Take Another Look: Police Response to Seizures and Epilepsy

Responding to the Call

How can officer safety be ensured in situations involving seizures due to epilepsy or other causes?

Officers and deputies will follow standard safety precautions when approaching an unknown situation; however, when there is a possibility that a seizure is the cause of the behavior that is observed, they will

• stay calm and assert authority to those in the surrounding area
• address the individual in a non-threatening tone to assess level of awareness and response
• look for medical information bracelet or necklace stating “epilepsy” or “seizure disorder”
• ask bystanders what happened, and whether the individual has had similar episodes in the past or is known to have epilepsy
• guide individual away from hazards or into a secluded area away from crowds by means of a shepherding motion (moving in front to block the way and thus turning into a preferred area and away from an undesirable location) while speaking in a calming, reassuring tone.
• remember that the most likely danger in dealing with someone having a seizure is that he or she will strike out aggressively in response to physical restraint. However, these are likely to be primitive, flailing, undirected, and involuntary movements which are unlikely to injure anyone and should not be treated as purposeful assault or resistance. The best way of handling such episodes is to avoid them by maintaining a measured, non-confrontational but confident, response.

How can an officer determine what is going on?

By observation, bearing in mind the differences between seizures and other episodes of unusual behavior as noted above.

By questions to bystanders, including:

• when did this start?
• was he or she acting strangely before this?
• does anyone know this person?
• has he or she had episodes like this before (Though seizures vary greatly, people generally repeat the same type of behavior each time.)
• does he or she have seizures (fits, falling out spells, or, in Spanish, ataques)?

How can an officer gain control of the situation?

By staying calm, exerting his or her authority, questioning bystanders, and dealing with the person having the seizure in a calm, confident, non-confrontational manner.

What should an officer do to protect the individual having a seizure from harm?

Seizures are medical events though usually not medical emergencies.

If the individual having generalized tonic clonic (grand mal) convulsions which have caused him or her to fall unconscious, stiffen, and experience massive muscle spasms that affect his or her whole body:

• Move hazardous objects out of the way
• Place something soft and flat under the head
• Loosen ties, scarves, any object that could interfere with breathing
• Remove glasses
• Turn the individual on one side
• Note the time, or ask bystanders how long convulsions have been in progress
• Look for medical ID (although its absence does not mean a seizure is not occurring)
• Place nothing in the mouth
• Speak reassuringly and re-orient the person to surroundings as seizure ends
• As consciousness returns, identify yourself as a police officer. Ask if the person has epilepsy and whether medical assistance is desired.
• Ask if there is anyone who should be called to help him or her get home.
• Do not leave alone until person is fully conscious, alert, and able to speak normally.

Complex Partial seizures (involving confusion, agitation, trance-like behavior) are typically characterized by a vacant stare, fumbling movements with the hands, picking at clothing, twitching movements of the mouth or face, and lack of response to other people. In rare instances there may be extreme agitation, verbalizations, and efforts to run or disrobe:

• Speak calmly and reassuringly.
• Ask bystanders for background on episode.
• Do not grab or restrain.
• Shepherd and guide away from hazards or crowds.
• Remember that any behavior that appears threatening is involuntary and should not be handled in a punitive way
• Stay with the person until fully recovered.
• If confusion is constant and unremitting, call for medical attention.

What should officers do if a person with epilepsy has to be arrested?

If a person with epilepsy is taken into custody for any reason, the medication schedule should continue without a break. People who rely on medicines to prevent seizures must keep a steady level of the drug in their blood, or seizures will occur. In some cases, these may be non-stop, potentially fatal, attacks that require hospitalization. The pharmacist or physician prescribing the medication may be called to authenticate its use, dose, and timing.

Be aware that police presence may be stressful of even frightening to people undergoing seizures or just coming out of a seizure. The officer should reassure victims of seizures that he or she is there to help.

Occasionally, the stress of being in an area which is subject to a police raid, or a police response to a domestic dispute, may trigger a seizure in a susceptible person. In these cases, someone, perhaps a family member or close associate, may try to explain what is happening, using words like “fit,” “fall out,” “spells,” “attacks,” or “ataques.” These terms should immediately alert officers to the likelihood that what is happening is in fact a seizure.

What should officers NOT do in responding to a seizure?

Officers should not place anything in the mouth of someone having a convulsive seizure.

Officers should not attempt to hold them down or restrain movement. During these seizures muscles are getting massive electrical signals to contract; trying to prevent the resulting movements may tear muscles and cause other physical injury.

Officers should not try to pry the mouth open or get hold of the tongue. It is an old myth that someone having a seizure will swallow the tongue or should have a spoon or other hard instrument placed in the mouth. Doing any of these things will injure the individual, perhaps severely.

Officers should not be aggressive towards an individual in a post-seizure confused state, or attempt to physically restrain a person who is having a complex partial seizure. Restraint triggers an INVOLUNTARY aggressive response, which in turn may produce a heightened police response with subsequent injury to the person involved.

Officers should not leave a person in a confused state during or after a seizure unless that person is in the care of a family member or other responsible person. People are vulnerable to all kinds of criminal activity during these episodes, because they are unable to protect themselves or their property until full awareness returns.

If a seizure occurs during police questioning or while in police custody on an unrelated matter, law enforcement officers should not use denial of medication or medical attention as punitive measures. As already noted, it is vital that seizure patients get their regular medicine on time. If they don’t, they may have serious re-bound seizures that are more severe than usual, harder to stop, and, in some cases, life threatening.

Do not rush the person or crowd his or her personal space. Do not touch him or her unless there is no other way to move the person away from danger.

Avoid being a “tough guy.” Tough methods will frighten the person, increase his or her agitation, cause an involuntary defensive or aggressive response.

What if the person must be restrained or force must be used?

If the circumstances of the situation dictate the lawful use of force, take the necessary action.

During a seizure, an individual is not capable of directed action, such as resisting arrest of threatening an officer, Even if other circumstances would indicate the use of force, the appropriate response would be seizure management until consciousness returns – while being alert to the possibility that the individual may be faking.

However, unusual, confused behavior alone is not a reason for physical force.

Only when a person is so dangerous or violent that he or another person is likely to be harmed should force be used, and then only the minimum amount necessary.

Handcuffs are not the best tool for restraint in these circumstances. They may injure the person. Blankets, sheets, or even drapes can be used to restrain if absolutely necessary, but nothing should be used that will obstruct breathing.

Should an ambulance be called when someone has a seizure?

The average seizure in a person who has epilepsy is not a medical emergency. It will end after a minute or two, be followed by some additional minutes of confusion, and full awareness will slowly return. Unless the seizure is quickly followed by another one, breathing is impaired, or consciousness does not return, there is usually no need to call for emergency aid, or take the person to the emergency room.

If there is a local rule requiring the presence of an ambulance in the case of an epileptic seizure, then the individual should at least have the option of refusing transportation to the hospital once he or she is sufficiently recovered to make the decision. Ambulance and emergency room costs are high, and are a special burden for people with epilepsy who may not have any insurance because of their condition.

When should an ambulance be called?

An ambulance should be called if there is no medical ID or not other way of finding out whether the person is having a first-time seizure or whether he or she has epilepsy. If the person is having a first-ever seizure, there may be a serious underlying medical problem that requires emergency care.

If she’s pregnant. Complications of pregnancy may be causing the seizure, and these may be serious.

If a medical ID indicates diabetes, or other medical problem. The seizure may be related to that problem and require treatment.

If the seizure has happened in water and there is any chance that water was ingested or inhaled. A medical evaluation is needed in these circumstances.

If there was an injury prior to or as a result of the seizure, or if there are any signs of injury (bleeding to the head, unequal pupils, vomiting). Medical evaluation is necessary in these cases also.

If the seizure is known to have followed cocaine use, there may be additional complications and a medical check is necessary.

If a convulsive seizure shows no sign of stopping after FIVE minutes, if another seizure begins shortly after the first, or if a seizure involving acute confusion shows no sign of resolving after about half an hour, emergency assistance should be sought.