Sharon has 21+ years of experience as a qualified Emergency Care Nurse registered with the Australian Health Practitioner Regulation Agency (APHRA) and 12+ years as a First Aid Trainer.
She takes pride in FirstAidPro making first aid training available, comprehensive and affordable to everybody.
Key Takeaways
- Choking is a life-threatening medical emergency that requires fast, confident action from whoever is closest.
- The 5 steps if someone is choking – adult or child over 1 year are: encourage coughing, call 000, give up to 5 back blows, give up to 5 chest thrusts, and alternate until help arrives or CPR is needed.
- Australia does not use the Heimlich manoeuvre — back blows and chest thrusts are the evidence-based national standard.
- If the choking person becomes blue, limp, or unconscious, begin CPR immediately starting with chest compressions.
- Reading about first aid is not enough — nationally accredited training through First Aid Pro gives you the skills and confidence to act when it matters most.
Why First Aid Knowledge Can Mean the Difference Between Life and Death
First aid is the immediate, temporary care provided to a person who has been injured or has become suddenly ill, until more advanced or professional medical help can take over. First aid for choking is a core skill in HLTAID011 because prompt recognition and action can significantly reduce the risk of serious injury or death in an airway emergency. Choking is a recognised cause of preventable death and injury in Australia, and incidents commonly occur in homes, schools, restaurants and workplaces. When a choking emergency occurs there is very little time to act, so the person closest to the casualty is often their best – and sometimes only – chance of survival.
That is the core value of first aid: it places life-saving capability in the hands of ordinary people who are prepared to use it.
Choking Is a Medical Emergency That Can Strike Without Warning
Choking happens when something — most commonly food or a small object — becomes lodged in the throat or airway instead of passing into the oesophagus. The obstruction blocks air from reaching the lungs, and without oxygen, the brain can begin to suffer irreversible damage within four to six minutes. This is why a choking emergency demands an immediate, structured response from anyone present.
Choking can occur anywhere, at any age. Young children naturally put small items in their mouths as part of exploration and development, and anything smaller than a 20-cent coin is a serious choking hazard for children under three years of age. In adults, meat, bread, and other dense or poorly chewed foods are among the most frequent causes. The risk is constant, and preparedness is the only reliable safeguard.
Why Every Australian Should Have Accredited First Aid Training
Knowing the signs of choking and understanding the correct response steps are important — but they are not the same as being genuinely prepared. A nationally accredited first aid course builds the muscle memory, composure, and practical confidence needed to act decisively under pressure. At First Aid Pro, our nationally recognised courses are aligned with the latest Australian Resuscitation Council (ARC) guidelines and delivered by experienced, qualified trainers. Whether you are a parent, a teacher, a carer, or simply someone who wants to be ready for the unexpected, comprehensive first aid training could one day help you save a life.
Enrol Today in a Nationally Recognised First Aid Course — First Aid Pro |
Understanding Choking — What Actually Happens to the Airway
The human airway is a precisely structured passage. When we swallow, a small flap of cartilage called the epiglottis closes over the trachea (windpipe) to direct food and liquid into the oesophagus. If a foreign object — food, a small toy, a coin — enters the airway instead of the oesophagus, it can become lodged in the trachea and partially or completely block airflow.
A partial blockage may allow some air to pass, which is why a forceful cough can sometimes dislodge the object without further intervention. A complete blockage prevents any airflow at all, and without prompt action, will lead to unconsciousness and, if untreated, death due to lack of oxygen.
What Causes Choking in Adults and Children?
Common causes of choking include:
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Food items that are too large, too tough, or not chewed properly — particularly common in older adults
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Small objects such as coins, buttons, beads, or toy parts — a significant risk for young children
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Eating too quickly, talking while eating, or being distracted during meals
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Laughing or sudden movement while food is in the mouth
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Certain medical conditions that affect swallowing function
Children under three years are especially vulnerable because their airways can be easily blocked by objects smaller than a 20-cent coin.
Recognising the Signs and Symptoms of Choking
Signs and Symptoms of Choking — Quick Reference
Sign or Symptom | What It Indicates |
Clutching the throat with one or both hands | Universal distress signal for choking |
Inability to speak or very weak voice | Significant airway obstruction |
High-pitched noise or silence when breathing | Partial or complete blockage |
Difficulty breathing or laboured breathing | Reduced airflow to the lungs |
Red face progressing to bluish colour (cyanosis) | Lack of oxygen — act immediately |
Weak, ineffective, or silent cough | Person cannot clear the obstruction alone |
Pale, limp, or unconscious | Critical — begin CPR immediately |
What Are the 5 Steps If Someone Is Choking? (Australian First Aid Guidelines)
Choking first aid for an adult or child over 1 year consists of five clear steps. These guidelines are consistent with the recommendations of the Australian Resuscitation Council (ARC). The same sequence applies to both adults and children over the age of 1.
The 5 Choking First Aid Steps at a Glance
Follow these steps in order and act quickly if the person cannot clear the obstruction.
Encourage coughing
Call triple zero (000)
Give up to 5 back blows
Give up to 5 chest thrusts
Alternate and start CPR if needed
Step 1 — Encourage Forceful Coughing to Clear the Blockage
If the choking person is conscious and able to cough, encourage them to do so as forcefully as possible. A strong, effective cough generates considerable pressure within the airway and may be sufficient to expel the obstruction without any further intervention. Keep the person as calm as you can — panic restricts breathing and significantly reduces the effectiveness of a cough.
Do not interfere with an effective cough. If the person is coughing with force, their airway is not completely blocked and they may resolve the situation themselves. If the cough is weak, silent, or produces no result after a short time, move immediately to Step 2.
Step 2 — Call Triple Zero (000) If Coughing Fails
If the blockage is not cleared quickly, or the choking person is unable to cough effectively, call triple zero (000) immediately and request an ambulance. Describe the situation clearly. If other people are present, direct one person to call 000 while you continue delivering first aid — do not interrupt your efforts to make the call yourself if this can be avoided.
Do not wait to see whether the situation resolves before calling for help. Emergency health authorities consistently advise that calling 000 early is one of the most important actions a bystander can take in any choking emergency. The ambulance should be on its way as early as possible, because even if your first aid is effective, the person will require medical assessment.
Step 3 — Give Up to 5 Back Blows Between the Shoulder Blades
Back blows are a central component of Australian choking first aid for both adults and children. Position yourself to one side and slightly behind the choking person. Support their chest with one hand, and encourage them to lean well forward so that their head is lower than their body — this positioning uses gravity to assist in expelling the object toward the mouth rather than further down the airway.
Using the heel of your hand — the firm, fleshy pad at the base of the palm — deliver up to 5 sharp, firm blows between the shoulder blades. Check after each blow to see whether the obstruction has been dislodged. If the object clears after 2 blows, there is no need to continue to 5. The goal is to give up to 5 back blows and then reassess, not to deliver all 5 regardless of the outcome.
💡 Technique note: Lean the person well forward before giving back blows. Use the heel of your hand for firm, targeted pressure. Check after every blow and stop immediately if the obstruction clears.
Step 4 — Give Up to 5 Chest Thrusts on the Lower Breastbone
If the airway remains blocked after 5 back blows, proceed immediately to chest thrusts. Stand behind the choking person and place one hand flat on their upper back for support. Place the heel of your other hand on the lower half of the breastbone — the centre of their chest, just above where the ribs meet at the bottom of the sternum.
Thrust sharply inward with firm, controlled force. Give up to 5 chest thrusts, checking after each one to see whether the obstruction has cleared. As with back blows, if the blockage is dislodged after fewer than 5 thrusts, stop and reassess immediately.
It is important to note that in Australian first aid guidelines, chest thrusts are delivered to the lower half of the breastbone and directed inward. This is distinct from the abdominal thrusts used in the Heimlich manoeuvre, which is not a recommended technique in Australia. For pregnant women or anyone for whom abdominal-based techniques would be inappropriate, chest thrusts are always the correct approach.
Step 5 — Alternate Back Blows and Chest Thrusts, Then Start CPR If Needed
If neither the 5 back blows nor the 5 chest thrusts have cleared the obstruction, continue alternating between them: 5 back blows — check — 5 chest thrusts — check — repeat. Maintain this cycle until the obstruction is dislodged, the person is able to breathe, or emergency services arrive.
If at any point the choking person becomes blue, limp, or loses consciousness, do not continue back blows or chest thrusts. Lower them carefully to the ground, call 000 if you have not already done so, and begin CPR immediately. Start with chest compressions — place the heel of one hand on the centre of their chest, place your other hand on top, interlock your fingers, and compress firmly and rhythmically at a rate of 100 to 120 compressions per minute. Continue CPR until the person recovers, regains consciousness, or paramedics take over.
The 5-Step Choking First Aid Sequence — Visual Reference
Use this quick visual guide to remember the correct choking first aid sequence for adults and children over 1 year.
Encourage coughing — a forceful cough may expel the obstruction
Call triple zero (000) — get an ambulance on the way early
Give up to 5 back blows — heel of hand between shoulder blades, head lower than body
Give up to 5 chest thrusts — heel of hand on lower half of breastbone, thrust inward
Alternate 5 back blows and 5 chest thrusts — start CPR if the person loses consciousness
Don’t Wait for an Emergency to Learn — Enrol in First Aid Pro’s Nationally Recognised HLTAID011 or HLTAID012 Course Today | firstaidpro.com.au
Back Blows and Chest Thrusts — Why Australia Doesn't Use the Heimlich Manoeuvre
If you have watched American films or television, you may be familiar with the Heimlich manoeuvre — a technique involving sharp abdominal thrusts delivered from behind a choking person. In Australia, this technique is not part of the standard first aid response to choking, and it is important to understand why.
What Is the Difference Between Chest Thrusts and the Heimlich Manoeuvre?
Different first aid systems recommend different choking response techniques. Australian guidelines prioritise back blows and chest thrusts.
| Technique | Used In | Method | Australian Guideline |
|---|---|---|---|
| Heimlich manoeuvre (abdominal thrusts) | USA (historically) | Inward and upward thrust to the abdomen | Not recommended |
| Chest thrusts | Australia, UK, and others | Inward thrust to the lower half of the breastbone | Recommended |
| Back blows | Australia, UK, and others | Up to 5 sharp blows between the shoulder blades | Recommended — used in combination with chest thrusts |
Australian and International Guidelines Supporting Back Blows and Chest Thrusts
The Australian Resuscitation Council (ARC), and the Royal Life Saving Society of Australia both endorse the combined use of back blows and chest thrusts as the appropriate and evidence-based response to a choking emergency in adults and children (modified for infants). This approach is also consistent with guidelines from the International Liaison Committee on Resuscitation (ILCOR) and the United Kingdom Resuscitation Council.
The clinical reasoning is straightforward. Back blows between the shoulder blades create vibration and pressure along the airway, helping to dislodge a foreign object. Chest thrusts replicate the mechanics of a cough from the outside, compressing the chest cavity and generating airflow that can expel an obstruction. Used together in alternating cycles, they provide a reliable, safe, and well-evidenced sequence of interventions — without the risk of internal injury that can be associated with abdominal thrusts.
When to Start CPR After a Choking Emergency
Recognising When a Choking Victim Loses Consciousness
If a choking person loses consciousness despite your first aid efforts, the situation has escalated to a cardiac and respiratory emergency requiring CPR. Watch for the person going limp, their face turning blue due to lack of oxygen, or them collapsing. At this point, back blows and chest thrusts are no longer appropriate and must stop.
If the child is still conscious but visibly deteriorating — becoming increasingly distressed, weaker, or less responsive — continue alternating back blows and chest thrusts while awaiting the ambulance. Do not leave the person unattended unless it is absolutely necessary to call 000.
How to Begin CPR With Chest Compressions After a Choking Emergency
Once the choking person is unconscious and on the ground, begin CPR without delay. Before attempting rescue breaths, check the mouth for any visible object — if you can see it, carefully remove it. Do not perform blind finger sweeps, as this can push the obstruction further down the airway.
For CPR in an adult after choking: place the heel of one hand on the centre of the chest at the lower half of the breastbone, place your other hand on top, interlock your fingers, and deliver 30 chest compressions at a rate of 100 to 120 per minute. After 30 compressions, tilt the head back gently, lift the chin, and attempt 2 rescue breaths. If the airway remains blocked and the breaths do not go in, return to compressions immediately and re-check the mouth before each rescue breath attempt. Continue this cycle until the obstruction clears, the person recovers, or paramedics take over.
Be Ready When It Counts — Book Your First Aid Course with First Aid Pro Today | firstaidpro.com.au
Choking First Aid Knowledge Test
Test your understanding of the Australian choking first aid guidelines with this short knowledge check.
References
- Better Health Channel: Choking First Aid
- Raising Children Network Australia. Choking first aid for babies under 12 months: in pictures
- Healthdirect: Choking
- Australian Resuscitation Council (ARC). Guideline 4 — Airway
Frequently Asked Questions
ItemCan I use the Heimlich manoeuvre in Australia? #1
No. Abdominal thrusts are not recommended under Australian first aid guidelines. The current national standard, endorsed by the ARC, is a combination of back blows and chest thrusts. If you have previously trained in the Heimlich manoeuvre, updating your skills through an accredited Australian first aid course is strongly recommended.
Are the choking steps the same for adults and children over 1 year?
Yes. The 5-step sequence applies to both adults and children over 1 year of age. First aid for a baby under 1 year uses different techniques — including the use of 2 fingers rather than the heel of the hand for chest compressions.
What should I do if a choking person loses consciousness?
Lower them to the ground and begin CPR immediately. Deliver 30 chest compressions, then check the mouth for any visible obstruction before attempting 2 rescue breaths. Continue alternating compressions and breaths until the person recovers or paramedics take over.
Is choking first aid different for pregnant women?
Chest thrusts remain appropriate and safe for pregnant women. Abdominal thrusts should never be used during pregnancy. A comprehensive first aid course will cover pregnancy-specific variations in technique.
Does a first aid course cover choking emergencies?
Yes. Choking first aid — including back blows, chest thrusts, and post-choking CPR — is a core component of all nationally accredited first aid courses in Australia. First Aid Pro’s courses include hands-on practice of these techniques so that every participant leaves genuinely prepared to respond in a real emergency.
