Outdoor First Aid – Seizures

One afternoon, sat in our holiday cottage I was talking through with a friend a walk she might like to try with her partner. Just as I was pointing out a tricky section on the map she started behaving really oddly, as if repeatedly confirming my point “aha, aha, aha, aha, aha …”

At this moment, my wife (a doctor) who knew this lass, swiftly stepped in and helped get her to the floor. There she cupped her head and said soothing words. Only then, did I realise that this person was having a seizure …

Seizures – what are they?

Seizures are caused by an abnormal discharge of electrical activity across the brain. If only part of the brain is affected it might be that the casualty only suffers an absence (focal) seizure. If the whole brain is affected it might lead to a generalised (tonic-clonic) seizure. Triggers can include:

• lack of food / sleep
• alcohol / drugs
• stress
• flickering light

What do we see? 

When someone has an absence (focal) seizure (also known as a petit mal) they may look spaced out / ‘not there’. They may be saying something repetitively or be stuck in an action like tugging at their collar. It will definitely look ‘not right’, as if something is odd, but it might not be obvious for the first-aider what is going on. As ever, knowledge of the people you are with will always help. This type of seizure will last a matter of seconds. Nothing may come of it, or they may go into a full tonic-clonic seizure.

With a tonic-clonic seizure the casualty will collapse, often with a cry. The body goes rigid and then begins convulsing. The casualty will be breathing through clenched jaws and possibly at an increased rate which will mean that the breathing can cause frothing at the lips. The casualty may lose control of their bladder or bowels. The seizure typically lasts for maybe a couple of minutes.

What do we do? 

When a casualty has an absence, they could go into a tonic-clonic seizure, so get them safely to the floor. At the soonest opportunity look at your watch. Knowing how long a seizure has lasted can be vital information for decision making later, down the line. When they come round, they may feel confused or embarrassed. Reassure them that they are alright and that everything is fine.

If a casualty has a tonic-clonic seizure their head is at risk of further injury. Move aside any furniture in the immediate area and support or cushion the casualty’s head. Because the casualty may lose control of their bladder etc ask any unnecessary people to give a bit of space and/or privacy. As above, remember to time the seizure: this could be vital information to have later on. If the seizure lasts for 5 minutes or more that is a long time for the casualty to have had restricted breathing and they will need to go to hospital.

Again, when they come round, they may feel confused or embarrassed. Reassure them that they are alright and that everything is fine. If their response is not meaningful, help them to lie on their side giving them a stable open draining airway, in case they start vomiting. Chances are, all the casualty will need will be to sleep.

In the outdoors you need to start thinking about the environment. Is this a safe place to be? Will the casualty get hypothermia? Will others in the group get hypothermia if they stay in one location for too long? Start considering the wider situation and try to consider your options. Do consider calling the police and asking for the assistance of the local mountain rescue team. They won’t necessarily need to send out a team if you don’t think it’s necessary, but they will gladly offer you great advice.

People have seizures and they often make a good recovery. These are the times when you need to get the casualty to hospital:

• If the seizure lasts longer than what is usual, or certainly as long as 5 minutes.
• If the casualty has no previous history of seizures.
• If one seizure follows another in succession.
• If the seizure has possibly been caused by the taking of drugs or alcohol or by an injury.

What may happen?

There are numerous reasons for seizures: epilepsy is not the only cause. You should not rule out that the casualty is having a cardiac arrest and you should be prepared to commence CPR.