Seizure emergencies

Not every seizure needs an ambulance, but some do. The person’s usual seizure pattern, recovery and individual emergency plan all matter. Emergency numbers and local advice differ by country, so this page separates general danger signs from UK-specific guidance.

The 5-minute rule

A convulsive seizure lasting 5 minutes or more is treated as a medical emergency. NICE recommends immediate emergency treatment for convulsive status epilepticus at this point.

If you do not know how long the person’s seizures usually last, use 5 minutes as the emergency threshold. If their normal convulsive seizures are much shorter, NICE also advises treating a seizure that continues for more than about 2 minutes longer than that person’s usual seizure as a medical emergency.

Call for emergency help if

• it is the person’s first known seizure
• a convulsive seizure lasts 5 minutes or more
• the seizure lasts significantly longer than is usual for that person
• another seizure starts before the person has recovered
• the person has repeated or cluster seizures that are outside their usual plan
• breathing remains difficult, they appear to be choking, or you are concerned about their airway after the seizure
• the seizure happens in water
• there is a serious injury, heavy bleeding, suspected fracture or significant head injury
• the person does not recover in their usual way or remains seriously unwell
• the person’s emergency plan tells you to call
• you believe the situation is life-threatening or significantly different from their usual seizures

Repeated and cluster seizures

NICE describes repeated or cluster seizures as typically 3 or more self-terminating seizures within 24 hours and recommends managing them as a medical emergency. NHS guidance also advises calling 999 when someone has had 3 or more seizures in 24 hours.

Some people who are known to have seizure clusters have a personalised plan and prescribed rescue medicine. Follow that plan if it is immediately available and you have been trained to use it. A plan does not override obvious life-threatening danger.

Breathing can look frightening — but look at recovery too

Breathing can temporarily look abnormal during a convulsive seizure because the chest and breathing muscles are affected. What matters afterwards is whether breathing recovers normally. Persistent breathing difficulty, choking, blue or grey colour, or a person who is not recovering as expected needs urgent medical assessment.

A seizure does not always mean an ambulance

Many people with established epilepsy have brief seizures that stop on their own and recover in a familiar way. They may not need hospital treatment every time. Unnecessary ambulance calls can remove control from someone who knows their own epilepsy well, so use their care plan where one exists.

The exception is when something is clearly outside the normal pattern: a much longer seizure, repeated seizures, serious injury, breathing problems, water-related seizure, unusual recovery, or another reason to suspect immediate danger.

Recovery still counts

The visible seizure can finish before the person is back to their usual baseline. Confusion, exhaustion, memory loss, fear, agitation, speech difficulty or unusual behaviour may continue in the postictal period. Stay nearby, reduce danger and compare recovery with what is normal for that person.

If the person does not recover as they usually do, has another seizure without recovering, or you are seriously concerned about breathing, injury or consciousness, seek emergency help.

UK guidance

In the UK, NHS guidance says to call 999 for a first seizure, a seizure that lasts longer than usual or longer than 5 minutes when usual duration is unknown, failure to recover normally, repeated seizures without recovery, serious injury or breathing difficulty after the seizure. The NHS also advises urgent GP or NHS 111 help after a possible first seizure when the person did not go to hospital, or after a seizure following a long seizure-free period.

Outside the UK

The same danger signs are widely used internationally, but emergency numbers and local guidance differ. For example, the US Epilepsy Foundation advises calling emergency services for seizures lasting 5 minutes or more, repeated seizures, difficulty breathing, water-related seizures, injury, first seizures, failure to return to the person’s usual state, or when the person asks for medical help.

Sources and guidance

NHS — What to do if someone has a seizure

NHS — Epilepsy

NICE NG217 — Status epilepticus, repeated, cluster and prolonged seizures

Epilepsy Foundation — Seizure first aid

Read full seizure first aid →

Medical note: This page gives general emergency information. Follow an individual emergency plan where one exists, unless the situation is clearly life-threatening.