Preparing for the holidays, a lesson in new choking guidelines should be on the menu

The holidays can be a time of indulgence, and those big bites and belly laughs at gatherings increase the risk of someone choking. Do you know what to do? 

Researchers at the O’Brien Institute for Public Health at the University of Calgary say back blows rather than the traditional abdominal thrusts (Heimlich maneuver) are the best method to dislodge airway obstructions. The research, led by Dr. Cody Dunne, MD, PGME'24, PGME'25, has shifted global first aid recommendations and influenced new choking guidelines recommended by the American Heart Association (AHA). 

For the first time since 2010, the AHA has revised how people should respond when someone is choking. Because the Heart and Stroke Foundation of Canada is linked to AHA guidance, this change will influence first aid training and public-response recommendations across North America.

We spoke with Dunne, an emergency physician in Calgary and a clinical lecturer at the Cumming School of Medicine, to find out what to do when someone is choking:

What should I do if someone near me is choking?

If the person, a child or adult, is conscious, the guidelines recommend alternating five back blows, followed by five abdominal thrusts (Heimlich maneuver) until the object is expelled or the person becomes unresponsive.

If you’re able to help someone, it’s important you try. Our study showed that people who had the foreign body cleared before paramedics arrived survived 99 per cent of the time, whereas 42 per cent of people who were still choking with paramedics died before or during their hospital admission. 

How and where on the person do I apply back blows? 

You want to lean the person forward by bending them at their hips so that they’re almost in line with the floor. Then, using the bottom of your palm, hit them between their shoulder blades with a firm strike up to five times. Don’t worry about hurting someone with this technique, it’s important to do hard strikes to be able to clear the object. 

If back blows still don’t clear the object, you should then try five abdominal thrusts. 

Does it matter if there is a complete blockage in their throat, or if the person is coughing or still making sounds? 

If someone is still able to cough, cry or speak clearly, then they are still able to clear the object on their own. Lean them forward and encourage them to keep coughing. However, once their cough goes quiet or they’re no longer able to cry or speak, you can immediately start with back blows and follow with abdominal thrusts if the object still doesn’t clear. Don’t forget to call 911! 

Should I ever offer someone a glass of water, or a drink if they are choking? 

If someone is choking, it’s best not to give them anything to drink, as this might make the choking worse. Instead, encourage them to cough or help them with back blows. Don’t let them leave the room. People tend to move away from others when they’re coughing and sometimes isolate themselves in a room. You want to always have an eye on them. 

What about a small child, or infant? 

For small children, the biggest difference is the height. You may have to get down to their level by kneeling, but still use back blows and abdominal thrusts. For infants, you can hold them in your arms. If the infant is still crying or coughing loudly, hold them with their heads down supported by your arms and legs. Then, if the object doesn’t clear and they start to get quiet, you should begin with back blows and then alternate with chest compressions. 

What if the person becomes unresponsive and passes out? 

If you haven’t yet at this point, get someone to call 911. Then you can initiate CPR, starting with chest compressions. The extra step to remember when someone is not breathing due to choking, is after the chest compression you can look in the mouth before giving rescue breaths and clear any object that you can see.

What was the biggest factor in changing the guidelines? 

Our study was the first to compare different choking-response techniques, before we just had data on how well they each worked on their own. We identified 709 choking cases where paramedics were called in Alberta. We found that back blows were associated with improved relief of airway obstruction and fewer injuries when compared with abdominal thrusts and chest compression. Up until now, international recommendations had relied mostly on small case series and expert opinion, with no comparative data to guide practice.