What are the steps to help a person who is choking?

Choking, a critical and potentially fatal emergency, occurs when food or an object blocks the airway, hindering air from reaching the lungs. In adults, food is the most common cause of choking, while children are at risk from both food and small objects.

Understanding the distinction between mild and severe airway blockages and knowing the appropriate response can save lives. This comprehensive guide outlines the essential steps to assist adults, children, and infants in choking emergencies.

Choking Emergencies in Adults and Children

Choking is when food or another object gets stuck in the airway in the throat. The object can block the airway and stop air from getting into the lungs.

• In adults: choking is often caused by food.
• In children: choking can be caused by food or another object.

The block in the airway that causes choking can be either mild or severe. If the airway block is severe, act quickly. Get the object out so that the person can breathe.

Mild Airway Block

If someone:

• Can talk or make sounds
• Can cough loudly

Then take the following actions:

1. Lean the person forward and encourage him cough.
2. If you're worried about the person's breathing, call your local emergency number.

Severe Airway Block

If someone:

• Cannot breathe, talk, or make sound or,
• Has a cough that has no sound or,
• Makes the choking sign, which is holding the neck with one or both hands.

Then take the following actions:

1. Act quickly.
2. For an adult or a child, give abdominal thrusts.
3. For a pregnant women or a large person, give chest trusts.
4. For an infant, give chest thrust and back blows.
5. Follow the steps to help an adult, child, or infant with a severe airway block.

NOTE: Your ability to respond swiftly and effectively in critical choking situations can make the difference between life and death. In the event of a complete airway blockage, the person is unable to breathe, and you have a maximum of 1 minute before they may collapse.

How to Help a Choking Adult or Child with a Severe Airway Block

Give Abdominal Thrusts, the "Heimlich Maneuver"

When an adult or child has a severe airway block, abdominal thrusts, commonly known as the "Heimlich Maneuver," are employed to help remove a blocked object from the airway.

The technique involves applying quick, upward pressure to the abdomen, slightly above the belly button. Like a cough, each thrust pushes air from the lungs. The objective is to generate enough pressure and force to dislodge the obstructing object from the airway.

Actions to Give Abdominal Thrusts

Follow these steps to help a choking adult or child who has a severe airway block:

1. Make sure the scene is safe: Before approaching the victim, assess the scene for any potential hazards to ensure your safety and the safety of others.
2. Assess the severity:
1. If you see someone clutching their neck with one or both hands, indicating they are choking, ask, "Are you choking? Can I help you?"
2. If the person nods yes and cannot cough or speak (no sound), this is a severe airway block.
3. Call for help: Ask someone to call 1.6.6.9 and to bring a first aid kit and an AED.
4. Reassure the person: Tell the person that you are going to help.
5. Give abdominal thrusts:
1. Stand firmly behind the person.
2. Place one leg between the legs of the victim to stabilize yourself.
3. If the person is a child, kneel (depending on your size and the size of the child choking.)
4. Lean the upper body of the victim forward to facilitate effective chest thrusts.
5. Put your arms under the armpits.
6. Wrap your arms around the person's waist so that your hands are in front.
7. Make a fist with one hand and put the thumb side of your fist slightly above the belly button and well below the breastbone.
8. Grasp the fist with your other hand and give quick inward and upward thrusts into the abdomen.
9. Give thrusts until the object is forced out and the person can breathe, cough, or speak, or until he becomes unresponsive.
6. Monitor: Continuously monitor the person's condition until the ambulance arrives and be prepared to provide CPR if the person becomes unresponsive.

NOTE: If the person becomes unresponsive, carefully lower them to the ground and immediately begin CPR, starting with chest compressions. Any person who has received abdominal thrusts for choking should see a healthcare provider as soon as possible.

How to Help a Choking Pregnant Woman or a Large Person with a Severe Airway Block

Give Chest Thrusts as a Safer Alternative

If the person who has a severe airway block is pregnant or very large, give chest thrusts instead of abdominal thrusts.

• In pregnant individuals: performing abdominal thrusts could potentially harm the developing baby.
• In larger individual: abdominal thrusts may be less effective due to the increased thickness of the abdominal area.

Actions to Give Chest Thrusts

If you can't give abdominal thrusts, give thrusts on the chest (chest thrusts) instead of on the abdomen.

Follow these steps to help a pregnant woman, or a large adult who has a severe airway block:

1. Make sure the scene is safe: Before approaching the victim, assess the scene for any potential hazards to ensure your safety and the safety of others.
2. Assess the severity:
1. If you see someone clutching their neck with one or both hands, indicating they are choking, ask, "Are you choking? Can I help you?"
2. If the person nods yes and cannot cough or speak (no sound), this is a severe airway block.
3. Call for help: Ask someone to call 1.6.6.9 and to bring a first aid kit and an AED.
4. Reassure the person: Tell the person that you are going to help.
5. Give chest thrusts:
1. Stand firmly behind the person.
2. Place one leg between the legs of the victim to stabilize yourself.
3. Put your arms under the armpits.
4. Wrap your arms around the person's chest so that your hands are in front.
5. Make a fist with one hand and put the thumb side of your fist on the lower half of the breastbone (in the center of the person's chest: on the nipple line).
6. Pull straight back to give chest thrusts.
7. Continue delivering chest thrusts until the blockage is dislodged, and the person can breathe, cough, or speak, or until they become unresponsive.
6. Monitor: Continuously monitor the person's condition until the ambulance arrives and be prepared to provide CPR if the person becomes unresponsive.

NOTE: If the person becomes unresponsive, carefully lower them to the ground and immediately begin CPR, starting with chest compressions. Any person who has received abdominal thrusts for choking should see a healthcare provider as soon as possible.

Choking: How to Help a Choking Infant with a Severe Airway Block

Give Backslaps and Chest Thrusts

When an infant has a severe airway block, use back slaps and chest thrusts to help remove the object. Give only backslaps and chest thrusts to an infant who is choking.

• Back slaps are performed by delivering firm but gentle blows between the infant's shoulder blades.
• Chest thrusts involve applying quick and forceful pressure to the infant's chest, just below the nipple line, aiming to dislodge the obstructive material.

NOTE: Never give thrusts to an infant's abdomen as it can cause serious harm.

Actions to Give Back Slaps and Chest Thrusts

Follow these steps to help an infant who has a severe airway block:

1. Make sure the scene is safe: Before approaching the victim, assess the scene for any potential hazards to ensure your safety and the safety of others.
2. Introduce yourself: Quickly introduce yourself to the infant's caregiver and ask permission to help.
3. Assess the severity:
1. If the infant is coughing forcefully or making noise, it indicates partial obstruction. Then encourage them to keep coughing.
2. If the infant is unable to cough effectively, give alternate back blows and chest thrusts.
4. Call for help: Ask someone to call 1.6.6.9 and to bring a first aid kit and an AED.
5. Give 5 back blows:
1. Support the infant's head and neck with one hand and place them face down along your forearm, with their head lower than their chest.
2. Use the heel of your other hand to deliver 5 firm back blows between the infant's shoulder blades.
6. Check the Mouth: After delivering 5 chest thrusts, check the infant's mouth for any remaining debris. Remove any visible obstructions with your fingers if safe to do so, but avoid blindly sweeping the mouth.
7. Give 5 chest thrusts:
1. If back blows do not dislodge the object, perform chest thrusts.
2. Turn the infant over onto their back, keeping their head lower than their chest.
3. Use two fingers to deliver 5 quick and downward thrusts to the center of the infant's chest, just below the nipple line.
8. Alternate back blows and chest thrusts: Continue alternating between back blows and chest thrusts until the object is expelled (the infant can breathe, cough, or cry), or the infant becomes unresponsive.
9. Monitor: Continuously monitor the person's condition until the ambulance arrives and be prepared to provide CPR if the infant becomes unresponsive.

NOTE: If you are alone with a choking infant and there is no one to help, you help first and administer backslaps with chest thrusts. Call emergency services once the baby expels the foreign object or becomes unresponsive.

How to Help a Choking Adult who Becomes Unresponsive

Start CPR Immediately

If you can't remove the object blocking the airway, the person will become unresponsive. Always give CPR to anyone who is unresponsive, not breathing normally, or only gasping.

Actions to Help a Choking Adult who Becomes Unresponsive

Follow these steps to help an adult with a severe airway block who becomes unresponsive:

1. Support their body down to the floor.
2. Shout for help.
3. Call your local emergency number and get an AED.
1. If someone comes to help and a cell phone is available, ask the person to:
2. Call your local emergency number on your cell phone.
3. Put it in speaker mode.
4. Go get an AED while you begin CPR.
5. If someone comes to help and a cell phone is not available, ask the person to:
6. Find a phone and call your local emergency number.
7. Go get an AED while you begin CPR.
8. If you are alone and do have a cell phone or nearby phone:
9. Call your local emergency number and put the phone on speaker mode while you begin CPR.
10. Give 5 sets of compressions and 2 breaths.
11. Go get an AED*
12. Return to the child and continue CPR.
13. If you are alone and don't have a cell phone:
14. Leave the person alone to find a phone
15. Call your local emergency number and get an AED
16. Return to the person and continue CPR
4. Provide CPR, starting with chest compressions.
1. After each set of 30 compressions, open the airway to give rescue breaths.
2. Look in the mouth (back of the throat). If you see an object in the mouth, take it out. Do not perform a blind finger sweep; this could cause the object to get lodged further back in the airway.
3. Give two rescue breaths, and then repeat 30 compressions.
5. Continue CPR until:
1. The person moves, speaks, blinks, or otherwise reacts.
2. Someone with more advanced training arrives and takes over

NOTE: If you find yourself alone with someone experiencing severe choking, prioritize immediate assistance by delivering abdominal or chest thrusts. If the person is able to expel the foreign object, call EMS 1.6.6.9 and stay with them until help arrives. However, if the person becomes unresponsive, promptly call EMS and initiate CPR procedures.

How to Help a Choking Child or Infant who Becomes Unresponsive

Start CPR Immediately

A child or an infant who has a severe airway block and becomes unresponsive needs immediate CPR.

If you are alone without a cell phone, it is important to provide 5 sets of 30 compressions and 2 rescue breaths first. Then, leave the child (or take him with you) to call your local emergency number and get an AED if one is available.

Actions to Help a Choking Child or Infant who Becomes Unresponsive

Follow these steps to help a child with a severe airway block who becomes unresponsive:

1. Shout for help.
2. Make sure the child or infant is lying on his back on a firm, flat surface.
3. Call your local emergency number and get an AED
1. If someone comes to help and a cell phone is available, ask the person to:
2. Call your local emergency number on your cell phone.
3. Put it in speaker mode.
4. Go get an AED while you begin CPR.
5. If someone comes to help and a cell phone is not available, ask the person to:
6. Find a phone and call your local emergency number.
7. Go get an AED while you begin CPR.
8. If you are alone and do have a cell phone or nearby phone:
9. Call your local emergency number and put the phone on speaker mode while you begin CPR.
10. Give 5 sets of compressions and 2 breaths.
11. Go get an AED*
12. Return to the child and continue CPR.
13. If you are alone and don't have a cell phone:
14. Give 5 sets of 30 compressions and 2 breaths
15. Leave the child alone to find a phone
16. Call your local emergency number and get an AED*
17. Return to the child and continue CPR
4. Begin CPR
1. Give sets of 30 compressions and 2 breaths
2. After each set of 30 compressions, open the airway to give rescue breaths.
3. Look into the mouth. If you see an object in the mouth, take it out. Do not perform a blind finger sweep. This could cause the object to get lodged further back in the airway.
4. Give two breaths
5. Continue CPR and looking in the mouth after each set of compressions until:
1. The child or the infant moves, cries, speaks, blinks, or otherwise reacts.
2. Someone with more advanced training arrives and takes over.

NOTE: Do not delay CPR to get an AED for a child or an infant.

Conclusion 

In choking emergencies, swift and appropriate action is crucial. Recognizing the severity of the airway blockage and applying the correct first aid measures, such as the Heimlich Maneuver for adults and children or chest thrusts for pregnant women and large individuals, can save lives. For infants, alternating back blows and chest thrusts are vital. Always call emergency services immediately if the situation worsens or if the person becomes unresponsive, and be prepared to administer CPR if necessary. Being informed and prepared can make all the difference in these critical moments.