Emergency First Aid Training - Choking First Aid

April 13, 2017

How Should You Manage a Choking Casualty in Australia?

Management of a choking casualty in Australia differs slightly from what is commonly taught in other parts of the world.

In countries such as the United States and the United Kingdom, the Heimlich manoeuvre (abdominal thrusts) is often taught as the primary response.

However, in Australia, first aid guidelines recommend a different approach: back blows and chest thrusts for the management of a complete airway obstruction.

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What Is the Correct First Aid Response to Choking in Australia?

In Australian first aid training, learners are taught to use:

Back blows
Chest thrusts

These techniques are designed to help dislodge a foreign object causing a complete airway obstruction.

They are included in all nationally recognised first aid courses and are supported by Australian Resuscitation Council (ARC) guidelines.

How Should a Back Blow Be Delivered Correctly?

What Is the Correct Technique for Back Blows?

One of the most common observations in training environments is incorrect technique when performing back blows.

Some students and even trainers demonstrate a “glancing” or upward motion when delivering back blows.

This often includes:

Standing behind the casualty
Supporting the patient forward at the waist
Attempting gravity-assisted positioning
Delivering a blow in an upward direction toward the shoulders

Should Back Blows Be Delivered in an Upward Direction?

Why Do Some People Teach a Glancing Back Blow?

When questioned, many learners explain that they were taught to “push the obstruction upwards.”

Others suggest it is intended to “lessen impact,” particularly when demonstrated on manikins or infants.

However, this raises an important question in first aid practice:

How does an upward glancing blow actually help dislodge an obstruction from the airway?

The goal of a back blow is not to push an object upward in a controlled direction — but to create a forceful pressure change that may help dislodge the obstruction.

What Is the Purpose of Back Blows in Choking First Aid?

How Do Back Blows Help Clear an Airway?

Back blows are intended to:

Create a sudden pressure change in the airway
Dislodge the foreign object
Stimulate a cough reflex if partial obstruction exists

In practice, the technique involves delivering firm blows between the shoulder blades using the heel of the hand.

The aim is effectiveness, not a directional “lift” of the obstruction.

What Do Australian Guidelines Say About Choking Management?

Are Back Blows and Chest Thrusts Evidence-Based?

Yes.

The Australian Resuscitation Council (ARC) bases its guidelines on international evidence and ongoing research.

Current recommendations include:

Back blows for complete airway obstruction
Chest thrusts if back blows are ineffective
Ongoing reassessment between cycles

These techniques remain the standard for layperson first aid in Australia.

Why Is There Debate Around Choking Techniques?

Is There Evidence Against Back Blows?

Like many areas of first aid, choking management has been studied extensively, with some debate in the literature regarding technique effectiveness.

However, current Australian practice continues to support:

Back blows
Chest thrusts

This is because they are practical, teachable, and supported by evidence for lay responders in emergency situations.

How Do Real-World Choking Incidents Present?

What Happens in Actual Choking Emergencies?

With nearly 20 years of paramedic experience, choking cases typically fall into two categories:

Mild obstruction where the person coughs effectively and clears it themselves
Severe obstruction where the airway is completely blocked and urgent intervention is required

In the most serious cases, outcomes can deteriorate rapidly if bystanders are unsure what to do.

What Is the Correct Way to Deliver a Back Blow?

What Should First Aiders Focus On?

A correct back blow should be:

Firm
Delivered between the shoulder blades
Directed straight into the back, not upward
Delivered using the heel of the hand
Supported by proper positioning of the casualty

The goal is to generate enough force to dislodge the obstruction, not to “aim” it in a particular direction.

How Is First Aid for Choking Evolving?

Will Choking Management Change in the Future?

First aid is constantly evolving as new evidence emerges.

While back blows and chest thrusts are currently recommended in Australia, future advancements may change practice, just as first aid has evolved to include:

Adrenaline auto-injectors
Updated CPR guidelines
Improved defibrillation access

The key principle remains the same:

First aid must be simple, effective, and evidence-based for the lay rescuer.

What Should You Learn From Choking First Aid Training?

Why Is Proper Training Important?

Correct technique matters because choking is a time-critical emergency.

Enrolling in a nationally recognised course ensures you learn:

Correct back blow technique
Chest thrust application
Recognition of airway obstruction
Emergency response actions