If the person is known to you and you have access to their Epilepsy Management Plan (EMP) then follow any first aid advice provided in that document.

<link to first aid poster and epilepsy seizure video>

Tonic-clonic seizures

During a tonic-clonic seizure the person’s body stiffens and, if standing, they fall to the ground (tonic phase – stiffening of the muscles) followed by limbs jerking in strong, symmetrical, rhythmic movements (clonic phase – the shaking of the body). A person experiencing this type of seizure may produce excess saliva from the mouth, go blue in the face, lose control of their bladder and/or bowel, or bite their tongue and/or cheek (some blood may be noticeable in their saliva). The person may also create vocal noises as the muscles in the chest contract and the air rushes between their vocal cords.

Generally a tonic-clonic seizure lasts for one to three minutes, and the person often feels sleepy, confused or tired after the seizure has ended. If a tonic-clonic seizure lasts for more than 5 minutes, it is considered a medical emergency and an ambulance should be called.

DO:

  • Stay calm and remain with the person
  • Time the seizure if you can (if someone is nearby ask them to assist)
  • If they have food, fluid or vomit in their mouth roll them on to their side immediately
  • Protect them from injury by moving any hard objects away from the area
  • Protect them by placing something soft under their head and loosen any tight clothing
  • Gently roll the person onto their side as soon as possible and tilt their chin upwards to assist with breathing and to protect their airway
  • Stay with the person until the seizure ends naturally, and calmly talk to the person until they regain consciousness (usually a few minutes)
  • Reassure the person and let them know you will stay with them until they recover or until a paramedic arrives if an ambulance has been called
  • Keep onlookers away, as waking up to a crowd can be embarrassing or confusing for the person.

DO NOT:

  • Restrain the person’s movements, or move them, during the seizure (unless they are in danger)
  • Put anything in the person’s mouth
  • Give the person water, food or pills unless they are fully alert.

CALL AN AMBULANCE (000) IF:

  • The seizure lasts more than 5 minutes or a second seizure quickly follows
  • The person remains non-responsive for more than 5 minutes after the seizure stops
  • The person is injured or has swallowed water
  • The person is pregnant
  • You think this is the person’s first seizure, or aren’t sure
  • The person asks for medical assistance
  • You feel uncomfortable dealing with the situation.

Our Seizure First Aid video and the Seizure First Aid poster are useful in learning what to do in the event of a tonic-clonic seizure.

Focal impaired awareness seizures

During these seizures the person may appear confused and dazed, and may do strange and repetitive actions (such as fiddling with their clothes, making chewing movements with their mouth or uttering unusual sounds). These seizures used to be called ‘complex partial seizures’.

DO:

  • Gently guide the person past obstacles and away from dangerous places if required
  • Remove any harmful objects that could be nearby
  • Calmly talk to the person as they regain awareness and ask if they are OK
  • Reassure the person that they are safe and that you will stay with them while they recover or until a paramedic arrives if an ambulance has been called.

CALL AN AMBULANCE (000) IF:

  • If the seizure activity lasts for more than 5 minutes, as this may indicate the person is experiencing ‘non-convulsive status epilepticus’
  • The person is injured or has swallowed water
  • The person is pregnant
  • You think this is the person’s first seizure, or aren’t sure
  • The person asks for medical assistance
  • You feel uncomfortable dealing with the situation.

Focal aware seizures

During these seizures the person is aware and may experience feelings such as déjà vu, an unpleasant smell or taste, or sensations such as ‘butterflies’ or nausea. These seizures may also involve motor activity (such as involuntary and brief jerking of an arm or leg). These seizures used to be called ‘simple partial seizures’. Generally this type of seizure does not require first aid because the person maintains full awareness.

DO:

  • Gently assist the person to stop any activity they are doing
  • Assist the person to sit down (f they are not already seated)
  • Reassure the person that they are safe and that you will stay with them while they recover or until a paramedic arrives if an ambulance has been called.

CALL AN AMBULANCE (000) IF:

  • Generally further medical assistance is not required after a focal aware seizure
  • But, if the seizure appears in clusters, or progresses into a focal impaired awareness seizure or a convulsive one then more assistance may be required.

Tonic and Atonic seizures

Both tonic and atonic seizures can result in injuries. Tonic seizures cause the person’s body, arms and legs to become very stiff and rigid (tonic – stiffening of the muscles) and may cause a person to fall and injure themselves. Tonic seizures are usually brief, lasting around 20 seconds. Atonic seizures cause a sudden loss of muscle tone usually resulting in the person falling if they were standing. These seizures are sometimes referred to as ‘drop seizures’ or ‘drop attacks’.

DO:

  • Check to see whether the person has sustained an injury
  • Calmly talk with the person as they recover and ask if they are OK
  • Reassure the person that they are safe and that you will stay with them while they recover or until a paramedic arrives if an ambulance has been called.

CALL AN AMBULANCE (000) IF:

  • The person is injured or has swallowed water
  • The person is pregnant
  • You think this is the person’s first seizure, or aren’t sure
  • The person asks for medical assistance
  • You feel uncomfortable dealing with the situation.

Absence seizure

Absence seizures, more common in children and young adults, involve sudden brief episodes of staring with loss of awareness. Absence seizures can be so brief that a person experiencing one is mistakenly thought to be ‘day-dreaming’ or ‘zoning out’. These seizures used to be referred to as ‘petit mal seizures’.

DO:

  • Remove any harmful objects that could be nearby or in their hands
  • Calmly talk with the person as they regain awareness and ask if they are OK
  • Reassure the person that they are safe and that you will stay with them while they recover or until a paramedic arrives if an ambulance has been called.
  • If an ambulance is not required and the seizure has finished, help the person resume the activity they were doing before the seizure started.

CALL AN AMBULANCE (000) IF:

  • If the seizure activity lasts for more than 5 minutes, as this may indicate the person is experiencing ‘non-convulsive status epilepticus’
  • The person is injured or has swallowed water
  • The person is pregnant
  • You think this is the person’s first seizure, or aren’t sure
  • The person asks for medical assistance
  • You feel uncomfortable dealing with the situation.

Seizures from a seated position

If the person is in a wheelchair, car seat, seat or stroller consider the following first aid instructions.

DO:

  • Leave the person seated
  • Protect the person from falling if there is no seat belt (or remove the seatbelt if you think it will cause injury)
  • Make sure the wheelchair or the stroller is secure, by putting the brakes on.
  • Protect the person’s head by placing something soft under the head if there is no moulded headrest.
  • Lean the person slightly to one side and tilt their chin upwards to assist with breathing and to protect their airway
  • Stay with the person until the seizure ends naturally, and calmly talk to the person until they regain consciousness (usually a few minutes)
  • Reassure the person and let them know you will stay with them until they recover or until a paramedic arrives if an ambulance has been called
  • Keep onlookers away, as waking up to a crowd can be embarrassing or confusing for the person.

DO NOT:

  • Restrain the person’s movements, or move them, during the seizure (unless they are in danger)
  • Put anything in the person’s mouth
  • Give the person water, food or pills unless they are fully alert.

CALL AN AMBULANCE (000) IF:

  • The seizure lasts more than 5 minutes or a second seizure quickly follows
  • The person remains non-responsive for more than 5 minutes after the seizure stops
  • The person is injured or has swallowed water
  • The person is pregnant
  • You think this is the person’s first seizure, or aren’t sure
  • The person asks for medical assistance
  • You feel uncomfortable dealing with the situation.

Seizures in water

A seizure in water (pool, bath, ocean) is a life threatening emergency and an ambulance (000) should always be called as soon as possible. Even if a person is breathing after the seizure, they may have inhaled water and be at significant risk.

DO:

  • Support the person’s head so that their face and head stays above the surface
  • Tilt the person’s head back to ensure a clear airway
  • Remove the person from the water as soon as the active movements of the seizure have ceased.
  • Assistance from others or use of a floatation device may be useful when removing a person from water.
  • Gently roll the person onto their side as soon as possible and tilt the chin upwards to assist with breathing and to protect their airway
  • Follow the instructions of the ambulance operator, who will instruct you step-by-step while an ambulance is dispatched.
  • Even if the person appears to be fully recovered, they still require a medical assessment as inhaling water can cause lung or heart damage.
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