Recognising a Seizure Emergency: Practical First Aid and When to Call for Help

Seizures are common in epilepsy, and most stop within a few minutes. The difficult part is often not the seizure itself but the decision that follows: is this a moment for calm first aid, or a moment to call 999? In the UK, ambulance services are under pressure, and no one wants to make an unnecessary call. Yet delaying help in a genuine emergency can be more harmful than calling when the need is uncertain. A clear plan, agreed in advance, helps families, carers and workplaces act with confidence.

The red flags that should prompt a 999 call

Call 999 if:

• the seizure lasts longer than five minutes, or you do not know how long it has been going on;
• breathing is difficult, noisy or irregular, or lips or skin look blue or grey;
• the person is injured, particularly with a head injury, or has fallen from height;
• another seizure starts before the person has recovered consciousness;
• the seizure happens in water;
• this is the person's first-ever seizure;
• you are in any doubt.

Some people with epilepsy have a personal care plan that sets out a lower threshold for calling, for example because of previous prolonged seizures or a rescue medication protocol. Follow that plan. If it is not available and the situation feels wrong, call 999.

What to do while you wait

Note the time. Move dangerous objects away and cushion the head with something soft. Do not restrain the person or put anything in their mouth; it is not true that someone can swallow their tongue. Do not move them unless they are in immediate danger, such as near traffic or water. Once the shaking stops and breathing is normal, turn them onto their side into the recovery position. Stay with them until help arrives or they are fully recovered.

If the person has been prescribed emergency medication, such as buccal midazolam or rectal diazepam, use it only as set out in their care plan. If you are unsure, the 999 call handler can guide you.

What to say to the 999 call handler

Give the full address first, including the postcode if possible. Say clearly that someone is having a seizure and give the time it started. Describe what you can see: whether they are conscious, breathing normally, injured, or have changed colour. Mention known epilepsy, other medical conditions, medicines and allergies. If there is a care plan, say so and read out the emergency instructions. Keep the line open and follow the handler's advice. Do not hang up until you are told to.

After the seizure

Most people are confused, tired or emotional after a seizure. Reassure them, keep them warm and stay until they are fully alert. Do not give food or drink until they are awake and swallowing normally. Check for injuries, and note the time, duration and what happened, as this is useful for their epilepsy team. If the seizure was unusual, longer than their usual pattern, or followed by another seizure, seek urgent advice.

Why a personal epilepsy care plan matters

A written epilepsy care plan turns a stressful decision into a prepared one. It should record the person's seizure types, their usual pattern, any rescue medication and when to use it, the circumstances in which to call 999, and who to contact afterwards. It can be shared with family, carers, a school, a college or an employer, with the person's consent. In the UK, epilepsy specialist nurses and neurology teams can help draft or review one. The plan should be updated when medication changes or seizure patterns shift.

For workplaces, a plan is not about surveillance; it is about practical safety. It might identify a quiet space for recovery, a named first-aider, and a clear route to emergency help. For families, it reduces the risk of hesitation and disagreement in the moment.

If you are unsure

Calling 999 when the need is uncertain is not a failure. Emergency services would rather assess someone who turns out not to need hospital care than arrive too late. The aim is not to make every seizure an emergency, but to recognise the minority that are. If you are worried, call. If the person has a care plan, use it. If you do not, seek advice from their GP, epilepsy nurse or NHS 111 after the event.

This article is general information and does not replace individual medical advice. Always follow the person's care plan and advice from their clinical team.