From Confusion to Confidence: Improving Seizure Outcomes Through First Aid
Introduction
One of the most valuable roles we have as healthcare professionals is educating the community on how to respond during emergencies. But what happens when the information we share is incorrect or worse, when our guidance leaves the public confused? Misinformation or mixed messages during critical moments can do more harm than good, especially when it comes to seizure response.
In this post, we’ll explore a real EMS case that highlights how improper first aid actions and unclear communication from providers can impact both the patient’s safety and the public’s trust.
Seizures and Epilepsy: A Prehospital Perspective
Seizures and epilepsy are among the most common neurological conditions in Saudi Arabia. Recent studies estimate that epilepsy affects approximately 6 out of every 1,000 individuals in the country — and this number may be even higher in underserved regions where access to neurological care is limited.
Given how frequent seizures can be, one of the most critical challenges lies not in the condition itself, but in how those around the patient respond. Friends, family members, and even first responders may act with the best intentions — but misconceptions can lead to harmful decisions.
Understanding Seizures and Epilepsy
A seizure is a sudden, temporary burst of abnormal electrical activity in the brain. This can affect how someone moves, thinks, feels, or remains aware. A single seizure does not mean a person has epilepsy — but repeated, unprovoked seizures do.
Seizure = symptom/event
Epilepsy = chronic neurological condition involving recurrent seizures
Epilepsy exists on a spectrum. Some people experience brief, rare episodes; others live with frequent, disabling seizures. The impact depends on:
Type, frequency, and severity of seizures
Which parts of the brain are affected
The person’s response to treatment
Underlying causes and coexisting conditions
Treatment may include medication, surgery, neurostimulation, or specialized diets.
Sources: Epilepsy Foundation, CDC
Real EMS Case: Confusion After the Seizure
(Scenario modified for privacy and educational purposes)
Incident
Dispatched at 16:20 to a private residence for a 24-year-old male in a postictal state following a witnessed seizure. Patient was found lying on the floor, breathing on his own but unresponsive. Multiple concerned friends were on scene.
Chief Complaint
Bystanders stated the patient had suddenly collapsed and experienced full-body convulsions lasting 1–2 minutes. They restrained him during the event “to prevent injury.” He remained unresponsive after the seizure ended.
History
While Responder 1 began a hands-on assessment, Responder 2 spoke with the friends and gathered key history:
Known epilepsy
No recent medication changes
Uses nicotine patches
No drug/alcohol use
Seizures are recurrent but usually self-limiting
Assessment
Patient was unresponsive but breathing well, with no evidence of trauma or incontinence. Vitals were stable:
HR: 98 bpm
BP: 124/78 mmHg
RR: 16
SpO₂: 96% on room air
Pupils equal and reactive
Despite the stable condition, Responder 1 performed a carotid sinus massage a maneuver typically reserved for certain cardiac arrhythmias (e.g., SVT), which was not indicated in this context. Responder 2 immediately questioned the decision, redirecting the care plan.
Treatment
The patient was placed in the recovery position, head supported, and hazards cleared. No medication was administered. Continuous monitoring was performed during transport.
Before departure, Responder 2 took time to educate the bystanders, saying:
“Next time, don’t restrain someone during a seizure. Let it run its course and just protect the head.”
However, Responder 1 contradicted this advice, saying:
“Actually, it was good that you held him you may have prevented injury.”
This contradiction created visible confusion among the friends and undermined the message.
Transport
The patient remained stable en route and was transferred to emergency staff at 16:58. Full documentation was completed.
Case Reflection & Discussion
This case illustrates both strong clinical judgment and areas needing improvement.
What Was Done Well
Medical history was thoroughly gathered by Responder 2, allowing for appropriate care.
Effort was made to educate the bystanders, reinforcing EMS's public health role.
What Went Wrong
Carotid sinus massage was inappropriately used, posing unnecessary risk.
Contradictory instructions confused the public and risked undermining EMS credibility.
Incorrect advice about restraining a seizing person was reinforced by a provider in uniform.
Seizure First Aid Reminder
If you're ever present during a seizure, remember the essentials:
Do NOT hold or restrain the person
Protect the head and remove nearby hazards
Once the seizure ends, place them on their side
Time the seizure and observe their breathing
Call emergency services if:
The seizure lasts more than 5 minutes
The person doesn’t regain awareness
It's their first seizure
They have difficulty breathing afterward
Final Takeaway
This scenario is a powerful reminder that clinical competence is only part of the job. Equally vital are:
Clear, respectful communication between team members
Consistent messaging in front of the public
A shared commitment to teaching and modeling best practices
When responders contradict each other at the scene, it doesn’t just cause confusion it damages the public’s trust in emergency care. Every scene is a chance to either build or break that trust.
Let’s use every call not just to care for the patient, but to educate those around us — together, and with clarity.
References
Epilepsy Foundation. (n.d.). What is Epilepsy?. Retrieved from https://www.epilepsy.com
Centers for Disease Control and Prevention (CDC). (2023). Types of Seizures. Retrieved from https://www.cdc.gov/epilepsy
Al Rajeh, S., Awada, A., Bademosi, O., & Ogunniyi, A. (2001). The prevalence of epilepsy and other seizure disorders in an Arab population: A community-based study. Seizure, 10(6), 410–414. https://doi.org/10.1053/seiz.2001.0521
World Health Organization (WHO). (2019). Epilepsy: A public health imperative. Retrieved from https://www.who.int/publications-detail-redirect/epilepsy-a-public-health-imperative
National Institute of Neurological Disorders and Stroke (NINDS). (2022). Seizures and Epilepsy: Hope Through Research. Retrieved from https://www.ninds.nih.gov
American Red Cross. (n.d.). Seizure First Aid Steps. Retrieved from https://www.redcross.org
