Key takeaways
- Choking is either partial where air still gets past and triggers a cough, or severe where the airway is fully blocked and often silent.
- A strong cough could clear it, so encourage coughing and watch closely. A weak or silent cough means call 111 and act.
- For severe choking, give five back blows then five chest thrusts and repeat until it clears. Never put your fingers in their mouth.
Choking is one of those emergencies that goes from a normal moment to a genuine crisis in seconds, often at a lunch table or a work morning tea with people right there who freeze because they don’t know what to do. The good news is that the response is simple, safe, and something anyone can learn.
The two types of choking
Choking is when a foreign object is stuck in someone’s airway and they can’t clear it themselves. There are two kinds:
A partial blockage is where something is stuck but air can still get past. This usually triggers a coughing reflex, and most of the time that cough does the job and clears it.
A severe blockage is where the airway is completely blocked. The frightening thing about this one is that it’s silent. You can’t hear a fully blocked airway, you can only see it. That’s why keeping an eye on people, especially kids, matters so much.
You can’t hear a fully blocked airway, you can only see it.
How to tell which one you’re dealing with
Look at the cough. If the person has a strong, effective cough, that’s a mild blockage and their own body is doing the work. Encourage them to keep coughing, and keep watching them closely for any sign it’s clearing or, just as importantly, any sign they’re getting worse.
If the cough goes quiet, becomes weak, disappears altogether, or the person goes silent, that mild blockage has become severe. If you have any doubt at all that they can clear it themselves call 111.
With adults you can watch their body language. People often clutch at their throat and many will feel embarrassed and try to walk away to deal with it privately – which is exactly when they need you to step in. With children it can look like a panicked face, watery eyes, a red face turning blue, and an open mouth with no normal breathing.
Severe choking: back blows and chest thrusts
If the person is responsive but can’t clear it/has an ineffective cough, call 111 and step in to help with your choking first aid skills.
Stand beside them and lean them forward as far as is safe. Using the heel of your hand give up to five firm back blows right between the shoulder blades, checking after each one to see if the object has come out.
If that hasn’t worked then it’s time to move to chest thrusts. Bring their back against your front, wrap your arms around them and make a fist. Place it in the centre of their chest with your other hand on top, lean them forward and give up to five firm chest thrusts one at a time, checking after each.
Then you simply repeat: five back blows, five chest thrusts, over and over until the object comes out or help arrives. If the person is much larger than you and you can’t get your arms around them safely, stand them against a wall and do the chest thrusts with your hands on the centre of their chest against the wall.
Infants under one are handled a little differently, supported along your leg with their head lower than their hips for back blows and in the same position but face up with a 2-finger technique for chest thrusts. The same sequence of five back blows and five chest thrusts applies.
Then you simply repeat: five back blows, five chest thrusts, over and over until the object comes out or help arrives.
When a patient becomes unresponsive
If your efforts don’t work and the person becomes unresponsive and stops breathing normally, lower them to the ground on their back and start CPR following the DRS ABCD steps.
One thing not to do
Do not put your fingers in their mouth to try to hook the object out. If they can’t cough it out themselves, blindly digging around has a high chance of pushing it further down the airway and making things worse. Stick to what’s proven safe and effective: call 111, five back blows, five chest thrusts.
The takeaway
Choking is fast and frightening but the response is simple. Read the cough to tell mild from severe, let a good cough do its work, and for a severe blockage call 111 and go straight into five back blows and five chest thrusts until it clears. Keep your fingers out of their mouth and be ready to move to CPR if they go unresponsive. It’s safe, it’s effective, and anybody can do it.
This is from the choking module in our online first aid course, part of the Online Platform, where your team can learn these skills properly with full demonstrations. This is general information and not a substitute for hands-on first aid training or individual medical advice, and in a real emergency always call 111. If you’d like your team trained and confident, book a call here.
