First Aid for Tonic-Clonic Seizures: Essential Steps You Must Know
First aid for tonic-clonic seizures is a set of emergency actions designed to protect the person having the seizure, maintain a clear airway, and prevent injury until the episode ends or professional help arrives. Imagine you’re at a coffee shop and a patron suddenly starts stiffening, then jerking violently. Panic can set in fast, but knowing exactly what to do can make the difference between a brief, uneventful event and a life‑threatening situation.
Recognising a Tonic‑Clonic Seizure
Before you intervene, you need to be sure you’re dealing with a tonic‑clonic seizure, not a faint or a panic attack. A tonic‑clonic seizure typically follows this pattern:
- Loss of consciousness - the person appears unaware of their surroundings.
- Tonic phase - muscles contract, the body stiffens, and the person may let out a gasp.
- Clonic phase - rapid jerking of arms and legs lasts from 30 seconds to 2 minutes.
- Post‑ictal state - confusion, fatigue, and sometimes a headache follow the seizure.
When you see these signs, act quickly but calmly.
Immediate Safety Measures
The top priority is protecting the individual from injury. Follow these steps:
- Clear the area. Remove hard objects, sharp furniture, or anything that could cause bruises or cuts.
- Place a recovery position a safe side‑lying posture that keeps the airway open and allows fluids to drain as soon as the jerking stops. This prevents choking on saliva or vomit.
- Check the mouth. Do not insert anything - no fingers, spoons, or medication unless you’re a trained professional with a prescribed rescue drug.
- Time the seizure. If it lasts longer than five minutes, treat it as a medical emergency.
These actions buy you precious minutes while the brain’s electrical storm runs its course.
When to Call for Emergency Help
Most tonic‑clonic seizures stop on their own within two minutes, but you should dial emergency services (000 in Australia) if any of the following occur:
- The seizure lasts more than five minutes (status epilepticus a life‑threatening condition requiring immediate medical intervention).
- The person has a second seizure without regaining consciousness.
- Injury occurs - head trauma, broken bones, or severe cuts.
- Breathing stops or the person remains unresponsive after the seizure.
- It’s the first seizure the individual has ever experienced.
When you call, clearly state that the person is having a tonic‑clonic seizure and provide any known medical history, such as epilepsy or diabetes.
Rescue Medication: What You Need to Know
People with a known seizure disorder often carry a rescue medication, usually a benzodiazepine like midazolam a fast‑acting anti‑seizure drug administered buccally or intranasally or lorazepam. If you’re a caregiver and the medication is prescribed, you can give it when the seizure exceeds two minutes.
- Follow the dosage instructions on the prescription label.
- Administer the drug as soon as the seizure prolongs - early treatment can stop it before it becomes status epilepticus.
- Stay with the person after administration and monitor breathing.
If you’re not authorised to give medication, focus on safety and call emergency services.
Post‑Seizure Care and Monitoring
After the jerking stops, the person will enter the post‑ictal phase. Here’s how to support them:
- Keep them in the recovery position until they’re fully awake.
- Offer reassurance. Explain briefly what happened once they’re alert.
- Check blood glucose if the person is diabetic. Low blood glucose the level of sugar in the blood, measured in mg/dL can mimic or trigger seizures.
- Watch for breathing difficulties or a second seizure.
- Document the event - duration, triggers, and any injuries - for the person’s seizure diary.
Most people recover within 30 minutes, but fatigue can linger for hours.
Common Pitfalls and Myths
Even well‑meaning bystanders can unintentionally worsen the situation. Avoid these mistakes:
- Putting something in the mouth. This can cause dental injury or obstruct the airway.
- Holding the person down. The muscles contract involuntarily; restraint can cause fractures.
- Giving food or drink too soon. The gag reflex may still be suppressed.
- Assuming every loss of consciousness is a seizure. Fainting (syncope) has different causes and requires a different approach.
Remember, the goal is to protect, not to stop the convulsions directly.
Quick‑Reference Checklist for Caregivers
| Step | Action | Why It Matters |
|---|---|---|
| 1 | Protect the person from surrounding hazards | Prevents bruises, fractures, head injury |
| 2 | Time the seizure | Identifies status epilepticus (>5min) |
| 3 | Place in recovery position once jerking stops | Maintains open airway, allows fluid drainage |
| 4 | Administer rescue medication if prescribed and seizure >2min | Stops seizure early, reduces complications |
| 5 | Call emergency services if seizure >5min, injury, or repeat seizures | Ensures rapid medical intervention |
| 6 | Monitor breathing and post‑ictal recovery | Detects airway compromise or secondary seizures |
| 7 | Check blood glucose if diabetic | Rules out hypoglycaemia as a trigger |
Related Concepts and Next Steps
Understanding tonic‑clonic seizure first aid opens the door to broader seizure‑management knowledge. Topics you might explore next include:
- Epilepsy diagnosis and treatment pathways - how neurologists classify seizure types and choose long‑term medication.
- Seizure triggers and lifestyle modifications - sleep hygiene, stress reduction, and alcohol avoidance.
- Seizure‑safe environments - designing homes and schools to minimise injury risk.
- Understanding status epilepticus protocols - advanced airway management and IV benzodiazepine administration.
Each of these areas builds on the foundations you now have for emergency response.
Frequently Asked Questions
How long does a tonic‑clonic seizure usually last?
Typical seizures last between 30 seconds and two minutes. Anything beyond five minutes is considered status epilepticus and requires emergency care.
Can I give a person food or water during a seizure?
No. The gag reflex is often suppressed, so food or drink can cause choking. Wait until the person is fully alert and sitting upright.
What is the best position to place someone after a seizure?
The recovery position - lying on their side with the lower arm extended and the upper knee bent - keeps the airway clear and lets fluids drain.
When should I use rescue medication?
If a prescribed benzodiazepine is available, give it when the seizure continues past two minutes, or sooner if the person has a history of prolonged seizures.
Is it normal for the person to be confused after the seizure?
Yes. The post‑ictal state often includes confusion, fatigue, and headache. It typically resolves within 30‑60 minutes.
Can a seizure cause permanent brain damage?
A brief tonic‑clonic seizure rarely leads to permanent damage. Prolonged seizures (status epilepticus) can cause oxygen deprivation and require urgent treatment.
What should I do if the person falls and hits their head?
Call emergency services immediately. Keep the person still, monitor breathing, and avoid moving them unless they’re in immediate danger.