Seizure Safety During Summer

By: Joan Asmus, BSN, LSN, NBSCN – Professional Advisory Board Member

It’s summertime! Many of us are expanding our activities to include fresh air and summer-specific activities. For many people, the scariest aspect of epilepsy is not knowing when or where a seizure will occur, and they may feel that they cannot engage in certain physical activities because of this. The following information will help individuals who have epilepsy determine the activities they can safely engage in. It is always advisable to check with your epileptologist or epilepsy nurse as to your seizure type and characteristics before engaging in activities.

We will begin by talking about water sports. In general, water sports, including swimming, snorkeling, jet-ski riding, windsurfing, and sailing, are risky for people with epilepsy, but with a few accommodations, they can be safely pursued by some.

Death from drowning is more common among people with epilepsy. For those who lose consciousness during seizures it’s especially dangerous to be in water, and should one occur, emergency care must go beyond the standard seizure first aid procedures.

To help promote the safety of swimming, individuals with epilepsy will want to consider some things:

Choose a swimming location. Swimming in a pool is safer than open water or a river that may have currents, tides, sudden changes in depth, and colder water temperatures. However, some pools, such as hotel pools, may not have lifeguards on duty which pose an additional risk.
Stay hydrated. Hunger or dehydration can cause seizures. Make sure to check in with yourself, or your loved one, before going in the water. This is especially important on hot, humid days.
Have an “informed buddy” with you during swimming or water sports. The American Red Cross recommends using the “Reach” system – making sure someone is within “reach” at all times. The “informed buddy” should be familiar with your specific seizure symptoms and the steps to provide immediate assistance. A tool that can explain different types of seizures is the Epilepsy Foundation of Minnesota’s (EFMN) “Seizure Recognition and Response” brochure. Another tool to help the “informed buddy” is the seizure first aide app. Kids and adults should use an “informed buddy,” even when seizures are well controlled. If the person with epilepsy has any implanted devices (such as a vagal nerve stimulator) or rescue medications, the “informed buddy” should know where it is stored and/or its safe use.
Lifeguards, when possible. If you’re at the pool, it is important to tell lifeguards that you or someone you are with has a seizure disorder. States vary widely on the legal requirement for a lifeguard being on site during operation. In Minnesota, look for signs stating if a lifeguard is on duty; at a public pool open to use, a warning sign must be in plain view. Minnesota Statute 4717.0950 states the following about the training and responsibilities needed for a lifeguard on duty:

“An individual currently certified in first aid and adult, child, and infant cardiopulmonary resuscitation must be on duty at all times the pool is open to use, unless a sign warning that a lifeguard is not present is posted as specified in part 4710.1050. The individual must have a Red Cross lifeguard certification or equivalent and be responsible for user supervision, safety, and sanitation at all times the pool is in use.

When possible, swim during quieter swimming sessions so it is easier for the lifeguards to see swimmers. It is especially important, when swimming in areas without a lifeguard on duty, that at least one person in the water or observing, be aware of the possibility of a seizure, and know basic life-saving techniques that include cardiopulmonary resuscitation (CPR). As of 2016, in Minnesota, all students must have training on providing basic life support before graduating from high school. When choosing your “informed buddy,” inquire as to their ability to provide CPR. You can also connect with EFMN about additional training for managing a seizure event in the water.

Personal flotation device (PFD). Always wear a high-quality, properly fitted life vest when near the water. If swimming in open bodies of water (ocean or lakes) or even riding a boat, it is essential that everyone, including the person with epilepsy, wear a life jacket. A properly fitted vest takes into consideration the person’s size, physical abilities, and likelihood that a seizure may occur with loss of consciousness, which should also include flotation adaptation that would keep their face/head out of the water while lying on their back.
Medical alert. Always wear a medic alert bracelet or necklace.

Other water sports and additional considerations:

Boating. Wear a PFD when in a boat, and when performing activities such as paddling a paddleboard, canoe, or kayak. There can be risks for people with epilepsy who paddle a kayak or canoe. If a kayak overturns when someone has a seizure they could be trapped underneath and their PFD could keep them pressed underneath the kayak. Although this is a risk for anyone who tips over a kayak, it is more of a risk for someone having a seizure as they may be unconscious or only partly conscious at the time. There is a lower risk of being trapped underneath an open canoe (sometimes called a Canadian canoe) during a seizure.
Water skiing or snorkeling. Wear a PFD and have an “informed buddy.”
Scuba diving. Scuba diving is not recommended for people who have seizures because of the risk of having a seizure underwater. Having a seizure underwater can be life-threatening and may also endanger the life of other divers. Once somebody has well-controlled seizures on medication the risk of further seizures is reduced but is never removed completely.

Here are steps for an “informed buddy” to follow if someone is having a seizure in water:

Support the person in the water with the head tilted so the face and head stay above the surface.
Call for help and as gently as possible tow the person to a location that the rescuer can stand as they support the person’s head above water. Remove the person from the water as quickly as possible.
Do not restrain the person unless this is needed to get them out of the water safely.

Check to see whether the person is breathing. If not, begin CPR immediately.
If breathing is normal, turn the person on their side and hold them in side-lying position until they recover.
Call 911. Even if the person appears to be fully recovered, he or she should have a full medical checkup. Inhaling water can cause lung or heart damage.

For other non-water related “summertime” activities that individuals with epilepsy may engage in, consider these strategies:

Use an “informed buddy” system, especially when using equipment such as weights or bike riding.
When riding a bike, avoid busy streets. Try bike paths or quiet residential streets instead. Don’t forget your helmet!
Walking is a great “lifelong” exercise. Use the same ideas – avoid busy streets and walk with an “informed buddy.”
Avoid using a treadmill alone because falling can lead to major injuries. It’s better to run outside or on a track.
Start small and don’t tackle long periods of exercise right away. If you tire easily, exercise in small amounts of 15 to 20 minutes, or to your abilities.
Take frequent breaks and drink plenty of fluids.
Choose the time of day that outside temperatures are not excessively hot.
Always wear a medical alert bracelet or necklace and carry a medical alert card!
Look at seizure alert systems that are being developed. Using one with a GPS locator is a great idea in case you have a seizure and need help.
A cell phone with a GPS locator can help people find you too. Program emergency numbers and key family members or contacts into your phone.

In summary, get out there and do it! Remember that one in 10 people will experience a seizure in their lifetime, and one in 26 will develop epilepsy. If you have epilepsy, you are not alone. Always choose to have an “informed buddy” with you when possible and make a plan for the safest choices for your summertime activities. Have fun, stay fit, and be healthy!