Choking first aid Australia involves encouraging an effective cough when the airway is only mildly obstructed and, for a conscious person with severe airway obstruction, sending for an ambulance and giving up to five back blows followed by up to five chest thrusts if the obstruction does not clear. Australian first aid guidance does not recommend abdominal thrusts, commonly known as the Heimlich manoeuvre. If the casualty becomes unresponsive and is not breathing normally, CPR should be started.
Choking can turn an ordinary meal, family gathering or lunch break into a life-threatening emergency within moments. Knowing how to recognise the difference between someone who can still cough effectively and someone whose airway is severely obstructed can determine what happens next.
For Sydney families, workers, carers and anyone responsible for others, choking is one of those emergencies where practical first aid knowledge really matters.
5 Key Takeaways
- An effective cough is important. Encourage the person to keep coughing and continue watching them closely.
- An ineffective cough indicates severe airway obstruction. Send for an ambulance and begin choking first aid.
- Give up to five back blows, checking after each one to see whether the obstruction has cleared.
- If back blows do not work, give up to five chest thrusts and continue alternating the techniques if necessary.
- Do not use abdominal thrusts or blind finger sweeps. If the casualty becomes unresponsive and is not breathing normally, commence CPR.
What Actually Happens When Someone Chokes?
Choking occurs when a foreign object obstructs the airway. Food is an obvious culprit, particularly in adults, but small objects can also become choking hazards, especially for babies and young children.
The obstruction may be partial or complete.
That distinction matters because someone who can cough effectively is still moving air. A person whose airway becomes completely obstructed may be unable to speak, breathe or cough effectively.
Signs can include coughing, wheezing or gagging, difficulty breathing, speaking or swallowing, unusual breathing noises, agitation and clutching at the throat. With a serious obstruction, the person may be unable to make any sound. Their lips or face can become blue and, without successful intervention, they can lose consciousness.
The situation can deteriorate rapidly, which is why recognising the effectiveness of the casualty’s cough is central to Australian choking first aid.
Mild Choking: When the Person Can Still Cough
ANZCOR describes an effective cough as mild airway obstruction.
If the casualty has an effective cough, encourage them to continue coughing in an attempt to expel the foreign material. Reassure them and watch closely for either recovery or deterioration. If the obstruction is not relieved, send for an ambulance.
This is an important point because the instinct to immediately start hitting someone on the back is not always appropriate.
An effective cough generates pressure within the airway and may dislodge the obstruction naturally. The first aider’s role at this stage is to encourage coughing and remain alert to any change.
If that strong cough becomes weak or ineffective, or the person can no longer breathe or speak properly, the emergency has become more serious.
Severe Choking: Recognising an Ineffective Cough
A person with severe airway obstruction may still make efforts to breathe but be unable to move enough air through the airway.
ANZCOR uses an ineffective cough as the simplest indicator of severe foreign body airway obstruction. With complete obstruction, there may be breathing efforts but no breathing sound and no air escaping from the nose or mouth.
This is the point at which you need to act.
For a conscious person with severe airway obstruction, send for an ambulance and begin back blows. If another person is present, have them call Triple Zero (000) while you provide first aid.
How to Give Back Blows for Choking
For a conscious adult or child with an ineffective cough, ANZCOR recommends up to five sharp back blows using the hand, delivered in the middle of the back between the shoulder blades.
The word up to is important.
You are not automatically trying to complete a set of five. After each back blow, check whether the obstruction has been relieved.
If the first blow clears the airway, stop. If it does not, give another and check again, continuing for up to five blows.
For adults and older children, Healthdirect advises bending the casualty forward before giving the back blows. This positioning helps an expelled object move out through the mouth rather than further into the airway.
If five back blows have not cleared the obstruction, move to chest thrusts.
How to Give Chest Thrusts for Choking
Chest thrusts are the next part of Australian choking first aid when back blows have been unsuccessful.
ANZCOR advises identifying the same compression point on the chest that is used for CPR and giving up to five chest thrusts. Chest thrusts are similar to chest compressions but are sharper and delivered at a slower rate.
Again, check after every thrust.
The purpose is not to mechanically complete five thrusts. The objective is to generate enough pressure to expel the obstruction, so stop once the airway has cleared.
If the person remains responsive and the obstruction is still present after the chest thrusts, continue alternating five back blows followed by five chest thrusts until the obstruction clears or emergency help takes over.
These are physical skills. Reading the sequence is useful, but practising choking management during recognised first aid training can make the steps far easier to recall when somebody suddenly needs your help.
At First Aid Pro Sydney, practical first aid training gives participants an opportunity to develop emergency response skills rather than relying on something they once read online.
What About the Heimlich Manoeuvre?
This is where Australian choking first aid differs from advice many people have encountered in films, television programs and overseas websites.
ANZCOR does not recommend abdominal thrusts, including the Heimlich manoeuvre, for managing foreign body airway obstruction.
ANZCOR notes that life-threatening complications associated with abdominal thrusts have been reported and recommends back blows and chest thrusts instead.
This difference is worth remembering.
Someone may have learnt years ago that the correct response to choking is to stand behind the casualty and perform forceful abdominal thrusts. That is not the technique recommended in current Australian resuscitation guidance.
When providing first aid in Australia, follow current Australian guidance: back blows and chest thrusts.
Choking First Aid for Babies
Choking in an infant can be particularly frightening, but the same basic principle of back blows followed by chest thrusts applies, with important differences in positioning.
ANZCOR advises that an infant may be positioned head down across the rescuer’s lap before back blows are delivered. Healthdirect describes laying the baby face down along your forearm, keeping the head lower than the body while supporting the head and shoulders, and giving up to five sharp blows between the shoulder blades.
Check after every blow.
If the obstruction remains, the infant is positioned on their back for chest thrusts. ANZCOR advises keeping the infant head down and on their back across the rescuer’s thigh. The same chest compression point used for infant CPR is used for the thrusts.
Do not simply hold a choking baby upside down, and do not use abdominal thrusts.
For parents, grandparents, childcare workers and anyone regularly responsible for babies or young children, this is a strong reason to learn the technique through practical first aid training rather than waiting until an emergency occurs.
What If the Choking Person Becomes Unconscious?
A severe airway obstruction can deprive the body and brain of oxygen. If the obstruction is not relieved, the casualty may become unresponsive.
If the person is unresponsive and not breathing normally, commence CPR in accordance with the ANZCOR Basic Life Support guidance.
Do not blindly put your fingers into the person’s mouth trying to find the object.
ANZCOR advises against blind finger sweeps. If an object is clearly visible in the mouth, manual removal can be considered, but blindly sweeping around the mouth can potentially push an obstruction further into the airway.
Continue following the emergency call-taker’s instructions and provide CPR until the casualty begins breathing normally, qualified help takes over or another recognised reason for stopping CPR applies.
Knowing CPR therefore forms an important part of being prepared for a choking emergency. A choking incident and a resuscitation emergency are not necessarily separate events; one can quickly become the other.
Why Choking First Aid Is Better Learnt Practically
Choking is a good example of why first aid involves more than memorising a list of instructions.
In a real emergency, you need to recognise whether a cough is effective, position the casualty appropriately, know where and how to deliver back blows and chest thrusts, recognise deterioration and be prepared to move into CPR if the person becomes unresponsive and stops breathing normally.
These skills are included within nationally recognised first aid training. The current requirements for HLTAID011 Provide First Aid, for example, include demonstrating management of a casualty with choking in line with ARC guidelines, alongside CPR and other common first aid emergencies.
If you live or work in Sydney, completing a recognised First Aid course with First Aid Pro Sydney can help turn written knowledge into practical skills you can draw on when somebody genuinely needs assistance.
You may never expect to encounter a serious choking incident. But when someone suddenly cannot clear their airway, knowing what to do — and having practised doing it — can make an enormous difference.
Related Reading
ANZCOR Guidelines – Choking (Management of Foreign Body Airway Obstruction)
Healthdirect – Choking | healthdirect
Better Health Channel – Choking
First Aid Pro – Free First Aid Charts on choking
FAQs
Should you give back blows to someone who is coughing?
If the person has an effective cough, encourage them to continue coughing and monitor their condition. If the obstruction is not relieved, send for an ambulance. Back blows and chest thrusts are used for severe airway obstruction with an ineffective cough.
How many back blows should you give a choking person?
Give up to five sharp back blows, checking after each blow to see whether the airway has cleared. You do not need to give all five if the obstruction is relieved earlier.
What do you do if five back blows don't work?
Give up to five chest thrusts, checking after each thrust. If the obstruction remains and the casualty is still responsive, continue alternating five back blows with five chest thrusts.
Is the Heimlich manoeuvre recommended in Australia?
No. ANZCOR does not recommend abdominal thrusts, including the Heimlich manoeuvre, for foreign body airway obstruction because serious complications have been reported. Australian guidance recommends back blows and chest thrusts.
When should you start CPR on someone who was choking?
If the casualty becomes unresponsive and is not breathing normally, commence CPR and follow the ANZCOR Basic Life Support approach. Send for emergency assistance and continue until qualified help takes over or the casualty begins breathing normally.
