About 4,000 Americans die each year from choking, usually the result of food going down “the wrong way”—meaning it doesn’t go down the esophagus as it’s supposed to, but ends up in the trachea (windpipe), thus blocking breathing.
Most of these deaths could be prevented with proper first aid, including the abdominal thrusts popularly known as the Heimlich maneuver, named after the doctor who first described this technique 40 years ago.
The maneuver made news early this year when Clint Eastwood used it at a party for the PGA Tour, rescuing the organization’s director, who was choking on a piece of cheese. Eastwood, while obviously familiar with the maneuver, said he had never done it before. You’ve probably seen that first-aid poster in restaurants showing how to do the maneuver, but would you really be able to do it? Here are some of the basics.
Note: No article, poster, or video can teach you how to deal with choking and other life-threatening emergencies as well as a course in basic life support, first aid, or CPR (cardiopulmonary resuscitation). You can find a course in your area—or take one online—through the American Red Cross or the American Heart Association.
1. Should you do the abdominal thrusts right away if you see someone choking?
First, you should make sure the person can’t speak, cough, or breathe. (Ask “are you choking?” and then “can you speak?”) If he can, you should not do the maneuver or anything else that could interfere with his ability to clear his airway by coughing forcefully. If he can’t breathe, speak, or cough, make sure someone calls 911 immediately.
There’s some disagreement about what you should do next. The American Heart Association and American College of Emergency Physicians still advise abdominal thrusts. But since 2006 the American Red Cross has advised starting with back slaps instead.
That is, you should lean the person forward, supporting his torso with your arm, and give his upper back (between the shoulder blades) five blows with the heel of your hand to dislodge whatever is blocking his airway. Only if that doesn’t work should you begin the abdominal thrusts, according to the Red Cross.
We think it’s okay to start with either the back slaps or abdominal thrusts.
2. How do you do the abdominal thrusts?
Stand behind the person and wrap your arms around his waist; make a fist and place the thumb side just above the navel and below the rib cage.
Grasp your fist with your other hand and make a quick 45-degree upward thrusting movement; the force should be confined to your hands as much as possible; do not squeeze the ribcage. Repeat five times.
According to the Red Cross guidelines, if neither the back blows nor the abdominal thrusts work, you should repeat the blows and then the thrusts until the object is forced out and the person can cough and breathe. Many online videos show how to do the thrusts (and back slaps). There are also smartphone apps showing first aid for choking as well as CPR.
If the choking person is pregnant or obese, position your hands higher up, at the base of the breast bone.
Ways to Prevent Choking
Afraid of choking? You can minimize your risk with simple common sense tips such as eating slowly.
3. What should you do if you’re choking and you are alone?
Try self-administered abdominal thrusts. Make a fist and place the thumb side against your abdomen, slightly above the navel.
Grasp your fist with the other hand and press it inward and upward with quick, sharp thrusts.
It may help to do this while pushing your abdomen forcefully into something about waist high—the top of a chair back, edge of a table, or a railing—so that it pushes your fist in and up.
Repeat until air is forced out and the food is expelled.
4. Can abdominal thrusts be dangerous?
Yes, but rarely. There have been case reports and papers describing adverse events, usually (but not always) when the maneuver was done incorrectly and sometimes unnecessarily. These include rib fractures, perforation of the esophagus, and ruptures of the stomach, diaphragm, spleen, or a heart valve.
Frail older people who have fragile bones or vascular disease are at increased risk for injury from the abdominal thrusts. Keep in mind that choking is a life-and-death situation, and the greatest danger is inaction on the part of bystanders.
5. Who is most likely to choke and why?
Children under five and the very old are most vulnerable. While children typically choke on small pieces of solid foods, older people often choke on semi-solid food, such as ground meat, mashed fruits, and bread, according to an Austrian study a few years ago.
Older people may have trouble chewing because of dentures or dental problems and have difficulty swallowing because of medications (like sedatives) and disorders that affect motor coordination (such as stroke, Parkinson’s, and Alzheimer’s). They may also lose some of the muscle tone needed to produce the normal gag reflex that can eject something that has gone down the wrong way.
Published November 12, 2014