Choking: clearing the airway (adults and children over 1 year)
If someone is choking and can still cough, speak and breathe: encourage them to cough hard. If the cough becomes weak or the person can no longer speak, cough or breathe: up to 5 firm back blows between the shoulder blades, then up to 5 abdominal thrusts (Heimlich manoeuvre), keep alternating and call the emergency number (112 in the EU). If the person becomes unconscious: resuscitation as the dispatcher instructs. With infants under 1 year the procedure is different – it is practised on courses. This text does not replace a first-aid course.
- Immediately; seconds to minutes
Explained simply
Sometimes a bite of food goes down the wrong way. Usually people cough it back up. If the person can still cough, speak and breathe, you tell them: "Cough, cough hard!" – and stay with them.
If they can no longer cough properly, cannot speak or cannot breathe, it is an emergency. Then you have the emergency number called (112 in the EU) and strike firmly up to five times with the flat of your hand between the shoulder blades while the person leans forward. If that does not help, the Heimlich manoeuvre comes next: up to five sharp pushes inwards and upwards on the upper abdomen. Then alternate again.
If the person becomes unconscious, you start resuscitation as the dispatcher tells you. With babies under one year the procedure is different – you learn it on a course. This text does not replace a first-aid course.
How it works
The windpipe and the gullet lie right next to each other in the neck. When swallowing, a small lid normally closes off the windpipe. If you laugh or talk with your mouth full, a bite can still get into the airway and block it partly or completely.
Coughing is the strongest natural defence. Only when it fails do back blows and abdominal thrusts help: they create a short burst of pressure from the lungs that can push the object out.
What really matters
As long as someone is coughing forcefully, do not slap their back – that could make the object slip further down. Only when the cough becomes weak or the person can no longer speak or breathe do you start back blows.
For back blows, support the person's chest with one hand and lean them forward, then strike between the shoulder blades with the heel of your hand. For abdominal thrusts, stand behind the person, place a fist between the navel and the bottom of the breastbone and pull sharply inwards and upwards. After every blow and every thrust, check whether the object is out.
Safety and limits
Abdominal thrusts can cause internal injuries. That is why everyone on whom they have been used must be examined by a doctor afterwards – even if they feel fine again. Do not sweep blindly in the mouth with your fingers; only remove what you can clearly see and easily grasp.
No abdominal thrusts are used on infants under one year. For pregnant women and very large people there are modified techniques. In all these cases: call the emergency number and follow the dispatcher's instructions.
Prevention and practice
Eat calmly, chew well, do not laugh or run around with your mouth full. Do not give toddlers nuts, whole grapes or small toy parts, or cut grapes into small pieces.
Back blows and abdominal thrusts should be practised once under instruction – on a course with manikins or training vests. Anyone who looks after small children should ideally take a paediatric first-aid course.
Step by step
- 1
Ask: "Are you choking?"
If the person can answer, cough and breathe, the airway is only partly blocked. Encourage them to keep coughing hard and stay with them.
- 2
Call if coughing fails
If the cough becomes weak or the person can no longer speak, cough or breathe: call the emergency number or have it called and carry on at once.
- 3
Up to 5 back blows
Stand beside the person, support their chest with one hand and lean their upper body forward. With the heel of the other hand, strike firmly between the shoulder blades up to 5 times. After each blow, check whether the object has come out.
- 4
Up to 5 abdominal thrusts
If that does not help: stand behind the person, put both arms around their upper abdomen, place a fist between the navel and the bottom of the breastbone, grasp it with your other hand and pull sharply inwards and upwards. Up to 5 times, checking after each thrust.
- 5
Alternate
If the object is still not out, keep alternating 5 back blows and 5 abdominal thrusts until it comes loose, the person breathes again or becomes unconscious.
- 6
Unconscious: resuscitation
If the person becomes unconscious, lower them carefully to the ground, make sure the emergency number has been called and start chest compressions – exactly as the dispatcher instructs. Have an AED fetched.
- 7
Medical check afterwards
If abdominal thrusts were used or coughing, pain or breathing problems remain, the person must be examined by a doctor.
Common mistakes
- Slapping the back while the person is still coughing forcefully
- Sweeping blindly in the mouth with your fingers
- Only calling once the person is unconscious
- Using abdominal thrusts on infants
- Skipping the doctor after successful abdominal thrusts
Quick view
Suitable for
- Choking while eating, on toy parts or other small objects
- Adults and children over 1 year
Not suitable for
- Infants under 1 year – no abdominal thrusts for them; call the emergency number and follow the dispatcher
- Breathing difficulty without choking (e.g. asthma, allergic reaction) – then call the emergency number
Prerequisites
- The person is an adult or a child over 1 year
- Ideally a first-aid course with hands-on practice
Safety
- This text does not replace a first-aid course. First aid is learned through hands-on practice under instruction. In an emergency always call professional help – via the local emergency number (112 in the EU) – and follow the dispatcher's instructions.
- After abdominal thrusts the person must always be examined by a doctor, even if they feel fine again – internal injuries are possible. The same applies if coughing, pain or breathing problems remain afterwards.
- Do not sweep blindly inside the mouth with your fingers – this can push the object further in. Only remove what is clearly visible and easy to grasp.
How it works
A foreign object stuck in the airway can block it partly or completely. As long as the person can cough forcefully, coughing is the most effective remedy, and blows could do more harm than good. If the cough becomes weak or breathing stops, firm blows between the shoulder blades and – if that is not enough – sharp abdominal thrusts create a burst of pressure in the lungs that can dislodge the object. If the person becomes unconscious, chest compressions not only support the circulation but can also dislodge the object.
Advantages
- Can save a life within seconds
- Needs no equipment
Disadvantages
- Abdominal thrusts can cause internal injuries
- Hard to perform correctly under stress without hands-on practice
Deep knowledge
Background
The ERC basic life support guidelines describe exactly this sequence for adults and children over 1 year with foreign-body airway obstruction: encourage coughing; if coughing is ineffective, up to 5 back blows, then up to 5 abdominal thrusts, alternating; if unconscious, resuscitation. They advise against blind finger sweeps and recommend a medical examination after abdominal thrusts.
The abdominal thrust is named after the US doctor Henry Heimlich, who popularised it in the 1970s. Choking often happens when eating hastily, laughing or talking with a full mouth, and in toddlers with nuts, grapes or toy parts.
Variants
- Pregnant and very large people
- For pregnant women and people whose abdomen you cannot reach around, courses teach modified techniques. Call the emergency number and follow the dispatcher's instructions.
- Infants under 1 year
- Infants have different body proportions and delicate organs, so a separate procedure without abdominal thrusts applies to them. Anyone who looks after small children should take a paediatric first-aid course. In an emergency call at once – the dispatcher will guide you.
Common mistakes
- Slapping the back while the person is still coughing forcefully
- Sweeping blindly in the mouth with your fingers
- Only calling once the person is unconscious
- Using abdominal thrusts on infants
- Skipping the doctor after successful abdominal thrusts
Limits and risks
- Does not replace a first-aid course with hands-on practice
- No procedure for infants under 1 year
- No detailed resuscitation instructions – for that, the dispatcher and a course
Sources
European Resuscitation Council – Resuscitation (journal) (2021): European Resuscitation Council Guidelines 2021: Basic Life Support
Foreign-body airway obstruction: cough, 5 back blows, 5 abdominal thrusts, resuscitation if unconscious
International Federation of Red Cross and Red Crescent Societies (IFRC) – Global First Aid Reference Centre (2020): International First Aid, Resuscitation, and Education Guidelines 2020
Lay first aid for choking