The most important thing you can do when someone is having a seizure is stay calm, keep them safe from injury, and time it. 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 protect the person until it passes and help them recover afterward.
Step-by-Step First Aid
If someone near you starts seizing, here’s what to do in order:
- Stay with them. Don’t leave to find help until the seizure is over or someone else can take your place.
- Ease them to the ground if they’re standing or appear to be falling. Clear away furniture, sharp objects, or anything nearby that could injure them.
- Turn them gently onto one side with their mouth pointing toward the ground. This keeps the airway clear and lets saliva or blood drain out instead of pooling in the throat.
- Place something soft and flat under their head, like a folded jacket or sweater.
- Remove eyeglasses and loosen anything tight around the neck, such as a tie, scarf, or buttoned collar.
- Start timing the seizure immediately. Use your phone. If it lasts longer than 5 minutes, call 911.
- Check for a medical ID bracelet or necklace that may list their condition, medications, or emergency contacts.
Once the seizure stops, help the person sit somewhere safe. They will likely be confused, groggy, or disoriented. Stay with them, calmly explain what happened, and offer to call someone who can help them get home.
What Not to Do
Never put anything in the mouth of a person who is seizing. This is one of the most persistent myths about seizure care, and it’s dangerous. Objects placed in the mouth can block the airway and make the situation worse. People do not swallow their tongues during seizures.
Don’t try to hold the person down or restrain their movements. Restraining someone mid-seizure risks injury to both of you. The muscle contractions during a convulsive seizure are powerful and involuntary, and fighting against them can cause sprains, fractures, or dislocations. The safest approach is to clear the space around them and let the seizure run its course.
Don’t offer water or food until the person is fully alert and able to swallow normally.
When to Call 911
Not every seizure requires an ambulance. But certain situations do. Call 911 if:
- The seizure lasts longer than 5 minutes
- The person doesn’t regain consciousness after the seizure ends
- A second seizure follows shortly after the first
- The person is injured during the seizure
- The seizure happens in water
- The person is pregnant
- You know (or suspect) this is their first seizure
- The person has difficulty breathing after the seizure stops
A seizure lasting more than 5 minutes is considered a medical emergency called status epilepticus. Brain activity that continues unchecked for that long can cause lasting damage. Paramedics carry fast-acting medications that can stop prolonged seizures, typically given as an injection or IV.
Not All Seizures Look the Same
When most people picture a seizure, they imagine someone falling to the ground and convulsing. That’s a generalized tonic-clonic seizure (formerly called grand mal), and it’s the type that requires the most active first aid: easing the person to the ground, rolling them on their side, cushioning their head.
But many seizures look nothing like that. Focal seizures, which start in one area of the brain, can cause a person to stare blankly, make repetitive movements like lip-smacking or hand-rubbing, or seem confused and unresponsive for 30 seconds to a couple of minutes. They might wander or mumble. These seizures are easy to miss or mistake for something else.
For focal seizures, the same core principles apply: stay with the person, guide them away from hazards (traffic, stairs, sharp objects), don’t restrain them, and time the episode. They may not realize anything happened once it’s over, so explain it gently and stay until they’re fully oriented.
Helping Someone Recover Afterward
The period right after a seizure, called the postictal state, can be disorienting and exhausting. Most people experience some combination of confusion, fatigue, headache, muscle soreness, or emotional distress. This is normal and typically resolves within minutes to an hour, though some people feel off for longer.
Occasionally, someone may become agitated or combative in the minutes after a seizure without being fully aware of what they’re doing. This is postictal delirium, and it usually passes quickly. Speak calmly, avoid making sudden movements, and give them space while keeping them safe. Don’t take confused or aggressive behavior personally.
Once the person is alert, ask if this has happened before and whether they have a seizure action plan or rescue medication. Many people with known epilepsy carry this information with them. If they seem to be recovering normally and this is a typical seizure for them, emergency care may not be needed. Let them guide the next steps.
Seizure Action Plans
If you live with someone who has epilepsy, or if your child has a seizure disorder, a seizure action plan is one of the most useful tools you can have. This is a written document, usually completed with input from a doctor, that spells out exactly what to do when a seizure occurs.
A good seizure action plan includes the person’s seizure type and what it typically looks like, how long episodes usually last, known triggers or warning signs, what to do during and after a seizure, when to administer rescue medication (if prescribed), and when to call 911. It also lists emergency contacts and the treating doctor’s information.
Schools, workplaces, and caregivers should all have copies. Many states offer standardized templates through their departments of health. If your child has epilepsy, work with the school nurse to make sure staff know where the plan is kept and how to follow it, including during bus rides, field trips, and lockdown situations.
VNS Magnets
Some people with epilepsy have a vagus nerve stimulator (VNS) implanted under the skin on the chest. This device delivers regular electrical pulses to help prevent seizures. It also comes with a handheld magnet that can be swiped over the device during a seizure to deliver an extra burst of stimulation, which may shorten or stop the episode.
If someone’s seizure action plan includes VNS magnet use, swipe the magnet over the generator site on the chest for one to two seconds, then immediately pull it away. Don’t hold it in place for more than two seconds, as this will temporarily shut the device off instead of activating it. The seizure action plan should specify how many swipes to perform.
Seizures During Pregnancy
Seizures during pregnancy carry real risks for both the mother and the baby. Convulsive seizures in particular can reduce oxygen delivery to the fetus and, in severe cases, cause bleeding in the baby’s brain or pregnancy loss. About two to four out of every 100 women with epilepsy will have a seizure during labor or delivery.
Pregnancy changes how the body processes seizure medications, so doses often need adjustment throughout the pregnancy to maintain the same level of protection. The goal is to control seizures with the simplest possible medication regimen while avoiding certain drugs known to increase the risk of birth defects. Women with epilepsy who are pregnant or planning to become pregnant are typically managed by both a neurologist and an obstetrician working together, with regular monitoring and detailed seizure tracking throughout the pregnancy.