As an Emergency First Response® (EFR®) Instructor, part of your role is to expand, as needed, on common illnesses to enable participants to spot signs and provide appropriate care. Lay responder first aid for epileptic seizures is important because it can help prevent injury, reduce panic and save a life. Knowing when to call emergency services will vary depending on circumstances.
What Is Epilepsy?
Epilepsy is one of the most common chronic brain diseases, affecting around 50 million people globally, across all ages, but particularly young children and older adults.
It’s characterized by recurring seizures that result from excessive electrical activity in the brain, temporarily disrupting normal brain function. A seizure is a sudden episode that causes uncontrollable movements in part or all of the body and may include loss of awareness or control of body functions. Seizures can vary from a very brief lapse of attention or small muscle jerks to severe and prolonged convulsions. They vary in occurrence by patient, from less than one per year to several per day.
A high percentage of deaths related to epilepsy are potentially preventable, because they are caused by falls, drowning or burns rather than the seizure itself.
Who Is Affected?
Up to one in 10 people will experience a seizure during their lifetime; however, a single seizure does not signify epilepsy because seizures can have other causes. Epilepsy is usually diagnosed after two or more unprovoked seizures, within a given period, and when a doctor believes there is a high chance of further seizures.
Signs and Symptoms
Characteristics of a seizure vary and depend upon the location in the brain where the disturbance first starts, and how far it spreads. The two main types of epileptic seizures are:
Focal seizures, which affect only one part of the brain.
- Signs include repeated small or large movements, such as small jerking movements or walking in a circle.
- Other signs and symptoms may be temporary loss of awareness or consciousness, change in sensations (including seeing flashing lights, strange smells or tastes, or tingling sensations) or a change in mood or other cognitive functions.
- Most focal seizures are short, lasting from a few seconds to several minutes.
Generalized seizures (called Tonic-clonic), which affect both sides of the brain and are the type of seizure most people recognize.
- May initially present with a pause, blank stare and brief lapse in awareness, moving to loss of consciousness, falling to the floor, emitting a vocal sound and potentially biting down on the tongue or inside of the mouth. This is the “Tonic phase.”
- The “clonic phase” is the type of seizure most recognizable, in which limbs move quickly and rhythmically. There may be loss of bladder or bowel control and cessation of breathing, leading to a blue tinge around the lips/mouth.
- This type of seizure usually lasts one to three minutes.
First Aid for Seizures
The focus of first aid is to remain with the patient and protect them from further harm, then provide reassurance and comfort afterwards.
For focal seizures:
- The patient may or may not know they are having a seizure. The seizure can be frightening and disorientating, so being calm and reassuring is the best first aid.
- Remain with the patient until they are fully recovered. They may feel confused and unsteady for a while after the seizure.
For Tonic-clonic seizures:
- When someone is having a seizure, it’s important to stay calm, remain with them and time the seizure.
- If they are convulsing, move any dangerous items away from them, cushion their head and loosen tight clothing around their neck. Do NOT try to restrain them or stop the movements, and do NOT put anything in their mouth.
- Look to see if they carry an epilepsy identity card or identity jewelry, as this may give information about their seizures and what to do.
- It is possible they may lose bladder or bowel control, so provide a light blanket or piece of clothing to cover the area. Move bystanders away.
- Once the convulsions have stopped, check their airway to ensure it is clear of vomit or saliva, then gently assist them into the recovery position.
- Remain with them until the seizure is over and they are fully recovered. Speak to them calmly and explain what happened.
Some people may have more than one type of seizure, and what may start as one type can move on to another.
Calling Emergency Services
It’s important to know that most people do not require emergency medical care when they have a seizure, and some people are prescribed with emergency medication to stop prolonged seizures. Seeking medical attention is important if:
- It is their first seizure,
- The seizure lasts for more than five minutes,
- They are having difficulty breathing or turn blue,
- They hurt themselves during the seizure, or
- They don’t regain consciousness or seem mentally impaired after the seizure.
Teaching Epileptic First Aid
Adding a five-minute discussion on epilepsy to your EFR courses could help one of your participants to assist someone in a time of need by preventing an injury or even death. Information on seizure first aid can be found in the Emergency Reference section of the EFR Primary and Secondary Care Participant Manual or eLearning, under Seizures.
