Seizure first aid: securing surroundings and what observations to record

I didn’t plan to memorize seizure first aid. It crept into my life one ordinary afternoon when a stranger stumbled near a curb and crumpled to the sidewalk. People froze; I felt my heart thump and my brain go fuzzy—then a quiet, practical voice took over: make the space safe, time what I’m seeing, and pay attention to details I can tell a clinician later. I’m writing this in the same spirit—like notes in a personal journal—because the basics are simple, humane, and worth having at your fingertips. And if you want a crisp one-page refresher, the CDC’s page on seizure first aid lays out the pillars clearly.

The moment I realized calm is a skill

When someone seizes, your nervous system wants to sprint. Mine does too. What helped me most was rehearsing a tiny mental script. I think protect, time, turn, observe, support. Those five moves keep me anchored. They align with what major organizations teach (you can also browse the simple step-by-step at MedlinePlus if you’re a visual learner). The important thing is to keep your actions focused and your language gentle. A calm tone steadies everyone within earshot.

  • Protect the person by clearing hazards and cushioning the head.
  • Time the event from the first unusual movement or unresponsiveness.
  • Turn onto one side when it’s safe, to help breathing and drainage.
  • Observe details you’ll want to remember or write down.
  • Support recovery, privacy, and dignity, and know when to call 911.

Securing the surroundings without overreacting

This is the part I practice in my head like a fire drill. Most seizures are brief and end on their own, so the goal is to prevent injury.

  • Clear a soft radius: slide away chairs, glassware, bags, cords, sharp or hot objects; move coffee tables and lamps; nudge pets and curious onlookers back.
  • Cushion the head: a folded jacket, a backpack, or your hands; avoid pressing down on the body.
  • Loosen tight things: neckties, scarves, collars. Gently remove eyeglasses if you can do so safely.
  • Guide to the ground if they’re standing and you can do it without force. Don’t try to hold still or restrain limbs.
  • Protect the airway by turning the person onto their side once convulsive movements ease or if they’re already lying down.
  • Do not put anything in the mouth—no wallets, spoons, fingers. That myth refuses to die; the Red Cross is very direct about this.
  • Keep the crowd calm: say, “They’re having a seizure. We’re keeping them safe. Please give space.” Assign one person to meet EMS if you call 911.

Special environments need tweaks: in a wheelchair, secure the brakes and tilt slightly to the side if possible while supporting the head; on a bed, roll away pillows or hard objects and turn to the side; in water, keep the head above water, get to land, and call 911. If you stumble upon someone in the middle of a street or on a stairwell, your risk calculus changes—move only as necessary to avoid immediate danger and then resume the basic steps.

A simple STOP framework I keep on a sticky note

I like mnemonics. This one rides easily in my pocket: STOP — Secure space, Time the seizure, On the side, Points to note.

  • S — Secure space: sweep hazards, cushion head, loosen tight clothing.
  • T — Time the seizure: start a timer right away; most last 30 seconds to 2 minutes.
  • O — On the side: recovery position supports breathing and reduces aspiration risk.
  • P — Points to note: make quick mental notes you can jot down.

Training helps. If you like learning stepwise with short videos, the Epilepsy Foundation’s short courses are digestible (see their Seizure First Aid training page).

What not to do and why those myths linger

Well-meaning people sometimes do risky things in a panic. The most common missteps can cause injuries we’re trying to avoid.

  • Don’t restrain arms or legs. It can cause muscle or shoulder injuries.
  • Don’t put anything in the mouth. You can chip teeth, cause choking, or injure fingers. People do not swallow their tongues.
  • Don’t force food, drink, or pills until fully awake and sitting up.
  • Don’t give breaths during active convulsions. Focus on keeping the airway clear by turning on the side once safe.
  • Don’t leave until they are fully alert or emergency help takes over.

If you want to double-check the “do’s and don’ts,” I like the succinct lists at MedlinePlus alongside the CDC summary I linked above.

The observation list I wish I’d had in my pocket

After a seizure, details fade quickly. A short, honest record can be gold for a clinician. If it’s safe, tap your phone’s timer as soon as you recognize the seizure, and—if the person would be okay with it—briefly record video for clinical review after you’ve handled safety. Here’s a checklist I use and keep in my notes app.

  • Start time and total duration to the best of your estimate. Note if there were multiple episodes back-to-back.
  • What you saw first: a blank stare, sudden drop, a loud cry, stiffening, rhythmic jerks, a head or eye turn to one side, fiddling movements, lip smacking, repeated swallowing, or wandering. First features often point to where in the brain it began.
  • Awareness: Were they responsive at any point? Could they follow a simple command?
  • Color and breathing: Any bluish lips or face? Snoring sounds? Vomiting or drooling?
  • Injury: head bump, tongue bite (often on the side), cuts, falls, incontinence.
  • Possible triggers in the prior 24–48 hours: missed medication, new medication or dose change, sleep deprivation, heavy alcohol, illness/fever, flashing lights, intense stress, menstruation.
  • Context: where it happened (bed, shower, street), and what the person was doing right before (standing, exercising, eating, swimming).
  • How they were afterward (the “postictal” phase): confusion, headache, muscle soreness, weakness in one limb or side, unusual speech, or agitation—and how long it took to return to baseline.
  • Medical ID: bracelet or phone medical ID with conditions, allergies, emergency contacts, or rescue-medication instructions.

If this was a first known seizure, a brief, factual note can help the next steps go faster. For background on how clinicians evaluate a first seizure, the American Academy of Neurology guideline explains the typical tests and follow-up decisions (EEG, imaging, labs) in plain language summaries.

When I would call 911 without hesitation

Most seizures are not medical emergencies. But certain situations change the calculus. The threshold I keep in mind mirrors the lists on CDC/MedlinePlus and the Red Cross.

  • Seizure lasts longer than 5 minutes or repeats without full recovery between episodes.
  • Breathing doesn’t normalize quickly after movements stop, or color remains blue/gray.
  • Serious injury occurs (head trauma, deep cut, fall from height, water inhalation).
  • It happens in water, near traffic, or in another high-risk setting.
  • It’s a first known seizure, the person is pregnant, very young, older, has diabetes, or has other medical red flags.
  • Recovery is unusual—prolonged confusion, one-sided weakness, repeated vomiting, or severe headache.

When calling, plain descriptions help dispatch: “Unresponsive with rhythmic jerking for about two minutes; now breathing, on side; lips briefly looked blue; awake but confused.” If the person has a known seizure action plan or rescue medication prescribed (for example, a nasal benzodiazepine), follow the specific instructions in that plan if you are trained to do so and it is appropriate; otherwise, wait for EMS guidance.

Privacy, consent, and kindness afterward

The minutes after a seizure deserve as much care as the event itself. I remind myself: protect dignity. Offer a calm update (“You had a seizure—you're safe. I’m here.”), cover with a jacket or blanket if clothing shifted, and give them time to reorient. If I recorded any video for clinical use, I ask permission to share it with their clinician; if they decline, I delete it. Help them find glasses, phone, or bag, and offer water only when fully awake and sitting safely. Ask who you can call.

Little habits I’ve added to daily life

I’ve made seizure first aid one of those low-effort skills I can reach for under pressure. Here are the small, practical things I’ve changed.

  • Saved phrases in my phone: “We’re making space so they don’t get hurt,” “Please step back,” “I’m timing this.” Simple words keep helpers coordinated.
  • Location awareness: when I enter a crowded venue, I note exits and clear floor space subconsciously, the way I would for fire safety.
  • Timer muscle memory: I practice starting my phone’s timer without looking. Seconds matter more than you think when you’re anxious.
  • Learned recovery position: roll onto the side, bottom arm straight, top knee forward as a brace. It becomes instinct with a little practice.
  • Periodic refreshers with trusted sources. A quick skim of the CDC or Red Cross pages keeps my mental script current.

If you’re curious to see a walk-through, there’s a concise visual guide at MedlinePlus (Part 2) that shows the recovery position and what to monitor while you wait for help.

Signals that make me slow down and double-check

It’s easy to jump to conclusions under stress. Here are the moments I pause, rethink, and sometimes ask another bystander to sanity-check with me.

  • Movements stop but breathing sounds wrong—I focus on airway: side-lying, jaw relaxed, head neutral, and watch for chest rise.
  • One-sided weakness afterward—this can be a temporary “postictal” phenomenon, but it’s also a reason to seek urgent evaluation.
  • Confusion that stretches on—I keep an eye on the clock; prolonged confusion adds weight to calling EMS.
  • High-risk context—water, heights, traffic, pregnancy, first-time events. These raise the bar for medical evaluation.
  • Any doubt—if my gut says, “This isn’t following the usual pattern,” I’d rather call and be told it’s okay than wish I had.

What I’m keeping and what I’m letting go

I’m keeping the five-part script that fits in one breath: protect, time, turn, observe, support. I’m holding onto the STOP mnemonic for busy brains. And I’m keeping a humble respect for uncertainty—first aid doesn’t diagnose, it buys safety and time. I’m letting go of the old myths (nothing in the mouth, ever) and the urge to do too much. If you want a one-stop refresher after this, bookmark the CDC page and the Red Cross quick steps, and consider taking a short training through the Epilepsy Foundation. These sources are updated periodically and put safety first.

FAQ

1) How long should I wait before calling 911?
Answer: If the seizure lasts around 5 minutes, or repeats without full recovery, call right away. Also call for first-time seizures, injuries, breathing problems, water-related events, or pregnancy.

2) Should I try to hold the person still or keep their tongue from blocking the airway?
Answer: No. Don’t restrain and don’t put anything in the mouth. Turn them on their side when safe and let the seizure run its course.

3) What details are actually useful for a clinician?
Answer: Start time and total duration; first sign you noticed; awareness; color and breathing; injuries; possible triggers (missed meds, illness, alcohol); and how recovery looked.

4) If someone has a prescribed rescue medication, should I give it?
Answer: Only if you’re trained, it’s part of their documented seizure action plan, and it applies to the situation (for example, a prolonged seizure). When in doubt, call 911 and follow instructions.

5) After a first seizure, what usually happens next?
Answer: A clinician typically checks for provoking factors and may order tests like EEG and brain imaging. Early follow-up helps tailor decisions about safety and treatment plans.

Sources & References

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).