What do I do if someone has a seizure?
Protect the head, move the danger rather than the person, time it, and turn them on their side afterwards. What not to do, and the six circumstances that mean 999.
- Difficulty
- beginner
- Time
- 7 min
- Read
- 4 min
- Safety
- warning
Short answer
Do not restrain them and do not put anything in their mouth. Move dangerous things out of the way rather than moving the person, cushion their head, loosen anything tight at the neck, and note the time it starts and stops. When the convulsions stop, turn them on their side and stay with them until they recover. Ring 999 if it is a first seizure, lasts over five minutes, repeats without recovery, causes serious injury, or leaves them struggling to breathe.
Watching a seizure is frightening and almost every instinct it provokes is the wrong one. There is very little to do, and knowing that is most of the skill: you are protecting them from the surroundings and timing it, not stopping it.
Safety
Step by step
- Note the time it starts.This is the most useful thing you will do. Five minutes is the threshold in the guidance, and five minutes watching a seizure feels like twenty. Look at a clock.
- Move the hazard, not the person.NHS advice is to move them only if they are in danger, such as near a busy road or a hot cooker. Otherwise clear furniture and hard objects away from them instead.
- Cushion their head.If they are on the ground, put something soft under the head — a folded coat is ideal. Repeated impact on a hard floor is the commonest injury from a seizure.
- Loosen anything tight at the neck.A collar, a tie, a scarf. It helps their breathing and it costs nothing.
- Do not restrain them and do not put anything in their mouth.Holding someone down during a seizure causes injuries to both of you. Putting anything in the mouth — including fingers — risks broken teeth, a blocked airway and a serious bite. Nobody swallows their tongue.
- When the convulsions stop, turn them on their side.The recovery position, with the airway open. Afterwards they will often be drowsy, confused and not themselves for a while, and that is expected.
- Stay and talk to them calmly until they recover.They may not know where they are or what has happened. Say who you are, where they are, and that they have had a seizure. Do not give food or drink until they are fully recovered.
- Know the six reasons to ring 999.It is their first seizure. It lasts longer than is usual for them. It lasts more than five minutes if you do not know their usual. They do not regain full consciousness, or have several seizures without regaining consciousness between them. They are seriously injured. They have difficulty breathing afterwards.
Tips
- People with known epilepsy often carry a card or wear a bracelet describing what their seizures are like and what to do. Look for one — it may say their seizures typically last a certain time.
- Recording the seizure on a phone feels intrusive and is genuinely useful to a neurologist, particularly for a first seizure. Ask afterwards whether they mind you keeping it.
- Clear the area of onlookers as far as you can. Coming round surrounded by a crowd is distressing and people are often incontinent during a seizure.
Common mistakes
- Trying to hold them still — It does not shorten the seizure and it causes injury — dislocated shoulders and broken bones are documented consequences of restraint.
- Putting something between the teeth — It is a persistent myth. It breaks teeth, can obstruct the airway, and gets the helper's fingers bitten badly. The tongue cannot be swallowed.
- Giving them a drink as soon as it stops — They are not able to protect their airway while drowsy and confused. Nothing by mouth until they are properly recovered.
- Assuming a known epileptic never needs an ambulance — A seizure longer than usual for that person, or one that repeats without recovery, is an emergency regardless of diagnosis.
If it doesn't work
The seizure has lasted more than five minutes
Cause: A prolonged seizure, which is a medical emergency — Fix: Ring 999 now. Do not wait to see whether it stops on its own; this is the specific threshold in the guidance.
A second seizure begins before they have come round from the first
Cause: Repeated seizures without recovery — Fix: Ring 999. This is on the list regardless of whether the person has known epilepsy.
They are confused and agitated afterwards
Cause: The normal recovery phase after a seizure — Fix: Stay calm, speak quietly, and do not restrain them. Confusion and even aggression during recovery are recognised and they pass. Keep them safe rather than trying to control them.
Questions people ask
What if it is a child with a fever?
Febrile seizures in young children are relatively common and frightening. The same handling applies — protect the head, do not restrain, turn them on their side afterwards. NHS advice is to ring 999 for a first febrile seizure, one lasting more than five minutes, or a child who does not recover properly.
Should I call 999 for someone with known epilepsy?
Not automatically. Someone with epilepsy having their usual kind of seizure, recovering as they normally do, does not necessarily need an ambulance. The six criteria above are what change that.
Do they need to be seen after a first seizure?
Yes. A first seizure needs medical assessment, and NHS advice is to call an ambulance for it. There are also driving implications that have to be reported to the DVLA.