Partial Blockage

Choking normally occurs when someone is eating.  Signs of someone choking could be:

• Difficulty in speaking and breathing
• Coughing or gagging
• Clutching at throat / pointing to their mouth
• Pale grey / blue skin (cyanosis)

Initial Response

You should always ask the casualty to cough (unless it’s a baby) as some people panic and forget.  

Check their mouth and remove any obvious obstruction.  This could be food, lego, dentures depending on their age.¹

Back Blows / Abdominal Thrusts

Both these procedures use external force to make the lungs react by coughing.

You should attempt 5 back blows followed by 5 abdominal thrusts (1 cycle) ensuring you check after each strike as to whether the obstruction has been removed.

If after one abdominal thrust the obstruction has not been removed you should dial 999 / 112 for assistance.

Back Blows

1. Move to the side and lean the casualty forwards placing your hand on the far shoulder.²  NB: For a child you may wish to kneel on one knee to get down to their height.
2. Use the heel of your hand to give 5 sharp blows between the shoulder blades checking after each. 

Abdominal Thrusts

If this is unsuccessful:

1. Stand behind the casualty with one front in front of the other.
2. Place your hands around the front putting the knuckle of your thumb just below their diaphragm.
3. Cup you hand and then with a rolling action (pushing in and up towards their chest), perform a maximum of 5 abdominal thrust checking after each.

Repeat back blows / abdominal thrusts until the obstruction is removed.

What if you can’t reach?

If you cannot physically get your arms around the front of someone to perform abdominal thrusts due a size difference or the person is wheelchair bound, just stick to performing continuous back blows.

Paediatric First Aid for Choking

If a baby (under 1) is choking you want to hold them on their front with their head facing down so gravity can help.

Give 5 sharp blows between the baby’s shoulder blades checking after each.

If this is unsuccessful, place the baby onto their back with their head down.  Use 2 fingers to sharply push up into the baby’s diaphragm.  Try 5 and then repeat the full cycle.

Full Blockage

If you cannot remove the blockage and your casualty becomes unconscious and unresponsive you should perform resuscitation and locate an automated external defibrillator (AED).

You may decide the treat a full blockage like drowning by performing 5 rescue breaths first.  You may be able to force the blockage down the trachea (windpipe).

This will end up in the lungs causing foreign body (pulmonary) aspiration.  You should place your casualty into the safe air position and dial 999 / 112 for immediate assistance.