For all seizures, your primary objective is to ensure the safety and well-being of the individual until they regain full function. It’s crucial to observe and document the sequence of events before, during, and after the seizure promptly. This information is invaluable for updating the seizure management plan with your healthcare team or at the health unit. Keep in mind that not all seizures manifest with convulsions, and some may be challenging to identify. Most seizures typically last under five minutes and do not constitute medical emergencies, except for Status Epilepticus.

Status Epilepticus constitutes any seizure lasting more than five minutes or recurring without complete recovery in between episodes. It’s a life-threatening emergency that requires immediate medical attention—call an ambulance promptly. Note that Status Epilepticus can occur with various types of seizures, not exclusively tonic-clonic.

If you or someone you care for is susceptible to prolonged or repeated seizures, emergency medications prescribed by a neurologist, such as rectal gel (Diastat) or orally administered Lorazepam (Ativan), can be administered at home.

First Aid for Tonic-Clonic Seizures:

  1. Stay Calm: Maintain composure to provide effective assistance.
  2. Ease Onto the Floor: Gently guide the person to the ground to prevent falls and injuries. (If they are in a wheelchair: Lock the wheelchair brakes to prevent it from moving during the seizure. This will help to keep the individual secure and stable. Reclining the wheelchair during a seizure can be a helpful measure to reduce the risk of injury and provide more stability for the individual.) 
  3. Check for Medical Alert Identification: Look for any medical identification that may provide additional information about the person’s condition, including specific seizure triggers or emergency contacts.
  4. Clear Airway: Position the person on their side to keep the airway open. If seated, gently turn their head to the side. Avoid moving them from a wheelchair.
  5. Do Not Insert Anything into the Mouth: Refrain from placing objects in the person’s mouth, as this can cause harm. They may bite their tongue but will not swallow it.
  6. Loosen Clothing: Remove any restrictive clothing, including neckwear and glasses, to prevent constriction or injury during convulsions.
  7. Cushion the Head: Place something soft under the person’s head to prevent injury, such as a folded jacket or cushion.
  8. Remove Hazards: Clear the surrounding area of any objects that could cause harm during convulsions, such as sharp furniture edges or hot appliances.
  9. Avoid Restraining: Refrain from restraining the person, as it could lead to muscle tears or fractures. Allow the seizure to run its course.
  10. Reassure and Support: Provide reassurance and comfort to the person after the seizure subsides. Offer emotional support and assistance as needed.
  11. Fluid Intake: Do not offer fluids until the person is fully conscious to prevent choking or aspiration.
  12. Assistance with Transportation: Offer assistance in arranging safe transportation home if needed, ensuring the person’s continued safety.
  13. Avoid Artificial Respiration: Unless trained and necessary, refrain from performing artificial respiration, as the person’s breathing typically returns to normal after the seizure.

First Aid for Focal Dyscognitive Seizures:

  1. Guide Away from Danger: Gently redirect the person away from any potential hazards to prevent injury.
  2. Speak Calmly and Reassuringly: Use a calm and reassuring tone to communicate with the person until consciousness is restored. Avoid sudden movements or loud noises that may exacerbate confusion.
  3. Assist with Transportation: Help the person safely reach their destination if they are disoriented or require support navigating their surroundings.

Seizure types such as absence, atonic, focal with retained awareness, myoclonic, and infantile spasms generally do not require immediate first aid intervention unless they exceed five minutes in duration or pose a risk to the person’s safety.

Following any seizure episode, it is advisable to schedule a follow-up evaluation with healthcare providers or at the health unit to review the incident, assess any potential triggers or complications, and adjust the management plan accordingly. Regular communication with the healthcare team is essential for optimizing seizure management and ensuring the individual’s overall well-being.

An ambulance should be called under the following conditions:

  • Status Epilepticus: Any seizure lasting longer than five minutes or recurring without complete recovery in between episodes.
  • First-time seizure or unknown seizure history of the individual.
  • Prolonged confusion lasting more than one hour following the seizure.
  • Seizure occurring in a water environment.
  • Failure to restore normal breathing and consciousness after the seizure episode.
  • The person affected is pregnant, diabetic, or has sustained injuries during the seizure.

Information for the ambulance attendant:

When the ambulance arrives, you should be prepared to provide comprehensive details about the patient’s condition:

  1. Level of Consciousness: Assess the person’s level of awareness, whether fully conscious, semi-conscious, or unconscious.
  2. Changes in Breathing: Report any alterations in the individual’s breathing pattern, including irregularities, shallow breathing, or difficulty breathing.
  3. Duration of Seizure: Provide specifics regarding the onset and duration of the seizure episode.
  4. Description of Seizure Event: Offer a detailed account of the seizure activity, including any convulsions, movements, or unusual behaviors observed.
  5. Injuries Sustained: Describe any injuries sustained by the individual during the seizure, such as bruises, cuts, or head trauma.