The Heimlich Manoeuvre in the 2020s: What's Changed in Choking First Aid?
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When someone mentions choking first aid, most people immediately think of the heimlich manoeuvre. This iconic technique, also known as abdominal thrusts, has maintained a firm grip on popular culture despite significant changes in emergency medicine protocols over the past decade. From Hollywood films to casual conversations, the heimlich continues to be referenced as the go-to response when a person is choking. However, modern first aid training has evolved considerably, incorporating new techniques that prove more effective.
The Legacy of the Heimlich Manoeuvre
The heimlich manoeuvre, developed by Dr Henry Heimlich in the 1970s, revolutionised treatment for choking when it was first introduced. The technique involves standing behind a choking person and using quick upward thrusts to the upper abdominal area to dislodge a foreign object from the airway. For decades, this method was taught as the primary response to airway obstruction, earning its place in both medical training and popular consciousness.
Despite evolving protocols in emergency medicine, people continue to reference “performing the heimlich” or “using the heimlich” when discussing choking situations. However, the nature of Dr Heimlich’s technique and its application has been refined significantly. Medical research over the past decade has provided new insights into effective ways to treat choking.
Modern Choking First Aid: Back Blows and Abdominal Thrusts
Today’s first aid training emphasises a more comprehensive approach to choking first aid. Rather than performing the heimlich manoeuvre, current protocols begin with encouraging the choking person to cough if they are able to do so. A strong cough is often the most effective way to expel a foreign object from the throat or windpipe naturally.
When a choking person cannot speak, cough effectively, or breathe, immediate intervention becomes necessary. Modern first aid techniques now combine back blows and abdominal thrusts rather than relying on abdominal thrusts alone. This combined approach has proven more effective across choking scenarios.
The current protocol begins with five back blows delivered between the shoulder blades using the heel of your hand. These back slaps effectively dislodge foreign bodies from the upper airway by creating sudden pressure changes that help expel the obstruction. If back blows fail to clear the blockage, proceed to five abdominal thrusts, applying inward and upward pressure to the upper abdominal area just below the ribcage.
Technique Variations for Different Demographics
Modern choking first aid acknowledges that adults and children older than one year can generally be treated with similar techniques, though the force applied must be appropriate for the person’s size. For infants under one year, the approach differs significantly, typically involving back blows and chest thrusts instead of abdominal thrusts due to their delicate internal anatomy.
Modern first aid training also addresses scenarios where traditional techniques may not be applicable. For someone who is alone and choking, self-administered techniques using the back of a chair or similar firm surface can be life-saving. These adaptations demonstrate how choking first aid has evolved beyond the simple application of abdominal thrusts.
Pregnant women and significantly overweight individuals may require chest thrusts instead of abdominal thrusts to avoid potential harm to the abdomen or developing baby. These modifications highlight the importance of comprehensive first aid training that prepares responders for various choking situations rather than relying on a single technique.
When CPR Becomes Necessary
If back blows and chest thrusts fail to clear the obstruction and the person becomes unconscious, the response shifts to CPR. This transition is crucial because unconsciousness often indicates severe oxygen deprivation. Chest compressions during CPR can sometimes be more effective than abdominal thrusts at dislodging objects from the trachea in unconscious victims.
When beginning CPR on a choking victim, first ensure the person is on a firm, flat surface. Tilt their head back slightly and lift their chin to open the airway, checking the mouth for any visible foreign object that can be safely removed. If you can see the obstruction, attempt to remove it with your fingers, but never perform a blind finger sweep as this can push the object deeper into the throat or windpipe.
Position yourself beside the person’s chest and place the heel of your hand on the centre of their chest, between the nipples. Place your other hand on top, interlacing your fingers and keeping your arms straight. Push hard and fast at least 5 centimetres deep into the chest at a rate of 100 to 120 compressions per minute. Allow the chest to completely recoil between compressions.
After 30 chest compressions, tilt the head back, lift the chin, and give two rescue breaths. Pinch the nose closed, create a seal over their mouth with your mouth, and give two breaths, each lasting about one second and sufficient to make the chest rise. Continue this cycle of 30 compressions followed by two breaths.
Continue CPR until emergency medical services arrive, the person begins breathing normally, or another trained responder takes over. If the foreign object becomes visible at any point during CPR, stop compressions and attempt to remove it carefully before continuing.
FAQs
Can performing abdominal thrusts cause internal injuries?
Yes, abdominal thrusts can potentially cause internal injuries including broken ribs, damage to internal organs, or bruising. However, these risks are far outweighed by the life-threatening nature of severe choking. Always recommend that anyone who has received abdominal thrusts seeks medical evaluation afterwards, even if the obstruction was successfully cleared, to check for any internal complications.
What should I do if the choking person is significantly larger than me?
If you cannot reach around the person effectively to perform abdominal thrusts, focus on back blows using maximum force with the heel of your hand. You can also have the person lean forward over a chair or table while you deliver back blows from above. For extremely large individuals, encouraging them to perform self-administered thrusts against a firm surface like a table edge may be more effective than your attempts at traditional abdominal thrusts.
What should I avoid doing during a choking emergency?
Never attempt a blind finger sweep of the mouth, as this can push the obstruction deeper into the airway. Don’t give water or other liquids to someone who is choking, as this can worsen the blockage. Avoid hitting someone on the back while they’re sitting upright, as this can lodge the object further down. Also, don’t attempt abdominal thrusts on someone who is still coughing effectively, and never use abdominal thrusts on infants under 12 months old.
