Choking Response (Heimlich Maneuver)
Authority: American Red Cross / American Heart Association Adult Choking First Aid Guidelines
Current American Red Cross and American Heart Association guidance for a choking adult who cannot cough, speak, or breathe: call 911, then alternate 5 firm back blows between the shoulder blades with 5 abdominal thrusts (Heimlich maneuver) above the navel, repeating this five-and-five cycle until the object clears or the person loses consciousness.
Confirm Choking and Call for Help
Ask if the person is choking. If they can cough forcefully, speak, or breathe, encourage them to keep coughing and do not interfere. If they cannot cough, speak, or breathe -- or are making high-pitched sounds -- call 911 (or have someone else call) and begin first aid immediately.
Give 5 Back Blows
Stand slightly behind the person and bend them forward at the waist so their upper body is roughly parallel to the ground. Support their chest with one hand and strike firmly between the shoulder blades with the heel of your other hand, delivering 5 sharp back blows.
Give 5 Abdominal Thrusts
Stand behind the person and wrap your arms around their waist. Make a fist and place the thumb side against the middle of the abdomen, just above the navel and well below the breastbone. Grasp the fist with your other hand and pull sharply inward and upward 5 times.
Alternate Back Blows and Abdominal Thrusts
Continue alternating cycles of 5 back blows and 5 abdominal thrusts -- the current five-and-five approach -- until the object is forced out, the person can breathe, cough, or speak on their own, or the person loses consciousness.
If the Person Becomes Unconscious
Lower them carefully to the floor, call 911 if it hasn't already been done, and begin CPR starting with chest compressions. Each time you open the airway to give breaths, look inside the mouth and remove the object only if you can see it -- do not perform blind finger sweeps.
How the Guidance Evolved
The abdominal thrust technique was introduced and popularized by physician Henry Heimlich, who described it in a 1974 article as a way to expel airway obstructions using upward pressure below the ribcage. For years afterward, major first aid organizations did not fully agree on the exact sequence -- guidance at different points favored abdominal thrusts alone, or back blows first, or the two used separately rather than together. Current guidance from the American Red Cross and American Heart Association has converged on an alternating five-and-five sequence, combining both techniques into a single repeating cycle rather than treating them as competing methods.
Regional variation still exists: the Australian Resuscitation Council, for example, recommends chest thrusts instead of abdominal thrusts in some circumstances. This is a reminder that choking response guidance is set by national and international resuscitation bodies and does get revised, so it is worth checking current guidance from a recognized organization rather than relying on what a first aid course taught decades ago.
If You're Choking and Alone
A person who is alone and choking can still perform abdominal thrusts on themselves. One method is to make a fist and pull it sharply inward and upward against the abdomen, above the navel, the same way it would be done by someone standing behind you. Another is to lean over a firm, stable object with a defined edge -- the back of a sturdy chair, a countertop edge, or a railing -- and thrust the upper abdomen against it forcefully.
Calling 911 first, or getting a phone within reach before starting, matters just as much when alone, since self-administered thrusts are not always as forceful or effective as thrusts from another person, and outside help may still be needed even after the airway partially clears.