How to Help a Coworker Having a Seizure
Why this matters
A coworker having a convulsive seizure is one of the most frightening things to witness on a job, and the urge to do something physical, hold them down, pry the mouth open, is strong. Both of those injure people. What actually helps is short and mostly passive: keep the person from hitting things, time the seizure, get them on their side when it stops, and know the few cases that need 911. On a ladder, a roof or near water the stakes go up, because the seizure is survivable and the fall or the water may not be.
The steps follow the CDC's seizure first aid guidance and current American Red Cross practice. This is not training; a hands-on first aid course is what makes a responder.
Not every seizure is a convulsion
The kind most people picture, a generalized tonic-clonic seizure, has the person stiffen, fall and jerk rhythmically, often with a cry at the start, drooling or frothing, and sometimes losing bladder control. Many seizures look nothing like that. A person may stare blankly, not respond, pick at their clothes, wander or chew for a minute or two. For those, the same rules apply in a gentler form: stay with them, guide them away from hazards (a ladder, a running tool, a roof edge, a street) without grabbing or restraining, time it, and do not assume they hear you until they answer normally.
Step 1: Look at the clock
The moment you realize someone is having a seizure, note the time, to the minute or better, or start a timer on your phone.
Why: the duration decides whether this is a 911 call, and you will be badly wrong if you guess. A minute of convulsions feels like five to the people watching.
What breaks if skipped: you call 911 too late for a seizure that is running long, or you report "it went on forever" to paramedics who need a number.
Step 2: Clear the space and protect the head
Move away anything the person could strike: tools, a ladder base, a chair, the open edge of a cabinet. If they are near something you cannot move, put padding (a jacket, a moving blanket, a seat cushion) between them and it. Put something soft and flat under their head. Take off their glasses. Loosen anything tight around the neck.
Do not move the person unless they are in immediate danger, such as in a roadway, in water or at the edge of a drop. Move the hazard, not them.
Why: most injuries during a convulsive seizure come from striking hard objects, particularly the head.
What breaks if skipped: a head strike on a concrete floor or a shelf turns a seizure into a head injury, which changes the response.
Step 3: Do not restrain them, and put nothing in their mouth
Let the movements happen. Do not hold the arms or legs, sit on them, or try to stop the jerking. Do not put anything in their mouth: not a finger, a wallet, a tool handle or a spoon.
Why: restraining a convulsing person can break bones, dislocate joints or injure the person holding them, and it does not shorten the seizure. A person cannot swallow their tongue. Objects in the mouth break teeth, cut gums and become choking hazards, and fingers get bitten.
What breaks if skipped: the well-meaning helper ends up with a crushed finger and the patient with broken teeth.
Step 4: Watch, time, and decide on 911
Stay with them, watch their breathing and color, and keep timing. Call 911 if any of these are true:
| Call 911 when | Why |
|---|---|
| It is their first seizure, or you do not know | Needs evaluation for a cause |
| The convulsions last longer than 5 minutes | Risk of a prolonged seizure |
| A second seizure follows soon after the first | Same risk, and they have not recovered |
| They do not wake up after it stops | May not be breathing well |
| They have trouble breathing afterward | Airway problem |
| They are injured, including a head strike | Injury needs care |
| It happened in water | Water may be in the lungs |
| They are pregnant, or have diabetes or another known condition | Seizure may be a symptom |
| It happened at height or in a dangerous place | Fall injury and rescue |
If the person has a known seizure disorder and carries a written seizure action plan, or has told you their plan, follow it. Some people carry a prescribed rescue medication and want it given at a set time; give it only as their plan says and only if they or their family showed you how.
Why: most seizures stop on their own within a couple of minutes and do not need an ambulance for someone with known epilepsy. The 911 cases are the ones above, and the 5-minute line is the one people forget to measure.
Step 5: When the convulsions stop, roll them onto their side
Once the jerking stops, gently roll the person onto their side, top knee bent forward to steady them, head tilted slightly back so saliva or vomit drains out of the mouth. Check that they are breathing.
Why: right after a seizure the muscles that protect the airway are slack, and on their back a person can choke on saliva or vomit.
What breaks if skipped: the airway fills while everyone is relieved the shaking has stopped.
If they are not breathing normally once the seizure is over, call 911, start CPR, and use the AED. See related: First Aid + AED on the Jobsite.
Step 6: Stay until they are fully back
Stay with them and speak calmly. After a convulsive seizure most people are confused, drowsy, embarrassed or frightened for anywhere from minutes to much longer. Tell them what happened in plain words. Keep onlookers back. Give nothing to eat or drink until they are fully alert and can swallow normally, and do not let them climb, drive or operate anything for the rest of the day.
Why: confusion after a seizure means they cannot yet judge whether they are okay, and they will often say they are.
What breaks if skipped: they are back on the ladder twenty minutes later.
Step 7: Hand over what you saw
Responders and the person's own doctor need facts only a witness has. Write them down while they are fresh.
SEIZURE NOTE - 10/20, SHOP WAREHOUSE AISLE 3
Person: new hire, history not known
Before: said "I feel weird," then cried out
Started: 2:14:30 pm fell, stiffened, then jerking
all four limbs
Head: struck lower shelf on the way down
Stopped: 2:17:10 pm (2 min 40 s of jerking)
After: rolled to side 2:17:20, breathing,
drooling, not answering until 2:23
911: called 2:15 (first known seizure, head)
Given: nothing by mouth, no medication
Why: the duration, what came first and what came after are what a neurologist uses, and the patient does not remember any of it.
A worked case: the warehouse aisle
The note above is from this event. A shop hired a parts runner two weeks earlier; nobody knew of any medical history. At about 2:14 pm he is pulling filters from a lower shelf in the warehouse.
Step 1. A tech nearby sees him go rigid and fall. She looks at the wall clock and starts her phone timer, which reads 0:00 at 2:14:30 pm.
Step 2. He struck the lower shelf with the side of his head going down. She pulls a box of filters and a hand truck out of reach and slides a folded moving blanket under his head. His safety glasses come off.
Step 3. A second coworker kneels to hold his arms. She tells him to let go and keep his hands off.
Step 4. Two reasons to call, and either one would be enough: this is the first seizure anyone knows of for this person, and he struck his head. The second coworker calls 911 at 2:15 and gives the shop address and the warehouse door to use. The jerking stops at 2:17:10, which is 2 minutes 40 seconds after it began. That is under the 5-minute line, but the call was already justified on the other two grounds.
Step 5. At 2:17:20 she rolls him onto his side. He is breathing, drooling, and does not answer.
Step 6. He starts answering at about 2:23, confused and asking why he is on the floor. She tells him he had a seizure and an ambulance is coming. He asks for water; she tells him to wait until the paramedics have seen him.
Step 7. The paramedics arrive at 2:24. She hands over the note on her phone.
What would change this answer. If he had a known seizure disorder, a seizure plan, no head strike and was fully awake again within a few minutes, his own plan might say no ambulance, and the right move is to follow it and let him rest. If the jerking had passed 2:19:30, the 5-minute line on its own would have made it a 911 call even with no head strike.
When it happens at height or in water
On a ladder. You cannot safely catch a falling adult from a ladder, and trying usually puts two people on the ground. If a coworker on a ladder says they feel strange or have a warning sign they know, get them down immediately. If a seizure starts while they are up, call 911, clear the area below, and stay clear of the ladder unless they are only a rung or two up.
On a roof. Keep everyone else away from the edge and do not attempt to move the person during the seizure. Afterward, keep them lying down away from the edge, and let the fire department bring them down. A post-seizure person climbing down a ladder is the next accident.
In water (a pool, a flooded basement). Support the head so the face stays above the water, and once the convulsions stop, get them out and onto their side. Any seizure in water is a 911 call even if they seem fine, because water inhaled during the seizure can cause breathing problems hours later.
The shop's work-at-height rules are the real prevention. A coworker with a known seizure disorder whose seizures are not controlled should be part of a private conversation, in advance and initiated by them, about what work fits. The federal Americans with Disabilities Act (for employers with 15 or more employees, with many state laws reaching smaller shops) keeps that a matter of individual assessment and reasonable accommodation, not a blanket rule; ask your own attorney before setting one.
References
- CDC, Seizure First Aid (Stay, Safe, Side) and when to call 911
- American Red Cross and American Heart Association Guidelines for First Aid, seizures
- Americans with Disabilities Act and EEOC guidance on epilepsy in the workplace
- See related: Head Injuries and Concussion on the Job
- See related: The First Five Minutes After Someone Is Hurt