A seizure is about ninety seconds long and it stops on its own. What decides whether it costs anything is where the person was standing: the same ninety seconds is a non-event in bed and a drowning in a bath.

Your own week, sorted by what it would cost

Nothing is saved and nothing leaves the page. Mark what you genuinely do, not what you might. If somebody is fitting as you read this, the first questions cover it.

What to do while it is happening, which is mostly nothing

• Note the time it started. The single most useful thing a witness can do. Everything afterwards — whether it was an emergency, what treatment is right, whether the pattern has changed — turns on a duration nobody can estimate afterwards, and ninety seconds feels like ten minutes when you are watching.
• Move the furniture, not the person. Take away what they are hitting, put something soft under the head, and let the seizure finish. Holding somebody down does not shorten it and does cause the shoulder and back injuries that turn up afterwards.
• Nothing in the mouth. No spoon, no fingers, no water, no tablets. Swallowing the tongue is not a thing that happens; broken teeth and bitten fingers are.
• When the shaking stops, roll them onto their side. That is the moment the airway matters: they will be deeply asleep, they may be sick, and the side is what keeps the airway clear. Stay until they know where they are.
• Call an ambulance if it passes five minutes, if a second starts before they have recovered, if they are hurt, if it happened in water, if they are pregnant or diabetic, or if this is the first one anybody has seen. Otherwise a known seizure that follows the usual pattern and settles does not need an ambulance, and the person often knows that better than the bystander.
• Afterwards, be boring. Confusion, exhaustion, a headache, not knowing what happened, being upset or aggressive without meaning it — all normal for minutes to hours. Quiet, no crowd, no questions they cannot answer yet, and no arguing with somebody whose brain is rebooting.

Why the witness matters more than any scan

• There is no test that says "seizure". The diagnosis is made from the description: an ordinary scan and an ordinary brain tracing are common in people who genuinely have epilepsy, and an abnormal tracing does not prove a seizure either. What decides it is what somebody saw.
• The person it happened to remembers nothing useful. That is the nature of it, which is why the appointment that goes badly is the one the witness could not attend. If they cannot come, a written account or a voice note is the next best thing.
• Six things are worth writing down within the hour. How long it lasted; what happened first; whether the eyes were open and where they were pointing; the colour of the face and lips; whether there was stiffness before shaking; and how long the confusion afterwards lasted.
• A phone video is genuinely valuable and worth explaining. Clinicians ask for them because they settle questions no description can. Film the person, not the room; keep it, do not post it; and tell the family why you filmed rather than helped, because that is the thing that gets misunderstood.
• The things that get mistaken for each other look different in specific ways. A faint has a warning, a pale sweaty person and a fast recovery; a cardiac arrest has no pulse and no proper breathing and needs compressions; a seizure with no confusion afterwards and closed eyes throughout may be something else again. None of those is for a bystander to decide — but the details that separate them are for a bystander to notice.
• What triggered it, and the twenty-four hours before. Sleep, alcohol, a missed dose, an illness, a new medicine, a fever. This is where the answer often is, and it is the part nobody asks about until the second appointment.

The fortnight afterwards, and the driving question

• Driving stops from today, and it is not the clinician's decision to make quietly. Every country requires the driver to notify the licensing authority after a seizure or a blackout, the period off the road is set in law rather than by how well you feel, and insurance is void for driving against that rule. Ask what applies where you live, in writing.
• Work is a conversation with a named person, not a resignation. Occupational health exists for this, adjustments for height, machinery, lone working and shifts are normal, and in most places a seizure disorder is a protected condition. Going quiet about it is what causes the dismissal that follows an accident.
• The appointment is worth preparing in one page. The witness account, the six observations, the twenty-four hours before, every medicine including the ones bought over a counter, alcohol honestly, and any previous episode however small — the odd jerk on falling asleep, the minute nobody could explain, the déjà vu with a strange taste.
• Ask what to do if it happens again, before you leave. What counts as an emergency for this person specifically, whether there is rescue medicine and who may give it, and what the plan is if it happens at work or on a bus. A page of instructions beats a leaflet about epilepsy.
• Do not start or stop a medicine on your own. Stopping an anti-seizure medicine suddenly can cause a worse seizure than the one being treated, and starting one after a single fit is a real decision with real trade-offs that belongs with a specialist.
• Tell two or three people what to do. The time, the side, nothing in the mouth, and when to call. This costs one message and it is what the next ninety seconds actually needs.

What people believe, and what is so

The drill: 16 moments

Sixteen ordinary rooms — the man on the kitchen floor with a crowd around him, the mother who has been told not to drive and nothing else, the shift worker who missed two doses, the friend filming instead of helping. Each has an obvious kind thing to do that makes it worse. Pick the move; every answer explains why.

The card

Print it, put one copy on the fridge and one in a bag. It is written for whoever is standing there, not for you.

🖨️ Print the card