Do You Have a Seizure Action Plan?

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Do You Have a Seizure Action Plan?

1.My personal information:
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 


6. Additional relevant information: 


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