Seizure first aid could be all that stands between you and disaster. Seizures do not announce themselves, and the person nearest when one happens is rarely a doctor or a paramedic. Anyone can have a seizure at any age, whether they have epilepsy or not, and the bystander who ends up responsible for those first few minutes is almost never someone who chose to be there.
Seizures can be frightening to witness, and the instinct to intervene in ways that seem helpful but are actually harmful can be strong. What you do in those first few minutes, and what you choose not to do, can be the difference between keeping someone safe and accidentally causing an injury.
What Is a Seizure?
Brain cells send electrical signals in an orderly pattern to control movement, sensation, and thought. A seizure occurs when that pattern is disrupted, causing a surge of uncontrolled signals that can affect the whole body or just one part of it.
The effects depend on where in the brain the disruption starts and how far it spreads. Some seizures cause violent convulsions and loss of consciousness. Others look like a brief staring spell or cause a strange sensation that only the person experiencing it would notice. A seizure may last anywhere from a few seconds to several minutes, but most seizures resolve in under five minutes, and many end in under two.
Seizures have many possible causes, and up to 10% of the population will experience at least one seizure in their lifetime. Epilepsy is the most common, and around 250,000 Australians are living with the condition. A high fever in young children, a head injury, low blood sugar, infection, or stroke can also trigger a seizure.
Types of Seizures
There are more than 30 recognised seizure types, but they fall into two broad categories: generalised seizures, which affect both sides of the brain from the start, and focal seizures, which begin in one specific area.
Generalised Seizures
Tonic-clonic seizures are what most people think of when they picture seizures. The person’s muscles tighten and their body stiffens, and they might only be able to cry or groan. They lose consciousness and fall, then their arms and legs begin jerking. Their face may go blue, they may bite their tongue, lose bladder control, or drool. A tonic-clonic seizure usually lasts between one and three minutes.
Tonic seizures cause the body to stiffen without the rhythmic jerking that follows in a tonic-clonic episode. They are brief, around 20 seconds, but can cause falls and injuries.
Atonic seizures produce the opposite effect: the person suddenly loses muscle tone, which may cause them to collapse or drop objects. Both tonic and atonic seizures carry a high risk of injury from falls.
Absence seizures are brief lapses in awareness that last only a few seconds. The person stops what they are doing, stares blankly, and may blink rapidly or make subtle chewing movements.
Focal Seizures
In a focal aware seizure, the person stays conscious but may experience unusual sensations: a sudden smell, a feeling of deja vu, tingling, or involuntary jerking in one limb. This type does not require seizure first aid unless it progresses to another stage.
In a focal impaired awareness seizure, the person loses awareness of their surroundings and may appear confused, stare blankly, or make repetitive movements like lip-smacking or picking at their clothes.
What to Do When Someone Has a Seizure
Tonic and tonic-clonic seizures are those which are most likely to require seizure first aid. Your goal is to protect the person from harm and keep their airway clear until the seizure ends on its own. You cannot stop a seizure once it has started.
Stay with the person and note the time the seizure starts. If someone is having a seizure, never leave them alone. Timing how long a seizure lasts is one of the most important pieces of information for paramedics and doctors, so time the seizure from start to finish.
Protect them from injury. If the person is standing, try to ease their fall. Clear away sharp objects, furniture, or anything nearby that could cause them injury. Place something soft under their head, like a folded jumper or jacket.
Move them into the recovery position. If the person’s mouth is full during their seizure, roll them onto their side with their mouth angled toward the ground to allow anything to drain from their mouth and keep it from blocking their airway. Otherwise, do so once their seizure has stopped.
After care. When the seizure has stopped, the person may be confused, sleepy, or unable to speak clearly. Calmly talk to them, tell them where they are, and let them know they are safe. Stay with the person until they have fully recovered. Do not offer food or water until they are fully alert. If they fall asleep, check their breathing and let them rest.
What NOT to Do
Do not put anything in their mouth. It is physically impossible to swallow your tongue during a seizure because the tongue is firmly attached to the floor of the mouth by tissue. Objects placed in the mouth can break their teeth, cut their gums, or become a choking hazard if the person were to bite off a piece and swallow the object.
Do not try to restrain the person or stop the jerking movements, and do not move them unless they are in immediate danger, such as on a road or near water.
When to Call an Ambulance, Seek Medical Help, or See A Doctor
Not every seizure requires an ambulance. Many people with epilepsy have seizures that end on their own in under five minutes and do not need emergency intervention, provided they have a seizure management plan in place. The ability to recognise when a seizure becomes a medical emergency is part of seizure first aid.
Call 000 for an ambulance if:
- The seizure lasts more than five minutes.
- The person does not regain consciousness within five minutes after the seizure ends.
- A second seizure begins before the person has fully recovered from the first.
- The person has breathing difficulties after the jerking stops.
- The person is injured during the seizure.
- The seizure happens in water.
- You believe the person is pregnant or has diabetes.
- You do not know the person or if they have an epilepsy management plan.
- It is the person’s first seizure.
Living With Epilepsy: What Families Should Know
A diagnosis of epilepsy changes daily life, but it does not define it. Around 70% of people with epilepsy gain seizure control through medication. For the remaining 30% whose seizures are harder to control, treatment may involve a combination of medicines, dietary therapies, or surgery. The condition is manageable, and people with epilepsy can lead active, independent lives.
The Epilepsy Management Plan. Develop an Epilepsy Management Plan (EMP) with your doctor. An EMP brings all the critical information into one document: the person’s seizure types, known triggers, how they want to be supported during a seizure, their medication, and what steps to follow in an emergency. The EMP should be shared with schools, workplaces, sporting clubs, and anyone who may be present if a seizure occurs. Review the plan annually or sooner if seizures or treatment change.
Talking to others. People with epilepsy benefit when the people around them know what to expect and how to respond. Parents of children with epilepsy can work with schools to ensure teachers and staff understand the child’s seizure types and have access to their management plan. For adults, telling trusted colleagues, friends, or coaches about the condition means seizure first aid can be provided quickly and calmly.
Emotional well-being. Epilepsy carries psychological weight. A diagnosis can bring anxiety about when the next seizure will happen, and both the person with epilepsy and their carer may experience stress, frustration, or grief. Peer support groups, run by organisations such as the Epilepsy Foundation connect families with others in similar situations. The National Epilepsy Support Service (1300 761 487) is available for information and support.
Learn First Aid for Seizures
Seizure first aid comes down to a calm presence, a few protective actions, and the knowledge to tell the difference between a seizure that will resolve on its own and one that needs emergency help. Every second you spend composed rather than panicked is a second the person experiencing a seizure is safer.
The line between a seizure that resolves safely and one that leads to injury sits with whoever is standing closest. You might be the person to carry the responsibility of providing seizure first aid. By taking a first aid course you can have the trained response to match it.
FAQs
How Does an Epilepsy Diagnosis Affect Driving in Australia?
Each Australian state and territory follows the Austroads medical standards for driver licensing. A person with epilepsy may hold a licence if their seizures have been controlled for a specified period, which varies depending on the licence type and seizure circumstances.
What Is Status Epilepticus?
Status epilepticus is a seizure that lasts longer than five minutes or two or more seizures that occur without the person regaining consciousness in between. It is a life-threatening medical emergency that requires immediate ambulance response and hospital treatment.
What Is a Febrile Seizure?
Febrile seizures are triggered by a rapid rise in body temperature during an illness, and they affect about 1 in 30 children between the ages of six months and six years. The seizure first aid steps are the same as for any convulsive seizure. A febrile seizure does not cause brain damage and does not mean the child has epilepsy, but you should always see a doctor afterwards so the underlying cause of the fever can be identified.
