Seizure in front of you? Here’s what to do.

This is about the seizure where the person falls, stiffens and then jerks, the one people call a “fit” or “convulsion”.

1. Stay calm, and note when it started

   Look at a clock or start a timer on your phone. If someone is with you, ask them to film the seizure; that video helps the doctor more than any description.

2. Move danger away, not the person

   Move furniture, sharp objects and glass. Only move them if they’re in immediate danger: in the road, near fire, water or stairs.

3. Protect their head

   Put something soft under it: a jacket, a cushion, or your hand. Remove glasses, and loosen anything tight around the neck, such as a collar, headscarf or tie.

4. Let the jerking happen

   Holding their arms and legs down won’t stop the seizure, and it can break a bone or dislocate a shoulder.

5. When the jerking stops, turn them on their side

   On their side, head tilted slightly back, mouth pointing down. They may seem to stop breathing for a few seconds while stiff; this is expected. Rescue breaths usually aren’t needed, and breathing returns by itself.

6. Stay until they’re back to themselves

   Speak calmly, and tell them where they are and what happened. Look for a medical bracelet or card. Keep onlookers away; waking up in a crowd is embarrassing.

Some things people do with the best intentions cause real harm.

• put anything in their mouthNo spoon, stick, cloth, or your fingers. People cannot swallow their tongue; it isn’t anatomically possible. Things put in the mouth break teeth or snap and block the airway, and fingers can be bitten hard.
• wave onion or perfume under their noseIt doesn’t stop the seizure. The seizure ends by itself at the same moment, so the onion seems to have worked.
• put a key or metal in their handIt has nothing to do with the seizure, and can cut their hand while they jerk.
• splash water on them or put them in the showerWater doesn’t stop a seizure, and it can get into their lungs while they’re unconscious.
• give water, food or medicine by mouthNot until they’re fully awake and can swallow. Before that, anything in the mouth can go into the lungs.
• start CPR during the jerkingThe heart keeps beating during a seizure. CPR is only for someone who, after the seizure ends, isn’t breathing and doesn’t respond.

The person may stare into space, chew or fiddle with their clothes, or walk aimlessly, and not answer you. Then:

• Stay near and gently guide them away from danger: the road, stairs, the cooker.
• Don’t grip them hard or shout; they may resist without meaning to.
• Speak calmly until they’re back to themselves, and note how long it lasted.

Absence seizures in children, a few seconds of staring before carrying on as if nothing happened, don’t need an ambulance, but they do need a doctor if they haven’t been diagnosed.

After a seizure it is normal to be confused or very sleepy, to have a headache or aching muscles, to have bitten the tongue or wet oneself. All of this is expected, and it can last from minutes to hours.

Rescue medicine

Some people have a medicine prescribed for long seizures, such as midazolam given in the mouth or nose. Give it only if it has been prescribed for this person, following their doctor’s plan, usually at five minutes. If you give it, call an ambulance and tell them.

What the doctor needs to know

The person usually doesn’t remember the seizure, so your account is what counts:

• What they were doing just before, and whether they said they felt strange.
• How it began: on one side of the body? Did their eyes or head turn to one side?
• How long it lasted, and how long they took to come round.
• The video, if there is one. A minute of footage can change the diagnosis.