If someone is choking right now and coughing is not clearing it, call 000. Put the phone on speaker and keep your hands free.
Ask the right question first
Do not ask “are you okay?” Ask “are you choking?” Someone with a blocked airway cannot answer a general question but can usually nod.
Then decide which of two situations you are in, because they need different responses.
- Mild blockage — they can still breathe, speak or cough forcefully. Encourage them to keep coughing. A strong cough moves more air than anything you can do with your hands. Stay with them and watch.
- Severe blockage — they cannot clear it by coughing. Signs include no sound at all, a whistling or crowing noise, or blue lips, face, earlobes or fingernails. Act immediately.
Adults and children over one year
- Call 000.
- Up to five sharp back blows. Bend the person well forward. Strike between the shoulder blades with the heel of one hand. Check after every single blow — stop the moment the blockage clears.
- Up to five chest thrusts. Support the middle of their back with one hand. Place the heel of the other hand on the lower half of the breastbone and give a quick, hard inward thrust. Again, check after each one.
- Alternate five back blows and five chest thrusts until the blockage clears or help arrives.
Bending the person forward matters. Striking the back of someone sitting or standing upright can drive the object further down.
Babies under one year
Same sequence, different handling, and far less force.
- Call 000 immediately and stay on the line.
- Back blows. Lay the baby face down along your forearm with the head lower than the body, supporting the head and shoulders. Give up to five back blows. If you can see the object, remove it gently with your little finger.
- Chest thrusts. Turn the baby onto their back on a firm surface. Give up to five chest thrusts using two fingers on the lower half of the breastbone.
- Alternate the two until the blockage clears or help arrives.
Never pick a choking child up and turn them upside down.
Abdominal thrusts are not taught in Australia
This is the point that surprises people most, usually because of films. The Heimlich manoeuvre is not recommended here — abdominal thrusts can break ribs and damage internal organs.
Australian first aid teaches back blows and chest thrusts. If you learned the Heimlich years ago or overseas, this is the thing worth updating.
Never do a blind finger sweep
Do not push your fingers into someone’s throat to feel for an object you cannot see. It pushes the obstruction deeper and can damage the airway. Only remove something you can actually see and reach.
If they become unresponsive
If the person goes limp, turns blue or loses consciousness, start CPR straight away, beginning with compressions. Chest compressions generate pressure that can dislodge the obstruction, so starting CPR is itself part of treating the choking. Follow the DRSABCD action plan and keep going until the ambulance arrives.
Afterwards
Anyone who has had back blows or chest thrusts should be seen by a doctor, even once they seem fine. Both can cause internal injury, and some of the object may still be in the airway.
This is a summary of what is taught in class, not a substitute for training. Skills like this are assessed practically for a reason — reading about them is not the same as having done them. In a real emergency, call 000.
Learn it properly
Choking management is taught and practised in HLTAID009 CPR, HLTAID011 first aid including CPR and HLTAID012 childcare first aid, which covers infant technique in detail. Best First Aid Training runs all three at Parramatta, Penrith, Blacktown and Liverpool.
Source: Healthdirect Australia, Choking.
