What to do when someone has a seizure in front of you

Look at the clock. That's the first move, before anything else, because the single most useful piece of information you can hand a paramedic is how long this has been going on. Phone clock, wall clock, wristwatch, doesn't matter. Note the minute.

Then clear the space around the person. Shove the coffee table back. Kick the dumbbell out of the way. Move the chair. A body in a full convulsion travels more than people expect, and most seizure injuries come from what's nearby, not from the seizure itself.

Third, if there's anything soft within reach, get it under the head. A folded hoodie, a gym towel, your hand if that's all you've got. Skull on tile or a rubber gym floor for ninety seconds does real damage. Take their glasses off. Loosen a tie or an unzipped collar if it's tight at the throat.

That's the whole emergency in three moves. Time it, clear it, cushion the head. Everything else is either waiting or not making it worse.

The five-minute rule

Most convulsive seizures stop on their own inside a minute or two. They look far longer than they are. You'll swear it's been ten minutes when it's been ninety seconds, which is exactly why you checked the clock.

Call 911 at five minutes of continuous convulsing. That's the line. A seizure that won't stop is a medical emergency with its own name and its own treatment, and it needs an ambulance rather than a ride in your truck.

Call sooner, right away, if any of this is true:

• It's their first seizure, or nobody there knows they have epilepsy
• One seizure ends and another starts before they're fully awake
• They're pregnant, or diabetic, or it happened in or near water
• They got hurt during it, hit their head hard, or they're bleeding
• Breathing doesn't come back to normal once the shaking stops
• They don't wake up after the convulsing ends

If someone standing there says "she has epilepsy, this happens, she's fine after," believe them and keep timing. Families who live with this know their person's pattern. They also usually know exactly when it's stopped being the usual pattern, so listen to them on that too.

The things that make it worse

Don't hold them down. Not the arms, not the legs, not a bear hug to "stop the shaking." You can't stop a seizure by force, and pinning a convulsing body is how shoulders get dislocated and ribs get cracked. Your job is to protect the head and get the furniture out of the way. That's it.

Don't put anything in the mouth. Not your fingers, not a wallet, not a spoon, not a folded belt. The idea that someone can swallow their tongue during a seizure is a myth that's been floating around for generations, and acting on it's how you lose a fingertip or drive a broken tooth into someone's airway. The jaw clamps down with more pressure than you're imagining.

Don't try to give water, pills or food while they're seizing or while they're still confused afterward. Nothing by mouth until they're fully awake and talking in complete sentences.

Don't start CPR on a convulsing person. They're not in cardiac arrest, and chest compressions on a beating heart are their own problem. If the shaking has stopped and they're not breathing and not responsive, that's different, and that's when you start compressions and send somebody for an AED.

Don't move them unless they're in traffic, on a stairwell, at the edge of a pool, or under a loaded barbell. The floor is a good place to be.

The part nobody warns you about

The convulsion ends and you think it's over. It isn't. What comes next can run from a few minutes to half an hour, and it's the stretch where most of the actual first aid happens.

Roll them onto their side. Bottom arm out, top knee bent forward so they don't roll back, head tilted slightly so anything in the mouth drains out. Saliva, blood from a bitten tongue, vomit. This one move is the reason a lot of people wake up fine instead of aspirating.

Expect confusion. Real, deep confusion. They may not know where they are, may not recognize you, may try to stand up and walk somewhere with total conviction. Some people come out of it combative, not because they're angry but because a stranger's hands are on them and their brain hasn't come back online yet. Back off, keep your voice low, say your name and where they are, and repeat it. Don't crowd them. Don't quiz them.

Loss of bladder control is common. If it happened, get a jacket over their lap before anybody else walks in and clear the room of spectators. That's not a small kindness. That's the thing they'll remember about the day.

Stay until they're fully oriented and somebody they know is with them. Ten minutes of your afternoon.

Not every seizure looks like the movies

Plenty of seizures never involve a convulsion at all. Someone stops mid-sentence and stares, lips smacking or a hand picking at their shirt, for thirty or forty seconds, then picks the sentence back up with no idea there was a gap. Someone suddenly smells burning rubber that isn't there. Someone's arm jerks while they're fully awake and can tell you about it.

You handle those the same general way. Don't grab them. Steer them away from stairs, the stove or the street with a light hand on the shoulder if they're wandering. Time it. Stay with them until they're back. And if it's the first time anyone's seen it, it still gets a doctor's appointment, because a staring spell that nobody can explain deserves a real workup.

At the gym, and at home

If it happens under a bar, get the weight off the body first and the head cushioned second. That's the one time you move fast and physically. Spotters exist for a reason, and this is one of them.

If it's your household, get a written seizure action plan from the neurologist and stick it where a babysitter can find it. It should say what a typical episode looks like for that person, how long it usually runs, when to call 911, and whether there's a prescribed rescue medication and who's allowed to give it. If there's one, get trained on it by the prescriber, not by a video.

Showers instead of baths. Never swim alone. And on driving, every state and province sets its own seizure-free waiting period before a license comes back, so get the rule from the actual licensing authority rather than from a guy at work who knew a guy.

None of this is a substitute for the neurologist, and a first seizure in an adult gets a full medical evaluation, always. But the five-minute clock, the hands off the mouth, and the roll onto the side are yours to know cold.

Because the person this happens in front of is almost never a doctor. It's whoever's standing there. Sooner or later that's you.