Do You Have a Seizure Action Plan?
1.My personal information:
Name:
Emergency contact:
Treating physician:
Seizure triggers:
2.How to recognize my seizure(s):
Seizure type, frequency, duration of seizure(s)/seizure cluster:
3.How to help me:
STAY calm and begin timing the seizure.
Keep me SAFE. Remove harmful objects, don’t restrain me, protect my head.
Turn me on my SIDE if I’m not awake, keep my airway clear, don’t put objects in my mouth.
STAY until I’m recovered from my seizure.
Call my emergency contact.
Give my rescue medication (see #4).
4.How to use my rescue medication:
Administer my rescue medication (if applicable).
It is located:
Instructions from my healthcare provider (dose, how to give, when to give):
5. When to call 911
Loss of consciousness longer than 5 minutes
Not responding to rescue medication
Repeated seizures longer than 10 minutes
Difficulty breathing after seizure
Serious injury occurs or suspected
Other:
6. Additional relevant information:
