Choking- an interesting observation (Demo)

Management of the choking casualty in Australia somewhat differs from other parts of the world. In the US and UK for instance the Heimlich manoeuvre is utilised. We prefer the back blows and chest thrust methods of clearing a complete airway obstruction.

The method of attempting to dislodge a complete airway obstruction by back blows and chest thrusts is taught in all first aid courses, but I have seen some interesting ways of demonstrating this procedure.

It is interesting to me how many students and other trainers for that matter, demonstrate a back blow in a kind of upward or glancing manner. That is, the student will do the main points correctly such as asking for consent to assist, positioning themselves behind the patient (or manikin in this case), they will utilise gravity or bend the patient at the waist and then deliver a slightly upward glancing blow between the manikins “shoulder area.”

I have asked a question of each person that I have seen deliver this type of back blow. I ask “why are you glancing upwards on your back blow?” The answer has always inevitably been either “because that’s what I was taught last time” or more so by trainers, “I am trying to force the obstruction upwards”

I have recently seen video evidence of this type of back blow while trolling through YouTube and I am still a little puzzled by the action. Don’t get me wrong I am prepared to learn new techniques and I am favourable for progress and innovation but I cannot think how glancing a back blow upwards will push an obstruction out of a choking patients’ trachea. My thoughts when delivering a back blow to a choking patient has always been to hopefully rattle that little sucker about a bit and allow the patient to cough it up. Am I wrong, did I miss something?

Where has this trend of glancing a back blow in an upward manner come from?

I have done some research and Dr Google has all sorts of fantastic stuff, some even relevant to the topic at hand. I have found quite a few references from first aid training companies advising the glancing back blow, I have even watched videos from local training companies advising the same.

I can only imagine that the glancing blow came about from either miscommunication or from a demonstration on an infant to perhaps, “lessen the impact” of a back blow…but isn’t that the main point?

Nearly 20 years as an ambulance paramedic has led me to a few choking victims. Usually they had a slight obstruction and coughed it up, or the odd case where the patient had a full obstruction and either nobody noticed or nobody knew what to do and the outcome was unfortunately poor, despite our interventions. I’m pretty sure I wouldn’t attempt back blows with an upward glancing blow, I would hit them in between the shoulder blades with the heel of my hand just hard enough to try and dislodge the obstruction.

While the method of training in Australia is not really the debate here, just the delivery; over the years there certainly has been debate as to the actual efficacy of the back blows and chest thrusts technique. Many papers have been written in support of this procedure and a few against. The Australian Resuscitation Council uses evidenced based assessment criteria and draw upon studies from around the world to formulate their guidelines. So for the moment at least, back blows and chest thrusts are the first aiders procedure in Australia. Who knows what will happen in the future, a simplified laryngoscope and Magills method of clearance or something even better perhaps. First aid is evolving and the layperson is ever being called upon to help in different ways. 20 Years ago I doubt we would have thought that a standard part of first aid training would be the use of an adrenaline auto injector, but it is!

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