Choking First Aid Techniques for Adults and Children by Red Crescent

Authors

  • Mohammed Radi Bodrees
  • Huda Ahmed M Al Marzooq
  • Hussain Saeed Alqatari
  • Mustafa Ali Alramadan
  • Hussain Radi Jaffer Al Rebh
  • Abdulmohsen Hussain Alnahwi
  • Narjess Hameed Alashour
  • Raja Ali Alibrahimalali
  • Ebtihal Ali AlHussain
  • Hassan Hussain Ali Aljanubi

DOI:

https://doi.org/10.22399/ijcesen.4009

Keywords:

Choking, Foreign Body Airway Obstruction (FBAO), First Aid, Heimlich Maneuver, Abdominal Thrusts, Pediatric Choking

Abstract

Choking is a critical emergency that requires immediate action, as it can obstruct airflow and lead to severe consequences within minutes. For adults, the first response is often the Heimlich maneuver, which involves standing behind the individual and wrapping your arms around their waist. The rescuer should make a fist with one hand and place the thumb side against the middle of the person’s abdomen, above the navel. A quick, inward and upward thrust can help expel the object blocking the airway. If the person becomes unconscious, it's essential to call emergency services and initiate CPR, alternating between chest compressions and rescue breaths to maintain circulation and oxygen flow. When dealing with choking in children, techniques vary slightly based on age. For infants under one year, the recommended approach is a series of five back blows, delivered between the shoulder blades using the heel of the hand, followed by five chest thrusts using two fingers on the lower half of the sternum. For children aged one year and older, the Heimlich maneuver can be adapted similarly to adults, though the rescuer should be mindful of using less force appropriate to the child's size. Regardless of age, it is crucial to remain calm and encourage the child to cough forcefully if they can, as this may help dislodge the object on their own. In all cases, seeking professional medical assistance afterward is advisable, even if the object seems to be expelled.

References

[1] Duckett SA, Bartman M, Roten RA. Choking. In: StatPearls. Treasure Island (FL): StatPearls Publishing, https://www.ncbi.nlm.nih.gov/books/NBK499941/ (2023, accessed 19 September 2022). [PubMed] [Google Scholar]

[2] Berzlanovich AM, Fazeny-Dörner B, Waldhoer T, et al. Foreign body asphyxia: a preventable cause of death in the elderly. Am J Prev Med 2005; 28(1): 65–69. [DOI] [PubMed] [Google Scholar]

[3] Ebrahimi M, Mirhaghi A. Heimlich maneuver complications: a systematic review. Eurasian J Emerg Med 2019; 18: 157–165. [Google Scholar]

[4] Olasveengen TM, Semeraro F, Ristagno G, et al. European resuscitation council guidelines 2021: basic life support. Resuscitation 2021; 161: 98–114. [DOI] [PubMed] [Google Scholar]

[5] Hartrey R, Bingham RM. Pharyngeal trauma as a result of blind finger sweeps in the choking child. J Accid Emerg Med 1995; 12(1): 52–54. [DOI] [PMC free article] [PubMed] [Google Scholar]

[6] Kabbani M, Goodwin SR. Traumatic epiglottis following blind finger sweep to remove a pharyngeal foreign body. Clin Pediatr (Phila) 1995; 34(9): 495–497. [DOI] [PubMed] [Google Scholar]

[7] Salih AM, Alfaki M, Alam-Elhuda DM. Airway Foreign bodies: a critical review for a common pediatric emergency. World J Emerg Med 2016; 7(1): 5–12. [DOI] [PMC free article] [PubMed] [Google Scholar]

[8] Gardner H, Baum C, Dowd M, et al. Policy statement-prevention of choking among children. Pediatrics 2010; 125: 601–607. [DOI] [PubMed] [Google Scholar]

[9] Pavitt MJ, Nevett J, Swanton LL, et al. London ambulance source data on choking incidence for the calendar year 2016: an observational study. BMJ Open Respir Res 2017; 4(1): e000215. [DOI] [PMC free article] [PubMed] [Google Scholar]

[10] Upendrababu V. Current changes in adult basic life support: based on recent guidelines of AHA, 2018.

[11] Taniguchi Y, Iwagami M, Sakata N, et al. Epidemiology of food choking deaths in Japan: time trends and regional variations. J Epidemiol 2021; 31(5): 356–360. [DOI] [PMC free article] [PubMed] [Google Scholar]

[12] Wu WS, Sung KC, Cheng TJ, et al. Associations between chronic diseases and choking deaths among older adults in the USA: a cross-sectional study using multiple cause mortality data from 2009 to 2013. BMJ Open 2015; 5(11): e009464. [DOI] [PMC free article] [PubMed] [Google Scholar]

[13] Australian and New Zealand Resuscitation Councils. ANZCOR guideline 4—Airway, https://resus.org.au/guidelines/ (2016).

[14] AWFA-First-Aid-E-Manual-V-6.3-Mar-2021.pdf, https://cdn.australiawidefirstaid.com.au/wpcontent/uploads/2021/04/29205857/AWFA-First-Aid-E-Manual-V-6.3-Mar-2021.pdf (accessed 7 May 2023).

[15] New Zealand Resuscitation Council. ANZCOR Guidelines, https://www.resus.org.nz/healthcare-resources/guidelines/ (accessed 7 May 2023).

[16] Australian and New Zealand Resuscitation Councils. ANZCOR guideline 4—Airway, https://resus.org.au/guidelines/ (2016).

[17] Perkins GD, Handley AJ, Koster RW, et al. European resuscitation council guidelines for resuscitation 2015: section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95: 81–99. [DOI] [PubMed] [Google Scholar]

[18] Berg MD, Schexnayder SM, Chameides L, et al. Part 13: pediatric basic life support. Circulation 2010; 122(18_suppl_3): S862–S875. [DOI] [PMC free article] [PubMed] [Google Scholar]

[19] Taniguchi Y, Iwagami M, Sakata N, et al. Epidemiology of food choking deaths in Japan: time trends and regional variations. J Epidemiol 2021; 31(5): 356–360. [DOI] [PMC free article] [PubMed] [Google Scholar]

[20] Berzlanovich AM, Fazeny-Dörner B, Waldhoer T, et al. Foreign body asphyxia: a preventable cause of death in the elderly. Am J Prev Med 2005; 28(1): 65–69. [DOI] [PubMed] [Google Scholar]

[21] Guazzo E, Burns H. Paediatric inhaled airway foreign bodies: an update. Aust J Gen Pract 2019; 48(4): 171–174. [DOI] [PubMed] [Google Scholar]

[22] Gardner H, Baum C, Dowd M, et al. Policy statement-prevention of choking among children. Pediatrics 2010; 125: 601–607. [DOI] [PubMed] [Google Scholar]

[23] Van de Voorde P., Turner N.M., Djakow J., de Lucas N., Martinez-Mejias A., Biarent D., Bingham R., Brissaud O., Hoffmann F., Johannesdottir G.B., et al. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation. 2021;61:327–387. doi: 10.1016/j.resuscitation.2021.02.015. [DOI] [PubMed] [Google Scholar]

[24] Igarashi Y., Suzuki K., Norii T., Motomura T., Yoshino Y., Kitagoya Y., Ogawa S., Yokobori S., Yokota H. Do Video Calls Improve Dispatcher-Assisted First Aid for Infants with Foreign Body Airway Obstruction? A Randomized Controlled Trial/Simulation Study. J. Nippon. Med. Sch. 2022;89:526–532. doi: 10.1272/jnms.JNMS.2022_89-513. [DOI] [PubMed] [Google Scholar]

[25] Lott C., Truhlář A., Alfonzo A., Barelli A., González-Salvado V., Hinkelbein J., Nolan J.P., Paal P., Perkins G.D., Thies K.C., et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152–219. doi: 10.1016/j.resuscitation.2021.02.011. [DOI] [PubMed] [Google Scholar]

[26] Hasselager A., Bohnstedt C., Østergaard D., Sønderskov C., Bihrmann K., Tolsgaard M.G., Lauritsen T.L.B. Improving the cost-effectiveness of laypersons’ paediatric basic life support skills training: A randomised non-inferiority study. Resuscitation. 2019;138:28–35. doi: 10.1016/j.resuscitation.2019.02.032. [DOI] [PubMed] [Google Scholar]

[27] Montoya D. Management of the choking victim. CMAJ. 1986;135:305–311. [PMC free article] [PubMed] [Google Scholar]

[28] Gross S.K. A Practical Treatise on Foreign Bodies in the Air Passages. 1st ed. Blanchard and Lea; Philadelphia, PA, USA: 1854. pp. 242–257. [Google Scholar]

[29] Heimlich H.J. Choking victims: Back blows and chest thrusts are hazardous, even lethal. Public Health Rep. 1987;102:561–562. [PMC free article] [PubMed] [Google Scholar]

[30] Tucker G.F., Jr. Report of the Committee for the Prevention of Foreign Body Accidents. Trans. Am. Bronchoesophagol. Assoc. 1969;49:181–182. [Google Scholar]

[31] Heimlich H.J. First aid for choking children: Back blows and chest thrusts cause complications and death. Pediatrics. 1982;70:120–125. doi: 10.1542/peds.70.1.120. [DOI] [PubMed] [Google Scholar]

[32] Heimlich H.J., Uhley M.H., Netter F.H. The Heimlich maneuver. Clin. Symp. 1979;31:1–32. doi: 10.1080/00325481.1990.11716329. [DOI] [PubMed] [Google Scholar]

[33] Heimlich H.J. Pop goes the cafe coronary. Emerg. Med. 1974;6:1954–1955. [Google Scholar]

[34] Heimlich H.J. Back blows are death blows. Emerg. Med. Serv. 1979;8:88–95. [Google Scholar]

[35] Ojeda Rodriguez J.A., Ladd M., Brandis D. Abdominal Thrust Maneuver. StatPearls Publishing [Internet]; Treasure Island, FL, USA: 2023. [PubMed] [Google Scholar]

[36] Topjian A.A., Raymond T.T., Atkins D., Chan M., Duff J.P., Joyner B.L., Jr., Lasa J.J., Lavonas E.J., Levy A., Mahgoub M., et al. Pediatric Basic and Advanced Life Support Collaborators. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;20:469–523. doi: 10.1542/peds.2020-038505D. [DOI] [PubMed] [Google Scholar]

[37] Ngamsanga S., Vathanophas V., Ungkanont K., Tanphaichitr A., Wannarong T. Pediatric respiratory tract foreign bodies in children: A systematic review. Auris Nasus Larynx. 2023;50:607–613. doi: 10.1016/j.anl.2022.10.003. [DOI] [PubMed] [Google Scholar]

[38] van de Voorde P., Turner N.M., Djakow J., de Lucas N., Martinez-Mejias A., Biarent D., Bingham R., Brissaud O., Hoffmann F., Johannesdottir G.B., et al. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation. 2021;61:327–387. doi: 10.1016/j.resuscitation.2021.02.015. [DOI] [PubMed] [Google Scholar]

[39] Dodson H., Cook J. Foreign Body Airway Obstruction. StatPearls Publishing [Internet]; Treasure Island, FL, USA: 2023. [PubMed] [Google Scholar]

[40] Igarashi Y., Norii T., Sung-Ho K., Nagata S., Yoshino Y., Hamaguchi T., Nagaosa R., Nakao S., Tagami T., Yokobori S. Airway obstruction time and outcomes in patients with foreign body airway obstruction: Multicenter observational choking investigation. Acute Med. Surg. 2022;9:e741. doi: 10.1002/ams2.741. [DOI] [PMC free article] [PubMed] [Google Scholar]

[41] Igarashi Y., Yokobori S., Yoshino Y., Masuno T., Miyauchi M., Yokota H. Prehospital removal improves neurological outcomes in elderly patient with foreign body airway obstruction. Am. J. Emerg. Med. 2017;35:1396–1399. doi: 10.1016/j.ajem.2017.04.016. [DOI] [PubMed] [Google Scholar]

[42] Landoni G., Morselli F., Silvetti S., Frontera A., Zangrillo A., Collaborators Pizza in adults and grape in children are the most frequent causes of foreign body airway obstruction in Italy. A national media-based survey. Resuscitation. 2020;149:141–142. doi: 10.1016/j.resuscitation.2020.02.016. [DOI] [PubMed] [Google Scholar]

[43] Igarashi Y., Suzuki K., Norii T., Motomura T., Yoshino Y., Kitagoya Y., Ogawa S., Yokobori S., Yokota H. Do Video Calls Improve Dispatcher-Assisted First Aid for Infants with Foreign Body Airway Obstruction? A Randomized Controlled Trial/Simulation Study. J. Nippon. Med. Sch. 2022;89:526–532. doi: 10.1272/jnms.JNMS.2022_89-513. [DOI] [PubMed] [Google Scholar]

[44] Taniguchi Y, Iwagami M, Sakata N, et al. Epidemiology of food choking deaths in Japan: time trends and regional variations. J Epidemiol 2021; 31(5): 356–360. [DOI] [PMC free article] [PubMed] [Google Scholar]

[45] Berzlanovich AM, Fazeny-Dörner B, Waldhoer T, et al. Foreign body asphyxia: a preventable cause of death in the elderly. Am J Prev Med 2005; 28(1): 65–69. [DOI] [PubMed] [Google Scholar]

[46] Guazzo E, Burns H. Paediatric inhaled airway foreign bodies: an update. Aust J Gen Pract 2019; 48(4): 171–174. [DOI] [PubMed] [Google Scholar]

[47] Gardner H, Baum C, Dowd M, et al. Policy statement-prevention of choking among children. Pediatrics 2010; 125: 601–607. [DOI] [PubMed] [Google Scholar]

[48] Rodríguez H, Passali GC, Gregori D, Chinski A, Tiscornia C, Botto H, et al. . Management of Foreign Bodies in the airway and Oesophagus. Int J Pediatr Otorhinolaryngol. (2012) 76:S84–91. doi: 10.1016/j.ijporl.2012.02.010 - DOI - PubMed

[49] Hay es NM, Chidekel A. Pediatric choking. Del Med J. (2004) 76:335–40. PMID: - PubMed

[50] Duckett SA, Bartman M, Roten RA. Choking In: Waggoner BC, editor. Statpearls. Treasure Island (FL): StatPearls Publishing; (2024) - PubMed

[51] Saccomanno S, Saran S, Coceani Paskay L, De Luca M, Tricerri A, Mafucci Orlandini S, et al. . Risk factors and prevention of choking. Eur J Transl Myol. (2023) 33:11471. doi: 10.4081/ejtm.2023.11471, PMID: - DOI - PMC - PubMed

[52] Chang DT, Abdo K, Bhatt JM, Huoh KC, Pham NS, Ahuja GS. Persistence of choking injuries in children. Int J Pediatr Otorhinolaryngol. (2021) 144:110685. doi: 10.1016/j.ijporl.2021.110685, PMID: - DOI - PubMed

[53] Nichols BG, Visotcky A, Aberger M, Braun NM, Shah R, Tarima S, et al. . Pediatric exposure to choking hazards is associated with parental knowledge of choking hazards. Int J Pediatr Otorhinolaryngol. (2012) 76:169–73. doi: 10.1016/j.ijporl.2011.10.018, PMID: - DOI - PubMed

[54] Montano D. Management of the choking victim. CMAJ. 1986;135:305–311. [PMC free article] [PubMed] [Google Scholar]

[55] Heimlich HJ, Uhley MH, Netter F.H. The Heimlich maneuver. Clin. Symp. 1979;31:1–32. doi: 10.1080/00325481.1990.11716329. [DOI] [PubMed] [Google Scholar]

[56] Alamr F, Alzahrani HMA, Alghamdi AMA, Alzhrani ASA, Alzahrani FAA, Alkhediwi LMA, et al. . Prevalence and risk factors of home accidents among children under five years of age in Al-Baha, Saudi Arabia. Cureus. (2023) 15:e46846. doi: 10.7759/cureus.46846, PMID: - DOI - PMC - PubMed

[57] Cyr C, Canadian Paediatric S, Injury PC. Preventing choking and suffocation in children. Paediatr Child Health. (2012) 17:91–2. doi: 10.1093/pch/17.2.91 - DOI - PMC - PubMed

[58] Bennett G, Hinkle R. Choking in children: what to do and how to prevent. Pediatr Ann. (2019) 48:e338–40. doi: 10.3928/19382359-20190819-01, PMID: - DOI - PubMed

[59] Heilman H. Choking and airway foreign bodies: A review of prevention strategies. Int J Pediatr Otorhinolaryngol. (2018) 113:234–9. doi: 10.1016/j.ijporl.2018.08.002, PMID: - DOI - PubMed

[60] Montana A, Salerno M, Feola A, Asmundo A, Di Nunno N, Casella F, et al. . Risk management and recommendations for the prevention of fatal foreign body aspiration: four cases aged 1.5 to 3 years and Mini-review of the literature. Int J Environ Res Public Health. (2020) 17:4700. doi: 10.3390/ijerph17134700, PMID: - DOI - PMC – PubMed

[61] Sharma A, Minh Duc NT, Luu Lam Thang T, et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med 2021; 36(10): 3179–3187. [DOI] [PMC free article] [PubMed] [Google Scholar]

[62] Higuchi O, Adachi Y, Adachi YS, et al. Mothers’ knowledge about foreign body aspiration in young children. Int J Pediatr Otorhinolaryngol 2013; 77(1): 41–44. [DOI] [PubMed] [Google Scholar]

[63] Ozdogan S, Sahin G, Avci O, et al. Mothers’ knowledge on foreign body aspiration. YMJ 2015; 11(36): 935–944. [Google Scholar]

[64] Bin Laswad BM, Alsulaimani HM, Alomairi MM, et al. Parental knowledge and practices related to foreign body aspiration in children in Makkah, Saudi Arabia. Cureus 2023; 15(2): e34816. [DOI] [PMC free article] [PubMed] [Google Scholar]

[65] Maalim Issack A, Jiru T, Wubetie Aniley A. Assessment of knowledge, attitude and practice on first aid management of choking and associated factors among kindergarten teachers in Addis Ababa governmental schools, Addis Ababa, Ethiopia. A cross-sectional institution-based study. PLoS One 2021; 16(7): e0255331. [DOI] [PMC free article] [PubMed] [Google Scholar]

[66] Halawani LM, Alghamdy SD, Alwazae MM, et al. Knowledge and attitude of Saudi female university students about first aid skills. J Fam Community Med 2019; 26(2): 103–107. [DOI] [PMC free article] [PubMed] [Google Scholar]

[67] Almutairi AT, Alharbi FS. Parental knowledge and practices toward foreign body aspiration in children in the Al Qassim region of Saudi Arabia. J Fam Med Prim Care 2021; 10(1): 199–204. [DOI] [PMC free article] [PubMed] [Google Scholar]

[68] Al-Johani AAS, Sabor S, Aldubai SAR. Knowledge and practice of first aid among parents attending Primary Health Care Centers in Madinah City, Saudi Arabia, A cross sectional study. J Fam Med Prim Care 2018; 7(2): 380–388. [DOI] [PMC free article] [PubMed] [Google Scholar]

[69] Al-Qudehy Z, Al-Sheif H, Al-Qudaihi G. Parental knowledge of foreign body aspiration: a comparative study between saudis and other nations. J Otolaryngol-ENT Res 2015; 2: 00008. [Google Scholar]

[70] Habeeb KA, Alarfaj G. Saudi parents awareness regarding burn, choking, and drowning first aid in children. J Fam Med Prim Care 2020; 9(3): 1370–1375. [DOI] [PMC free article] [PubMed] [Google Scholar]

[71] Ganfure G, Ameya G, Tamirat A, et al. First aid knowledge, attitude, practice, and associated factors among kindergarten teachers of Lideta sub-city Addis Ababa, Ethiopia. PLoS One 2018; 13(3): e0194263. [DOI] [PMC free article] [PubMed] [Google Scholar]

[72] Rodríguez H, Passali GC, Gregori D, Chinski A, Tiscornia C, Botto H, et al. Management of Foreign Bodies in the airway and Oesophagus. Int J Pediatr Otorhinolaryngol. (2012) 76:S84–91. doi: 10.1016/j.ijporl.2012.02.010 - DOI - PubMed

[73] Bin Laswad BM, Alsulaimani HM, Alomairi MM, et al. Parental knowledge and practices related to foreign body aspiration in children in Makkah, Saudi Arabia. Cureus 2023; 15(2): e34816. [DOI] [PMC free article] [PubMed] [Google Scholar]

[74] Sheng C.K., Zakaria M.I., Rahman N.H.N.A., Jaalam K., Adnan W.A.W. Cardiopulmonary Resuscitation: The Short Comings in Malaysia. Malays. J. Med. Sci. 2008;15:49–51. [PMC free article] [PubMed] [Google Scholar]

[75] Canadian Guidelines Consensus Task Force 2016 Canadian Consensus Guidelines on First Aid and CPR. [(accessed on 6 August 2024)]. Available online: [redacted]

[76] Canadian Heart & Stroke Foundation. Basic Life Support Provider Manual. American Heart Association; Toronto, ON, Canada: 2020. pp. 85–92. [Google Scholar]

[77] Canadian Ski Patrol. System Patroller’s Manual: Advanced First Aid. 19th ed. Canadian Ski Patrol; Ottawa, ON, Canada: 2022. pp. 94–99. [Google Scholar]

Downloads

Published

2025-01-31

How to Cite

Mohammed Radi Bodrees, Huda Ahmed M Al Marzooq, Hussain Saeed Alqatari, Mustafa Ali Alramadan, Hussain Radi Jaffer Al Rebh, Abdulmohsen Hussain Alnahwi, … Hassan Hussain Ali Aljanubi. (2025). Choking First Aid Techniques for Adults and Children by Red Crescent. International Journal of Computational and Experimental Science and Engineering, 11(4). https://doi.org/10.22399/ijcesen.4009

Issue

Section

Research Article