Over the next few weeks, we will be looking at first aid for seizures to make people aware of how they can help someone who is having a seizure.

Most seizures are self-limiting and will stop on their own. However, knowing simple first aid steps can help keep a person safe during and after a seizure.

In this blog, we will look at first aid for tonic-clonic seizures.

What is a tonic-clonic seizure?

This is one of the most recognisable types of seizure. During a tonic-clonic seizure, a person will stiffen, which is called the tonic phase. The person suddenly falls to the ground and their breathing temporarily stops.

This is followed by jerking movements, all over the body, which is called the clonic phase. Breathing resumes during the clonic phase but it may sound laboured and noisy.

The person may make a grunting noise, produce a lot of saliva, bite their tongue, and/or empty their bladder and/or bowels.

The jerking usually stops after a couple of minutes. Because breathing is affected during a tonic-clonic seizure, skin can become pale, and colour may drain from lips.

How do you know a tonic-clonic seizure has stopped?

You will know the seizure has stopped when the jerking stops. After this, breathing and colour returns to normal, and the person slowly regains full consciousness.

The person will take some time to come round and may feel sleepy, confused, have a headache or sore arms and legs.

Recovery from a tonic-clonic seizure is not instant. It can take a person several hours, sometimes several days, before they feel well again, even without an injury.

What to do if someone has a tonic-clonic seizure?

• Stay calm, most seizures will stop on their own.

• Time the jerking part of the seizure.

• Check for medical identification jewellery, such as a bracelet or a necklace, or a card in the person’s wallet or pocket. This may have important information on the person’s seizures, how long they usually last, when to call an ambulance and emergency contact details.

• Move any objects that could cause injury.

• Put something soft like a jacket or cushion under the person’s head to prevent a head injury.

• Loosen tight clothing around the neck and remove glasses.

• Wipe away any vomit or saliva. This will help maintain the person’s airway.

• If possible, turn the person onto their side into the recovery position during the jerking phase.

Once the jerking part of the seizure has stopped

• If you have not already done this, turn the person onto their side into the recovery position.

• Tilt the head slightly backwards as this will keep the person’s airways open.

• Protect the person’s dignity and stop other people from crowding around. If the person has emptied their bladder, cover the lower part of their body with a jacket or blanket.

• Speak softly and gently and explain to the person what has happened. You may need to repeat yourself as the person may still be confused.

If you know the person, they may have a written care plan or emergency medication protocol providing detailed information about their seizures and how to support them during and after a seizure.

This may include information on emergency medication, and how and when to administer this.

Recovery position

Many people are familiar with the recovery position. If you do not know what to do, turn the person onto their side and tilt the head slightly back.

This can help keep the person’s airways clear and support breathing. There are plenty of videos you can watch online to learn about the recovery position.

What not to do during a tonic-clonic seizure

• Do not move the person unless they are in danger, for example if they have fallen at the top of stairs and are in danger of falling downstairs.

• Do not try to stop the jerking or restrain the person in any way.

• Do not put anything in the person’s mouth or between their teeth.

• Do not offer the person anything to eat or drink until they are fully recovered, i.e. until they have returned to full consciousness and their breathing has returned to normal.

When to call an ambulance

You should always call an ambulance if:

• this is the person’s first seizure as far as you are aware

• the person has injured themselves beyond first aid

• you suspect they may have inhaled food, liquid or vomit

• the jerking lasts for five minutes, or longer than is usual for that person

• one seizure follows another with no full recovery in between

• the person is having problems breathing after the seizure has stopped.

For more information, please check out our first aid for seizures factsheet by clicking here.