Choking first aid involves emergency techniques used to clear a blocked airway when someone cannot breathe due to an obstruction. When a person is choking, immediate action using back blows and chest thrusts can be the difference between recovery and a fatal outcome.
In Sydney and across NSW, choking remains a significant hazard in homes, workplaces, schools, aged-care facilities, cafés, and childcare settings. NSW Ambulance responds to choking emergencies regularly, particularly during mealtimes and in environments where young children or older adults require supervision. Knowing what to do—and acting fast—can save a life long before paramedics arrive.
This guide explains how to recognise choking, how to respond in adults, children, and infants, and when to call Triple Zero (000). It also outlines common choking risks in various settings and highlights prevention strategies based on Australian Resuscitation Council (ARC) guidance.
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Key Takeaways
- Recognise choking immediately: look for the universal choking sign and an inability to speak or breathe.
- Encourage strong coughing if the person can still expel air.
- Choking first aid: give up to 5 back blows, then 5 chest thrusts if back blows fail.
- Keep alternating both techniques until the blockage clears.
- Call Triple Zero (000) early—NSW Ambulance paramedics treat choking cases frequently.
- Begin CPR if the person becomes unresponsive and stops breathing.
What Is Choking and Why It Happens
Choking occurs when food, fluid, or a foreign object becomes lodged in the airway, preventing normal breathing. Without oxygen, permanent brain damage can occur in minutes.
NSW sees choking incidents in a wide range of environments—from Sydney CBD restaurants and food courts to playgroups in suburbs like Parramatta, Randwick, Penrith, Blacktown, and the Northern Beaches. Young children, older adults, and people with swallowing difficulties are most at risk.
Common Causes of Choking in Adults and Children
Recognising the Signs and Symptoms of Choking
Distinguishing between a mild and a severe airway obstruction determines how you respond.
Signs of Mild Choking
- Can cough and speak
- Making breathing noises
- Responsive and able to follow instructions
- Skin colour appears normal
What to do: Encourage strong, continuous coughing. Do not interfere if the person can clear their airway effectively.
Signs of Severe Choking
- Cannot speak or cough effectively
- Silent or making high-pitched sounds
- Clutching throat (universal choking sign)
- Skin may turn blue (cyanosis)
- Quick deterioration if the airway remains blocked
What to do: Treat as a medical emergency — start back blows and chest thrusts immediately and prepare to call Triple Zero (000).
Choking First Aid for Adults
How to Perform Back Blows
- Ask “Are you choking?” — if they nod but cannot speak, act immediately.
- Position them leaning forward with the head lower than the chest.
- Support the chest and deliver up to 5 sharp back blows with the heel of your hand.
- Check after each blow to see if the obstruction has cleared.
How to Perform Chest Thrusts
- If five back blows are unsuccessful, position yourself behind the person.
- Place the heel of your hand in the centre of their chest (on the breastbone).
- Push sharply inward and upward, giving up to 5 chest thrusts.
- Alternate 5 back blows and 5 chest thrusts until the airway clears.
- Have someone call Triple Zero (000), or call yourself after one full cycle if alone.
Special Circumstances: Pregnant or Obese Adults
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Choking First Aid for Children (Ages 1–8)
Children require careful but firm techniques appropriate for their size. Follow these steps based on Australian Resuscitation Council guidance.
Step 1: Back Blows
- Bend or kneel to the child’s height so you can support them safely.
- Support their chest and bend them forward so the head is lower than the chest.
- Deliver up to 5 firm back blows between the shoulder blades with the heel of your hand.
Step 2: Chest Thrusts
- Move into position behind the child.
- Place the heel of one hand on the centre of their chest, over the breastbone.
- Give up to 5 chest thrusts, pulling inward and slightly upward.
- Alternate 5 back blows and 5 chest thrusts until the airway clears.
Choking First Aid for Infants (Under 1 Year)
Parents often panic during infant choking emergencies — staying calm and using correct technique matters.
Step 1: Back Blows (Infants)
- Place the infant face-down along your forearm.
- Support their head and neck at all times.
- Keep the infant’s head lower than their body.
- Deliver up to 5 gentle but firm back blows between the shoulder blades.
Step 2: Chest Thrusts (Infants)
- Turn the infant face-up along your forearm.
- Use two fingers in the centre of the chest.
- Deliver up to 5 chest thrusts, pressing down then releasing.
- Alternate 5 back blows and 5 chest thrusts.
If the Person Becomes Unconscious
Choking Prevention Tips
When to Seek Medical Attention
Even if the airway appears clear, seek immediate medical care if:
- The person was unconscious at any point
- Back blows or chest thrusts were used
- There is ongoing coughing or breathing difficulty
- There is chest or throat pain
- Blood is coughed up
- Any doubt remains about whether the airway is fully clear
Knowledge Test: Choking First Aid
1️⃣ What should you do first when an adult is choking but can still cough strongly?
2️⃣ How many back blows should you give before checking or moving to chest thrusts?
3️⃣ What position should the person's head be in when giving back blows?
4️⃣ What do you use for chest thrusts on an infant?
5️⃣ If someone who is choking becomes unresponsive and not breathing, what do you do?
Choking First Aid: Essential Steps to Save a Life
Choking is frightening, but with clear, practical knowledge based on ARC guidelines, you can take decisive action. Remember: encourage effective coughing, give up to 5 back blows, follow with up to 5 chest thrusts, and call Triple Zero (000) if the blockage does not clear.
Sydney’s busy homes, workplaces, restaurants, and childcare centres all carry choking risks, so being prepared matters. Hands-on training remains the most effective way to learn these skills and respond confidently.
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References
- Australian Resuscitation Council (2024). Guidelines: Basic Life Support
- Kidsafe Australia (2024). Choking Prevention Information.
- Royal Children’s Hospital Melbourne (2023). Foreign bodies inhaled
- Better Health Channel: Choking
- Healthdirect: Choking
Frequently Asked Questions
What’s the difference between back blows and chest thrusts in choking first aid?
In choking first aid, back blows use sharp strikes between the shoulder blades while the person leans forward. Chest thrusts create internal pressure to force the blockage out. ARC guidelines used across NSW recommend back blows first, followed by chest thrusts.
Should I call Triple Zero (000) immediately in a choking incident?
If the person cannot breathe, cannot speak, or is silent, call 000 at once. In mild cases where the person can cough strongly, monitor closely. If alone, complete one full cycle of 5 back blows and 5 chest thrusts before calling.
Why aren’t abdominal thrusts used in Australia?
NSW follows Australian Resuscitation Council guidance, which states abdominal thrusts carry a higher risk of severe injury. Back blows and chest thrusts are the safest, recommended techniques.
Can I help even if I don’t have first aid training?
Yes—doing something is better than doing nothing. However, NSW workplaces and families are strongly encouraged to complete accredited training to build confidence and improve outcomes.
What should I do if I’m alone and choking?
Call 000, then attempt strong coughing. You can also perform self-administered chest thrusts using the edge of a chair or table. Continue until help arrives.
