Help a choking adult

If an adult cannot cough, speak, or breathe, act at once: 5 back blows, then 5 abdominal thrusts, repeated until the object comes out.

A man holding his hand to his throat. — Photo: Tima Miroshnichenko / Pexels

Area: SafetyFrom age 14Time to learn: 15 minutes to learn; a certified first aid class to practicePractise in a class

You will recognize severe choking and clear a conscious adult's airway with back blows and abdominal thrusts.

SafetyNever practice real force on a person; practice on a manikin in a class. Anyone who received abdominal thrusts should be checked by a doctor afterward. The American Red Cross, the Canadian Red Cross, and the American Heart Association (since its 2025 guidelines) all teach cycles of 5 back blows followed by 5 abdominal thrusts for a conscious adult. If you are alone and choking, call 911, then give yourself abdominal thrusts with your fist or press your belly hard against the back of a chair, avoiding sharp edges (Red Cross).

Why it matters

When the airway is fully blocked, the person cannot breathe, so the people nearby are the only help in the first minutes. Choking often happens at meals, in front of family or friends. The steps take a few minutes to learn.

How to do it

Ask, 'Are you choking?' If the person can cough hard, speak, or cry, encourage them to keep coughing and stay with them.
If they cannot cough, speak, or breathe, or are making high-pitched sounds, act right away. Have someone call 911, or call on speaker yourself.
Back blows: stand to the side and slightly behind them. Put one arm across their chest and bend them forward at the waist until their upper body is close to parallel with the ground.
With the heel of your other hand, give 5 firm, separate blows between the shoulder blades.
Abdominal thrusts: stand behind them with one foot between their feet and your knees slightly bent. Find their belly button with two fingers.
Make a fist with your other hand. Place the thumb side against their stomach, just above the belly button. Cover your fist with your other hand.
Pull sharply inward and upward 5 times. Make each thrust forceful and separate.
Keep repeating 5 back blows and 5 abdominal thrusts until the object comes out, the person can cough, speak, or breathe, or they become unresponsive.
If they become unresponsive, lower them to the floor, make sure 911 has been called, and start CPR with chest compressions.
If the person is pregnant or too large to get your arms around, alternate 5 back blows with 5 chest thrusts instead of abdominal thrusts.

Common mistakes

Hitting the back of someone who is coughing well. Coughing is their best tool.
Placing your fist too high on the ribs or too low on the belly.
Doing a blind finger sweep. Only remove an object you can see.
Leaving the person alone, even after they seem fine.

You can do this when …you can show the hand positions for back blows and abdominal thrusts on a training manikin or a partner (without force), and say what to do if the person becomes unresponsive.

Reading is not training. Practise on a manikin or in a supervised class with the American Red Cross or the American Heart Association, or in Canada with the Heart and Stroke Foundation, St John Ambulance or the Canadian Red Cross.