How to Perform Choking Emergency Response Steps

By the end of this guide, you will know how to recognize choking and respond with the correct sequence of back blows, abdominal thrusts, and rescue positioning until help arrives or the airway clears. No equipment is required, but taking a hands-on First Aid or CPR course is the best way to build real confidence for a true emergency. The steps below follow the order that matters most: assess correctly, get help moving, then work through the physical response for the specific person in front of you.

Step 1: Confirm It's a Choking Emergency

Not every cough is a crisis. A mild airway obstruction still allows some air to pass, and the person will usually be coughing forcefully, gagging, or wheezing while able to speak at least a few words. A severe obstruction looks different: the person cannot cough, speak, or breathe at all, may clutch at their throat, and their lips or face may start to change color as oxygen runs low. Some people go silent almost immediately because no air is moving past the blockage.

Before doing anything physical, ask the person directly, "Are you choking?" If they can answer, even with a strained or partial word, or if they're coughing hard enough to move air, encourage them to keep coughing on their own. A forceful cough is often more effective at clearing an object than anything you can do for them, and interrupting it with back blows or thrusts can push the object deeper or turn a manageable situation into a dangerous one.

Move to hands-on intervention only when the cough becomes weak or silent, when the person can no longer make sound, or when they nod instead of speaking because no air is getting through. This distinction is the most commonly rushed step in a real emergency. Bystanders often see someone coughing and immediately jump to abdominal thrusts, assuming they're helping, when the better first move is to stay close, stay calm, and watch closely for signs the obstruction is worsening rather than clearing.

Step 2: Call for Help Before You Act Alone

If other people are nearby, send one of them to call 911 immediately while you begin care. Give clear instructions, such as "You, call 911 now and come back and tell me what they said," rather than a general request to the room, which often results in no one acting.

If you're alone with a choking adult or older child, current guidance from the American Red Cross and American Heart Association is to give care first, cycling through back blows and abdominal thrusts for about two minutes, before stopping to call 911 yourself if the airway hasn't cleared. The logic is simple: a severe obstruction can cause someone to lose consciousness within minutes, and those first moments of hands-on care matter more than the call.

Infants and young children are the exception. Their airways are smaller and obstructions can progress to full unresponsiveness faster than in adults, so have someone call EMS right away rather than waiting. If you're alone with a choking infant, use a phone's speaker function so you can talk to the dispatcher while continuing to give back blows and chest thrusts.

While you or someone else is on the phone, take a mental note of the nearest AED location. If the person loses consciousness, you'll move into CPR, and having that equipment ready to go saves precious seconds. Many workplaces, gyms, and public buildings post AED locations near entrances or stairwells, so it's worth knowing before an emergency, not during one.

Step 3: Give Five Back Blows

Once you've confirmed a severe obstruction, position yourself slightly behind and to the side of the person. Use one hand to support their chest and help bend them forward at the waist so their upper body is roughly parallel to the ground. This forward angle uses gravity to help move the object up and out rather than pushing it further down.

With the heel of your other hand, deliver five firm, distinct back blows between the shoulder blades. Each blow should be a separate, deliberate strike, not a rubbing or patting motion. The goal is a sharp jolt that dislodges the object, so don't hold back out of concern for hurting the person. A choking emergency calls for firm, confident action.

Between attempts, glance briefly into the person's mouth. If you can clearly see the object, you may remove it with your fingers. Avoid blind finger sweeps, reaching into the mouth without seeing the object first, because this can push it further into the airway or cause injury. Only remove what you can see.

If five back blows don't clear the obstruction, move directly into abdominal thrusts rather than repeating back blows indefinitely. The Red Cross and AHA now teach these two techniques as a connected cycle rather than isolated methods, so plan to move fluidly from one to the other. Watch the person's color and responsiveness throughout. If at any point they go limp or stop responding to you, you'll shift immediately into the unresponsive-person protocol covered later in this guide, rather than continuing to cycle through back blows and thrusts.

Step 4: Give Five Abdominal Thrusts

If back blows haven't cleared the airway, move behind the person and wrap both arms around their waist. Make a fist with one hand and place the thumb side against the person's abdomen, just above the navel and well below the tip of the breastbone. Grasp that fist firmly with your other hand.

Deliver quick, distinct thrusts inward and upward, as if trying to lift the person slightly off their feet with each pull. This motion, informally known as the Heimlich maneuver, compresses the diaphragm and forces trapped air up through the windpipe, carrying the object with it. Give five thrusts in a row, each one a separate and deliberate movement rather than a continuous squeeze.

If the object still hasn't come free, alternate: five back blows, then five abdominal thrusts, then back to back blows again. Continue this cycle without long pauses in between. Keep going until one of three things happens: the object comes out and the person can breathe or cough forcefully on their own, the person begins coughing hard enough to move air, or the person becomes unresponsive.

Stay verbally reassuring throughout, telling the person what you're doing and that help is coming, even though they can't answer you. This won't clear the airway, but it keeps the person as calm as possible and keeps you focused on the sequence rather than panicking. Once the object is out, don't assume everything is fine. Move to Step 7 for what comes next, since even a successful rescue needs medical follow-up.

Step 5: Adjust Technique for Special Situations

The steps above work for a typical conscious adult, but several populations need a modified approach:

Infants under one year: Never use abdominal thrusts on an infant, since their organs are still developing and thrusts can cause internal injury. Instead, hold the infant face-down along your forearm, supporting the jaw and head, and give five firm back blows between the shoulder blades with the heel of your hand. Then flip the infant face-up along your other forearm and give five chest thrusts using two fingers on the center of the breastbone. Alternate this cycle until the object clears or the infant becomes unresponsive.

Pregnant individuals or people too large to reach around: Use chest thrusts instead of abdominal thrusts. Stand behind the person, position your fist against the center of the breastbone, and thrust straight back rather than upward, avoiding pressure on the abdomen entirely.

A person choking alone: You can self-administer abdominal thrusts. Make a fist and place it above your navel, then pull inward and upward with your other hand, just as you would for someone else. If that's not effective, lean over a firm, stable object such as a chair back, countertop edge, or railing, and press your abdomen against it sharply to create the same inward-upward force.

Mixing up these techniques, such as using abdominal thrusts on an infant or forgetting that pregnancy changes hand placement, is one of the more common errors bystanders make under stress. Taking a certification course that includes hands-on practice with infant manikins and coached positioning is the most reliable way to make these adjustments automatic rather than something you're trying to recall in the moment.

Step 6: Respond If the Person Becomes Unresponsive

If the choking person goes limp or stops responding at any point during back blows or thrusts, lower them carefully to the ground, supporting their head and neck as you go. Once they're on a firm, flat surface, begin CPR starting with chest compressions rather than rescue breaths. Compressions generate pressure inside the chest that can help dislodge the object even without a clear airway.

Before each set of rescue breaths, open the airway using a head-tilt, chin-lift and look inside the mouth. If you can now see the object that you couldn't see before, remove it. This is often the point where the object finally becomes visible, since compressions can shift it upward. Continue to avoid blind finger sweeps. Only remove what you can clearly see and reach.

Continue cycles of compressions and airway checks until one of three outcomes occurs: the object comes out and the person starts breathing or responding, the person shows signs of recovery, or EMS personnel arrive and take over care. If an AED becomes available and the person shows no signs of breathing or circulation, follow the device's prompts as you would in any cardiac emergency, since prolonged oxygen deprivation from choking can progress to cardiac arrest.

This is the moment where earlier steps pay off. Because you already know where the AED is and someone has already called 911, you can devote your full attention to compressions and airway checks instead of scrambling to arrange either one.

Step 7: Get Follow-Up Medical Care and Review Prevention

Even after a successful rescue, when the object comes out and the person is breathing and talking normally again, they should still be seen by a medical professional. Abdominal thrusts apply significant force to internal organs, and it's possible to cause bruising or internal injury without obvious external signs. A brief evaluation, even at an urgent care clinic, is worth the trip.

Once the immediate crisis has passed, it's worth reviewing what makes choking more likely in the first place. For adults, common risk factors include eating too quickly, talking or laughing while chewing, and taking overly large bites, especially of tough meats or dry foods. Cutting food into smaller pieces and slowing down at meals reduces risk meaningfully. For young children, the bigger hazards are small round foods like grapes, hot dogs, and hard candies, along with toys or small objects that fit within a toilet paper tube, a rough gauge for what a young child could swallow.

One more note worth flagging: the American Red Cross and American Heart Association periodically update their choking response protocols as new evidence emerges, including adjustments to sequencing and technique over the years. If you're studying this topic ahead of a certification course, confirm you're working from the current edition of your course materials rather than an older summary, since small details in hand placement or sequencing do change from time to time.

Building Confidence Beyond This Guide

Reading through these steps gives you the sequence, but real confidence comes from practicing on a manikin, feeling the correct hand placement, and getting coached feedback in real time. That kind of hands-on repetition is what turns a mental checklist into muscle memory you can rely on when someone is actually in front of you and can't breathe.

Taylored Instruction offers dual certification through both the American Red Cross and the American Heart Association, giving you flexibility depending on what your workplace, school, or licensing board requires. Don't wait until an emergency happens, get the life-saving certification you need today. Register for a CPR, First Aid, or Lifeguarding class and gain the confidence and skills to respond when it matters most.