Choking is the fourth most common cause of unintentional injury death in the United States with approximately 3,000 people dying each year, according to the National Safety Council. Health care providers who are properly trained in first aid techniques, including abdominal thrusts and back blows, can save lives.

Still, there remains some controversy as to whether back blows or abdominal thrusts should be used to assist a choking victim. With a better understanding of the different approaches, when to use them, and how to perform them, medical professionals can render the proper aid for any situation. Read on to learn the most up-to-date thinking in terms of teaching first aid when it comes to assisting a choking victim.

ILCOR Recommendation: The “Five and Five” Approach

The International Liaison Committee on Resuscitation (ILCOR) recommends a combination of back blows and abdominal thrusts for choking adults and children over the age of one.

Also commonly referred to as the "five and five" approach, this technique involves standing to the side and just behind a choking adult (or kneeling down behind a choking child). From there, one arm is placed across the person's chest for support before the victim is bent over at the waist and parallel to the ground. At this point, five back blows should be delivered between the victim's shoulder blades using the heel of the hand.

If this is unsuccessful at clearing the victim's airway, the person providing aid should switch to a series of five abdominal thrusts (also commonly known as the Heimlich maneuver). This is done by standing behind the victim and placing one foot slightly in front of the other for proper balance. Next, arms should be wrapped around the victim's waist while tipping them slightly forward (note that if rendering abdominal thrusts to a child, it may be necessary to kneel down behind the victim instead).

Next, the person giving aid should make a fist with one hand and position it slightly above the victim's navel. Using the other hand, grasp the clenched fist and press hard into the victim's abdomen with a quick and upward thrust. Five thrusts should be performed before moving back to the back blow method. From there, rescuers should alternate between the two methods until the blockage is cleared or the person becomes unresponsive. If the victim becomes unresponsive, cardiopulmonary resuscitation (CPR) measures should begin.

AHA Recommendation: Abdominal Thrusts Only

The American Heart Association (AHA), on the other hand, does not recommend alternating between abdominal thrusts and back blows. Instead, the AHA only recommends abdominal thrusts for dislodging an airway in responsive adults and children over the age of one. With this method, abdominal thrusts should be performed on a choking victim until the blockage is cleared or the victim becomes unresponsive (at which point, CPR should be administered).

Which Technique is Better for Choking Victims?

For decades, there has been a fair amount of controversy regarding whether the "five and five" approach or abdominal thrusts alone are more effective for saving a choking victim. Ultimately, there is no scientific evidence proving that one method is more effective than the other.

For a brief period in the 1980s, it was speculated that back blows might actually make a choking situation worse, potentially creating a total blockage. However, the study making these claims was partially funded by Dr. Henry Heimlich, creator of the Heimlich maneuver, and has been challenged by many experts for lack of supporting evidence.

Ultimately, many medical professionals agree that alternating between back blows and abdominal thrusts increases the chances for a successful rescue. Knowing how to properly perform both back blows and abdominal thrusts certainly gives rescuers more tools to work with. Still, rescuers should always refer back to their own training; those who have not learned how to perform back blows, for example, should stick with abdominal thrusts; attempting to perform a technique without correct form could waste precious seconds, making a choking situation even more dire.

First Aid for Choking Victims: The Bottom Line

Nobody wants to find themselves in a situation where they need to perform first aid on a choking victim. Unfortunately, this is a common scenario for many health care providers—which is why being prepared is so important. 

Standard First Aid, CPR, and AED, Eighth Edition offers recommendations developed by the ILCOR and is consistent with guidelines established by the AHA and other resuscitation councils around the world. This manual is a valuable resource for those teaching life-saving skills (including back blows and abdominal thrusts) to medical students as part of their first aid training.

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