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Stay with the person, start timing, protect them from injury, and keep their airway clear. Do not restrain them or put anything in their mouth. Most seizures do not require an ambulance, but call 911 in the specific situations listed below—especially when the seizure lasts longer than five minutes, repeats, affects breathing or alertness, causes injury, occurs in water, or involves a first known seizure, pregnancy, or diabetes with loss of consciousness.
You do not need to identify the seizure type to provide useful first aid. Seizures can involve falling and rhythmic jerking, but they can also look like staring, confusion, wandering, unusual movements, or a brief change in awareness.
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What to do immediately
Use this sequence when you witness a possible seizure. If the surroundings are dangerous, protect yourself first and move hazards rather than trying to move the person unnecessarily.
- Stay and start timing. Note the time the seizure begins, preferably with a phone or watch. Ask people nearby to remain calm and give the person space. The duration is important when deciding whether to call 911.
- Make the area safer. Move chairs, tables, tools, hot drinks, sharp objects, and other hazards away. If the person is falling and you can do so without putting yourself at risk, ease them to the ground instead of trying to catch or hold them upright.
- Protect the head and neck. Place something soft and flat, such as a folded jacket, under the head. Remove eyeglasses. Loosen tight clothing around the neck. Do not place a pillow or other bulky item under the head that could restrict breathing.
- Turn them onto their side when safe. If they are lying down, gently roll them onto their side with the mouth angled toward the ground. This recovery position helps fluids drain from the mouth. Do not force a side turn while powerful movements make it unsafe; wait for a safe opportunity.
- Observe without interfering. Watch breathing, skin color, movements, responsiveness, and anything that could help a clinician later. Look for a medical identification bracelet or card. If the person has a seizure action plan or prescribed rescue medicine, follow that plan and assist with medicine only if the instructions authorize you and you have the required training.
- Stay until recovery. When the movements stop, help the person sit or lie somewhere safe. Remain with them until they are awake and alert, explain simply what happened, and offer help contacting someone they trust.
These steps reflect guidance from the Centers for Disease Control and Prevention (CDC), the Epilepsy Foundation, and the American Red Cross. Your role is safety and observation, not diagnosis.
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Recognizing that seizures do not all look alike
A seizure is a burst of abnormal electrical activity in the brain. The visible signs depend on which brain networks are involved. A dramatic fall followed by stiffening and rhythmic jerking is only one presentation, and the CDC cautions that it may not be the most common one.
Convulsive or generalized-appearing signs
A person may suddenly lose awareness, stiffen, fall, and have repeated jerking movements on both sides of the body. They may not respond when spoken to. Keep the area clear and protect the head; never try to stop the movements by holding the arms or legs.
Focal-appearing signs
Focal seizures begin on one side of the brain. The person might stare, make repetitive movements, have a change in sensation, appear confused, or be unable to answer normally. Some people wander or seem awake but cannot follow instructions. Calmly guide them away from traffic, stairs, water, heat, or other hazards without grabbing or restraining them. If they become unresponsive or fall, use the immediate safety steps above.
When you cannot tell what is happening
You do not need to label a seizure as focal or generalized. Treat an unexplained episode of loss of awareness, stiffening, jerking, unusual behavior, or sudden confusion as a possible medical event: create space, time it, watch breathing, and be ready to call 911 using the criteria below.
When to call 911 in the United States
Call 911 if any of these conditions applies. Tell the dispatcher what you saw, when it started, how long it lasted, whether another seizure followed, and whether the person is breathing and responsive now.
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| Call 911 when | What to do while help is coming |
|---|---|
| The seizure lasts longer than five minutes. | Keep timing, protect the head, clear hazards, and follow any documented seizure action plan. |
| Another seizure starts soon after the first. | Do not assume the person has recovered; continue safety measures and report the sequence to the dispatcher. |
| The person has trouble breathing or waking after the seizure. | Check responsiveness and breathing once movements stop. Follow dispatcher instructions. |
| The person is injured. | Do not move them more than necessary, especially after a possible head, neck, or back injury, unless the scene is unsafe. |
| The seizure happens in water. | Get the person out of the water safely, call 911, and report possible water inhalation even if they appear better. |
| The person has never had a seizure before. | Stay with them, note what happened, and give emergency responders the timing and observed signs. |
| The person has diabetes and loses consciousness. | Call 911. Do not give food, drink, or glucose by mouth while they are not fully alert. |
| The person is pregnant. | Call 911 and tell responders about the pregnancy, any injury, and the seizure duration. |
The CDC states, “Seizures don’t usually require emergency medical attention.” That statement does not mean you should wait when one of the conditions above is present. For readers outside the United States, use your local emergency number rather than 911.
Breathing, unresponsiveness, and CPR
Do not give mouth-to-mouth breaths during the seizure. Focus on protecting the person and observing them. After the movements stop, reassess responsiveness and breathing.
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Keep them on their side when possible, maintain privacy, and stay nearby while they regain awareness. Someone may be sleepy, confused, embarrassed, or have a headache. Speak in a calm voice and use short explanations.
If the person is unresponsive and not breathing normally
Call 911 or direct another bystander to call. Begin CPR according to your training and use an automated external defibrillator (AED) if one is available, following its voice prompts. The American Red Cross includes this action for a person who remains unresponsive and is not breathing after a seizure. If you are untrained, the dispatcher can provide instructions.
What not to do
- Do not restrain the person. Holding down the arms, legs, or torso can cause injuries and does not stop the seizure.
- Do not put anything in the mouth. Never insert fingers, a spoon, a wallet, or another object. A person cannot swallow their tongue, and an object can break teeth, block the airway, or injure the mouth. Keep your own fingers away from the teeth.
- Do not give food, water, pills, or other substances to swallow until the person is fully alert. Swallowing may be unsafe while awareness is impaired.
- Do not shout, shake, slap, or demand that the person wake up. These actions do not end a seizure and can increase confusion or distress.
- Do not give rescue medicine unless the person’s plan permits it and you are trained to do so. Use the prescribed device, dose, and timing in the action plan; never substitute someone else’s medication.
- Do not assume the episode is harmless because the movements stop. Check breathing, responsiveness, injuries, and the emergency criteria before leaving.
What to do after the seizure
Help the person recover safely
When the seizure ends, keep the person on their side if they are drowsy or not fully steady. If they can sit safely, support them in a quiet place away from crowds, bright lights, traffic, stairs, or machinery. Do not rush them to stand or resume normal activity.
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Explain what happened
As awareness returns, say who you are and describe the event plainly: “You had what looked like a seizure. It lasted about two minutes. You are safe, and I stayed with you.” Avoid arguing about what they remember. Confusion can last for a while, and they may not know where they are.
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Offer practical support and privacy
Ask whether they want you to call a family member, friend, caregiver, or clinician. Protect their dignity by moving onlookers away and covering exposed clothing if needed. Do not post video or details about the event. If they have a medical identification card or action plan, keep it with them for responders.
Record useful observations
Write down the start and end times, whether they fell, which body parts moved, changes in breathing or color, possible injuries, what they said before or after, and whether another seizure followed. Give this information to the person, their caregiver, or medical professionals. Do not claim certainty about a diagnosis based only on what you saw.
Special situations that need extra care
The person is wandering or confused
Some seizures cause impaired awareness without a fall or shaking. Use a calm voice and remove hazards such as roads, balconies, pools, fireplaces, and stairways. Walk alongside the person and gently redirect them. Do not block them with force, chase them, or lock them in a room. Call 911 if they are injured, in immediate danger, do not recover, or meet any criterion in the emergency table.
The seizure occurs near water
Water exposure is an emergency criterion. Get help and call 911. If the person is in a pool, bath, or open water, prioritize a safe rescue; do not put yourself in danger. Once on land, check responsiveness and breathing after the seizure. Be prepared to begin CPR if the person is unresponsive and not breathing normally.
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A fall or other injury occurred
Clear the area and avoid unnecessary movement. If a serious head, neck, or back injury is possible, keep the person as still as the scene allows and wait for emergency responders. Bleeding, severe pain, deformity, or loss of consciousness after the seizure are reasons to call 911.
The person is pregnant
Call 911 and tell the dispatcher the person is pregnant. Protect the head, position them safely on their side when possible, and observe breathing. Do not give anything by mouth while they are not fully alert.
The person has diabetes
If a person with diabetes loses consciousness during a seizure, call 911. Do not put sugar, juice, tablets, or other food in the mouth of someone who cannot swallow safely. Follow a documented emergency plan only when it specifically instructs you and you are trained.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Why timing and observation matter
The five-minute threshold cannot be judged reliably by memory, so start a timer at the first unusual movement or loss of responsiveness. Note whether the person returns to awareness before another event begins. Emergency clinicians also need to know about breathing, injuries, water exposure, pregnancy, diabetes, and whether this was a first known seizure.
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Descriptions are more useful than labels. Instead of saying “It was definitely a grand mal seizure,” report observable facts such as “They stared for about 30 seconds, did not answer, then became confused,” or “They fell, stiffened, and had rhythmic jerking for four minutes.”
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Seizure first aid for workplaces, schools, and public places
People who coach, lead groups, work in schools, or supervise public settings may be more likely to witness a seizure. A simple plan reduces hesitation:
- Keep a clear route away from stairs, glass, heat, traffic, and water.
- Know who is authorized to access a participant’s seizure action plan or prescribed rescue medicine.
- Train staff to time the event, protect the head, use the side position when safe, and recognize the 911 criteria.
- Assign one person to stay with the individual, another to call 911 when required, and another to meet responders.
- Protect privacy; share medical details only with people who need them for care.
- Document the observed facts and hand the record to the person, family, caregiver, or clinician.
The Epilepsy Foundation offers free online, on-demand seizure first-aid training. It also publishes an English seizure first-aid poster; the listing identifies a July 2024 revision. A poster can support a workplace or classroom plan, but it is not a substitute for calling 911 when emergency criteria are present.
How common are seizures?
The CDC reported in 2024 that about 1 in 10 people in the United States may have a seizure during their lifetime. This is a U.S. lifetime estimate, not an annual rate and not a prediction that every episode will be epilepsy. A single event can have many causes, and a bystander should concentrate on immediate safety and emergency signs rather than trying to determine the cause.
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- Stay with the person and start timing.
- Clear dangerous objects and ease a fall when possible.
- Protect the head, remove glasses, and loosen tight neck clothing.
- Turn the person onto their side when it is safe.
- Watch breathing, responsiveness, injuries, and what the movements look like.
- Check for medical identification and follow an existing seizure plan only within your training.
- Never restrain the person or put anything in their mouth.
- Do not give food, drink, or pills until they are fully alert.
- Call 911 for any condition in the emergency table.
- Afterward, provide privacy, reassurance, and practical help until the person is awake and steady.
For most witnesses, the safest response is calm, simple, and consistent: protect, time, observe, and support. Your observations and prompt action can prevent injury and help emergency professionals decide what care is needed.
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