First Aid for Seizures: Positioning, Protection, and Calling Emergency Services

A seizure in a public space, at work, or at home often triggers panic among bystanders. The affected person jerks uncontrollably, doesn't respond when spoken to, and foam may appear at the mouth. In moments like these, calm and correct action determines whether the person gets through the seizure safely – or whether well-intentioned but wrong measures cause additional harm. Because hardly any emergency scenario is surrounded by as many persistent myths as the seizure. This article gives you a clear, evidence-based step-by-step guide and debunks dangerous misconceptions.

What Happens During a Seizure?

A seizure – medically referred to as an epileptic seizure or cerebral convulsion – is caused by a sudden, uncontrolled electrical discharge of neurons in the brain. Depending on which brain regions are affected, the seizure manifests differently:

• Generalized tonic-clonic seizure (grand mal): The classic form with loss of consciousness, stiffening of the entire body (tonic phase) followed by rhythmic jerking (clonic phase). Often accompanied by tongue biting, excessive salivation, and involuntary urination.
• Focal seizure with impaired awareness: The person appears absent, performs automatic movements (lip smacking, fumbling, wandering around) but does not respond appropriately when spoken to.
• Absence seizures: Brief lapses of consciousness lasting a few seconds, common in children. The person stares blankly and then resumes their activity as if nothing happened.

Not every seizure means the person has epilepsy. Triggers can also include fever (especially in children), hypoglycemia, alcohol withdrawal, electrolyte imbalances, traumatic brain injuries, or poisoning. For first aid purposes, the cause is initially irrelevant – the immediate measures are fundamentally the same.

The Most Dangerous Myths – And Why You Should Forget Them

Before we get to the actual step-by-step guide, we need to address three particularly persistent and dangerous myths. These misconceptions have persisted for decades and repeatedly lead to injuries – not from the seizure itself, but from incorrect first aid.

Myth 1: "You need to put something between their teeth"

This is probably the most widespread and dangerous misconception. The idea that the affected person could "swallow" or "bite off" their tongue leads first responders to shove pens, spoons, wallets, or even their own fingers into the mouth of the seizing person. The reality: It is anatomically impossible to swallow your own tongue. The tongue is attached to the floor of the mouth. A tongue bite can occur – usually on the side and typically harmless. Attempting to pry open the jaw or insert objects, however, causes broken teeth, jaw injuries, lacerations inside the mouth, and bite wounds to the helper's fingers. Never insert anything into the mouth of a person having a seizure.

Myth 2: "You need to hold the person down"

During a generalized seizure, the muscles generate enormous forces. Attempting to suppress the jerking or hold the person down on the ground leads to fractures, dislocations, and soft tissue injuries – both for the affected person and for you. The convulsions cannot be stopped by restraining the person. Never forcibly restrain a person having a seizure.

Myth 3: "Start mouth-to-mouth resuscitation immediately"

During a seizure, breathing may briefly stop or become irregular. Bluish discoloration of the lips (cyanosis) is common and understandably causes fear among bystanders. Nevertheless, ventilation during active convulsions is neither possible nor necessary. Breathing typically resumes spontaneously after the seizure ends. Only if normal breathing is absent after the seizure do you intervene – and then with the full resuscitation algorithm.

Step-by-Step Guide: How to Help Correctly

Step 1: Stay Calm and Secure the Surroundings

This first point sounds trivial but is the most important. Your calm demeanor transfers to bystanders and enables you to think clearly.

• Check the time: Note the time or start the stopwatch on your phone. The duration of the seizure is critical information for the emergency medical services.
• Remove hazards: Push furniture, glasses, sharp-edged objects, and hard items away from the immediate vicinity of the affected person.
• Do not reposition: Only move the person from their position if there is immediate danger (traffic, edge of stairs, water).

Step 2: Protect the Head

The head is particularly vulnerable during convulsions. Repeated impact on a hard floor can lead to traumatic brain injuries.

• Place something soft under the head: a folded jacket, a sweater, a pillow, a blanket – whatever is available.
• If nothing is at hand: kneel down and cushion the head with your hands or thighs – without actively restricting movement.

Step 3: Loosen Restrictive Clothing

If possible without using force:

• Loosen tie, scarf, or neckerchief
• Open shirt collar or tight jacket
• Loosen belt

This facilitates breathing and reduces the risk of injury from pressure on the neck and thorax.

Step 4: Wait – And Do Not Interrupt the Seizure

Now comes the most difficult part for many first responders: You have to let the seizure run its course. The overactive neurons need to exhaust themselves. In the vast majority of cases, this takes one to three minutes, even though it subjectively feels much longer.

During the seizure:

• Do not hold or restrain the person
• Do not insert anything into the mouth
• Do not try to shake the person awake or shout at them
• Do not try to administer fluids
• Keep onlookers at a distance – protect the dignity of the affected person

Step 5: After the Seizure – Recovery Position

When the convulsions stop, the so-called postictal phase begins. The person has an altered level of consciousness, is confused, drowsy, and responds slowly or not at all. Now your active intervention is needed:

1. Check the airway: Gently tilt the head back and lift the chin. Is breathing present? Can you see chest movements, hear or feel breath?
2. Recovery position: Carefully turn the person onto their side. This allows saliva, blood (from a tongue bite), or vomit to drain from the mouth and prevents aspiration.
3. Check the oral cavity: Only now – when the seizure is over and jaw muscle tone decreases – can you carefully remove visible foreign bodies, loose dentures, or larger amounts of blood from the mouth.
4. Maintain warmth: Cover the person. After a seizure, the body cools down quickly.
5. Speak calmly: When the person slowly regains consciousness, speak to them calmly and provide orientation: "You are safe. You had a seizure. I'm staying with you."

Step 6: Monitor Until Full Recovery

Postictal confusion can last a few minutes or over an hour. Stay with the person. Do not let them stand up or walk away alone until they are fully oriented. Some individuals may become restless or even aggressive during this phase – this is not personal but an expression of brain dysfunction.

When Should You Call Emergency Services (144)?

Not every seizure necessarily requires emergency medical services. Many people with known epilepsy have an individual emergency plan and often carry an emergency ID card or medical bracelet. However, there are clear situations in which you should always call 144:

• First-time seizure: The person has never had a seizure before, to their own or others' knowledge.
• Seizure duration over five minutes: A seizure lasting more than five minutes is considered status epilepticus and is a life-threatening emergency.
• No awakening after the seizure: The person does not regain consciousness even after several minutes.
• Seizure clusters: Multiple seizures in succession without the person fully regaining consciousness in between.
• Injuries: Visible head injuries, bleeding, suspected fractures.
• Seizure in water: Even if the person feels fine after the seizure – always call emergency services.
• Pregnancy: A seizure during pregnancy may indicate eclampsia and is always an emergency.
• Pre-existing conditions: The person is diabetic, has heart disease, or has recently sustained a traumatic brain injury to your knowledge.
• Uncertainty: When in doubt, always call emergency services. Better one call too many than one too few.

What to Tell the Emergency Services

When you call 144, the following information is particularly valuable:

• Where are you? (Address, floor, notable landmarks)
• What happened? (Person is having a seizure)
• How long has the seizure been going on?
• What did the seizure look like? (Whole body or only one side? Jerking or stiffening?)
• Who is affected? (Estimated age, known epilepsy, other pre-existing conditions if known)
• Consciousness: Is the person responsive? Are they breathing?

Special Situations

Seizure While Sitting on a Chair or in a Wheelchair

Do not try to move the person to the floor while the seizure is active. Instead, support the upper body to prevent the person from sliding off the chair, and cushion the head. Lock the wheelchair brakes. Only after the seizure, place the person in the recovery position on the floor.

Seizure in Children with Fever (Febrile Seizure)

Febrile seizures affect approximately three to five percent of all children between the ages of six months and six years. They look dramatic but are generally harmless. The same basic principles apply: secure the surroundings, protect the head, let the seizure run its course, then place in the recovery position. Always call emergency services for a first-time febrile seizure. Do not submerge the child in cold water or rub them with ice cubes.

Seizure in Water

Rescue the person from the water immediately – mind your own safety. Even if the person feels fine after the seizure, medical evaluation is absolutely necessary. There is a risk of secondary drowning from aspirated water.

What You Can Do for the Affected Person AFTER the Seizure

When the person regains consciousness, they are often exhausted, embarrassed, and disoriented. Your behavior in these minutes makes a big difference:

• Protect their privacy: Keep onlookers away. If involuntary urination has occurred, discreetly cover the person with a jacket or blanket.
• No blame, no probing questions: Questions like "Are you taking your medication?" or "Why don't you have an ID card with you?" are inappropriate in an acute situation.
• Provide orientation: Tell the person where they are, what happened, and that they are safe.
• Offer to stay: Offer to call someone, or stay until the person gets home safely.

Key Points at a Glance

DO THIS	DON'T DO THIS
Stay calm	Spread panic
Document time/duration	Hold the person down
Remove hazards	Put anything in the mouth
Cushion the head	Forcibly open the jaw
Loosen restrictive clothing	Administer fluids
Let the seizure run its course	Shake the person awake
Recovery position afterwards	Ventilate during the seizure
Call 144 if needed	Leave the person alone

Practical Training

First aid for a seizure is more than theoretical knowledge – it's about confidence in action at a moment when stress and uncertainty impair clear thinking. In the first aid course by Simulation Tirol, you train exactly these scenarios hands-on: from recognizing the situation, to correct positioning, to making a structured emergency call. Under the guidance of experienced instructors, you practice with realistic simulations so that in a real emergency, you don't have to think – you can act. All content is based on the guidelines of the American Heart Association and is taught in small groups. More information is available at simulation.tirol.