Prevent and prepare

• Understand the difference between partial or complete choking and Asthma attack, Allergic reaction and anaphylaxis and other conditions that may cause sudden breathing difficulties.
• Be aware when people are eating as this is usually when choking occurs.
• Monitor a baby who is eating or might put something in their mouth.
• Be aware that people who have reduced responsiveness, a neurological impairment that affects their swallowing and coughing reflexes (e.g., Stroke, Parkinson’s disease, cerebral palsy or dementia) or respiratory disease are at an increased risk of choking. People are also at a higher risk if they are intoxicated (due to drugs or alcohol), if their teeth are in poor condition or if they are an older adult.

Early recognition

The person may have had something in their mouth, such as food. Ask the person: “Are you choking?”.

Mild choking

• Weak or forceful coughing.
• Can speak or cry out.
• Makes high-pitched noises while inhaling, but is still able to breathe.

Severe choking

• Unable to cough, speak, cry or breathe.
• Clutches the throat with one or both hands.
• Panic.
• Bluish colour to the skin of the lips, ears, fingers and toes.
• Becomes unresponsive if the blockage is not removed.

First aid steps

Adults and children

Mild choking

1. Encourage the person to cough to clear the blockage.
2. Monitor the person until they improve, as it could develop into a complete airway obstruction.

Severe choking

1. If the person cannot cough, speak or breathe, give up to five firm blows between their shoulder blades.
2. If the back blows are unsuccessful, give up to five abdominal thrusts by putting your fist between their ribs and their belly button and pulling it sharply inward and upward using the other hand.
3. If the abdominal thrusts are unsuccessful, immediately access emergency medical services (EMS).
4. Continue alternating between five back blows and five abdominal thrusts until the blockage clears or the person becomes unresponsive.

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NOTE

• If the person has mild choking, avoid taking action as they may be able to clear the airway more effectively on their own.
• If the person becomes unresponsive, give standard CPR.
• Only remove solid material in the airway with your fingers if you can see it. Do not blindly sweep the mouth with your fingers.

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Babies
 

Mild choking

1. If the baby is coughing, wait to see if they can cough to clear their own airway.
2. Monitor the baby until they improve, as it could develop into a complete airway obstruction.

Severe choking

1. If the baby cannot cough or breathe, give up to five firm blows between their shoulder blades.
2. If the back blows are unsuccessful, turn the baby over and give up to five chest thrusts by pushing sharply downwards in the centre of their chest.
3. If the chest thrusts are unsuccessful, access EMS immediately.
4. Continue alternating between five back blows and five chest thrusts until the blockage clears or the baby becomes unresponsive.

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NOTE

• If the baby becomes unresponsive, start standard CPR.
• Only remove solid material in the airway with your fingers if you can see it. Do not blindly sweep the mouth with your fingers.

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Access help

• In the case of severe choking, always access EMS. The person may have internal injuries from the abdominal thrusts, or the object may have caused some damage to their airway. Even if they are no longer choking, they may have a piece of the object in their lungs that can later cause complications.
• In the case of mild choking, the person should seek medical care if they continuously cough, experience difficulty swallowing or feel as though the object is still stuck in their throat.

Context considerations 

• Consider which contexts learners are most likely to encounter choking and if there are specific signs to which they should be more alert. For example, those working with older adults at an assisted living residence should recognise what it looks like to choke. Conversely, the signs of choking present differently in babies so learners caring for this age group will need to be aware of those signs.
• Because choking often happens while eating, a choking emergency could happen in a public place. Programme designers may consider framing this as a “helping behaviour” topic as it is one where the Bystander Effect could result in people feeling uncomfortable to step forward and help. Emphasise the first step as asking the person if they are choking.
• In babies and children, reported cases of choking occur while eating or playing with non-food items such as coins or small toys. Learners should explore ways to reduce the risk of babies and children putting objects in their mouths; for example, placing small items out of reach.

Learner considerations 

• Some babies experience mild choking frequently when they are learning to eat solids. While usually not serious, the experience can be very distressing for caregivers. Include an opportunity for caregivers to share their fears and their experiences as a way of building confidence to help babies effectively.
• Learning to give back blows can be challenging as it is not possible to practise this on another person for fear of hurting them. Stress that a gentle slap will not expel the object stuck in someone’s throat: force is needed to dislodge the object even if this might hurt the person.
• If the learners are likely to need to help a pregnant or obese person with choking, see the Facilitating choking skills resource for an adaptation for abdominal thrusts.

Facilitation tips 

• Focus choking education on the prevention and first aid domains within the Chain of survival behaviours.
• Explain why it is important to do the different actions on someone who is choking. Back blows create a strong vibration and pressure in the airway while abdominal thrusts and chest thrusts squeeze the air out of the lungs, creating additional pressure in the airway. These techniques may dislodge the object and help the person to breathe again.
• Explore how using gravity (by bending over or holding the baby’s head lower than the body) can help dislodge the foreign object or liquids drain out.
• Learners practising back blows and chest thrusts for a choking baby should sit or kneel. Although it can be easy to hold a manikin baby in one arm (straddle arm technique), it can be more challenging with a real baby, especially for younger learners. Supporting the baby on their lap can be more effective and safer (Gesicki & Longmore, 2019).
• Explain that learners should not use abdominal thrusts for babies as their organs are still developing and may get damaged.
• While facilitators may include participants in demonstrating how to position oneself to give back blows and abdominal or chest thrusts, the real actions should be demonstrated on a manikin.
• If teaching children or demonstrating for a child, the facilitator should go on their knees at the child’s height to demonstrate back blows and abdominal thrusts.
• Explore and address any misconceptions about choking, such as giving the person a drink to clear the blockage or hanging a baby upside down.

Facilitation tools

• When instructing learners on how to do back blows and abdominal or chest thrusts, refer to the resource Facilitating choking skills.
• Use videos or demonstrations to help learners understand how to do back blows, chest thrusts or abdominal thrusts. Emphasise that while these actions may seem aggressive, they could save the person’s life. Explain that learners should adapt the force of their actions depending on the size of the person, but that those actions still need to be forceful enough to clear the airway.
• In addition to manikins, use objects such as punching bags or stuffed sacks to practise back blows and abdominal or chest thrusts.
• Develop scenarios to practise recognising and helping someone who is choking. These scenarios may be used to assess learners’ knowledge and skills on this topic.

Learning connections

• If someone who is choking becomes unresponsive it is necessary to start CPR as the chest compressions or rescue breaths may dislodge the object from their airway and help them to breathe again. See Unresponsive and abnormal breathing adolescent and adult or baby and child.