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Are you choking?

Updated: Dec 13, 2019


Whilst there are thousands of choking incidents every year, figures from the Office for National Statistics (ONS) suggest that only about 300 people die as a result.


Most choking is related to eating, with the majority of the remainder due to children and babies putting small objects in their mouths while playing and exploring the world around them.


Whilst most people relate choking to babies and young children, it is far more prevalent in other groups of people, such as those who:

  • Are older

  • Are intoxicated through alcohol or drugs

  • Have a reduced cough or gag reflex (usually due to a medical condition such as a stroke or Parkinson's disease)

  • Have a mental impairment or dementia

That said, choking can happen to people of any age and can be rapidly fatal if not recognised and treated effectively.


Recognition


There are two fundamentally different types of choking, mild and severe.


Regardless of the type, you're likely to get clues that it could be choking because of the situation:

  • People are eating

  • Children are playing

  • The person is looking anxious

  • The person is coughing, gagging or has gone quiet


Mild Choking


In mild choking there is only a partial airway obstruction. The problem is usually caused by something like a stringy piece of meat. This person will be able to cough and talk, as they can still move air through their airway.




Severe Choking


In severe choking, the person has a complete airway obstruction. This is usually caused by something like a grape, large chip or a mass of chewed food. This person will not be able to cough or talk as they can't move a significant amount of air. They will probably not be making any noise.





In order to assess what is going on, you should ask the person:

Are you choking? Can you cough?

This will tell you whether they have a partial or complete obstruction, which in turn will determine your treatment.


Treatment


Resuscitation Council (UK) 2015 Guidelines



Whichever type of choking you're dealing with, it's a medical emergency and needs an ambulance immediately. Ideally you should get someone else to call 999, but if you are on your own then you need to do it yourself. Put the phone on speaker while you try to treat the person.







Mild Choking


In mild choking, we simply ask the person to continue to cough. Try to get them to lean forward so that they are not fighting against gravity.


Continue to monitor them for deterioration until the ambulance arrives.


Severe Choking


If the person can't move any air, you'll need to try something different. There are only two techniques that are proven to work, which are 'back blows' and 'abdominal or chest thrusts'. Both techniques are attempting to emulate a cough.


If someone is choking and can't cough, you should...

Perform 5 back blows followed by 5 abdominal (or for an infant, chest) thrusts and then repeat until cleared or the person becomes unconscious

How you perform these techniques is different for adults and children or infants. In all cases, you are trying to simulate the normal cough reflex by rapidly expelling air from the lungs.


Adults and Children (>1 year old)








Back Blows

  • Stand to the side and slightly behind the person

  • Bend the person well forward

  • Support the chest with one arm

  • Give sharp blows between the shoulder blades with the heal of your other hand

  • It might be easier to lay small children across your lap










Abdominal Thrusts

  • Stand behind the person

  • Put both arms around the upper part of their abdomen

  • Clench one fist and put it in-between their belly button and ribs

  • Put the other hand over the top

  • Pull sharply inwards and upwards up to 5 times



Infants (<1 year old)





Back Blows

  • Lie the infant face down along your forearm, head downward

  • Support its head with your hand but make sure the mouth and nose are clear

  • Give sharp blows between the shoulder blades with the heal of your other hand




Chest Thrusts

  • Turn the infant to be face up along your forearm, still head downward

  • Support its head with your hand

  • Give sharp chest compressions with two fingers in the middle of the chest


If the blockage is cleared and the person has received abdominal or chest thrusts, they should still seek immediate medical attention.


If the person becomes unconscious before you are able to clear the blockage you should lower them to the floor and treat them for Cardiac Arrest (send for a defibrillator and start CPR). Read this Cardiac Arrest blog to find out more.



Summary


Don't forget, most choking incidents aren't fatal, but swift intervention could make the difference between life and death.

  1. Ask if they're choking

  2. Call 999

  3. Ask them to cough. If they can't cough...

  4. Deliver back blows and abdominal or chest thrusts

  5. Repeat until cleared or they become unconscious

If you'd like to know more, or get better at dealing with someone who's choking, why not book one of our first aid courses for your group?

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