The most important thing you can do when someone is having a grand mal seizure is stay calm, protect them from injury, and let the seizure run its course. Most grand mal seizures end on their own within one to two minutes. Your job isn’t to stop the seizure. It’s to keep the person safe until it passes, then stay with them as they recover.
What You’re Seeing
A grand mal seizure, now called a tonic-clonic seizure, happens in two visible stages. The first stage is a sudden stiffening of the entire body. The person may let out a groan or cry, lose consciousness, and fall. This stiffening phase typically lasts 10 to 20 seconds. Then the second stage begins: rhythmic jerking of the arms and legs, alternately flexing and relaxing. These convulsions usually last one to two minutes. Knowing this timeline helps, because it means you can start timing the seizure from the moment it begins and know roughly what to expect.
Step-by-Step First Aid
As soon as you recognize what’s happening, take these steps in order:
- Ease them to the ground if they’re standing or sitting in a chair. This prevents a fall injury.
- Clear the area around them. Push away furniture, sharp objects, anything they could strike during convulsions.
- Put something soft under their head. A folded jacket, a bag, even your hands will help protect their skull from hitting the ground repeatedly.
- Turn them gently onto one side with their mouth angled toward the ground. This keeps saliva and any fluids from blocking their airway.
- Remove glasses and loosen anything tight around the neck, like a tie, scarf, or buttoned collar.
- Start timing. Check a clock or start your phone’s stopwatch. The duration matters more than almost anything else you can do.
- Check for a medical ID bracelet or necklace that may list their condition, medications, or emergency contacts.
Stay with the person the entire time. Don’t leave to get help unless you can send someone else. Your calm presence is one of the most useful things you can offer, both during the seizure and in the confusion that follows.
What Not to Do
There are a few instinctive reactions that actually make things worse. The biggest one: do not put anything in the person’s mouth. Not a wallet, not a spoon, not your fingers. The old belief that someone can swallow their tongue during a seizure is a myth. The tongue is anchored to the floor of the mouth and cannot be swallowed. Forcing an object between clenched teeth can break teeth, cut gums, or cause choking.
Do not try to hold the person down or restrain their movements. Their muscles are contracting with enormous force, and fighting against that can injure both of you. Don’t attempt CPR during the seizure itself. The person’s breathing may look irregular or pause briefly, but it will typically resume once the convulsions stop. Don’t offer water or food until they’re fully alert.
When to Call 911
If the seizure lasts five minutes or longer, call 911 immediately. A seizure that continues past five minutes is classified as a medical emergency called status epilepticus, which can cause serious harm if not treated. This is why timing matters so much. Five minutes feels like an eternity when you’re watching someone convulse, so trust the clock, not your gut feeling.
You should also call 911 if:
- The person has never had a seizure before (or you don’t know their history)
- They are pregnant
- They are in water
- They are injured during the seizure
- They have trouble breathing after the seizure ends
- A second seizure follows closely without the person regaining consciousness between them
- They have diabetes or another known medical condition
What Happens After the Seizure Ends
When the convulsions stop, the person enters a recovery phase that can look almost as alarming as the seizure itself. They may be unconscious or extremely drowsy. They’re often confused, disoriented, or unable to speak clearly. Some people feel nauseated, have a headache, or become emotional. This is all normal and expected.
Keep them on their side in a recovery position. An unresponsive person lying on their back risks choking on saliva or vomit, so the side-lying position protects their airway until they’re fully awake. Stay with them and speak calmly. Don’t bombard them with questions. Let them know who you are, where they are, and that they had a seizure. Many people have no memory of the event and will be disoriented for minutes to hours afterward.
Don’t offer food or drink until they can sit up and respond clearly. Let them rest as long as they need to. If they want to sleep, that’s fine, but keep monitoring their breathing.
What to Write Down for Their Doctor
If this person will be seeing a doctor afterward, the observations you made are incredibly valuable. Medical professionals rely on bystander accounts because the person who had the seizure usually remembers nothing. Try to note:
- The time the seizure started and how long it lasted
- What the person was doing right before it began
- Which part of the body moved first, and whether movements spread
- Whether the body went stiff before jerking started
- Any skin color changes (flushing, turning blue around the lips, clamminess)
- Whether the eyes rolled or the eyelids fluttered
- Any sounds they made, or any actions they performed
- How long it took them to become alert and responsive afterward
You won’t catch every detail, and that’s okay. Even a rough timeline and a general description of what you saw gives a neurologist far more to work with than no information at all. If you can, recording video on your phone (after ensuring the person is safe) provides the clearest possible picture for their medical team.