Choking First Aid: How to Use the Heimlich Maneuver

Choking can happen quickly, and knowing what to do in an emergency can save a life. The Heimlich maneuver, a simple first aid technique, is designed to help remove obstructions from a person's airway and restore breathing. Whether you're at home, in a restaurant, or out with friends, learning how to perform the Heimlich maneuver is an essential skill that everyone can benefit from. Anyone can learn the Heimlich maneuver, even people without medical knowledge. Continue reading to learn how to administer first aid when someone is choking.

What is the Heimlich Maneuver?

The Heimlich maneuver is a first aid technique and basic life support measure for adults and children who are choking. It involves performing abdominal thrusts on a choking victim with foreign body airway obstruction (an object stuck in the throat). This life-saving maneuver should only be used in conscious adults and children who cannot breathe.

Henry Heimlich (1920-2016) was an American thoracic surgeon who invented the Heimlich maneuver in 1974. It is widely recognized by the medical community as the best technique to save the lives of choking victims.

Recognizing Choking Symptoms

Choking can quickly become a life-threatening situation, and it's important to recognize the signs so that you can help you take immediate action. The following signs could indicate someone is choking:

Clutching the throat with one or both hands.
Looking panicked, shocked, or confused.
Unable to talk.
Noisy or strained breathing.
Squeaky sounds during breathing.
A weak or forceful cough.
Blue-gray discoloration of the skin, lips, and nails.
Loss of consciousness.

Performing the Heimlich Maneuver Safely

What To Do When Someone Is Choking?

If you're alone and choking, call 911 immediately and then give yourself the Heimlich maneuver (abdominal thrusts) to dislodge a stuck object from your throat; abdominal thrusts can be performed with a closed fist or by using the back of a chair
If you are the only person with someone who is choking, give them back blows and abdominal thrusts, and then call 911.
If there are other people around a choking adult or child, give first aid and have someone else call 911.

What Not To Do With a Choking Person?

If a choking person is coughing forcefully, don’t try to do the Heimlich maneuver. Let them cough. The force of coughing might naturally dislodge the stuck foreign object.

What Are the 4 Steps of the Heimlich Maneuver?

Stand behind the choking person and bend your knees for balance and support.
Wrap your arms around the victim’s waist and tip them slightly forward.
Make a fist with one hand, grasp it with the other hand, and place it above the person’s navel or bellybutton.
Give 5 firm abdominal thrusts, pulling inward and upward.

Step-by-Step Guide for Adults and Children

If a choking person can’t speak or cough, perform the Heimlich maneuver. When performed correctly, the Heimlich maneuver can save lives.

Here is a step-by-step guide from the American Red Cross to help a choking person:

To perform the Heimlich maneuver, the rescuer stands to the side and slightly behind the choking person. However, you may need to kneel behind a small child.
Place your arm across the person’s chest to support their body.
Bend the choking victim over at the waist so they are facing the ground.
Using the heel of your hand, give 5 firm back slaps between the person’s shoulder blades.
If there’s no improvement, have the victim stand up straight and move behind them.
Bend your knees for balance and wrap your arms around the victim’s waist, tipping them slightly forward.
Make a fist with one hand and place it just above the person’s belly button. Grasp your fist with the other hand.
Give 5 firm abdominal thrusts by pressing into the stomach and pulling upward and inward each time, like you’re trying to lift the person up. This is called the Heimlich maneuver. Note: Be relatively gentle with a child to avoid damage to internal organs.
Alternate between 5 back blows and 5 abdominal thrusts until the person can cough, talk, or cry.
Stop if the person becomes unresponsive. With the victim lying face up on a firm, flat surface, begin CPR (cardiopulmonary resuscitation) with chest compressions.
If you are trained in CPR, you can also provide rescue breaths. Before giving rescue breaths, check the person’s mouth for any small objects. Remove any foreign object with your fingers. But never do a finger sweep (blind insertion of your finger into the mouth without visualization of a foreign body) unless a foreign body is visible. You might inadvertently push the foreign object deeper into the airway. This risk is especially high in young children. Recheck the mouth after each set of compressions and rescue breaths for visible objects.

Do You Give Back Blows or Heimlich First?

You give back blows first and then perform the Heimlich. Some experts recommend that you only perform the Heimlich maneuver (abdominal thrusts) on a person with upper airway obstruction (choking signs). Either method is ok for adults and children over the age of 1. If you haven’t learned the back-blows technique, you can do the Heimlich maneuver alone.

How To Do the Heimlich Maneuver on Infants

If an infant younger than 1 year of age is choking:

Sit down and rest your arm on your thigh.
Place the infant face down on your arm.
Support the baby’s chin and jaw with their head lower than the rest of the body.
Thump the middle of the infant’s back firmly but gently five times using the heel of your hand.
Keep your fingers pointing up to avoid hitting the baby’s head.
The effect of gravity and the back thumps should clear the upper airway obstruction (windpipe blockage).
If breathing does not start, turn the infant face up on your arm with the head lower than the trunk.
Perform five firm but gentle chest compressions. Use two fingers just below the nipple line and press the chest down by about 1-1/2 inches.
Allow the chest to rise between the chest thrusts.
Call for emergency help.
If the infant does not start breathing, alternate between back thumps and chest thrusts.
Start infant CPR after ensuring the airway is clear and the infant isn’t breathing.

Modifications for Pregnant Women and Obese Individuals

If you can’t get your arms around a pregnant or obese person’s abdomen, give chest thrusts instead of abdominal thrusts.

Place your hands in the upper abdominal area, at the base of the person’s breastbone, just above the lower rib cage.
Press firmly on the upper abdomen and quickly thrust upwards. The action for the upward thrusts is similar to the Heimlich maneuver.
Repeat until the airway obstruction is cleared.

How To Give Yourself the Heimlich

If you are alone and choking, call 911 first. Then give yourself abdominal thrusts or the Heimlich maneuver to remove a stuck foreign body.

Make a fist and place it with the thumb side slightly above your belly button.
Hold the fist with your other hand.
Bend over a hard surface such as a table edge, countertop, or chair.
Perform abdominal thrusts by pushing your fist upward and inward.

Calling Emergency Services

A person's airway may still remain blocked after you try back blows and abdominal thrusts. That’s why it’s important to call 911 or your local emergency medicine services. Tell the operator a person is choking and then continue with alternating cycles of 5 back blows and 5 abdominal thrusts until help arrives.

Choking Prevention

Common Choking Hazards

Common choking risks for adults include certain foods (like hot dogs, nuts, grapes, and hard candy), behaviors like eating too fast or talking while eating, and medical conditions that affect chewing or swallowing.

Young children are at a high risk of choking. Choking risks in children include small objects and foods that are uncooked or in certain shapes or sizes.

Safety Tips for Parents and Teachers

Keep small objects and other choking hazards safely out of reach of children.
Cut food into smaller pieces or give young kids mashed food.
Be especially careful with foods such as nuts, grapes, and hot dogs.
Don’t give hard candy to young children.
Supervise your child at meal times and during play.

Educational Resources and Courses

You can learn the Heimlich first aid procedure and CPR through first aid courses offered by organizations such as the American Red Cross, the American Heart Association, and local community centers.

Addressing Common Questions and Misconceptions

Is the Heimlich Maneuver Still Recommended?

Yes, the Heimlich maneuver or abdominal thrusts are still recommended if a person is conscious and choking.

What Not to Do in a Choking Emergency?

In a choking emergency, don't perform back slaps with the person upright. Gravity might cause the foreign object to slip deeper down the trachea (windpipe). Back blows and chest thrusts should be performed with the person leaning forward.

Why Is It No Longer Called Heimlich Maneuver?

Some people started referring to the choking first aid maneuver as abdominal thrusts instead of the Heimlich maneuver after a controversy arose when Heimlich’s colleague alleged he was the co-developer of the maneuver.

Does Drinking Water While Choking Help?

No, drinking water while choking does not help and may cause serious harm. Instead, encourage the person to cough forcefully. If they can’t cough or speak but are conscious, perform the Heimlich maneuver. If the person is unconscious, perform CPR.

When Not To Do the Heimlich Maneuver?

Absolute contraindications to the Heimlich maneuver are children less than 1 year of age.

Relative contraindications are young children (below age 5 and weighing less than 45 lbs or 20 kg). Children should receive back blows and abdominal thrusts with only moderate pressure.

Pregnant and obese people should receive chest thrusts instead of abdominal thrusts.

What Are The Dangers of Performing the Heimlich Maneuver?

The Heimlich maneuver is a safe method of helping choking victims and can save lives. But if it isn’t done correctly, it can cause serious harm from sharp blows, including rib fractures and perforations in the gastrointestinal tract. However, first aid experts and healthcare providers still recommend doing the Heimlich maneuver for choking first aid in a life-or-death situation.