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The most appropriate EMS system response to a patient with seizures is not known, because presentations vary greatly. Many patients experience a brief event that has terminated by the time of EMS arrival. Other patients may be convulsing and require ALS interventions. Often a patient with a history of seizures who has recovered to become alert requests not to be transported. Usual system protocols should be followed for patient nontransport provided the patient is alert, oriented, and judged capable of making decisions. Ideally, there should be a companion present for assistance should the seizures reoccur.

A brief period of observation and examination should be performed by EMS clinicians. Establish unresponsiveness as a survey for trauma is undertaken. Note if there is resistance to eye opening, because most patients with seizures will have open eyes. Forced eye closure may suggest nonepileptic seizures. Safety issues include protection by moving the patient away from any hard or sharp objects that might be struck during convulsive movements. If the teeth are clenched, they should not be pried open. However, if chewing movements are continuing and the tongue is being lacerated, an adjunctive airway device, such as an oropharyngeal airway, may be gently placed between the teeth to prevent further injury.

Following a generalized seizure, the patient is often somnolent. Snoring respirations, if present, will typically resolve with insertion of a nasopharyngeal airway. Oxygen supplementation by facemask is recommended. Assessment for airway integrity proceeds as usual, but with the expectation that the patient will become more responsive as the postictal state resolves. IV access is recommended if the patient is not fully awake.