What Should You Do If Someone Has a Seizure? A First Aid Guide

If someone has a seizure, stay calm, time it, cushion their head, move dangerous objects away from them, and do not hold them down or put anything in their mouth. Once the jerking stops, roll them onto their side and stay with them until they have fully recovered. What many people do not realise is that most seizures stop on their own within a few minutes and do not need an ambulance. The NHS says to call 999 if it is someone’s first seizure, if it lasts longer than usual for them (or more than 5 minutes if you do not know), if they are seriously injured, have difficulty breathing, or do not regain full consciousness.

At a glance: Nexis CPD’s £9 Epilepsy Awareness course covers seizure types, first aid and supporting people with epilepsy. It is CPD accredited and 100% online with a verifiable e-certificate, and any three courses cost £18. It is awareness training: it does not qualify you to give rescue medication such as buccal midazolam, which needs practical, person-specific training.

What should you do if someone has a seizure?

The NHS guidance on what to do if someone has a seizure is short and practical. The charity Epilepsy Society sums up its basic first aid message for someone you do not know in three words: Calm, Cushion, Call. In practice, for a seizure where the person falls, stiffens and jerks (a tonic-clonic seizure), the steps are:

1. Stay calm and note the time. Check the time the seizure starts and finishes. Timing decides whether this is an emergency.
2. Only move them if they are in danger, such as near a busy road or a hot cooker. Otherwise move furniture and other hard objects away from them instead.
3. Cushion their head. Put something soft, such as a folded jumper, under their head, or cup their head in your hands to stop it hitting the floor.
4. Loosen anything tight around the neck, such as a collar or tie, to help breathing.
5. Look for medical ID such as a bracelet or card. It may tell you the person has epilepsy and what to do.
6. Keep onlookers back so the person is not crowded.
7. When the jerking stops, roll them onto their side into the recovery position and check their breathing.
8. Stay with them and talk calmly until they have fully recovered.

Epilepsy Society notes that although a tonic-clonic seizure can be frightening to see, it “is not usually a medical emergency”, and that once the movements stop the person usually recovers and their breathing returns to normal.

What should you never do during a seizure?

Most of the harm done at seizures comes from well-meaning bystanders acting on myths. Both the NHS and Epilepsy Society are clear on what not to do:

• Do not put anything in their mouth — not a spoon, not a wallet, not your fingers. Epilepsy Society puts it plainly: “they will not swallow their tongue.” Forcing something between their teeth risks damaging teeth and injuring your fingers.
• Do not hold them down or try to stop the movements. Epilepsy Society’s advice is to “allow the seizure to happen”.
• Do not move them unless they are in immediate danger.
• Do not give them anything to eat or drink until they have fully recovered.
• Do not try to “bring them round” by shaking them, shouting or splashing water on them.

When should you call 999 for a seizure?

The NHS says to call 999 and ask for an ambulance if:

• it is the first time the person has had a seizure;
• the seizure lasts longer than is usual for them;
• the seizure lasts more than 5 minutes, if you do not know how long their seizures usually last;
• the person does not regain full consciousness, or has several seizures without regaining consciousness;
• the person is seriously injured during the seizure;
• the person has difficulty breathing after the seizure.

The NHS epilepsy page adds one more trigger: if the person has had 3 or more seizures in 24 hours. This matches NICE’s epilepsy guideline (NG217), which says repeated or cluster seizures — “typically 3 or more self-terminating seizures in 24 hours” — should be managed as a medical emergency.

Equally important is when you do not need to call. The NHS says people with epilepsy “do not always need an ambulance or to go to hospital every time they have a seizure”. They usually have a care plan that says what to do, and “if you know what to do and have been trained then you can follow their care plan.”

Why 5 minutes — and why “2 minutes longer than usual” matters too

The 5-minute figure comes from the definition of status epilepticus. NICE’s recommendations on status epilepticus and prolonged seizures define convulsive status epilepticus as “seizures lasting 5 minutes or more” and call for resuscitation and immediate emergency treatment. NICE notes that status used to be defined as 30 minutes.

For someone whose usual seizure pattern is known, the trigger can come sooner. NICE defines a prolonged convulsive seizure as one that “continues for more than 2 minutes longer than a person’s usual seizure” and says it should be managed as a medical emergency. Epilepsy Society’s ambulance list likewise includes a seizure that “lasts two minutes longer than is usual for them”. So if a resident’s seizures normally last one minute and this one is still going at three, do not wait for the 5-minute mark — follow their plan.

What are the different types of seizure, and how do you help?

Not every seizure involves falling and jerking. The NHS lists symptoms ranging from stiffness and jerking to staring into space, strange smells or tingling, and “walking around and not being aware of what you’re doing”. Using the NHS’s categories and Epilepsy Society’s first aid advice:

• Tonic-clonic seizures. The person loses consciousness, may fall, goes stiff and then jerks. Their breathing may be affected and they may go pale or blue around the mouth, and may bite their tongue or cheek. Use the full first aid steps above.
• Focal seizures with preserved awareness. The person is conscious and may notice an odd smell or taste, twitching in a hand, a rising feeling in the stomach, or sudden fear. Reassure them.
• Focal seizures with impaired awareness. The person may wander, pick at clothing, make chewing movements or behave strangely, and may be confused afterwards. Guide them gently away from danger, speak calmly, and do not restrain them.
• Absence seizures. A brief loss of awareness — the person looks blank and stares. Stay with them and keep them away from danger.
• Tonic and atonic seizures. Muscles suddenly go stiff (tonic) or floppy (atonic, sometimes called a “drop attack”), often causing a fall. They are brief. Check for injuries; a head or face injury may need medical help.
• Myoclonic seizures. Brief muscle jerks, often shortly after waking and sometimes in clusters. Epilepsy Society says you don’t need to do anything other than check the person has not hurt themselves.

How do you put someone in the recovery position after a seizure?

Do not try to roll someone while they are still convulsing. The NHS says to turn them onto their side after the convulsions stop, and links to St John Ambulance’s step-by-step recovery position guide.

After a tonic-clonic seizure, Epilepsy Society advises:

• if their breathing sounds difficult or noisy, gently open their mouth to check nothing is blocking the airway;
• wipe away any spit from their mouth;
• “try to minimise any embarrassment” — if they have wet themselves, deal with it as privately as possible, for example by putting a coat over them;
• stay with them until they have completely recovered, offering gentle reassurance.

Recovery takes time: Epilepsy Society says people often want to sleep and “may not feel back to normal for several hours or sometimes days”.

Screening the person from onlookers and speaking to them by name as they come round are part of good first aid — see our guide to dignity in care.

What should you record after someone has a seizure?

A clear eyewitness account is one of the most valuable things a doctor or epilepsy nurse can receive, because the person having the seizure often cannot remember it. The NHS suggests noting what they were doing beforehand and any warning sensations or mood change; whether they lost awareness; any colour change (on brown or black skin it may be easier to see on the palms, soles, lips, gums and inside the eyelids); which parts of the body stiffened or jerked; any change in breathing; how long it lasted; whether they lost bladder or bowel control or bit their tongue; and how they were afterwards, including how long they slept.

In care homes and supported living, this goes into a seizure chart or diary that the person’s GP, neurologist or epilepsy specialist nurse can review. The NHS recommends seizure diaries because they help identify triggers such as tiredness, stress, periods, flashing lights, food or drink.

What should an epilepsy care plan include?

NICE’s guideline says people with epilepsy, and their family or carers where appropriate, should be given a copy of their care plan, “which includes details of their care and support as discussed and agreed” with them (recommendation 2.1.7).

For anyone at risk of prolonged or repeated seizures, NICE also recommends an individualised emergency management plan. In explaining its status epilepticus recommendations, the NICE committee says the plan “should include details of any emergency medicine that has been prescribed, who is trained to use it and when to give it”. NICE recommends agreeing a plan after any episode of status epilepticus, prolonged seizure or cluster of seizures if the person does not already have one and there is concern it may happen again.

In practice, a good seizure plan in a care setting usually answers these questions:

• What do this person’s seizures look like, and how long do they usually last?
• Are there known triggers or warning signs?
• What first aid do they want — for example, do they prefer to be left to sleep afterwards?
• Is rescue medication prescribed? If so, which one, what dose, at what point, and can a second dose be given?
• When exactly should staff call 999?
• Which staff are trained to follow the plan, and when does that training need refreshing?

The person should be involved in writing their plan as far as possible. NICE asks for information in formats such as easy read or large print for people with a learning disability or other complex needs — see our guide to person-centred care.

Can care workers give rescue medication such as buccal midazolam?

Yes — but only if they have been trained, and only in line with the person’s written plan. NICE NG217 says that if someone in convulsive status epilepticus “has an individualised emergency management plan that is immediately available, administer medication as detailed in the plan” (recommendation 7.1.2). Where there is no plan to hand, NICE recommends giving a benzodiazepine — buccal midazolam or rectal diazepam — immediately as first-line treatment in the community (7.1.3). NICE says buccal midazolam should remain the first choice in the community, with rectal diazepam as an alternative.

If the seizure does not respond to the first dose, NICE says to “call emergency services in the community” (7.1.7) and to keep following the person’s plan, or give a second dose if the seizure has not stopped within 5 to 10 minutes of the first (7.1.8).

On who may give it, the charities are unequivocal. Epilepsy Society says “carers need training in giving emergency medication” and that the person should have their own written protocol about when to give it. Epilepsy Action says rescue medicine “should only be given by someone who has been trained”. Buccal midazolam is given by syringe between the gum and cheek; both it and rectal diazepam are sedatives, and Epilepsy Action notes that they can rarely cause breathing problems, so the person needs to be watched closely afterwards.

For registered care services in England, this also sits within CQC’s Regulation 12 (safe care and treatment). It requires providers to ensure that people providing care “have the qualifications, competence, skills and experience to do so safely” and to ensure “the proper and safe management of medicines”. CQC’s guidance adds that staff who administer medication “must be suitably trained and competent”, and that staff “must only work within the scope of their qualifications, competence, skills and experience”. If you are asked to give rescue medication and you have not been trained for that person, say so and escalate — and call 999.

The general principles in our guide to the six rights of medication administration apply, including accurate recording afterwards.

What if someone has a seizure in a wheelchair or in water?

In a wheelchair. The NHS says to put the brakes on and leave any seatbelt or harness on. Support them gently and cushion their head, “but do not try to move them”.

In water. For a tonic-clonic seizure in a pool or bath, Epilepsy Society advises keeping the person’s face out of the water by gently tilting their head, calling for help, and moving them to shallower water if possible — then cushioning their head once out of the water. For focal and absence seizures, hold their head above water or guide them away from deep water. This is why the NHS advises people with epilepsy to “have showers instead of baths if you can”, and why bathing arrangements belong in the care plan.

Is every seizure caused by epilepsy?

No. The NHS says “having a seizure does not always mean you have epilepsy, as seizures can have other causes”, and that people are usually diagnosed with epilepsy if they have had more than one seizure, or tests show they are at risk of more. That is why a first seizure always needs an ambulance or urgent medical assessment.

• Febrile seizures in children. According to the NHS febrile seizures page, these happen with a high temperature, usually in children between 6 months and 6 years old, usually last 2 to 3 minutes, and are not the same as epilepsy. Call 999 for a first seizure or one lasting more than 5 minutes.
• Other medical causes. NICE asks clinicians to be aware of underlying causes of status epilepticus including hypoglycaemia (low blood sugar) and alcohol withdrawal. Epilepsy Action says that in people who already have epilepsy, one of the most common causes of status epilepticus is having low levels of epilepsy medicine.
• Non-epileptic (dissociative) seizures. NICE notes these “can be similar in presentation to convulsive status epilepticus”. Epilepsy Action says they can often go on for longer and can be confused with status epilepticus. First aid — protecting the person and timing the event — is the same; diagnosis is for specialists.

If you are unsure whether someone has collapsed because of a seizure or a cardiac arrest, check their breathing. Someone who is unresponsive and not breathing normally needs CPR and a defibrillator — see our guide to CPR.

How can care staff reduce the risks of seizures?

The NHS says “seizures are not usually harmful, although they can cause accidents or injuries”. But some risks can be reduced.

Sudden unexpected death in epilepsy (SUDEP). The NHS describes SUDEP as rare, and says treatment can reduce the risk. NICE lists potentially modifiable risk factors (recommendation 10.1.2):

• not taking medication as prescribed;
• alcohol and drug misuse;
• having tonic-clonic seizures, including focal seizures that spread to both sides of the brain;
• having uncontrolled seizures;
• living alone;
• sleeping alone without supervision.

For people who have seizures during sleep and have been assessed as being at higher risk, NICE recommends discussing “introducing or increasing night-time supervision”, giving the example of a night monitor (10.2.1). Any monitoring has to be agreed with the person, or decided in their best interests under the Mental Capacity Act if they lack capacity to decide.

Everyday safety. The NHS advises people with epilepsy not to miss doses of medication, to make the home safer (for example with carpets and radiator covers), to consider an alarm, and to have showers rather than baths. It also warns that drinking too much alcohol can increase the risk of seizures, and that anyone who has had a seizure must not drive and must tell the DVLA. For care staff, this means medication support and environmental risk assessment rather than blanket restrictions.

What epilepsy training do care workers need?

There is no single legally prescribed epilepsy course. What the law requires is competence: CQC Regulation 12 requires care staff to have the skills to deliver care safely, and NICE emphasises that the emergency plan should say who is trained to use any rescue medicine. In practice, training comes in two layers:

• Awareness and first aid for everyone who might witness a seizure — seizure types, the do’s and don’ts, when to call 999 and recording. Online CPD courses suit this.
• Practical, person-specific training for staff who will give rescue medication. This is usually face to face, includes practising with the device, and is linked to the individual’s protocol. An online course does not replace it, and you should never give buccal midazolam on the strength of an awareness certificate alone.

See also our guides to first aid training requirements and mandatory training for healthcare workers.

Which courses cover seizure first aid?

These three £9 courses work well together for care workers, support workers, teaching assistants and workplace first aiders, each with a verifiable certificate:

• Epilepsy Awareness — what epilepsy is, seizure types, triggers, first aid and supporting people with epilepsy day to day.
• Seizure Awareness — recognising and responding to seizures, including when a seizure becomes an emergency.
• Workplace First Aid Awareness — the wider first aid principles, including the recovery position and when to call for help.

Administering Medication and Basic Life Support are useful alternatives. Any three courses cost £18 with the pay-for-2-get-3 offer — add them to the cart and the discount applies automatically. These are awareness courses. They are CPD accredited, but they are not regulated qualifications, they are not a practical first aid at work certificate, and they do not train you to give rescue medication.

Frequently asked questions

What should you do if someone has a seizure?

Stay calm and time the seizure. Move hard objects away, cushion their head and loosen anything tight around their neck. Do not hold them down or put anything in their mouth. When the jerking stops, roll them onto their side, check their breathing and stay with them until they have fully recovered.

Should you put something in someone’s mouth during a seizure?

No. Never put anything in their mouth, including your fingers. A person cannot swallow their tongue during a seizure, and forcing something between their teeth can break teeth or injure you. Do not give food or drink until they have fully recovered.

When should you call an ambulance for a seizure?

Call 999 if it is the person’s first seizure, if it lasts longer than usual for them or more than 5 minutes if you do not know, if they have repeated seizures without recovering, if they are seriously injured, have difficulty breathing afterwards, or have had 3 or more seizures in 24 hours.

Does every seizure need an ambulance?

No. People with diagnosed epilepsy do not always need an ambulance or hospital each time they have a seizure. Most seizures stop on their own within seconds or minutes. If the person has a care plan and you have been trained to follow it, follow the plan.

Can a care worker give buccal midazolam?

Yes, if they have been trained and the medicine is given in line with the person’s individual emergency plan. Epilepsy charities say rescue medicine should only be given by someone who has been trained, and CQC requires staff who administer medicines to be suitably trained and competent.

What is status epilepticus?

Convulsive status epilepticus is a seizure lasting 5 minutes or more, or seizures that follow one another without the person recovering in between. It is a medical emergency that needs immediate treatment, so call 999 and follow any emergency plan.

Be ready before it happens

£9 per course. CPD accredited, 100% online, verifiable e-certificate. Pay for 2, get 3 — any 3 courses for £18.

This article is general information, not medical or legal advice. It summarises NHS, NICE (NG217), CQC and epilepsy charity guidance available at the time of writing. Always follow the person’s own care plan and the advice of their GP, epilepsy specialist nurse or neurologist, and call 999 in an emergency. A Nexis CPD awareness course is CPD accredited but is not a regulated qualification and does not replace practical first aid or rescue medication training.