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Neurology

Managing seizures

  • First-aid management of seizures

    If you are a witness to person having any type of seizure you should use the following simple step by step instructions:

      Major seizures Minor seizures
      Convulsive seizures with major movement manifestations
    eg: tonic-clonic, tonic, myoclonic, atonic, and partial motor seizure    		 Seizures with staring, impaired consciousness or unusual behaviour e.g. complex partial seizures and absence seizures
    1 Stay calm Stay calm
    2 Check for medical identification Check for medical identification
    3 Protect the person from injury by removing harmful objects close to them. Loosen any tight clothing or restraints. Place something soft under their head. Protect the person from injury by removing harmful objects close to them
    4 Stay with the person and reassure them. Do not put anything in their mouth and do not restrain them. Stay with the person and reassure them
    5 Time the seizure Time the seizure
    6 When the seizure is over, roll the person onto their side to keep their airway clear If a tonic-clonic seizure develops, follow major seizure management
    7 Treat any injuries Stay with the person and reassure them, they may be sleepy, confused or combative after the seizure
    8 Consider if an ambulance needs to be called (see below)  
    9 Stay with the person and reassure them, they may be sleepy, confused or combative after the seizure  

    When to call an ambulance?

    It is not necessary to call an ambulance every time a seizure occurs in a person with known epilepsy. Most people who have epilepsy and have a seizure will recover without difficulty after a few minutes and may only need limited assistance. There are circumstances when an ambulance should be called by dialling 000 on the telephone and these are when:

    • The seizure lasts longer than 5-10 minutes
    • Another seizure quickly follows
    • The person remains unconscious after the seizures ceases
    • The person has been injured
    • You are about to administer diazepam or midazolam
    • You are unsure
    • The seizure happens in water
    • The person is pregnant or a diabetic
    • The person is not known to have epilepsy 

    General questions callers will be asked by the ambulance operator

    • What is the exact location of the emergency?
    • What is your contact phone number?
    • What is the problem? What exactly happened?
    • What is the age of the person needing the ambulance?
    • Is the person conscious?
    • Is the person breathing?

    Questions asked in an epilepsy emergency

    • Has the person had more than one fit?
    • Is she pregnant? (If female age 12-50)
    • Did the person hit their head before the fit?
    • Is the person diabetic or have a history of heart problems?
    • Is the person known to have epilepsy?
    • Has the jerking (twitching) stopped yet?
      (You go and check. I'll stay on the line)
    • Is the person breathing now?

    To assist the ambulance

    • Avoid third party calls. Whoever is with the person and has the most current, accurate information should speak to the operator.
    • Answer each question calmly, accurately.
    • Provide accurate location details - the nearest intersection is helpful.
    • Have someone wait outside.
    • Ring back on 000 if the person's condition changes.

    Administering emergency medication

    Some parents or carers may have received special instructions and training to give  rectal diazepam or intranasal/ buccal midazolam as an emergency treatment for their child's seizures. This emergency treatment and training only occurs after medical consultation.

    General measures

    We recommend that all persons with epilepsy or their parents or carers should consider developing an Action Plan in conjunction with their doctor. This plan will provide simple, easy to read instructions on what do if a seizure occurs and help to ensure consistent assistance and interventions from any carers.

    You can download an Epilepsy Management Plan EFV which should be filled in together with your doctor.

    Persons with epilepsy should consider wearing a medical ID (such as MedicAlert) bracelet or necklace and utilise a helmet if prone to frequent falling with seizures. You should always try to take medication as ordered, avoid trigger factors for seizures, recognise potential dangers and adapt the environment to reduce injury risks.

    Parents and carers should also consider undertaking a general first aid course which improves confidence in their own abilities to handle situations and may help others. A general first aid course is beneficial for providing assistance in many normal household emergency situations, not just seizure management.

    First-aid courses

    St John Ambulance (Victoria)