Someone who is coughing will get through it on their own. Someone who makes no sound has a few minutes.
ACT
First, ask the only question that matters: are they coughing?
They're coughing, talking, or breathing noisily. The blockage is partial and air is still getting through. Don't intervene. Coughing is the most effective manoeuvre there is, far better than a back blow. Encourage it, stay close, and don't slap their back — a badly placed blow can move the object and close the airway completely.
They make no sound, can't speak or cough, clutch their throat, panic. The blockage is complete. Act immediately.
- Have someone else call for help while you act. If you're alone, act first.
- Five back blows. Stand to the side and slightly behind. Lean the person well forward, supporting their chest with one hand — this is what stops the object going further down. With the other hand, give up to five firm blows between the shoulder blades with the heel of your open hand. Check after each blow: if the object comes out or the coughing starts again, stop.
- Five abdominal thrusts, if the back blows didn't work. Stand behind them, put your arms under theirs, and lean them forward. Put a closed fist in the pit of the stomach, above the navel and below the breastbone, with your other hand on top. Pull sharply towards you and upwards. Release between each one. Up to five.
- Alternate five back blows and five thrusts, without stopping, until the object comes out or breathing resumes.
- If they lose consciousness: lower them to the ground without letting them fall, make sure help has been called, and start cardiopulmonary resuscitation, beginning with chest compressions — the full sequence is in Unconscious person. Look in the mouth at the end of each cycle and remove the object only if you can see it and reach it.
Never sweep blindly in the mouth with your fingers. You'll push the object further in.
ADAPT
It's a woman in late pregnancy, or someone with obesity. Abdominal thrusts are impossible or unsafe. The sequence stays the same — five back blows, then five thrusts — but the thrusts are done on the chest, on the breastbone, not on the abdomen.
It's a baby under one year old. The technique is different and can't be improvised from the adult one: chest thrusts, not abdominal ones, with the baby held head-down along your forearm. It's a skill learned in a first aid course, and this sheet doesn't replace one.
You're alone and you're the one choking. You can give yourself thrusts by leaning hard over the back of a chair, the edge of a table or the corner of a wall, with the pit of your stomach at the point of contact, dropping your whole weight onto it. Repeat. It works, and it's documented.
The object came out and everything seems fine. It isn't over. Someone who has had abdominal thrusts must be checked: the manoeuvre can injure internal organs. And any lasting discomfort, pain, or difficulty swallowing or breathing afterwards calls for medical advice, even if everything seems back to normal.
The person stopped breathing afterwards. Move on to Unconscious person, without delay.
You're very far from any help. It doesn't change the actions, which remain the only ones available. It does make prevention matter more: eat slowly, cut food small, don't talk or laugh with your mouth full, and keep an eye on elderly people and young children during meals.
UNDERSTAND
Air no longer gets through, and the body has a few minutes of oxygen in reserve before the brain suffers. That's why choking is one of the rare emergencies where you act before calling: nobody will arrive in time.
Each action has a precise mechanical logic.
A back blow causes a jolt and a reflex exhalation that loosen the object. Leaning the upper body forward is essential: on someone standing upright, the same blow pushes the object down instead of driving it up and out.
An abdominal thrust pushes the diaphragm upwards. The diaphragm squeezes the lungs, and the air forced out all at once acts like an artificial cough. That's why the pressure point is the pit of the stomach, not the ribs: pressing on the ribs breaks them without clearing anything.
The two are alternated because they work differently, and one sometimes succeeds where the other fails. No sequence has proven so superior that the other should be dropped.
One last point, which explains the rule of not intervening. A partial blockage makes noise: it's a sign that air is flowing around the object. Stepping in at that moment risks turning a situation that would resolve itself into a complete blockage. Noise is reassuring; silence is the emergency. That's exactly the opposite of what instinct suggests, and it's what makes this sheet useful.