The most important thing you can do for someone having a seizure is stay with them, protect them from injury, and time how long the seizure lasts. Most seizures end on their own within one to three minutes and don’t require emergency medical care. Your job isn’t to stop the seizure. It’s to keep the person safe until it passes.
What to Do During a Convulsive Seizure
When someone collapses and their body stiffens or shakes, this is a tonic-clonic seizure (sometimes called a grand mal seizure). It looks alarming, but there’s a clear set of steps that genuinely helps.
First, ease the person to the ground if they’re not already there. Clear the area around them of anything hard or sharp: chairs, tables, glasses, anything they could strike during convulsions. If you can, place something soft and flat under their head, like a folded jacket. Loosen any tight clothing around their neck, such as a tie or buttoned collar.
Start timing the seizure immediately. Use your phone’s stopwatch. This single detail matters more than almost anything else you do, because the five-minute mark is the threshold where a seizure becomes a medical emergency. If it reaches five minutes, call 911.
Stay calm and stay close. Talk to the person in a reassuring voice, even if they can’t respond. Other people may gather, and you can help by asking bystanders to give the person space and privacy.
What Not to Do
Several old first aid “rules” for seizures are actually harmful. Do not hold the person down or try to restrain their movements. Their muscles are contracting involuntarily, and fighting against those contractions can cause muscle tears or joint injuries.
Do not put anything in their mouth. It is a myth that someone can swallow their tongue during a seizure. Forcing a wallet, spoon, or finger between their teeth can break teeth, injure the jaw, or create a choking hazard. Do not attempt CPR while the seizure is happening. During the convulsive phase, the chest muscles tighten, and the person may appear to stop breathing briefly. Breathing resumes on its own once the muscles relax. Do not offer food or water until the person is fully alert and oriented afterward.
After the Seizure Ends
Once the shaking stops, the person enters what’s called the postictal phase. They’ll be groggy, confused, and possibly unresponsive for several minutes. Some people feel exhausted, emotional, or disoriented for much longer. This is normal.
Gently roll the person onto their side into the recovery position. This keeps their airway clear and lets any saliva or fluid drain from the mouth. Here’s how to do it: kneel beside them and extend the arm closest to you out at a right angle, palm facing up. Take their other arm and fold it so the back of their hand rests against the cheek nearest you. With your free hand, bend their far knee to a right angle, then use that knee as a lever to carefully roll them toward you. Their head should now be resting on their folded hand, and their bent leg keeps them stable on their side. Gently tilt the head back slightly and lift the chin to open the airway.
Stay with them until they’re fully awake and aware of their surroundings. Let them know what happened, speak calmly, and help them get oriented. Many people feel embarrassed after a seizure, so a reassuring, matter-of-fact tone goes a long way.
Helping During a Non-Convulsive Seizure
Not all seizures involve falling and shaking. During a focal impaired awareness seizure, a person may appear awake but confused. They might stare blankly, make repetitive movements like lip smacking or picking at their clothes, or wander aimlessly. They won’t respond normally to your voice.
Your approach here is different. Don’t grab or restrain them, but do stay nearby and gently guide them away from danger: a busy street, a staircase, a hot stove. Speak softly and keep your movements slow. Time this seizure the same way you would a convulsive one. If it passes five minutes, call 911. Once the person comes around, they may have no memory of what just happened, so calmly explain it.
Seizures in Water
A seizure in a pool, bathtub, or any body of water is immediately life-threatening because of the drowning risk. Support the person’s head above the surface with their face tilted upward, and get them out of the water as quickly as possible. Once they’re on solid ground, check whether they’re breathing. If they’re not, begin CPR right away and call an ambulance.
Even if the person seems fully recovered after a water-related seizure, they need a medical evaluation. Inhaling even a small amount of water can cause lung or heart complications that aren’t immediately obvious.
When to Call 911
You don’t need to call an ambulance for every seizure, especially if the person has a known seizure disorder and recovers normally. But certain situations require emergency help:
- The seizure lasts longer than five minutes. This is the clearest rule. A prolonged seizure can cause brain damage and needs medical intervention.
- It’s the person’s first seizure, or you don’t know whether they have a seizure disorder.
- A second seizure follows quickly without the person regaining consciousness between them.
- The person is injured during the seizure, especially a head injury.
- The person is pregnant. Seizures during pregnancy can signal a dangerous condition called eclampsia that requires immediate emergency care.
- The seizure happens in water.
- The person has difficulty breathing after the seizure ends, or doesn’t start breathing normally within a minute of the convulsions stopping.
If the Person Has a Seizure Action Plan
Some people with epilepsy carry prescribed rescue medications designed to stop prolonged or repeated seizures. These come as nasal sprays or gels that a trained caregiver can administer without needing an IV or a trip to the hospital. One type is a nasal spray approved for people 12 and older, and another nasal form is approved for ages six and up.
If someone you know has epilepsy, ask them (when they’re well) whether they have a seizure action plan and where they keep their rescue medication. The plan will specify exactly when to give the medication, typically after a seizure reaches a certain duration or when seizures cluster. Knowing this information in advance is the single most useful thing a caregiver or family member can do. These medications work best when given early, so fumbling to figure out instructions during a crisis costs valuable time.
If you’re caring for a child or adult with known epilepsy, their neurologist can walk you through hands-on practice with the rescue medication so you feel confident using it if the moment comes.