Most seizures end on their own within one to three minutes, and the single most important thing you can do is keep the person safe until it stops. That means protecting them from injury, timing the seizure, and staying calm. The specifics depend on the type of seizure, but the core principles are simple and easy to remember.
During a Convulsive Seizure
When someone drops to the ground and their body stiffens or shakes, your priorities are protecting their head, keeping their airway clear, and tracking time. Start by easing them to the ground if they’re not already there. Move furniture, sharp objects, or anything hard away from them. Place something soft under their head, like a folded jacket or sweater.
Check the time or start a timer on your phone right away. If the seizure lasts longer than 5 minutes, call 911. This threshold matters because prolonged seizures can become a medical emergency that requires intervention.
Once the shaking stops, gently roll the person onto their side. This recovery position lets saliva or fluid drain from the mouth and helps keep the airway open. Stay with them. People coming out of a seizure are often confused, exhausted, or disoriented for minutes to hours afterward. Speak calmly, tell them where they are and what happened, and let them rest.
What Not to Do
Some of the most common instincts during a seizure are exactly the wrong ones. Do not hold the person down or try to stop their movements. Restraining someone mid-seizure can cause injuries to both of you. Do not put anything in their mouth. The old idea about “swallowing the tongue” is a myth: it is physically impossible, and forcing an object between clenched teeth can break teeth or injure the jaw. Do not offer water or food until the person is fully awake and alert.
When to Call 911
Not every seizure requires an ambulance. Many people with epilepsy have seizure action plans and recover without emergency care. But certain situations always warrant a 911 call:
- The seizure lasts longer than 5 minutes
- A second seizure follows closely after the first
- The person has trouble breathing or doesn’t wake up afterward
- They were injured during the seizure
- The seizure happened in water
- It’s the person’s first seizure ever
- The person is pregnant
- The person has diabetes and has lost consciousness
Non-Convulsive Seizures
Not all seizures involve falling and shaking. Some cause a person to stare blankly, stop responding, or make repetitive movements like lip-smacking or fumbling with their clothes. These are often called focal seizures, and they require a different response.
If the person seems unaware of their surroundings, gently guide them away from hazards like traffic, stairs, or sharp objects. Don’t grab or restrain them. Speak in a calm, reassuring voice. Once they start to come around, they may not realize anything happened. Let them know they’re safe and stay with them until they’ve fully recovered.
If the person remains conscious during the seizure but seems “off,” help them stop whatever activity they’re doing and sit down. Some people experience strange sensations, involuntary twitching on one side of the body, or brief confusion. These episodes usually pass quickly, but the person may still feel shaken afterward.
Seizures in Water
A seizure in a pool, bathtub, or any body of water is immediately life-threatening. Support the person’s head above the surface with their face tilted upward so they can breathe. Get them out of the water as quickly as possible. Call 911 even if they seem fine afterward, because water aspiration can cause complications that aren’t obvious right away.
Febrile Seizures in Children
Young children with high fevers sometimes have seizures, which can be terrifying for parents but are usually not dangerous. The approach is similar to adult seizures: protect the child from injury, move hard objects away, and cushion their head with a blanket or clothing (keeping it away from the nose and mouth). Do not restrain the child or put anything in their mouth.
After the seizure stops, place the child on their side with their head tilted slightly back to keep the airway open. Check that they’re breathing normally. You can give acetaminophen or ibuprofen once the child is awake and able to swallow, though fever reducers haven’t been shown to prevent further febrile seizures. They can help the child feel more comfortable.
Do not use ice baths, cold water, or rubbing alcohol to cool a child down. Rubbing alcohol is absorbed quickly through the skin and can cause alcohol poisoning. Cold water can cause shivering, which actually raises body temperature. If the child is awake and able to drink, offer cool water or juice.
Rescue Medication
Some people with epilepsy carry prescribed rescue medication for seizures that don’t stop on their own. The most common forms are nasal sprays and rectal gels. If someone has a seizure action plan that includes rescue medication, follow the instructions on the plan. Nasal rescue medications are delivered by spraying directly into one nostril while the person is on their back or side. The person may experience brief nasal irritation, but the medication works quickly to stop seizure activity. Only administer rescue medication if it has been prescribed for that specific person and you’ve been shown how to use it.
What to Record for Medical Follow-Up
What you observe before, during, and after a seizure is some of the most valuable information a doctor can get. The earliest moments of a seizure, including any warning signs or unusual behavior right before it started, give critical clues about where in the brain the seizure originated.
Try to note:
- What the person was doing when the seizure began
- Whether the shaking started on one side of the body or both
- How long the seizure lasted (not counting the recovery period)
- Whether the person could respond to their name or your voice afterward
- How long it took them to return to normal
- Any weakness, numbness, mood changes, or headache during recovery
Write these details down as soon as you can. If possible, use your phone to record video of the seizure. Memory of stressful events fades quickly, and the specifics you capture in the moment can shape diagnosis and treatment decisions later.
The Recovery Phase
After a seizure ends, the person enters a recovery period that can last anywhere from a few minutes to a couple of hours. In some cases, confusion or unusual behavior persists for up to a day or two. During this time, the person may not know where they are, may have trouble speaking, or may feel extremely tired. This is normal and typically resolves on its own with rest.
Stay with the person until they’re alert and oriented. If they want to sleep, let them. Keep the environment calm and quiet. Avoid bombarding them with questions right away. A simple “You had a seizure, you’re safe, I’m here” is often the most helpful thing you can say.