I have a student this semester that told me that there’s a small chance she may have a grand mal seizure due to a switch in her medication. I’ve known a few people with epilepsy and know what to do when they seize (get them on the ground, don’t restrain them, don’t put anything in their mouth, etc.), but if she starts seizing while sitting at her desk, what’s the best way to deal with it? Should I leave her there and let her finish or should I get a few other students to help get her on the ground? (I teach adults and have a few strapping young men in my class, so getting volunteers wouldn’t be a problem.) I realize that there’s a greater chance she’ll hurt herself in her desk, but I also don’t want anyone to get hit or kicked while they’re lifting her to the ground. Thoughts?
You should ask her, and also the administration of your educational institution, to be sure you don’t violate some sort of policy. You should probably immediately call emergency services or have another student do so.
Yes, ask her. Failing that, ask your school nurse.
If they have no person-specific advice, the general rule is to first look at the clock and note the time (write it down; you think you’ll remember, but you won’t), then move the person to the floor and remove all nearby objects (like the desk and the chair) that they could hurt themselves on. Then you just stay out of the way until the seizure passes. For a grand mal, however, you need to decide if you can safely move the person without risking you or your helpers getting hurt. Some grand mals involve lots of flailing arms and kicking legs, and you don’t need to have three students hurt instead of one.
Emergency care is not generally needed after a seizure, or during a seizure, unless the seizure lasts more than 5 minutes or another seizure begins less than 5 minutes after the first one ends. (That’s called “status epilepticus,” and that’s when they start thinking they should do medical intervention and monitoring.)
She’ll probably be sore, embarrassed, thirsty and maybe not thinking too clearly after the event though. It would be kind to send her - with an escort - to the nurse’s office so she can gather her wits together and drink some water and regroup before she goes back to class.
I agree that emergency care will likely not be needed, but making that judgment call should not fall to a teacher. On the off-chance that someone is hurt or the seizure does not stop, everyone will ask why the teacher did not act to summon professional medical help. Better to get help that isn’t needed than the opposite situation.
One other detail, from a seizure I witness in Jr. High School, circa 1965. In Science class, the girl sitting right next to me had a seizure.
In the classroom was a fire extinguisher, and a box on the wall next to it with a fire blanket. He got out the fire blanket for her to lie down on.
Most of the time, seizures aren’t fatal, or a serious emergency. IF her condition is so severe that she’s going to need acctual professional care, then she should arrange for that.
WhyNot’s information is correct – you’ll need to get her gently to the floor, and make sure to turn her on her side, not on her back or stomach. And yes, I cannot stress enough about not putting anything in a seizing person’s mouth. Make sure none of the rest of your students don’t – it’s a good way to get bitten. (My mom learned that the hard way) It’s physically impossible to swallow your tongue.
Sometimes a seizing person can wet him or herself – just a heads up. Fortunately, this never happened to me, but it’s common.
Please go ahead and call 9-1-1. Emergency intervention probably will not be needed, but if it is needed it is much better to already have the ambulance on the way. Status epilepticus is life threatening.
Assign someone to meet the ambulance and guide them to the patient. This much easier for the ambulance crew rather than trying to find their way around inside the school.
Move the patient to the floor, clear the area, and do not restrain the patient in any way.
Once the seizure ends, check the patient’s breathing. Assuming the patient is breathing place her on her side in a recovery position. If she vomits be sure her airway is clear.
Be prepared for CPR. Send a student to get an AED if one is available, just in case.
As someone else mentioned, you should be talking to your administration. They are the ones liable if you do something wrong.
You could also ask the paramedic service.
What if the area is a small office, or someplace where there is no room to clear the floor? What should be done then?
Protect the person’s head as much as possible. The last thing an epileptic needs is a head injury.
Watching someone have a seizure is can be frightening, but it’s usually not life-threatening.
The incident that stands out in my mind was a man who had a seizure on the El platform in Chicago. The only intervention we did was to pull him away from the edge of the platform so he wouldn’t wind up on the tracks. The seizure ended and he was very groggy. Someone must have called 911 as paramedics did show up. Didn’t hear all the ensuing conversation between the man and them but they left without taking him anywhere. Not everyone needs to go to the hospital afterwards.
If you can, you take them into the hallway. If you can’t, you just do the best you can to clear what’s most likely to hurt them. (And when it’s done, you clean up your office so that you have some room. 
If you can’t lay a person down in there, it doesn’t sound like you have much of a safe exit route in case of fire, either.)
Also, recall that *most *seizures aren’t the big jerky convulsive ones. Do they happen? Yes, and if like the OP you know someone who’s had them in the past, it doesn’t hurt to prepare for it. But you’re far more likely to see someone who twitches a couple of times, or who just gets a blank look on their face and doesn’t answer to their name for a few moments and never falls out of their chair.
On the EMS issue: this is why I suggest sending her to the school nurse instead of calling 911…first, because that’s why we have school nurses, so s/he can make that judgement call based on medical need. Second, I suspect the teacher is discouraged from calling 911 themselves from an administrative and security standpoint. It makes the main office very twitchy if unexpected ambulances roll up to the front of the school and they don’t know where to send the paramedics or why they’re needed. But mostly because it’s horrifically embarrassing to have a seizure at all, much less to have paramedics push a stretcher into your history class and start checking your vitals. Since emergency care is so very seldom needed, there’s a huge risk of causing social and emotional harm (which can very literally be devastating to young adults, appropriate with their social development) without a lot of potential benefit. There just isn’t anything short of keeping someone safe that a paramedic can or should do for a simple seizure. Any assessment they should do afterwards can be done in a more private setting afterwards. (Again, assuming we’re not talking about status epilepticus. If she’s Status, that will become clear by definition at the 5-6 minute mark, and then, yes, EMS should be called by whomever the school wants to designate to be the one to call EMS. The 5 minute delay is unlikely to compromise the outcome.)
It certainly wouldn’t hurt for a teacher to keep the nurse’s cell number in his/her phone, and call them when the student is safely seizing on the floor, though.
Since the OP stated that the students were adults, there is probably not a school nurse. Even the elementary schools in my district have only nurses that rotate among several schools, so at any given point there is unlikely to be one at a given school. Obviously if a nurse or other medical professional is available, one should defer to his or her chosen course of action.
Good point. This may vary by state; in my state, any school teaching children *or *offering degree programs must have a nurse. That leaves schools like Bob’s Driver’s Education School the only ones without a nurse. I have heard that there’s been a move to sharing nurses between buildings, which I think is incredibly reckless and wrong-headed, and I look forward to the day when that becomes illegal.
Well, your state may not have its head as far up its ass as mine. 
They cut all of the useful stuff from our budget long ago and now care only about having the latest computers and misprinted textbooks.
Status epilepticus is when one is in a seizure that lasts longer than 5 minutes, as has been stated. That’s not the same as a grand mal seizure. IF, said seizure doesn’t end, THEN you should call 9-11. Your first response shouldn’t be to call an ambulance. You’ll embarass your student, and she might end up having to pay for the unneeded ambulance. Don’t immediately jump to the phone.
You might, however, have to call a ride home for her, depending on how she is afterwards.
Seriously, ask her in advance – “if you have a seizure, do you want us to call 9-11?” Chances are she’ll say no.
If your school has no official policy, it should. Obviously your first concern is your student, but you also need to protect your school and yourself. I think an inservice covering this and other medical problems of students is long overdue.
Once again, I think tsarina should ask her student if she would like her to call 9-11. Personally, if someone did that to me, I’d be pissed. Most of the time, a seizure isn’t an emergency – there’s nothing an EMT can do. Likely it’ll be over by the time they get there.
My SIL has brain cancer, so I have a handy-dandy Seizure guide, courtesy of the American Brain Tumor Association:
Seizure First Aid
Make sure the person can breathe. If he can’t breathe, call for emergency immediately.
Do not Panic
Clear the Area of Sharp Objects, including their glasses.
Protect the person’s head from being bumped, but do not restrain their legs or arms
Do not put anything in the person’s mouth, including your fingers.
Wait out the seizure. After it ends, allow the person to rest and recover.
Call for emergency help if:
The person stops breathing
The seizure lasts more than 5 minutes
The person is injured during the seizure
The person is pregnant or has diabetes
The seizure occurs in water
The person has no history of seizures or no medical id
A second seizure immediately follows.
http://www.abta.org/understanding-brain-tumors/symptoms/seizures.html
These instructions are pretty much in line with what WebMD recommends for epileptics seizures:
We each seem to be approaching this issue based upon our personal history and experience. Mine is as a 9-1-1 supervisor who just had a Status Epilepticus call that resulted in a patient’s death a couple days before this thread started, and as someone with a family member with epilepsy.
From the family member’s perspective I certainly understand the desire to not call 9-1-1 right away. These things are almost always over in a few minutes and the patient almost never really needs emergency medical attention.
As a 9-1-1 supervisor I know the most likely reasons for needing emergency treatment for a seizure are due to injuries secondary to the seizure itself (i.e. head injury from fall during seizure). I recognize that seizure calls are so routine that it is easy to get complacent.
At 9-1-1 our medical calls are generally triaged into three response categories.
The highest response is Medic Priority Response - these calls have the potential to be life threatening. The middle response is BLS Priority Response - these calls are emergencies but not expected to be life threatening. the lowest response is BLS Standard Response - these calls are not emergencies.
Left untreated any patient could become worse and later require a higher priority response.
Seizure calls are all either Medic Priority Response or BLS Priority Response, depending upon particulars.
A patient who is having (or has just had) a seizure and is currently experiencing any of these criteria warrants a
Medic Priority Response *
[ul]
[li]Not breathing after seizure stops[/li][li]Extended seizures greater than 5 minutes[/li][li]Multiple seizures[/li][li]First time seizures (except children under 6 yrs)[/li][li]Diabetic[/li][li]Pregnant[/li][li]Secondary to drug overdose[/li][li]Secondary to recent head injury[/li][li]Any seizure that is different than normal[/li][li]Seizure, unknown history (caller does not know if patient has seizure history)[/li][/ul]
A patient who is having (or has just had) a seizure and is currently experiencing any of these criteria warrants a
BLS Standard Response *
[ul]
[li]Any seizure in a child 6 years or younger[/li][li]Single seizure with a history of seizure disorder.[/ul][/li]
Some of these criteria point to other related underlying medical issues. (e.g. Seizure in a pregnant patient with history of seizure disorder is probably just her normal seizure but could be an indication of eclampsia which is a life threatening complication of pregnancy)
No one ever knows how long a seizure will last when it begins. Ambulance response times in many areas exceed five minutes. So from the 9-1-1 perspective we would much rather have an ambulance on the way and tell it to stand down or have the patient refuse treatment than to need them there and not yet have them on the way.
*Exact criteria for each category may vary according to jurisdiction. All such standards are local.
Question (real question, not JAQing): do you bill for stand down or patient refuses transport calls?