Being one of the most prevalent health emergencies, seizures cause disabling and life-threatening complications. Early and correct first aid provision by family members, caregivers, or bystanders may reduce the risks and improve health outcomes for the affected individuals. Notwithstanding the importance of first aid, community competencies for managing seizures are frequently inadequate. Along with ignorance of proper first aid measures, many people harbour misconceptions concerning of how to provide aid and consider dangerous interventions that may be translated into reality [1].

Evidence-based first aid guidelines [2] are essential for disseminating the best principles and methods of public response to health crises. These documents inform the development of educational programs and awareness campaigns, potentially influencing community attitudes towards first aid and its application in emergencies. Although previous research has shown that published first aid guidelines may lack mutual congruence and omit essential recommendations [3–5], to the best of the authors’ knowledge, a comprehensive analysis of guideline documents conveying recommendations on seizures first aid has not been carried out.

A full-content structured analysis of English-language international and national guidelines was performed to determine the scope, coverage, and consensus regarding all seizure-related first-aid recommendations. The initial search for these guidelines, which included web and PubMed searches, was conducted for a separate targeted review on the use of the recovery position during generalized seizures, which findings were published elsewhere [5].

Thirteen documents were reviewed, including eight national (for Australia and New Zealand, Canada, India, Singapore, and the United States) and five international guidelines published between 2000 and 2024. The generated dataset showing the distribution of specific recommendations among the guidelines with links to the publications is available online [6] (Supplement 11). Table 1 presents a summary of the recommendations and their coverage by the documents.

The analysis found over 50 recommendations on seizure first aid, extending from general advice to prevent injury to the convulsing person or call emergency medical services to peculiar instructions, e.g., on assisting an individual experiencing seizures in water.

The coverage of recommendations was poor. Most guidelines left out advice to keep an individual with seizures from a fall, avoid moving them unnecessarily, mark the seizure onset, and stay with a person until recovery or medical aid arrived. Other recommendations aimed at protecting a victim from harm were omitted on many occasions (see Table 1). Despite the risk of sudden unexpected death in epilepsy, less than half of the guidelines advised checking person’s breathing once the seizures have stopped and immediately starting cardiopulmonary resuscitation if unconscious victim had apnoea or agonal respiration. A recommendation to put the person on their side was communicated inconsistently, with multiple documents admitting application of the manoeuvre during the convulsions despite the risk of causing skeletal injuries [7][8] (reviewed specifically in [5]).

Taken together, the revealed gaps and the lack of agreement between the recognized and influential guideline documents raise concerns regarding the adequacy for current first aid education and practice and underscore the compelling need for achieving an international consensus on evidence-based seizures first aid.

1. See the electronic version of the journal: https://epilepsia.su.