Panic Attack First Aid: How to Help Someone (or Yourself), When It Could Be Something Else and When to Call 988 or 911

Quick answer: stay with the person, speak calmly, move somewhere quieter if you can, and encourage slow breathing with a longer breath out than in. Remind them that panic attacks peak within minutes and pass. But call 911 if this is their first episode, they have chest pain or pressure, they are older or have heart disease, or the symptoms do not ease within about 10 to 20 minutes, because a heart attack and other emergencies can look like panic. If someone is in emotional crisis or talking about suicide, call or text 988.

A panic attack can feel terrifying to the person having it and confusing to the people nearby. Racing heart, shaking, shortness of breath and a sense of doom can make someone believe they are dying. In crowded city spaces like subways, elevators and busy stores, panic attacks are not unusual, and knowing how to respond can make a real difference. This article is part of our emergency first aid guide for city households.

Sources: National Institute of Mental Health (NIMH) information on panic disorder; American Psychiatric Association descriptions of panic attacks; 988 Suicide and Crisis Lifeline (988lifeline.org); American Heart Association heart attack warning signs; Substance Abuse and Mental Health Services Administration (SAMHSA). This article is general information. It does not replace professional medical or mental health care.

What a Panic Attack Is

A panic attack is a sudden surge of intense fear or discomfort that reaches its peak within minutes. It often comes with strong physical symptoms, even when there is no real danger. The body’s alarm system, often called the fight-or-flight response, switches on as if facing a threat. Adrenaline rises, the heart beats faster and breathing speeds up.

Panic attacks can happen to anyone. Some people have one or two in their lifetime, often during a period of stress. Others have repeated attacks and worry about having more, which can be a sign of panic disorder. NIMH notes that panic disorder is treatable, most often with therapy, medication or both.

Common Symptoms

During a panic attack, a person may have several of these symptoms:

• Pounding or racing heart
• Sweating
• Trembling or shaking
• Shortness of breath or a feeling of being smothered
• Feeling of choking
• Chest pain or discomfort
• Nausea or stomach upset
• Dizziness or lightheadedness
• Chills or hot flashes
• Numbness or tingling
• Feeling detached from oneself or surroundings
• Fear of losing control or “going crazy”
• Fear of dying

The person may also feel a strong urge to escape the place they are in.

When It Could Be Something Else

Many symptoms of a panic attack overlap with serious medical emergencies, especially heart attack, asthma attacks, severe allergic reactions, low blood sugar and pulmonary embolism. You cannot tell for sure just by looking. If there is any doubt, treat it as a medical emergency.

Call 911 if the person:

• Has chest pain, pressure, squeezing or fullness, especially if it spreads to the arm, jaw, neck or back
• Has never had a panic attack before
• Is older, or has heart disease, diabetes or other risk factors
• Has trouble breathing that does not improve, or lips that look bluish
• Faints or becomes confused
• Has symptoms that keep getting worse or do not ease within about 10 to 20 minutes
• Has facial drooping, arm weakness or slurred speech, which can be signs of a stroke
• Has hives, swelling of the face or throat, or a known severe allergy

The American Heart Association stresses that heart attack symptoms in women can be less typical and may include shortness of breath, nausea, back or jaw pain. Our guide to heart attack warning signs explains what to look for. Getting checked out and learning it was panic is far better than missing a heart attack.

How to Help Someone Having a Panic Attack

If you are reasonably sure it is a panic attack, for example because the person tells you they have them and this feels familiar, these steps can help.

1. Stay calm and stay close

Your calm voice and presence help. Introduce yourself if you do not know them and ask if they would like help. Speak in short, simple sentences.

2. Ask what they need

Many people who have panic attacks know what helps them. Ask, “Have you had this before? What usually helps?” Some carry medication prescribed by their doctor or have a technique they use.

3. Move to a quieter place if possible

Crowds, noise and bright lights can make panic worse. If the person is able and willing, help them move to a quieter corner or step outside. On public transit, getting off at the next stop may help. Do not force them to move.

4. Encourage slow breathing

Rapid breathing can cause tingling, dizziness and a sense of not getting enough air, which feeds the panic. Encourage slow breathing through the nose with a longer breath out. You might say, “Breathe in with me for a count of four. Now out slowly for six.” Breathe along with them.

Do not have them breathe into a paper bag. That older technique is no longer recommended, partly because it can be dangerous if the cause is actually a heart or lung problem.

5. Try grounding

Grounding techniques help bring attention back to the present. One common method is the 5-4-3-2-1 exercise: name five things you can see, four you can touch, three you can hear, two you can smell and one you can taste. Holding something cold, like a water bottle, or pressing feet firmly into the floor can also help.

6. Reassure without dismissing

Saying “calm down” or “it’s all in your head” rarely helps. Instead, try “This will pass,” “I’m here with you,” or “You are safe right now.” Avoid arguing about whether their fear is reasonable.

7. Stay until it passes

Most panic attacks peak within about 10 minutes and ease over the next while, though the person may feel tired, shaky or embarrassed afterward. Offer water, help them get home or contact someone they trust.

Helping Yourself During a Panic Attack

If you are the one having the attack:

• Remind yourself that panic attacks pass and are not dangerous in themselves, if you have been checked by a doctor before and know this is panic.
• Slow your breath and lengthen each exhale.
• Name what is happening: “This is a panic attack. It will pass.”
• Use grounding, such as the 5-4-3-2-1 exercise.
• Relax your shoulders, unclench your jaw and loosen your hands.
• Let the feelings rise and fall instead of fighting them.
• Call or text someone you trust.

If this is your first attack or symptoms feel different from usual, get medical care.

Supporting a Roommate or Family Member

Living with someone who has panic attacks means you may be the first person there when one starts. A few conversations ahead of time make those moments easier for both of you.

Ask them, at a calm time, what an attack feels like for them and what helps. Some people want to be talked through slow breathing. Others prefer quiet company and no talking at all. Some want to be left alone for a few minutes and then checked on. Knowing their preference saves guessing in the moment.

Ask whether they have been checked by a doctor and whether there are any symptoms that would mean something different for them, such as chest pain that does not match their usual pattern. If they take medicine for panic, find out where it is kept and how it should be used, but let them decide when to take it.

Try not to organize your shared life around avoiding every possible trigger. Avoidance can make panic worse over time, and treatment often involves gradually facing feared situations with support. Encourage professional care, offer to help find a provider, and take care of your own stress as well. Supporting someone you love is easier when you also have people to lean on, and caregivers can call or text 988 for guidance too.

Making a Personal Panic Plan

People who have repeated panic attacks often find it helpful to write a short plan and keep it on their phone or in a wallet. A simple plan might include:

• The early signs that an attack is starting, such as a racing heart or a sense of unreality
• Two or three techniques that help, such as slow breathing, grounding or holding something cold
• A short phrase to repeat, such as “This is panic, and it will pass”
• One or two people to call or text
• The 988 number
• Symptoms that would mean calling 911 instead, such as chest pain that feels different from usual
• Notes from a doctor or therapist about medicine, if prescribed

Reviewing the plan when you feel calm helps the steps come more naturally during an attack. Sharing it with a trusted roommate, partner or coworker lets them help the way you want.

When to Call or Text 988

The 988 Suicide and Crisis Lifeline offers free, confidential support 24 hours a day, 7 days a week, by call or text to 988 or chat at 988lifeline.org. It is for anyone in emotional distress, a mental health or substance use crisis, or thinking about suicide. You can also call on behalf of someone you are worried about.

Reach out to 988 if:

• Panic or anxiety feels overwhelming and you need someone to talk to
• Someone talks about wanting to die, being a burden or having no reason to live
• Someone is in crisis and you are not sure what to do

If someone is in immediate danger, such as having a weapon, having taken an overdose or being unable to stay safe, call 911.

Panic Attacks in Public and Crowded Places

City life brings situations that can trigger or worsen panic, such as packed trains, stalled elevators and crowds at events. If you are helping someone in public:

• Ask bystanders to give the person space.
• Alert station staff, building security or a train operator if needed.
• If you are stuck somewhere, such as an elevator, focus on breathing and communication with rescuers. Our guide to what to do if you are stuck in an elevator explains the steps.
• Respect the person’s privacy and dignity afterward.

After a Major Emergency

Panic and anxiety are common after frightening events such as fires, storms, crime or accidents. Feelings like trouble sleeping, irritability and being on edge often ease over weeks, but they can last longer. SAMHSA runs the Disaster Distress Helpline at 1-800-985-5990, which offers crisis counseling to people affected by disasters. Our guide to disaster stress and mental health covers coping strategies for families.

Getting Long-Term Help

Panic attacks are common and treatable. If they happen often, interfere with work, school or daily life, or make you avoid places, talk to a doctor or mental health professional. NIMH lists cognitive behavioral therapy and certain medications as effective treatments for panic disorder. Many health insurance plans cover mental health care, and community health centers offer care on a sliding fee scale.

Frequently Asked Questions

How long does a panic attack last?

Panic attacks typically peak within about 10 minutes. Symptoms usually ease after that, though the person may feel drained for a while.

Can a panic attack hurt you?

A panic attack itself is not usually dangerous, but its symptoms can look like serious medical problems. If you are not sure, call 911.

Should I call 911 for a panic attack?

Call 911 for chest pain, a first-ever episode, symptoms that are getting worse or not easing, or any sign of a heart attack, stroke or severe allergic reaction.

What is the difference between a panic attack and an anxiety attack?

“Panic attack” is a defined medical term for a sudden surge of intense fear with physical symptoms. “Anxiety attack” is an informal phrase people use for many kinds of anxious episodes.

Can I call 988 for someone else?

Yes. You can call or text 988 if you are worried about someone, and counselors can help you figure out how to support them.