A two-page plan that tells school staff how to respond when a student with epilepsy has a seizure during the school day: seizure types, first aid, when to give rescue medication and when to call 911. Families bring it to the student's treating provider to complete and sign, and the parent then hands the signed plan to the school nurse, who uses it to direct staff.
The student's treating health care provider fills in the seizure information, school protocol, rescue therapy orders and daily medicines, then signs and dates the Provider signature line. The parent or guardian supplies contact details and signs the separate 'My signature' line.
Enter the student's name, birth date, address and phone, then the parent or guardian with a phone number and an emergency contact with relationship and phone. These lines are what staff use when the school protocol says to notify the parent or emergency contact, so each one should list a number that reaches someone during school hours.
A four-row table with columns for Seizure Type, How Long It Lasts, How Often and What Happens. List each seizure type the student has and describe what it looks like in words a teacher or aide will recognize. The nurse relies on the usual duration and frequency here to judge whether an event is typical or calls for rescue therapy or 911.
Check the steps staff should follow: first aid (Stay. Safe. Side.), give rescue therapy according to the plan, notify the parent or emergency contact, contact the school nurse at a named location or number, call 911 for transport to a named hospital, or other. This box is the school-specific core of the plan, so check only the steps you want staff to take.
Three checklists. First aid covers staying calm and timing the seizure, keeping the student safe, turning on the side if not awake, staying until recovery, swiping the magnet for VNS and writing down what happens. The 911 and provider-first lists are preprinted; the provider-first list covers a change in seizure pattern, not returning to usual behavior, a first seizure that stops on its own, and pregnancy or other problems.
Up to three orders. For each, state the trigger in 'If seizure (cluster, # or length)', then the Name of Med/Rx, How much to give (dose) and How to give. The school nurse reads these as the medication order, so the trigger, dose and route need to be specific enough that staff can act without calling the office first.
Describe what help the student needs after a seizure and when the student can resume usual activity, such as returning to class. The Special instructions lines are addressed to First Responders and the Emergency Department, a place to note anything paramedics or the emergency team should know about this student's seizures or treatment.
Four rows for Medicine Name, Total Daily Amount, Amount of Tab/Liquid, and How Taken (time of each dose and how much). This tells the school which doses fall during school hours and gives emergency staff the current regimen. Match the entries to the current prescription so the plan and the medication the family sends in agree.
Record triggers, important medical history, allergies, epilepsy surgery (type, date, side effects), any device (VNS, RNS or DBS) with the date implanted, and diet therapy (ketogenic, low glycemic, modified Atkins or other). Close with any special instructions. If you checked the VNS magnet step on page 1, the device entry here confirms it.
List the epilepsy provider, primary care, preferred hospital and pharmacy, each with a phone number. The plan ends with two signature lines: 'My signature' for the family and 'Provider signature' for the treating clinician, each dated. An unsigned provider line leaves the rescue therapy orders without the clinician's authorization.
Download the current version from the source each time; forms change without notice.
Seizure Action Plan (School)
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Sources for this guide
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The student's treating health care provider signs and dates the Provider signature line on page 2 after completing the seizure details and rescue therapy orders. The family signs the separate 'My signature' line. The parent or guardian then gives the signed plan to the school nurse.
Yes. The Epilepsy Foundation offers a Spanish version of the seizure action plan alongside the English fillable PDF. Its companion Questionnaire for Parents of a Student with Seizures, which families fill out for the school, comes in English, Spanish, Hindi and Punjabi.
The layout is the same, but the school version adds a parent or guardian line, a 'Protocol for seizure during school' with a box to contact the school nurse, and asks when the student can resume usual activity. The general plan, revised in 2023, is written for caregivers, camps and workplaces.
The printed criteria are a seizure with loss of consciousness longer than 5 minutes or repeated seizures longer than 10 minutes without recovery, in both cases not responding to rescue medication if available, plus difficulty breathing after a seizure, a serious injury, or a seizure in water. The provider can name a hospital for transport.