Seizure First Aid: A Las Vegas Guide for Bystanders

A seizure in public is one of the most alarming things most people will ever witness. The convulsions, the loss of consciousness, the sounds that sometimes accompany a tonic-clonic seizure: to someone who has never seen one before, all of it looks catastrophic. The first aid for most seizures is simpler than people expect, and the most dangerous responses are the ones that feel instinctively helpful: holding the person down, putting something in their mouth, restraining their movements. None of those help. They can cause harm.

Whether the moment lands in a CCSD classroom, on a Strip casino floor, or at a Henderson dinner table, seizure first aid means understanding what you are actually trying to do. You are not trying to stop the seizure (you cannot stop a seizure from the outside). You are trying to keep the person safe while it runs its course. Most seizures last between one and three minutes and end on their own. Your job during that time is to prevent injury, stay present, and recognize the situations that require calling 911.

What to Do During a Seizure

Start the clock from the moment the seizure begins. Timing matters because a seizure lasting longer than five minutes is a medical emergency called status epilepticus that needs immediate response. Estimating five minutes accurately under stress is hard, so watch the clock from the start.

Clear the area around the person. Move furniture, hard objects, and anything else they could hit. Place something soft (a folded jacket, a bag) under their head if you can do it without restraining them or moving them significantly. If the person is not already on the ground, ease them down if possible.

Turn them onto their side once convulsive movements have slowed or stopped. The recovery position helps prevent saliva and fluid from pooling in the throat. Do not try to roll them during active convulsions; wait for the movements to ease, then turn them gently. Loosen anything tight around the neck if it can be done easily, a collar button, a tie, a tight necklace. Stay with the person, talk calmly to them as they begin to regain consciousness, and do not leave until they are fully alert and oriented.

What Not to Do

Do not put anything in the person’s mouth. The belief that someone can swallow their tongue during a seizure is a myth that has caused significant harm. The tongue cannot block the airway in a way that requires external intervention, and placing your fingers or any object in the mouth of someone who is convulsing risks injury to both the person and to you. Teeth can clench with considerable force during a seizure. This is one of the most persistent and dangerous pieces of folk first aid still in circulation.

Do not hold the person down or try to restrain the convulsions. The movements of a seizure come from the brain, not the muscles, and restraint does not stop or reduce them. It can cause fractures, dislocations, or soft-tissue injuries in someone who is already in an altered state and cannot tell you they are being hurt. The goal is to protect the space around them, not to control their body.

Do not offer food or water until the person is fully conscious and alert. Someone in the postictal phase (the period of confusion and fatigue that follows many seizures) is not yet in a state to swallow safely. The recovery phase can last minutes to an hour depending on the individual and the seizure type. Rushing it creates aspiration risk.

When to Call 911

Not every seizure requires emergency services. A known epileptic who has a typical seizure, returns to full consciousness within their normal recovery window, and shows no unusual features may not need an ambulance. They and their medical team typically have specific guidance for when to call. Several situations do require 911 without hesitation.

Call immediately if the seizure lasts longer than five minutes, if a second seizure follows closely without the person fully regaining consciousness between them, or if the person does not return to a normal level of consciousness within a reasonable time after the seizure ends. Also call if the seizure occurred in water (a Strip resort pool, a Lake Mead beach, a Henderson backyard pool), if the person was injured during the seizure, if the person is pregnant, if this appears to be a first seizure with no known epilepsy diagnosis, or if the person is diabetic or has a cardiac condition.

After a first-ever seizure in an adult with no prior history of epilepsy, medical evaluation is appropriate even if the person recovers normally and feels fine. New-onset seizures in adults warrant investigation into the cause. That investigation starts with an emergency department or an urgent neurological evaluation, not a wait-and-see approach.

After the Seizure: The Recovery Phase

Most people go through a postictal phase after a convulsive seizure: a period of confusion, fatigue, disorientation, and sometimes headache or muscle soreness that can last anywhere from a few minutes to over an hour. The person may not know what happened or where they are. They may be frightened when they first regain awareness. Stay calm, speak clearly, and reorient them gently. Tell them what happened, that they are safe, and that a seizure occurred.

Check for injuries. The person may have bitten their tongue or cheek, sustained a bruise or cut from contact with the floor, or have muscle soreness from the convulsions. Those are common and generally minor. More significant injuries (a head injury from a hard fall, a fracture from a fall or muscle contraction) are less common but possible, particularly in older adults or in seizures that begin standing.

If this is someone with a seizure action plan (a document prepared with their neurologist specifying when to call for help and how to manage their specific situation), follow it. People with established epilepsy often have specific guidance that differs from general first aid recommendations. Their plan takes precedence over generic protocols.

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