The terrified voice over the radio screamed for help.

It took about a minute to get there after we had been called. Adrenaline pumping, no idea what we were running into, just hearing panicked screams for help.

I had an awesome first aid instructor who would simulate what a seizure looks like whenever I took a course with him. Fortunately he was pretty bang on with the way he re-enacted it. When I saw what was happening, I instantly knew what was going on.

As the tremors started to slow down, we could finally get access to him after we had cleared the area around his side.

He laid there unconscious, frothing at the mouth.

I tried to put an oral airway in, to help him breathe and maintain the airway. He wouldn’t accept it.

He was still breathing, so we did our best to support him. Called 9-1-1 to get an ambulance there and had no idea how this happened. Looking up at his co-workers they were all shaken and bewildered over the last couple of minutes, watching their friend go through something so traumatic.

I was at his side supporting his head when he started to regain consciousness. He looked at me confused and couldn’t sound out proper words. It just sounded like gibberish. Slowly, he started to come back, only to be confused by the multiple people standing around him wondering what the hell just happened.

Why Helping Someone Having A Seizure Can Be Scary

I’ve written about this story a couple of times now, but I wanted to write about it again because I think it bears repeating.

Dealing with someone having a seizure can be a pretty scary thing, especially if you’ve never seen it before. Even after watching my First Aid teacher re-enact a seizure, I was still pretty surprised that first time.

While it is depicted so often on TV and movies where the person is just flopping around on the floor, from my experience it doesn’t look like that. The person can also experience prolonged contractions through their whole body as opposed to actually shaking. There can also be incomprehensible sounds and cursing coming from the person while the contractions are happening.

The person can be frothing at the mouth and possibly have blood present in the area. I will admit that the first time I helped someone in this case the frothing from the mouth is what threw me off the most until I realized it was normal and part of the process.

Causes Of Epilepsy And Seizures

Seizures can result from several different things, but the most common one is Epilepsy. Epilepsy only affects about 1% of the population and is characterized by short recurrent attacks of motor, sensory and physiological malfunction.The seizures start from abnormal electrical discharges in the brain that stimulate nerve impulses over their pathways.

Partial seizures have milder symptoms that begin on one side of the brain, while generalized seizures happen on larger areas on both sides of the brain resulting in loss of consciousness. 

Epilepsy is usually controlled by medication and there are surgeries that some people elect to have if the medications aren’t controlling the condition well. But people with Epilepsy can still have seizures from time to time even if using medication. The person in the story had epilepsy, but just forgot to take their medication that day. Unfortunately none of us knew he had epilepsy, so we had no idea why this seizure was happening.

There are several things that cause Epilepsy including:

• Brain damage at birth.
• Metabolic disturbances.
• Infections.
• Toxins (ie: drugs and alcohol).
• Vascular issues.
• Head injuries (happened to me when I was 18).
• Abscess on the brain.

This is where a good Massage Therapy intake form is priceless. Making sure you look over an intake form to see if one of your new patients is on medication or lists Epilepsy as a medical condition, puts you a step ahead in preparation for dealing with this one day. Also making sure that each patient’s intake form is updated every so often, just in case someone develops a condition like this is just as important.

But Epilepsy isn’t the only cause of seizures. There are a few other things to consider (especially if Epilepsy isn’t listed on that intake form): (First Aid and CPR Manual)

• Fever.
• Heat Stroke.
• Drug or alcohol withdrawal.
• Video Games (some even come with a warning now before you start playing them).
• Infants and young children with a high fever (febrile seizures).

While the causes may be different, most generalized seizures are going to look the same and providing care for the person is something we can all easily do.

The Signs Of A Seizure Massage Therapists Need To Recognize 

There are a few stages to a seizure that Massage Therapists need to recognize. In the case of someone with Epilepsy they will usually be able to recognize that a seizure is coming on. However with someone who has never experienced a seizure before, it’s less likely they would realize what’s going to happen.

In the case of a generalized seizure there are some warning signs that come on before the uncontrolled muscular contractions take place. The stages of the seizure will look like this:

1. Aura phase – they sense something unusual is happening with a strange sound, taste or smell.
2. Tonic phase – they go unconscious and experience tense muscles.
3. Clonic phase – the seizure (which can range from blackout to convulsions lasting minutes).
4. Postictal phase – the gradual recovery from the seizure.

Having the ability to recognize what’s about to happen goes a long way to being able to help a person if they are having a seizure.

What Massage Therapists Can To Do Help A Seizure

If you recognize that a seizure is about to happen (someone with Epilepsy will know what’s about to happen and may ask for help), get the person sat down on the floor in an open space.

Once the actual seizure starts, clear everything away from the person. We want to make sure there is an open area for them, so that they are not bumping into anything and causing an injury while the seizure happens.

• Don’t try to suppress them, or stop the seizure from happening, just let it happen.
• If they’re on your table when a seizure happens, try to prevent them from falling off the table.
• Make some noise if you have to and get some of the other practitioners in your clinic to come in and stand at the side of the table to prevent the person falling off.
• If they were face down on the table, grab some pillows and do your best to support their head coming off the face piece.

If they were face up when it happened, still do what you can to prevent falling off the table and support their head. DO NOT stick anything in their mouth. Biting the tongue enough to cause any injury isn’t common. However you can end up causing significant injury to yourself by trying to put something in the person’s mouth.

Your biggest responsibility now is to manage the person’s airway. Watch for any frothing at the mouth or possible vomiting. Once the seizure stops, get the person turned onto their side to help maintain the airway and keep it clear.

When the seizure is over and the airway is being maintained, go into your secondary survey. Check out the rest of the person’s body to see if there were any other injuries that occurred. Look for medical alert bracelets or necklaces to see if the person has a medical condition that would suggest this happening.

If the person was naked or in their underwear on your table, make sure to cover them up with a blanket, not only to help prevent shock but also to show them respect and privacy. As the person begins to come out of a seizure they will be a little disoriented and possibly embarrassed. Try to give as much reassurance to them as possible.

10 Reasons A Seizure Can Be A Medical Emergency

Someone who has epilepsy or is known to have seizures doesn’t necessarily mean you have to call 9-1-1…yet.

In the story I told at the beginning, he was mad at me for calling the Ambulance (although I had no idea he had epilepsy). With individuals that are prone to having seizures, it is usually part of everyday life, and they manage the condition with directions from their Doctor. However there are some guidelines that show when it’s necessary to get more advanced help:

• Seizure lasts more than a few minutes.
• The person sustained an injury.
• They experience repeated seizures.
• You don’t know why the seizure happened.
• The person is pregnant.
• It is a baby or a child.
• The seizure happened in water.
• The person has diabetes.
• They don’t regain consciousness afterwards.
• It is a febrile (baby or child) seizure combined with a high fever.

With any of the above instances make sure to call 9-1-1 and get some more advanced medical care. There is also something called “status epilepticus” where a person has continuous seizures and do not regain consciousness. This is a case where Ambulance must be called in to get the person to a hospital ASAP. They must get to advanced medical care.

In a case where a baby or child is having a seizure due to a fever, do what you can to cool the baby. Use room temperature water, give the baby a sponge bath and provide what care you can until Ambulance arrives.

While a seizure can be a scary thing to deal with, there are so many things we can do as healthcare professionals to assist our patients if it happens. Taking the time to recognize the events leading up to a seizure and how to properly handle what happens will help to make it not so scary.

“I feel so lucky that I met the love of my life. You know somebody’s in it to win it when…you’re having a seizure and they’re holding you…”  Kathleen Hanna

It was so hot out you could fry an egg on your massage table.

Out of the blue a volunteer walks up supporting a guy with one arm draped over his shoulder and says “I don’t know what,s wrong with him, but he’s acting funny, you need to deal with this”, flops him on the table and walks away.

Umm okay, never seen this person before but I’ll see what I can do, thanks for the help by the way.  

He didn’t look too good.

He looked flush, he was dizzy, lethargic and had a headache. He had no idea what was going on or how he even got to my massage table.

Unfortunately athletes will sometimes ignore the warning signs that something is wrong and just try to push through a problem, which can sometimes lead to more serious issues.

This wasn’t just a case of an athlete trying to push through fatigue.

There was something bigger going on. He needed help and needed it quickly.

How To Handle Environmental Issues

It happens every year.

Organizers email, call and generally canvas looking for Massage Therapists to give treatments at their events.

Each summer charity events like runs, walks and marathons that are participated in where the people participating aren’t always prepared the best. A lack of proper preparation combined with the heat of summer can lead into some serious emergency situations that we should be able to deal with.

Here are three emergencies you should be prepared for…

1. Heat Cramps

This is the initial sign that someone is having a heat related issue. The person will have severe and painful muscle cramps most likely caused by the salt that is lost during profuse sweating. Recognizing this and treating the condition properly is the best way to prevent things from getting progressively worse.

If we don’t deal with this the persons condition will continue to get worse and can lead into more serious problems that can become a medical emergency.

Fortunately, we are pro’s at dealing with this. Since heat cramps are involuntary muscle contractions, helping the person stretch and massaging the area is one of the things we can do to help them out. The biggest thing we need to do in order to prevent things getting worse is cooling the person down and getting fluids in them. At this point they have lost about 4% of their body water. 

2. Heat Exhaustion

This is the first sign that the person’s body is losing the ability to control its temperature. Watch for the person to feel dizzy, nauseous and exhausted along with possible vomiting.

The ability to recognize this will be our biggest tool in preventing a medical emergency. There is a fine line between Heat Exhaustion and Heat Stroke (which is a medical emergency).

Heat Exhaustion is not a medical emergency…yet. Again just like with Heat Cramps, we want to cool the person down and get fluids into them. Do your best to get them out of the hot environment and get water or sports drinks of some sort into them to help balance out their electrolytes. This represents a loss of about 5% of their body water. 

Usually with treatment the person will begin to feel better.

Here is a detailed list of some actions you can take to properly cool the person and some guidelines for fluid intake.

• strip off any excess clothing
• get the person out of the heat and into some shade
• use something to fan the person, getting cooler air around them
• pour water down the back of their neck
• put ice packs around their groin, armpits and neck
• wet down one of the sheets you brought and wrap it around them
• gradually give them something to drink, water is good but so are sports drinks to help get some salt back in their system. Give them 1/2 a glass every 15 minutes.
• Continually monitor their ABCs
• Do not let them return to competition, they need to rest

3. Heat Stroke

This is the point where we have a medical emergency on our hands.

If we don’t treat someone having heat exhaustion and cool the body down it will lead into heat stroke, which is fatal if not dealt with promptly. The person has now lost 2% more body water compared to heat cramps for a total of 6%.  That percentage isn’t a huge number and it can happen pretty quickly. If the person gets to the point of a 10-20% loss of body water it can lead to death. So we need to act fast.

The signs and symptoms between heat exhaustion and heat stroke are similar with a couple of warning signs that things are getting worse.

• The person stops sweating. This is important to know because it is the warning sign that their body is beginning to shut down and has lost the ability to cool itself.
• A gradual loss of consciousness. This is not typical if someone has heat exhaustion and it is dealt with appropriately. It will only happen if the condition continues to worsen.

If you realize that things are progressing to heat stroke and this has become a medical emergency:

• call for more help from other people around
• call 911
• send somebody to the main event entrance to wait for the ambulance so that they can guide the paramedics to your exact location.
• stay with the person and monitor them in case they lose consciousness  and you have to help them breathe or CPR protocols need to be started.

Photo By: bark

Emergency Preparedness

Keep an eye out for things like this during your summer activities. If you are doing any massage outreaches in the heat try to be as prepared as possible before you go. Bring some extra water, sports drinks and ice or ice packs with you just in case.

And if anyone tries that whole frying an egg with coconut oil on your table, let me know how it goes. I love eggs.

The scary thing is, you never know how severe an allergic reaction is going to be.

When I showed up, I couldn’t believe the state she was in.

Mere steps away from the medication that could have saved her life, but she just didn’t get to it in time.

We cycled through CPR for 45 minutes but our efforts were in vain. We couldn’t bring her back.

It’s an issue everywhere these days.

Allergic reactions to so many foods, substances and insects. Such innocent things but enough for a person to lose their life.

At any given moment we could see this in our clinic, at an outreach or just in day-to-day life.  

The Signs and Symptoms You Need to Know

People who have this type of severe allergy (anaphylaxis) generally know they have it and will let you know if you need to deal with it.

There are a few different things that can cause anaphylaxis, the most common being food allergies and insect stings. Reactions can also be brought on with latex allergies, participating in exercise, medications and sometimes for no reason at all.

May is food allergy awareness month and if you’ve never seen someone having this kind of reaction, the Red Cross First Aid & CPR Manual highlights some signs to look for.

They may end up with:

• Hives
• Itching
• Rash
• Weakness
• Nausea
• Vomiting
• Dizziness and
• Breathing Difficulties

You may remember the Big Bang Theory episode where Wolowitz ate the granola bar to get Leonard out of the house?

Although it doesn’t look that extreme in real life, it gives you a bit of an idea what is happening when a person has a reaction.

If left too long the reaction can have dire consequences. In the story I told at the beginning, the person was ten feet from their medication which was the difference between life and death.  These allergies are so common now that schools are limiting whether kids can bring peanut butter sandwiches or other peanut ingredient snacks to school.

There has even been huge arguments over whether it is okay to use one student’s medication on another student having a reaction, to the point that schools are now having to carry their own supplies in case of emergency.

What Can Massage Therapists Do To Help?

Our biggest responsibility is to help the person breathe, so getting them sat down in a position of comfort to make breathing easier is the first step. This is usually going to be in a seated position leaning forward so that it takes some pressure off the diaphragm.

There are so many stories out there about how people panic when this type of thing happens.

They do their best to help but then get flustered. Time is of the essence here, the person needs that medication and they need it NOW.

Slow down, breathe and don’t panic. If the person sees you worked up it’s only going to cause them further stress that will worsen their condition.

The next step is to get that felt pen looking thing. It’s called an EpiPen and contains the hormone epinephrine.

Once delivered the epinephrine should start to relieve the swelling in a person’s airway and make breathing easier. But before they take the shot of medication there are a couple of things you should check.

1. Make sure it is their EpiPen

• This is important if it is not with them and you have to go get it. Always make sure you are giving a person THEIR medication with THEIR specified dose.
• Ask them “is this yours?” and hold it up in front of them to confirm it.

2. Check the expiry date.

• If the medication is expired it should not be used (unless it’s your only option as a last resort), which means that calling 9-1-1 is a good idea at this point as the Ambulance will have medication with them.

Fortunately the design on new EpiPen’s are a lot easier to use than the older style ones and cause a lot less confusion.

Photo by: Greg Friese

If you’ve never seen or used one before they’re pretty simple to use. One end is blue and the other end is orange. The orange end is where the needle comes out to deliver the medication, so don’t get the two mixed up (you don’t want to have a person stick the needle into their thumb). All you have to do is get the pen out of the case and it’s ready to go.

1. Pop the cap on the case and remove the EpiPen.
2. Remove the blue cap at the top of the pen.
3. The patient plunges the orange end into their thigh and holds for around 10 seconds.
4. Monitor the person’s ABCs to make sure the medication is working.

It shouldn’t take too long for the person to start feeling the effects and make breathing a little easier. However they should still seek medical attention because sometimes the epinephrine can start to wear off, making breathing difficult again.

Remember that we cannot deliver the medication, the patient has to do it themselves.

Make sure to call 9-1-1 after to make sure they get needed medical attention.

Do not leave the person alone while you wait for paramedics to arrive. Your responsibility now shifts to making sure their ABCs are maintained in case their airway starts to swell.

As healthcare professionals you can contact www.epipen.ca and there is a wealth of information on the site about how to use an EpiPen, allergic risk factors, video tutorials and they will even send you an EpiPen training device for practice.

I always assumed you had to have a prescription to get an EpiPen but I contacted Anaphylaxis Canada and they informed me you can get them behind the counter in all pharmacies in Canada (however in the U.S. it is still obtained by prescription only). If you’re doing much treatment outdoor, on site or even if you’re just worried about some of your patients in clinic, for the cost of around $85 it might be a good investment for your practice.

If you decide to keep some with you or in your clinic, make sure you only give it to someone who has used it before and has had it prescribed by their doctor. 

At least (if nothing else) Howard Wolowitz has taught us what an allergic reaction could look like, and maybe how not to be too creepy.