Someone starts choking at lunch. They're coughing, spluttering, red in the face.
A colleague rushes over and starts thumping them on the back.
Sounds helpful, doesn't it? Not always.
While someone is coughing effectively, the cough is doing the work. Charging in too early can distract from it, and an obstruction that might have cleared on its own can end up as a complete blockage.
Choking is one of the most misunderstood emergencies, because most people think it's one problem. It's actually two very different situations, and knowing the difference could save a life.
The First Question: Can They Cough?
It's the scene from every film. Someone coughs, panic erupts and a hero appears delivering dramatic back slaps.
Real life isn't a film. Choking first aid isn't about acting quickly. It's about acting correctly. And the first thing to ask is: can they still cough, breathe or speak?
Mild Choking: They Can Cough, Breathe or Speak
If they can cough, speak, breathe or make noise, the airway is only partly blocked. That's actually a good sign. Coughing is the body's own, very effective way of clearing an obstruction.
The right response?
- Encourage them to keep coughing.
- Stay with them and watch closely.
That's it. No back blows. No abdominal thrusts. No dramatic rescue. Sometimes the hardest thing to do is very little, but here, less really is more.
Severe Choking: They Can't Cough, Breathe or Speak
Everything changes if the airway becomes fully blocked. They may:
- Be unable to speak, breathe or cough effectively
- Clutch at their throat
- Look panicked
- Start turning blue or grey
Now speed matters. A lot.
What To Do for an Adult Who Is Choking
1. Up to 5 back blows
Stand to the side and slightly behind them. Support their chest with one hand and lean them well forward. Give up to 5 sharp blows between the shoulder blades with the heel of your other hand. Check after each one to see if the blockage has cleared.
2. Up to 5 abdominal thrusts
If back blows don't work, stand behind them and put both arms round their upper stomach. Lean them forward. Make a fist and place it between the belly button and the bottom of the breastbone. Grab your fist with your other hand and pull sharply inwards and upwards. Do this up to 5 times, checking after each one.
3. Call 999 and keep going
If it still hasn't cleared after 3 rounds of back blows and abdominal thrusts, call 999 (or get someone else to) and carry on until help arrives.
4. If they become unresponsive
Lower them carefully to the floor, call 999 and start CPR.
After Choking
Anyone who has had abdominal thrusts should be checked by a medical professional, even if they feel fine, as there could be internal injury. They should also get checked if they have a persistent cough, difficulty swallowing or still feel as though something is stuck.
Choking Happens Wherever People Eat
Restaurants, yes. But also workplaces, schools, care homes, nurseries, sports clubs, staff rooms and office kitchens. Wherever people eat, choking can happen.
The question isn't whether it's possible. It's whether your team knows what to do when it does.
Instinct Isn't Enough
We're wired to act when we see someone struggling. That's a good thing. But without training, people often step in too early, misjudge how serious it is or use the wrong technique.
Training replaces panic with precision.
If someone started choking in your workplace today, would your team know the difference between mild and severe choking, or would they react on instinct?
The Takeaway
If someone can cough, encourage them to keep coughing. If they can't cough, breathe or speak, act fast: up to five back blows, then up to five abdominal thrusts, and call 999 if it hasn't cleared. Anyone who's had abdominal thrusts should always be checked by a medical professional afterwards.
Sources
- Resuscitation Council UK – Adult choking guidelines (resus.org.uk)
- NHS – First aid for choking (nhs.uk)
About the Author
Jim Jones is Director of Passion First Aid Limited, a first aid training provider based in Hardwicke, Gloucester. Passion First Aid delivers regulated workplace, paediatric, CPR and defibrillator training through Qualsafe and Highfield for businesses, schools and organisations across Gloucestershire, Herefordshire, Worcestershire, Oxfordshire, Wiltshire, Bath & North East Somerset, Somerset and Bristol. Find out more at www.passionfirstaid.co.uk or call 07811 025169.
