trying to help.

3. Loosen restrictive clothing

Loosen tight clothing around the neck, such as a tie, scarf or top button. This may make breathing more comfortable. Do not place anything around the neck that could tighten or obstruct the airway.

4. Do not restrain the movements

Do not hold the person down, pin their arms or legs, or try to stop the jerking. Restraining them can cause injuries to both the person and the helper. Keep your hands away from moving limbs and allow the seizure to run its course while protecting the head and surroundings.

5. Do not put anything in the mouth

Never place fingers, a spoon, cloth, food, drink or medicine in the person’s mouth. A person cannot swallow their tongue, and objects in the mouth can cause choking, broken teeth or injuries to the mouth. You could also be bitten severely. Wait until the person is fully alert before offering anything by mouth.

6. Observe without crowding

Ask bystanders to give the person space. Note what happened before, during and after the seizure, including unusual movements, changes in awareness, breathing, injuries or possible triggers. If local guidance and privacy considerations allow, a brief video may help a clinician, but never delay first aid or expose the person unnecessarily.

What to do when the movements stop

When the jerking stops, check whether the person is breathing normally and responding. If they are breathing but remain unconscious or very drowsy, place them in the recovery position on their side. This helps keep the airway clear and allows saliva or vomit to drain.

1. Kneel beside the person and remove glasses if present.
2. Place the arm nearest to you at a right angle to the body, with the palm facing upwards.
3. Bring the far arm across the chest and place the back of that hand against the cheek nearest to you.
4. Bend the far knee and pull it towards you so the person rolls onto their side.
5. Adjust the upper leg so the hip and knee are bent, and gently tilt the head back to help keep the airway open.
6. Stay with the person and continue checking breathing and responsiveness.

If the person is awake and able to communicate, reassure them quietly. Tell them what happened in simple terms. They may be confused, embarrassed or frightened. Protect their privacy, keep them warm and allow them to rest. Do not rush them to stand, walk or return to work until they are alert and steady.

When to call emergency services

Call emergency services immediately if:

• The seizure lasts five minutes or longer, or you cannot tell when it started.
• Another seizure begins before the person has recovered from the first.
• The person has difficulty breathing, does not regain consciousness or does not return to their usual state.
• The person is seriously injured, especially if there is a head injury, heavy bleeding or a suspected broken bone.
• The seizure happens in water, or the person may have inhaled water.
• The person is pregnant or has recently given birth.
• The person has diabetes and does not recover normally, or low blood sugar may be involved.
• The seizure is a first known seizure, or the cause is unclear.
• The seizure occurs in a child with a high fever, unless a clinician has given the family a specific plan and the child recovers as expected.
• The person has been poisoned, has taken an overdose or may be withdrawing from alcohol or drugs.
• The seizure happens while the person is driving, operating machinery or in another particularly dangerous situation.

Use your local emergency number. In Kenya, emergency numbers commonly used for urgent assistance include 999 and 112; elsewhere, use the number provided by local emergency services. Follow the dispatcher’s instructions and send someone to meet responders if the location is difficult to find.

If the person is not breathing normally

After a seizure, breathing may be irregular for a short time, but it should be monitored closely. If the person is unresponsive and not breathing normally, call emergency services and begin cardiopulmonary resuscitation (CPR) if you are trained. Ask someone to bring an automated external defibrillator (AED), if one is available. Follow the emergency dispatcher’s instructions.

Do not assume that a person is simply sleeping if they cannot be woken or their breathing is abnormal. A seizure can sometimes be followed by a serious problem requiring immediate treatment.

Special situations

A seizure in water

Call for help and remove the person from the water as soon as it is safe to do so. Support the head and neck if an injury is possible. Once on land, check breathing and begin CPR if the person is not breathing normally. Water inhalation can cause delayed breathing problems, so urgent medical assessment is important even if the person appears to recover.

A seizure in a public place

Ask bystanders to move back and protect the person’s dignity. Do not allow people to crowd around, take photographs or offer untrained medical advice. After the seizure, ask whether the person has an emergency identification card, medical bracelet or support person to contact. Do not take them somewhere private or transport them alone if they are confused or medically unwell.

A person with a known seizure plan

Some people with epilepsy have an individual emergency plan or prescribed rescue medicine. Follow the plan only if you are trained and authorised to do so, and only use medicine that belongs to that person and has been prescribed for this purpose. Never give another person’s medication or attempt to use a treatment you have not been trained to administer. Call emergency services if the plan says to do so or if the seizure does not resolve as expected.

What not to do after a seizure

Several well-intentioned actions can create additional danger. Do not give food, water or tablets while the person is drowsy, confused or unable to swallow normally. Do not slap, shake or shout at them to make them wake up. Do not assume that a seizure is caused by alcohol, a mental health condition or deliberate behaviour. Do not leave the person alone immediately after the movements stop, particularly if they remain confused or have been injured.

Do not force the person to stand or walk. Check for injuries when it is safe, but avoid moving the neck or spine unnecessarily after a fall or collision. If they are wearing a medical alert bracelet or carrying an emergency plan, share the information with responders.

Recording useful information

Accurate observations can help a healthcare professional understand what happened. If possible, record:

• The time the seizure started and stopped.
• What the person was doing immediately beforehand.
• Whether they were responsive or able to speak.
• Which body parts moved, and whether the movements were on one side or both sides.
• Changes in breathing, skin colour, eye position or awareness.
• Any fall, head impact, bleeding or other injury.
• How long confusion, weakness or unusual behaviour lasted afterwards.

Avoid presenting guesses as facts. For example, say that the person “stared and did not respond for about 30 seconds” rather than declaring that they had a particular type of seizure. Clear observations are more useful than a confident but uncertain diagnosis.

Reducing risk in workplaces and community settings

Employers, schools, sports clubs and community organisations can prepare by teaching basic seizure first aid, keeping first-aid supplies accessible and ensuring that staff know how to contact emergency services. A calm response is easier when people have agreed procedures for clearing hazards, timing the event, managing crowds and recording incidents.

Workplaces should also consider ordinary safety measures that reduce harm if someone loses awareness or falls: keeping walkways clear, storing hot liquids safely, using guards around dangerous machinery and ensuring that staff know how to summon help. These measures support everyone, whether or not anyone has a known seizure disorder.

Applying This in Practice

Imagine a colleague suddenly falls beside a desk and begins jerking. First, move the chair and other hard objects away, place something soft under their head and note the time. Do not hold them down or put anything in their mouth. When the movements stop, check breathing and place them on their side if they are breathing but not fully alert. Call emergency services if the seizure reaches five minutes, if breathing is abnormal, if they are injured, if this is their first known seizure, or if they do not recover normally.

If the colleague becomes alert, remain with them, speak calmly and explain what you observed. Give responders the timing and details rather than speculating about the cause. Respect their privacy and do not share video or personal information without a clear, appropriate reason.

Key Takeaways

• Time the seizure, protect the person from hazards and cushion their head.
• Never restrain the person or put anything in their mouth.
• After the movements stop, check breathing and use the recovery position if they are breathing but unconscious or very drowsy.
• Call emergency services for a seizure lasting five minutes or more, repeated seizures, breathing problems, serious injury, a first known seizure and other listed emergencies.
• Do not give food, drink or medicine until the person is fully alert and able to swallow safely.
• Record clear observations and share them with healthcare professionals or emergency responders.