01 — Heart attack
Heart attack symptoms differ in women, older adults, and people with diabetes. Missing them delays care that is time-critical.
The AHA 2024 guidelines and the Red Cross both note that while chest pain is the most recognized heart attack symptom, significant groups of people may present with different or milder symptoms. This matters because treatment outcomes for heart attack are strongly linked to how quickly care begins. Symptoms that seem unrelated to the heart can delay the decision to call 911.
Classic presentation
- Chest pain, pressure, squeezing, or tightness lasting more than 3 to 5 minutes or coming and going
- Pain radiating to the left arm
- Pain in the jaw, neck, or back
- Shortness of breath
- Cold sweats
- Nausea or lightheadedness
Less typical — more common in women, older adults, diabetics
- Chest symptoms may be mild or absent entirely
- Unexplained extreme fatigue
- Shortness of breath without chest pain
- Nausea, vomiting, or indigestion-like discomfort
- Pain in the upper back, jaw, or neck
- Dizziness or lightheadedness
The Red Cross first aid response is the same regardless of which symptoms are present: call 911 immediately. Do not drive the person to the hospital yourself — AHA research shows that people transported by EMS receive faster treatment and have better outcomes. One study found that approximately 1 in 300 people with chest pain who were transported by private vehicle had a cardiac arrest en route.
While waiting for EMS, have the person stop activity and rest in a comfortable position. If they are conscious, can swallow, and are not known to be allergic to aspirin or told by a doctor not to take it, assist them in chewing and swallowing 162 to 325 mg of aspirin (two to four low-dose 81 mg tablets, or one regular-strength 325 mg tablet). Do not give aspirin if the person is unconscious or cannot swallow safely.
02 — Seizure response
Protect, time, and observe. Do not restrain. Do not put anything in the mouth.
Seizures result from abnormal electrical activity in the brain. They can be caused by epilepsy, fever, head injury, low blood sugar, heat stroke, and other conditions. Most seizures last one to three minutes and resolve on their own. The first aid role is to protect the person from injury, monitor the situation, and know when to call 911.
Do
- Stay calm and stay with the person
- Ease them to the ground if they are about to fall
- Cushion their head with something soft
- Turn them gently on their side when convulsions stop — this keeps the airway clear
- Clear the area of hard or sharp objects
- Time the seizure from start to finish
- Loosen anything around the neck that could restrict breathing
- Check for a medical ID bracelet for instructions
Do not
- Do not hold down or restrain the person — it will not stop the seizure and causes injury
- Do not put anything in the mouth — it is impossible to swallow the tongue; objects in the mouth cause dental damage and aspiration risk
- Do not give water, food, or medication during or immediately after the seizure
- Do not leave the person alone until they are fully alert
The AHA and Red Cross 2024 guidelines specify calling 911 for seizures in any of these situations: first-ever seizure; seizure lasting more than 5 minutes; multiple seizures without returning to normal awareness; a seizure that occurs in water; a seizure accompanied by breathing difficulty, injury, or choking; seizure in an infant under 6 months of age; seizure in a pregnant person; or if the person does not return to their baseline mental status within 5 to 10 minutes after the seizure stops.
After a seizure, a period of drowsiness, confusion, and disorientation lasting up to 20 minutes is normal. This is the postictal period. Stay with the person, speak calmly, and do not offer anything by mouth until they are fully alert and able to swallow normally.
03 — Low blood sugar
If they can swallow, give 15 to 20 grams of fast-acting glucose. If they cannot, call 911.
Hypoglycemia — low blood sugar — can occur in people with diabetes, especially those who take insulin or certain oral medications. It can also occur in non-diabetics under certain circumstances. Symptoms include shakiness or trembling, sweating, pale skin, confusion, difficulty concentrating, weakness, headache, rapid heartbeat, and hunger. Without treatment, hypoglycemia can progress to seizure, loss of consciousness, and permanent brain injury.
The AHA 2024 First Aid Guidelines state that for a person with suspected hypoglycemia who is awake and able to swallow safely, the first aid provider should encourage them to take 20 grams of oral glucose or a glucose-equivalent food. Glucose tablets or gels are the most reliable form — they are absorbed predictably and produce a consistent blood sugar rise. Other options include 4 ounces of juice or regular (not diet) soda, or several pieces of hard candy. Fifteen to 20 minutes after treatment, blood sugar should be rechecked if the person has a glucose meter available.
When to call 911 instead
Call 911 immediately if the person is unconscious, is having a seizure, or is unable to follow simple commands or swallow safely. Do not attempt to give anything by mouth to someone who cannot swallow — aspiration is a serious risk. Intravenous glucose or glucagon injection by emergency medical personnel is the appropriate treatment for severe hypoglycemia.
Untreated hypoglycemia can cause seizures and status epilepticus. If a person with known diabetes becomes unresponsive or begins seizing, the presumption should be low blood sugar until proven otherwise, and emergency services should be called immediately.
Quick reference
- Heart attack: call 911; do not self-transport — EMS improves outcomes; aspirin 162–325 mg if conscious and not contraindicated
- Women, older adults, and diabetics may present with atypical symptoms: fatigue, jaw pain, nausea, shortness of breath — without classic chest pain
- Seizure: protect, time, observe; do not restrain; do not put anything in mouth; turn on side when convulsions stop
- Call 911 for seizures: first-ever, longer than 5 minutes, multiple without recovery, in water, breathing difficulty, pregnancy, infant under 6 months, or no return to baseline in 10 minutes
- Low blood sugar (alert person): give 15–20 grams fast-acting glucose (glucose tablets, 4 oz juice, regular soda)
- Low blood sugar (unconscious or seizing): call 911; do not give anything by mouth
Primary sources
- AHA / Red Cross — 2024 First Aid Guidelines: Women, diabetics, and older adults may experience atypical heart attack symptoms; seizure first aid: do not restrain, do not place objects in mouth, turn on side, call 911 for first-ever seizure or seizure lasting more than 5 minutes; hypoglycemia: 20 grams oral glucose for alert patients able to swallow.
- Red Cross — Heart Attack: Symptoms, Causes, How To Help: Women may experience milder or absent chest pain, with shortness of breath, nausea, extreme fatigue, and dizziness being more prominent; aspirin 162–324 mg if conscious and able to swallow and not contraindicated.
- CDC — First Aid for Seizures: Ease to ground, cushion head, turn on side with mouth toward ground, clear area, time seizure; do not hold down, do not put anything in mouth; call 911 for first-time seizure, seizure over 5 minutes, another seizure soon after, breathing difficulty, injury, seizure in water, or diabetes and loss of consciousness.
- Red Cross — Seizures: Causes, Symptoms, and Types: It is impossible to swallow the tongue; do not put objects in mouth; post-ictal period of up to 20 minutes of drowsiness and confusion is normal.