What happens during a seizure may vary from one person to the next. The type of first aid needed during a seizure can be tailored to what happens during the seizure and the person's safety. It helps to think about seizures in relation to whether the person's alertness or awareness is affected, and if any physical movements occur that can place them at risk of injury.

Seizures Without Any Change in Awareness

Some people may remain fully awake and alert during a seizure and remember everything that occurs. For example, awareness is not affected during simple partial or myoclonic seizures. During these types of seizures, pay particular attention to the following:

• Usually you don’t need to do anything.
• Stay calm and reassure the person they are safe.
• If the person is frightened or anxious, encourage them to take slow deep breaths or do something that is calming or relaxing.
• Stay with the person until the seizure is over. Make sure that they are fully aware of what is going on before they are left alone.

Seizures with Altered Awareness

Sometimes people may look awake during a seizure, but they really are not aware of part or all of what is going on around them. They may not remember what happens during the seizure or have difficulty communicating during or after it. The person may walk around during the seizure, but not be in control of where they are going, and they may not be able to protect themselves. These seizure behaviors may be seen with complex partial seizures or clusters of absence seizures. During these episodes, in addition to basic first aid, pay particular attention to the following:

• If the person has a warning before they lose awareness, help them to a safe place.
• Stay with the person and don’t let them wander away. Let them walk in an enclosed area if possible.
• Keep the person away from sharp objects or dangerous places.
• If the person tries to run or is in a dangerous situation, call for help and hold them back if needed to keep them out of danger.
• Do not assume that they can talk or that they can hear you and follow instructions. Assure them they are safe and repeat instructions on what they should do next.
• Make sure that they are alert, oriented and safe after the event before they are left alone.
• Time the seizure – these types of seizures are usually longer than convulsions or tonic clonic seizures. It may be hard to tell when the seizure ended and when the recovery period begins and ends.
• If the seizure turns into a convulsive seizure, follow first aid steps for tonic-clonic seizures.

Seizures with Loss of Consciousness

Some types of seizures can affect a person’s awareness completely – they may be considered ‘unconscious’. They are not able to talk, are not aware of what is going on around them, and may not realize what occurred afterwards. If they have a warning at the start of the seizure, they may be able to get to a safe place – otherwise they are at risk for injury during and after the seizure. Follow the steps for care and comfort first aid with attention to the following:

• Watch how long the seizure lasts – call for emergency medical help if a generalized seizure lasts 5 minutes or longer.
• Protect the person from injury but don’t restrain their movements.
• Watch their breathing – turn them on the side to help keep the airway open. If breathing problems occur, call 911.
• Don’t put anything in their mouth.
• Know when to call for emergency help.
• Stay with the person after the seizure until they are aware and safe.

• Tonic clonic
• Atonic
• Absence
• Complex partial
• Simple partial
• Seizures in water
• Seizures on airplanes

Continue to Recording What Happens

Topic Editor: Steven C. Schachter, MD and Patricia O. Shafer, RN, MN.
Last Reviewed:5/25/07