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SEIZURE ACTION PLAN (SAP) - Epilepsy Foundation

When rescue therapy may be needed:WHEN AND WHAT TO DO If SEIZURE (cluster, # or length) _____Name of Med/Rx _____ How much to give (dose) _____How to give _____If SEIZURE (cluster, # or length) _____Name of Med/Rx _____ How much to give (dose) _____How to give _____If SEIZURE (cluster, # or length) _____Name of Med/Rx _____ How much to give (dose) _____How to give _____Name: Birth Date: Address: Phone: Emergency Contact/Relationship Phone: SEIZURE ACTION PLAN (SAP)How to respond to a SEIZURE (check all that apply) FFirst aid Stay. Safe. Side. F Notify emergency contact at _____ FGive rescue therapy according to SAP F Call 911 for transport to _____ FNotify emergency contact F Other _____Seizure TypeHow Long It LastsHow OftenWhat HappensFirst aid for any SEIZURE FSTAY calm, keep calm, begin timing SEIZURE FKeep me SAFE remove harmful objects, don t restrain, protect head FSIDE turn on side if not awake, keep airway clear, don t put objects in mouth FSTAY until recovered from SEIZURE FSwipe magnet for VNS FWrite down what happens _____ FOther _____When to call 911 FSeizure with loss of consciousness longer than 5

until recovered from seizure F Swipe magnet for VNS F Write down what happens Person does not return to usual behavior (i.e., confused for a _____ F Other _____

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  Foundations, Epilepsy, Epilepsy foundation

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