If someone near you is having a seizure, stay with them, move anything dangerous out of the way, and gently roll them onto their side. Most seizures end on their own within one to three minutes and don’t require emergency medical care. Your job as a bystander is to keep the person safe until it’s over, then help them recover. Knowing what to do (and what not to do) can prevent serious injury.
How to Recognize a Seizure
Not all seizures look like what you see in movies. The dramatic, full-body convulsions are called tonic-clonic seizures, where muscles stiffen and then jerk rhythmically. The person may cry out, lose consciousness, and fall to the ground. This is the type most people picture, and it’s the one that requires the most active first aid.
But seizures can also be subtle. Some cause a person to stare blankly into space, blink rapidly, or make repetitive chewing or hand movements. Others cause confusion, lip-smacking, or clothes-picking, and the person may not be able to respond to questions for several minutes. A person having one of these seizures might look dazed or “out of it” rather than in obvious physical distress. These focal seizures still require your attention and patience, even though they look less alarming.
Step-by-Step First Aid
For a convulsive seizure (the kind with stiffening, falling, or jerking), follow these steps:
- Ease them to the ground if they appear to be falling, and clear the space around them. Push away furniture, sharp objects, or anything they could strike.
- Place something soft and flat under their head, like a folded jacket or sweater, to cushion it against the floor.
- Turn them gently onto one side with their mouth pointing toward the ground. This keeps the airway clear so saliva or vomit can drain instead of being inhaled.
- Note the time. Check a clock or start a timer on your phone as soon as you can. The duration of the seizure is one of the most important details for medical professionals.
- Stay with them until the seizure ends and they are fully awake and aware.
For a non-convulsive seizure (staring, confusion, repetitive movements), you don’t need to move the person to the ground. Stay nearby, speak calmly, and gently guide them away from hazards like traffic, stairs, or hot surfaces. Don’t grab or shake them. Wait for it to pass.
What Not to Do
Two deeply ingrained instincts can actually cause harm during a seizure: putting something in the person’s mouth and holding them down.
A person cannot swallow their tongue during a seizure. Placing an object in their mouth, whether it’s a wallet, spoon, or stick, creates a real choking hazard. The jaw muscles can clamp down hard enough to break the object or crack teeth, sending fragments into the airway. Nothing should go in the mouth, ever.
Restraining someone mid-seizure is also dangerous. Holding their limbs down while muscles are contracting forcefully can dislocate a shoulder or cause other injuries. Let the seizure run its course. Your role is to protect the space around them, not to control their body.
When to Call 911
A seizure lasting 5 minutes or longer is a medical emergency called status epilepticus. It’s defined as either continuous seizure activity or repeated seizures without the person regaining consciousness in between. This is a life-threatening situation that requires immediate emergency medical help. If your timer hits 5 minutes, call 911 right away.
You should also call for emergency help if:
- The person has never had a seizure before (or you don’t know their history).
- They are injured during the seizure.
- They have difficulty breathing or don’t start breathing normally afterward.
- The seizure happens in water.
- They have a second seizure shortly after the first.
- They don’t return to their normal state within several minutes after the seizure stops.
If the Seizure Happens in Water
A seizure in a pool, bathtub, or any body of water is always an emergency. Support the person’s head above the surface with their face tilted up so they can breathe. Get them out of the water as quickly as possible. If they aren’t breathing once you’ve removed them, begin CPR immediately and call for an ambulance.
Even if the person seems fully recovered afterward, they need a medical evaluation. Inhaling even a small amount of water during a seizure can cause lung or heart complications that aren’t immediately obvious.
What to Do After the Seizure Stops
The minutes after a seizure, sometimes called the recovery phase, can be just as disorienting as the event itself. The person may feel confused, exhausted, or frightened. They might have a headache, feel nauseous, or not remember what happened. Some people need to sleep for hours afterward.
Keep them on their side until they’re fully alert. Speak calmly and let them know they’re safe and what happened. Don’t offer food or water until you’re sure they can swallow normally. They may need to rest for the remainder of the day and avoid anything mentally or physically demanding.
What to Track for Their Doctor
If you witness someone’s seizure, the details you remember can be extremely valuable to their medical team. Knowing what happens during a seizure and how often they occur are two of the most important pieces of information a doctor needs.
Try to note:
- What time the seizure started and how long it lasted.
- What the person was doing right before it began.
- Which body parts were affected: did jerking start on one side, did the whole body stiffen, did the eyes roll?
- Whether the person lost consciousness or seemed aware.
- How they behaved afterward (confused, sleepy, able to speak).
Recording a video on your phone, if you can do so without stepping away from the person, gives the doctor a firsthand look that descriptions alone can’t always capture.
Rescue Medications
Some people with epilepsy carry prescription rescue medications designed to stop a prolonged seizure or a cluster of seizures. These are typically nasal sprays or medications placed under the tongue, between the cheek and gum, or (for young children) administered rectally. If you’re a caregiver or family member, the person’s doctor should provide a written seizure action plan that specifies exactly when and how to give the medication.
If you’re a stranger witnessing a seizure, you won’t be expected to administer anything. Focus on the basic first aid steps, keep the person safe, and let emergency responders handle the rest.