Choking is where an object blocks the airway, either fully or partially, preventing someone being able to breathe properly. Whether it’s a loved one or a stranger in a restaurant, your first instinct is usually to help someone with choking. Everyone always thinks of the manoeuvre where you squeeze someone from behind – it's a favourite in many films – but few people know the specifics. So let’s take you through what to do first, and then come on to how to effectively perform abdominal thrusts, otherwise known as the Heimlich manoeuvre. This advice is for adults. It’s a similar sequence for children and babies, but as their bodies are much smaller, we’ve written about the techinque for them separately.
You might notice someone is clutching at their neck or chest, and finding it hard to speak, breathe or cough. They may be going quite red in the face, and blueness is a worrying sign. Food is often the culprit, so choking is most often seen in restaurants and other food outlets. At no point should you try to remove anything from their mouth with your fingers or an instrument, as you can cause serious injury and push it deeper.
First things first, assess the situation: if someone is coughing effectively, let them cough. It means their airway is at least partially open, and this is the most effective way to remove an obstruction that’s lodged in the wrong place. Reassurance and enouragement to cough at this stage can help keep them calm. If they are entirely silent and unable to cough, this means their airway may be completely obstructed and their ability to breathe is at risk. You or another bystander need to call 999 for an ambulance immediately. If they are unable to speak or if coughing hasn’t worked, you should proceed to 5 back blows. Bend them forwards and hit them firmly with the heel of your hands between the shoulder blades. Repeat this up to 5 times. These back blows are aimed at dislodging the blockage, as the jolt creates a pressure in the airways. Bending them forwards encourages whatever is causing the blockage to fly out of the mouth, rather than lodging itself further down.
If unsuccessful after 5 back blows, you can try 5 abdominal thrusts. Encircle your arms around them from behind, meeting around at a point between their belly button and under their rib cage, and bend them slightly forwards. Clasp one hand in a fist, with the other hand over it, and pull inwards and upwards in one sharp movement. Repeat this up to 5 times. These abdominal thrusts aim to dislodge the blockage by pushing air out of the lungs and causing a sudden wave of pressure up the airways.
If they are coughing and speaking at first, try these procedures, but if 5 back blows and 5 abdominal thrusts are unsuccessful, call 999 for an ambulance. Keep repeating the sequence while you wait for help. Call 999 back if anything changes in their condition in the meantime. If someone is unconscious and has stopped breathing, call an ambulance immediately and start chest compressions if you feel confident to do so. Alternatively, stay on the phone with the ambulance call handler while they talk you through how to do CPR (cardiopulmonary resuscitation). Keep CPR going (or swap in with another bystander) until help arrives. It should come quickly.