How to help someone choking: back blows and abdominal thrusts, in that order

The first thing to establish when someone may be choking is whether they can still move air. Ask, "Are you choking? Can you speak?" — and if the person is coughing forcefully and can speak, do not intervene, because a strong cough is the most effective way to shift the object [s1]. Step in only when they cannot speak or are struggling to breathe. Then the MedlinePlus sequence is specific: repeated cycles of five back blows followed by five abdominal thrusts, until the object comes out or the person becomes unconscious [s1].

The technique, in order

Back blows come first. Stand behind the person, support the upper body with one arm, lean them forward until the chest is roughly parallel to the ground, and deliver five firm blows between the shoulder blades with the heel of your hand, checking after each whether the object has cleared [s1]. If that fails, move to abdominal thrusts — the Heimlich manoeuvre. Standing behind, wrap your arms around the waist, make a fist with the thumb side just above the navel and well below the breastbone, grasp it with your other hand, and give a quick upward-and-inward thrust, up to five times [s1]. Then alternate: five and five, and repeat.

Two groups need a different hand position. For someone who is pregnant or has obesity, the guidance is to use chest thrusts rather than abdominal thrusts, with the arms wrapped around the chest and the fist on the middle of the breastbone between the nipples rather than on the belly [s1]. The reason to start with back blows at all is that they are quick to deliver and low-risk, and either back blows or thrusts may be the move that clears the airway — so the cycle keeps alternating rather than betting everything on one manoeuvre.

Why the abdominal thrust works — and a version you can do alone

The mechanism is a sharp rise in pressure inside the chest that pushes air, and the obstruction, back up the airway. A physiological study in Thorax measured those pressures in healthy volunteers and found some practical points that guidelines had left uncertain [s3]. The angle of the thrust — straight up versus circumferential — did not change the intrathoracic pressure generated, and self-administered abdominal thrusts produced pressures similar to those delivered by another person [s3]. Notably, thrusting the upper abdomen against the back of a chair generated higher pressures than the other manoeuvres [s3]. The authors argued that both self-administered and chair-assisted thrusts should be taught in basic life support — useful to know for anyone who chokes while alone [s3].

New evidence that bystander action matters

For years the case for back blows and thrusts rested largely on physiology and case reports. A 2025 analysis from Japan's MOCHI registry — a prospective study across 25 hospitals — offers harder outcome data [s2]. Among 407 adults who reached emergency departments with a foreign-body airway obstruction, at a median age of 81, those who had received abdominal thrusts from a bystander were significantly more likely to have a favourable neurological outcome at 30 days: 38% versus 16% for those who got no bystander intervention, an adjusted difference of 22 percentage points [s2]. Back blows also helped, at 31% versus 16%, and were additionally linked to higher survival [s2].

This is observational data in an older, hospital-referred population, so it cannot prove that the manoeuvres alone caused the better outcomes, and the numbers of treated patients were small [s2]. But the direction is consistent with the physiology and with every current guideline: doing something structured beats freezing.

How common, and when to call

Complete airway obstruction is rare but not negligible. An analysis of London Ambulance Service data found 1,916 choking episodes serious enough to summon an ambulance in a single year, about 0.2% of all emergency calls, or an average of 5.2 a day, with incidence rising at the extremes of age and peaking around lunch and dinner times [s4].

Call emergency services immediately for anyone who cannot breathe, cough or speak, and keep going with back blows and thrusts until help arrives or the object clears [s1]. If the person becomes unconscious, the response changes to CPR, which this article does not attempt to teach. The single most useful thing to carry away is the order: encourage coughing first, and only if that fails, five back blows, then five thrusts, again and again.