First aid for seizures in schools

This is a summary of first aid for different seizure types. For a more detailed discussion of what to do if a pupil has a seizure at school, complete the module S03 Managing seizures.

Tonic-clonic
Focal
Absence
Myoclonic
Tonic
Atonic

 

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Tonic-clonic seizures

There are two phases in a tonic-clonic seizure: the ‘tonic’ phase, followed by the ‘clonic’ phase.

During the tonic phase, the person loses consciousness, their body goes stiff, and they fall to the floor. During the clonic phase, their limbs jerk, and they may lose control of their bladder or bowels.

Do:

  • Protect the pupil from injury (remove any harmful objects from nearby)
  • Cushion their head
  • Once the seizure has finished, help the pupil to breathe by placing them in the recovery position
  • Stay with the pupil until recovery is complete
  • Be calmly reassuring

Do not:

  • Restrain the pupil’s movements
  • Put anything in the their mouth
  • Try to move them, unless they are in danger
  • Give them anything to eat or drink until they are fully recovered
  • Try to bring them round

Focal seizures

Focal seizures can cause lots of different symptoms and each pupil will have their own individual experiences and symptoms.

During a focal seizure, a pupil might:

  • Retain full awareness of what’s going on or
  • Be partially aware of what is going on around them or
  • Be totally unresponsive

Focal seizures can be frightening and disorientating for the person, so try not to ‘crowd’ them.

If they are behaving in an aggressive way or lashing out, it is advisable to remain quiet and keep your distance from them.

Do

  • Stay with the pupil until recovery is complete
  • Only intervene if you need to guide them away from danger
  • Be calm and reassuring
  • Explain anything that they might have missed

Do not

  • Restrain the pupil’s movements
  • Make any abrupt movements
  • Shout at the pupil
  • Try to bring them round
  • Assume that they are aware of what is happening
  • Give them anything to eat or drink until they are fully recovered

It might not always be obvious that a pupil’s level of awareness has been affected. However, they could be at risk of wandering into dangerous situations, such as near a road, a river or the top of some stairs.

Sometimes people feel aggressive and irritable during or after a focal seizure, particularly if they are experiencing fear, hallucinations or altered awareness. They might lash out if they feel crowded or threatened, or they do not understand what you are doing.

It is vital that you find out as much as you can about each pupil’s seizures and what happens to them. This will help you to give them the help and support they need. You will find this information on the pupil’s individual healthcare plan (IHP).

Absence seizures

A pupil having an absence seizure is unconscious for a few seconds. They will stop doing whatever they were doing before it started, but will not fall. They might blink, have slight jerking movements of their body or limbs. They don’t know what is happening around them and they can’t be brought out of it.

Absence seizures can be very hard to spot, and the pupil might appear to be daydreaming or ‘switching off’.

Absences can recur repeatedly. Some people have hundreds of absence seizures a day. They are often more common when the person is falling asleep or waking up.

Do:

  • Gently guide the pupil away from any dangers (especially if they are having repeated absences)
  • Stay with the pupil until recovery is complete
  • Be calmly reassuring
  • Explain anything they might have missed

Do not:

  • Restrain the pupil’s movements
  • Make any abrupt movements
  • Shout at the pupil
  • Try to bring them round
  • Assume they are aware of what happened
  • Give them anything to eat or drink until they have fully recovered

Myoclonic seizures

During a myoclonic seizure, the person’s muscles jerk. Usually, just one or both arms jerk, but sometimes the person’s head or whole body jerks .The jerking can be very mild, like a twitch, or it can be very forceful. Occasionally, severe myoclonic jerks in the legs can make the person fall and hurt themselves.

Myoclonic seizures may happen as one isolated jerk. Or, they can happen in clusters.

Myoclonic seizures are very brief, but can be extremely frustrating. For example, they can result in spilt drinks or injuries.

There is nothing you can do to help a pupil during a myoclonic seizure, because they happen so quickly However you can help them afterwards if they have an accident or injury.

Tonic seizures

If a pupil has a tonic seizure, their muscles will stiffen. If they are not already lying down, they might fall down.

They might turn blue and appear to stop breathing. This is because their chest muscles stiffen.

Tonic seizures last less than 60 seconds. Some people tend to have clusters of tonic seizures, where they have several seizures in a short space of time.

Tonic seizures are more likely to happen when a person is asleep.

Do:

  • Protect the pupil from injury (remove any harmful objects from nearby)
  • Stay with the pupil until recovery is complete
  • Be calmly reassuring

Do not:

  • Restrain the pupil’s movements
  • Put anything in the their mouth
  • Try to move them, unless they are in danger
  • Give them anything to eat or drink until they are fully recovered
  • Try to bring them round

Atonic seizures

Atonic seizures are also called drop attacks. The person loses all muscle tone and drops heavily to the floor.

The seizure is very brief and the person is usually able to get up again straight away.

However, falls can result in injury, often to the face, nose or head.

There is nothing you can do to help a pupil during an atonic seizure, because they happen so quickly. However you can help them afterwards if they have had an accident or injury.

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This information has been produced under the terms of The Information Standard.
Updated September 2014
To be reviewed September 2017