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In most of the EU Countries people learn First Aid as part of their driving test - this does not happen in the UK and it is therefore more than likely that a driver involved in an accident will not be equipped with the necessary skills to help. This article helps to give to a brief overview as to what to do, but it is strongly advised that you undertake a First Aid course to properly gain the confidence to help.

Cyclists are particularly vulnerable road users and it is vitally important that all cyclists know what to do (and what not to do) if someone is involved in an accident. If you are cycling with children and teenagers, reinforce the importance of not overtaking lorries, buses and other large vehicles on the inside and explain about their blind spots.

All road users should have basic first aid supplies with them, even if it is just a couple of calico triangular bandages. Car drivers and motorcyclists should have an appropriately stocked kit: advice as to what to put into your kit can be found here.
The following is a step by step approach as guidance should you be the first on scene at an accident:

When approaching an accident scene it is really important to ensure your own safety. Make sure that all traffic has stopped and it is flagged up that there has been an accident otherwise there may be additional casualties. Be aware of oncoming traffic to ensure that is not posing an additional danger. Note if there is any fuel spillage or potential fire risk - turn off car ignitions if possible. Put on vehicle hazard lights and use a warning triangle if there is one available.

If other people are around; get them to phone the emergency services - if you are on your own, assess the situation and treat any life threatening conditions first.

Quickly establish how many vehicles have been involved and assess the occupants of all the vehicles to ensure no one has life threatening injuries.

People screaming, crying and making a noise have to be breathing - your initial priority is therefore to check anyone quiet and not moving.

Quickly check if quiet casualties are responsive: - if there is no response check if they are breathing. If they are unresponsive and breathing ensure they are in a position where they are leaning forward or to one side in a position where the airway will remain open. Move them the minimum necessary and avoid twisting them. Keep talking to the casualty calmly as they can hear you even if they are unconscious. Keep them warm.

Support the head and neck to avoid them twisting - do not cover their ears, keeping talking to them calmly and keep checking that they are still breathing

If the person is not breathing you will need to resuscitate - if you are on your own and have not called an ambulance - do this now and ask their advice as to the best way to resuscitate, as this is not easy to do in a car.

Only remove an unconscious person from a vehicle if there is an immediate danger to their life from fire, flood, and explosion....ask the emergency services over the phone for their advice as to what you should do. It is very difficult to remove an unconscious person from a vehicle and there is a major danger that you could worsen their injuries and injure yourself in the process.

Conscious casualties should be entrusted to the care of bystanders and removed from the wreckage to a safe area. Be aware of confused and dazed casualties who may wander into danger. Brief the bystanders to keep the casualties warm and calm and help them to contact next of kin. Look for any major bleeding and life threatening injuries and treat these first.

Note the nature of the wreckage and be aware of possible injuries as a result: bodies are softer than metalwork, so if there is major damage to the vehicle it is possible that there could be internal injuries to the casualty - ensure the bystanders notify you if there is any change in the casualty's condition.

People thrown from horses, motorbikes or bicycles are at particular risk of damaging their pelvis. If you know how to stabilise someone's pelvis then do this and keep monitoring them for signs of shock as a fractured pelvis can lead to internal bleeding.

Anyone trapped in a vehicle should be monitored carefully and the emergency services notified immediately. If someone is crushed, note the exact time when the accident happened as this is important in deciding on how and when to release the casualty). If there are additional people around, show them how to support the person's neck to avoid them twisting as there is the possibility of a spinal injury.

If there is severe bleeding this will need to be controlled - wear gloves and apply dressings.

Do not allow anyone to smoke at the scene or give the casualties anything to eat or drink following the accident in case they later need an operation.

If a motorcyclist is involved only remove their helmet if they are unconscious and there is no other way to assess their breathing or their airway is in danger. There is usually a way of lifting the visor, it may be sensible to loosen their chin strap.

If a casualty has been hit by a car and they are lying on their back unconscious and breathing - they should be carefully rolled into the recovery position to keep their spine in line. This should ideally be done with the support of others to avoid twisting the spine.

(If you have received advanced training on MILS and recognition of early airway obstruction and are confident that you are able to react quickly if their airway is in danger - then maintain MILS and continuous airway monitoring and roll them into the recovery position immediately should they begin to obstruct).

If a casualty has been hit by a vehicle or thrown from one and they are conscious in the road, they should be encouraged to keep still. Ensure that someone is directing traffic and maintaining safety. Support their head and neck, keep them warm and dry and wait for the emergency services.

Everyone on the road should have a suitably stocked First Aid kit and know how to use its contents.

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Accidents on the Road - how to help - First Aid for Life

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In most of the EU Countries people learn First Aid as part of their driving test - this does not happen in the UK and it is therefore more than likely that a driver involved in an accident will not be equipped with the necessary skills to help.

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‎According to The Royal Society for the Prevention of Accidents, 19,000 cyclists are killed or injured in road accidents each year. St John Ambulance believe that no cyclist should die in conditions where first aid could have been the difference between life and death. This app is targeted specifica...

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Fainting Symptoms and First Aid - St John Ambulance

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Get first aid tips and information from St John Ambulance for Fainting. Find out about symptoms and treatment.

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Unresponsiveness can last for a few seconds (e.g. fainting) or for a long time. It's often brought on by serious illness or injury (e.g. a head injury), or by taking alcohol or other drugs. Find out what to do if an adult is unresponsive and breathing.
Poster download: What to do if an adult is unresponsive
What to look for - Unresponsive and breathing adult

When someone looks like they're asleep but they're unable to respond to noise or body contact, it's likely they're unresponsive.

What you need to do - Unresponsive and breathing adult

Step 1 of 5: Open the airway

* Place one hand on the casualty's forehead and gently tilt their head back. As you do this, the mouth will fall open slightly.

* Place the fingertips of your other hand on the point of the casualty's chin and lift the chin.

Step 2 of 5: Check breathing

* Look, listen and feel for normal breathing - chest movement, sounds and breaths on your cheek. Do this for no more than ten seconds.

Step 3 of 5: Put them in the recovery position

* This will keep their airway open.

* Kneel down next to them on the floor.

The next three steps are for if you find the casualty lying on their back. If you find them lying on their side or their front you may not need all three.

1. Place their arm nearest you at a right angle to their body, with their palm facing upwards.

2. Take their other arm and place it across their chest so the back of their hand is against their cheek nearest you, and hold it there. With your other hand, lift their far knee and pull it up until their foot is flat on the floor.

3. Now you're ready to roll them onto their side. Carefully pull on their bent knee and roll them towards you. Once you've done this, the top arm should be supporting the head and the bent leg should be on the floor to stop them from rolling over too far.

Step 4 of 5: If you suspect spinal injury

* If you think the casualty could have a spinal injury, you must keep their neck as still as possible. Instead of tilting their neck, use the jaw thrust technique: place your hands on either side of their face and with your fingertips gently lift the jaw to open the airway, avoiding any movement of their neck.

Step 5 of 5: Call for help

* Once you've put them safely into the recovery position, call 999 or 112 for medical help.

* Until help arrives, keep checking the casualty's breathing.

If they stop breathing at any point, call 999 or 112 straight away and get ready to give them CPR (cardiopulmonary resuscitation - a combination of chest pressure and rescue breaths).

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Unresponsive breathing adult - St John Ambulance

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Unresponsiveness can last for a few seconds (e.g. fainting) or for a long time. It's often brought on by serious illness or injury (e.g. a head injury), or by taking alcohol or other drugs. Find out what to do if an adult is unresponsive and breathing.

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Help us help you get the treatment you need

Because of coronavirus (COVID-19), it can be hard to know what to do if you're unwell. It's important to get medical help if you think you need it.

For help from a GP - use your GP surgery's website, use an online service or app, or call the surgery.

For urgent medical help - use the NHS 111 online service, or call 111 if you're unable to get help online.

For life-threatening emergencies - call 999 for an ambulance.

If you're advised to go to hospital, it's important to go.

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Help us help you get the treatment you need Because of coronavirus (COVID-19), it can be hard to know what to do if you're unwell. It's important to get medical help if you think you need it. For help from a GP - use your GP surgery's website, use an online service or app, or call the surgery.

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Free mobile first aid app - St John Ambulance

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Get life saving advice at your fingertips with the free first aid app from St John Ambulance, the nation's leading first aid charity.

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Download the British Red Cross first aid apps for iOS, Android and Windows

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Access Point - Support and social care services | Brighton & Hove City Council

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Support for women

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Mental health Information for young people in Brighton and Hove.

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A service offering a range of support if you are experiencing emotional difficulties such as feeling anxious, low, or depressed. They are an NHS community-based service supporting people from age 4 years upwards in Brighton and Hove. You may self-refer directly to the service on their website.

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A local service providing short-term, flexible support for people with mental health challenges in Brighton and Hove.

They will support you to find out about, and access, activities in your local community that you're interested in and help you create links with support agencies and groups. They will encourage you to have confidence in your own abilities and work with you to overcome challenges.

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A local service for young people who are experiencing mental health or emotional wellbeing difficulties.

The site offers advice and support on a range of low to moderate mental health or emotional wellbeing issues such as anxiety, depression, self-harm and eating disorders as well as signposting to services that are more specialist where your need is greater.

All services accept self-referrals and some offer drop-in sessions.

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You can #HelpMyNHS to give the best care by making sure you and your loved ones get the right care, at the right time, in the right place.

The #HelpMyNHS website helps you do this by highlighting where you can get medical treatment that is right for you.

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Brighton & Hove CCG's Mental Health Rapid Response Service offers support from a mental health professional anytime, day or night, as well as face-to-face appointments.

The service offers mental health support for people who feel at risk to themselves and/or others or if someone feels concerned that a person is at risk to themselves and/or others due to their mental health. Face-to-face assessments for all agreed urgent referrals will be delivered within four hours, either at a patient's home, in a GP surgery or at one of the local service clinics.

Opening hours: 24 Hours a day, 7 days a week
Call 0300 304 0078
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Mental health services | MyLife Brighton and Hove

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Add to shortlist Mental health Information for young people in Brighton and Hove. View website Add to shortlist A service offering a range of support if you are experiencing emotional difficulties such as feeling anxious, low, or depressed. They are an NHS community-based service supporting people from age 4 years upwards in Brighton and Hove.

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Mental health and wellbeing | Brighton & Hove City Council

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Our mental health and wellbeing are central to our overall quality of life and general health. Mental health problems are widespread and common.

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Call Rise for help

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RISE is an independent, Brighton-based registered charity that helps people affected by domestic abuse.

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Brighton & Hove Sexual Health and Contraception Service

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Brighton and Hove sexual health and contraception service (SHAC) is a free and confidential specialist service open to everyone regardless of age and sexuality.

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Mind Brighton & Hove | for better mental health

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Mind in Brighton and Hove works to promote good mental health in our city and across Sussex. We seek to empower people to lead a full life as part of their community.

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Learn first aid with education resources, advice and courses from the British Red Cross, including first aid at work.

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First Aid Tips, Information & Advice - St John Ambulance

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Get first aid tips and advice from St John Ambulance about paediatric first aid, the role of a first aider, and first aid techniques, such as the primary survey.

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Non-epileptic seizures (NES) or dissociative seizures are different from epilepsy as they have a different cause. If you, or someone you know, has been diagnosed with non-epileptic seizures it may be helpful for you to identify the type of seizures that are relevant to you and how you feel about them. Non-epileptic seizures (NES) are not caused by disrupted electrical activity in the brain and so are different from epilepsy. They can have a number of different causes.

What causes non-epileptic seizures?

Types of NES

Non-epileptic seizures (NES) can be divided into two types: organic non-epileptic seizures and psychogenic seizures.

Organic NES

These seizures have a physical cause (relating to the body). They include fainting (syncope) and metabolic (biochemical processes in the body) causes such as diabetes.

Because organic NES have a physical cause, they may be relatively easy to diagnose and the underlying cause can be found. For example, a faint may be diagnosed as being caused by a physical problem in the heart. In these cases, if the underlying cause can be treated the seizures will stop.

Psychogenic NES

Some NES are called 'psychogenic seizures'. 'Psychogenic' means they are caused by mental or emotional processes, rather than by a physical cause. Psychogenic seizures may happen when someone's reaction to painful or difficult thoughts and feelings affects them physically.

Psychogenic seizures include different types:

Dissociative seizures happen unconsciously, which means that the person has no control over them and they are not 'put on'. This is the most common type of NES.

Panic attacks can happen in frightening situations, when remembering previous frightening experiences or in a situation that the person expects to be frightening. Panic attacks can cause sweating, palpitations (being able to feel your heart beat), trembling and difficulty breathing. The person may also lose consciousness and may shake (convulse).

Factitious seizures means that the person has some level of conscious control over them. An example of this is when seizures form part of Münchausen's Syndrome, a rare psychiatric condition where a person is driven by a need to have medical investigations and treatments.

Other names for non-epileptic seizures

Non-epileptic seizures are sometimes known as non-epileptic attacks. People who have non-epileptic seizures may be described as having 'non-epileptic attack disorder' (NEAD).

These terms are not always helpful because they describe the condition by saying what it is not rather than by saying what it is.

NES used to be called 'pseudoseizures' but this name is unhelpful because it sounds like the person is not having 'real' seizures or their seizures are deliberately 'put on'.

A newer name for non-epileptic seizures is 'dissociative seizures'. This is helpful because it does not describe seizures in terms of epilepsy. It is also recognised by the World Health Organization (this means that it is included in the International Classification of Diseases: a list of all known diseases and conditions).

How are non-epileptic seizures diagnosed?

If you have seizures, your GP will usually refer you to a specialist for diagnosis. This will usually be a neurologist to see if the seizures are epileptic. Or you may be referred to a psychiatrist or psychologist (as NES are usually classified as a psychiatric condition).

It may be easier for doctors to try and rule out possible physical causes first, including epilepsy. This will influence the types of tests you might have.

NES can be difficult to diagnose because they can appear similar to epileptic seizures. There are no symptoms that will definitely identify NES from epileptic seizures.

Taking a personal history

Tests used to find the cause of seizures cannot, on their own, confirm a diagnosis. However, taking a 'personal history' can help to find the cause of your seizures. This includes looking at:

your neurological history (about your brain and nervous system and its development)

your psychological development and mental health, including whether you have had depression or other psychiatric conditions, or have been subject to stress and trauma in the past

whether there is a family history of depression or other conditions

the history of your seizures, such as when they first started and when they happen

whether you have been diagnosed with epilepsy but your seizures have never been controlled with anti-epileptic drugs.

What happens during the seizure

Asking you about what happens during a seizure can be helpful to find the cause. If you don't remember your seizures, you might like to bring someone to the appointment who has seen your seizures. See our guide to recording what happens during a seizure.

The specialist might ask you:

when your seizures happen

whether you get any warning before a seizure happens

what happens to you during the seizure (if you don't remember, a witness could help describe what happens to you)

how long the seizures last

what you remember, if anything, about the seizure afterwards

how you feel afterwards and how long it takes you to recover.

Medical tests

Some tests are used to rule out other causes of seizures, including epilepsy.

Medical examinations and blood tests can be used to check your overall health and see if your seizures have a physical cause such as diabetes.

Brain scans such as CT (computerised tomography) or MRI (magnetic resonance imaging) are used to form a picture of your brain. This may show a physical cause for epileptic seizures, but would not usually be helpful in diagnosing NES.

An EEG (electroencephalogram) records the electrical activity of the brain. It is often used to see if seizures are caused by disrupted brain activity, which helps to diagnose epilepsy. NES are not caused by changes in brain activity.

Video telemetry involves having an EEG and being filmed at the same time. This compares what a person is doing with what is happening in their brain during the seizure, and can often show the difference between epileptic and non-epileptic seizures. This can help to diagnose epilepsy (if, during a seizure, your brain activity changes) or diagnose NES (if, during a seizure, your brain activity does not change).

If the tests show no neurological or physical cause for your seizures, and your specialist thinks it might be NES you may be referred to a psychiatrist or a psychologist for diagnosis.

Treatment options

Treatment may depend on the cause of your seizures, and your medical history. Your specialist may talk to you about what treatment options might be helpful.

Medication

Seizures that are not epileptic they will not be controlled by anti-epileptic drugs (AEDs).

If you already take AEDs, for example if you were previously diagnosed with epilepsy, your specialist may suggest you gradually reduce them. If you have NES and epilepsy, you will usually continue to take AEDs for your epileptic seizures.

If you also have anxiety or depression, your specialist might talk to you about whether other medication, such as anti-depressants, might be helpful.

Other forms of treatment

Psychotherapy is the recommended treatment for NES. Psychotherapy is the name for a group of different 'talking' therapies (treatments).

Mental health professionals, including psychiatrists and psychologists, are trained in different forms of psychotherapy.

Cognitive behavioural therapy (CBT) is often recommended for NES. CBT looks at how you think about things, how this affects you physically and emotionally and how it affects what you do (your behaviour). By changing the way you think about yourself, other people and the world around you, this may change the way that you behave. CBT tends to focus on how things are affecting you in the present, and ways to help you to view current situations more positively and cope with stressful events.

CBT can take several months or longer as it may take time for you to feel comfortable talking about your experiences and feelings.

Living with non-epileptic seizures

First aid

The general first aid guidelines for NES are the same as for epileptic seizures:

keep the person safe from injury or harm, and only move them if they are in danger

if they have fallen, put something soft under their head to protect it

allow the seizure to happen, don't restrain or hold them down

stay with them until they have recovered.

Keeping a normal routine if possible

For some people, NES may disrupt their daily life or they may want to avoid activities in case they have a seizure. However, studies show that it can help to keep as normal a routine as possible, and try to take part in activities with other people, so as to avoid becoming isolated and anxious, which may make seizures more likely.

Treatment for NES may work best when someone is active in life, including working, studying or taking prt in other activities which are meaningful or satisfying. If you are working, your employer has a responsibility to keep you and other employees safe at work. To do this, they need to know about any medical conditions that may affect you at work, including NES. Your employer may need to do a ' risk assessment' to see if your condition might affect safety at work.

Financial help

You may be able to apply for financial help, depending on how your seizures affect your daily life. Whatever the cause, seizures can affect different areas of life for some people.

Driving regulations

Driving regulations for the UK are set by the Driver and Vehicle Licensing Agency (DVLA).

You will need to stop driving, tell the DVLA that you have NES, and return your licence to them.

Each case may be looked at individually, but you may be able to apply for a new licence once your doctors confirm that your seizures have been 'satisfactorily controlled' for three months and that there are no relevant mental health issues.

These regulations are based on the possibility of having a seizure while driving and the risks this could bring.

Seizures and disability

The Equality Act 2010 aims to protect people against discrimination if they have certain characteristics, including having a disability. Someone has a disability if they have:

"a physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities".
Equality Act 2010.

Here 'substantial' means it is difficult or time-consuming to do activities compared to someone without a disability, and 'long-term' means at least 12 months. 'Day-to-day activities' include being able to get around, hear, see, remember and concentrate.

The Equality Act does not include a list of every disability covered. Although epilepsy is listed as a physical disability, NES is not listed. To be covered by the Equality Act, you need to show that you meet the definition above.

How you feel about your diagnosis

Being diagnosed with any condition can cause different emotions, and may affect many parts of your life. You may be relieved to know what is causing your seizures. Or you may find it hard to come to terms with, particularly if you were previously diagnosed with epilepsy and have now been diagnosed with NES.

Being diagnosed can also feel quite scary or upsetting because of the stigma around how psychiatric conditions are sometimes viewed. Understanding that NES can be your body's natural way of reacting to stressful situations might be helpful.

There is no 'right' way to feel about your diagnosis, but being able to accept it can be part of helping to improve your seizure control.

You might like to call our confidential helpline to talk about your diagnosis and how you feel about it.

Other organisations

Related:

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Non-epileptic seizures (NES) or dissociative seizures are different from epilepsy as they have a different cause. If you, or someone you know, has been diagnosed with non-epileptic seizures it may be helpful for you to identify the type of seizures that are relevant to you and how you feel about them.

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Read about preventing strokes. The best way to prevent a stroke is to eat a healthy diet, exercise regularly, and avoid smoking and excessive consumption of alcohol.

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A stroke happens when the blood supply to part of your brain is cut off, causing your brain cells to become damaged or die. The risk factors are similar to heart disease

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What to do