First Fit Management in Primary Care

Management of someone with suspected epilepsy

  1. Urgent referral
  2. Carer advice
  3. Driving / Swimming etc
  4. Information

Urgent Referral

  • Include a description of the fit from first hand witness and contact details of the witness

Carer Advice

Management of Seizure

  • look for epilepsy card/jewelry
  • Prevent them from injury by cushioning head / removing harmful objects or moving person to safety
  • Don’t restrain them or put anything in their mouth
  • When seizure stops check airway and place them in the recovery position
  • If it’s a first seizure – emergency admission
  • If it’s lasted more than 5mins or more than three seizures in an hour
    • may need buccal midaz or rectal diazepam (or IV loraz)
  • Call ambulance if:
    • prolonged/recurrent seizure
    • high risk – so if there’s a history of status epilepticus or repeated seziures
    • monitoring is difficult
  • Observe them until completely recovered
  • Check for any injuries

Record possible seizures with video if possible on phone + record seizure diary


Patient must stop driving until seen by specialist.

They must inform DVLA of the condition.

Advise on swimming / bathing with care to avoid drowning.

(Be aware that this will be a lifestyle change and may impact upon work/hobbies/mental health – may get depressed)



Lots of advice available