Choking in Adults: The Australian First Aid Response
Back blows. Chest thrusts. Not the Heimlich. Here is what Australian guidelines say, and why it matters.
By Britt Brennan, REACHAU | Updated 16 October 2026
Quick answer
In Australia, the recommended first aid response for a choking adult is the 5-and-5 technique: up to 5 firm back blows between the shoulder blades, followed by up to 5 chest thrusts if the airway is still blocked. Call 000 early. If the person becomes unresponsive, call 000 if you have not already, and start CPR.
Choking is one of the most frightening emergencies to witness. It happens without warning, often at mealtimes or in workplaces, and it needs immediate action.
Without help, a complete airway obstruction can cause brain damage within minutes.
This article explains how to recognise choking in adults, what to do step by step, and why the Australian approach differs from what many people have seen on American television.
1Recognising a Choking Adult
First, confirm the person is actually choking and not having a medical episode such as a heart attack or stroke.
A choking adult will typically:
- Clutch their throat with one or both hands
- Be unable to speak, or only whisper
- Be unable to cough effectively
- Have a red or increasingly blue face
- Show obvious distress and panic
Partial obstruction
The airway is not fully blocked. The person can still cough, breathe or speak, even if it is difficult and noisy. Encourage them to keep coughing and do not interfere. Their body is still working to clear the obstruction. Stay with them and watch closely in case it gets worse.
Complete obstruction
The airway is fully blocked. The person cannot cough, speak or breathe. This is a medical emergency. Act immediately.
2Why Australia Does Not Use the Heimlich
The recommended response for adult choking in Australia is back blows and chest thrusts. The Heimlich manoeuvre (abdominal thrusts) is widely shown on American television, but it is not the technique taught in Australian first aid courses.
Abdominal thrusts carry a risk of internal injury, particularly for older adults and people who are pregnant. Back blows and chest thrusts aim to do the same job without that risk.
| What TV shows | What Australian first aid teaches |
|---|---|
| Stand behind the person, wrap your arms around them and thrust inward and upward under the ribs. | Lean them forward. Give up to 5 firm back blows between the shoulder blades. If that does not work, give up to 5 chest thrusts. Alternate until the object comes out. |
3Step by Step: What to Do for a Choking Adult
| Step | Action |
|---|---|
| 1 | Stand or kneel beside the person. Lean them forward slightly if possible. Get someone to call 000 while you start. |
| 2 | Give up to 5 firm back blows between the shoulder blades using the heel of your hand. Each blow should be forceful and deliberate. Check after each one to see if the object has come out. |
| 3 | If back blows have not worked, give up to 5 chest thrusts. Place one hand against the lower centre of their chest and push sharply inward and upward, like a firm, short heave. Check after each thrust. |
| 4 | Keep alternating 5 back blows and 5 chest thrusts. Check the airway after each cycle. |
| 5 | If the person becomes unresponsive, lower them carefully to the ground, call 000 if not already done, and start CPR. |
The core principle
Once you can see the airway is completely blocked, do not wait to see if the person clears it themselves, and do not stop to look for equipment. Start back blows straight away and keep going until the airway is clear or the person becomes unresponsive.
4Choking in Special Circumstances
| Situation | What to do |
|---|---|
| Pregnant adult | The approach is the same as for any adult. Use back blows and chest thrusts. Do not hold back from helping because of the pregnancy. |
| You are alone and choking | Call 000 if you can, and try to cough forcefully. If you can, lean forward over a firm surface such as the back of a chair or a bench, and try to give yourself back blows or press your chest firmly against the surface. If you cannot clear it, keep the line open to 000 and get to a place where you can be found. |
| Anti-choking suction device nearby | Devices such as LifeVac are not part of the standard Australian first aid sequence and the evidence for them is still limited. Never delay back blows and chest thrusts to find one. If a device is on hand and you have been trained to use it, treat it as an extra tool only after standard first aid has been started and a second person is available to help. |
5When Choking Leads to Cardiac Arrest
If the person becomes unresponsive, stop back blows and chest thrusts.
- Lower them carefully to the ground.
- Call 000 if you have not already, and put the phone on speaker.
- Start CPR following DRSABCD. Chest compressions can sometimes help dislodge the object.
- Each time you open the airway, look in the mouth. If you can see the object, remove it. Do not sweep blindly with your fingers.
- Keep going until the object comes out, the person starts breathing normally, or paramedics arrive.
Learn how to perform CPR properly in a CPR course: HLTAID009 Provide CPR. For the full action plan, see the DRSABCD action plan.
Frequently Asked Questions
Why does Australia use back blows instead of the Heimlich manoeuvre?
Australian first aid guidance recommends back blows and chest thrusts rather than abdominal thrusts because abdominal thrusts carry a risk of internal injury, particularly for older adults and people who are pregnant.
What should I do if back blows and chest thrusts are not working?
Keep alternating 5 back blows and 5 chest thrusts, checking after each cycle, and make sure 000 has been called. If the person becomes unresponsive, lower them to the ground and start CPR.
Can I use a LifeVac device instead of back blows?
No. Anti-choking suction devices are not a replacement for standard first aid and the evidence for them is limited. Start back blows and chest thrusts first, and never delay them to find a device.
What do I do if the person choking is pregnant?
Use the same approach as for any other adult: back blows and chest thrusts. Do not hold back from helping because of the pregnancy.
What should I do if the choking person becomes unresponsive?
Stop back blows and chest thrusts. Lower them carefully to the ground, call 000, and start CPR. Look in the mouth each time you open the airway and remove the object only if you can see it.
Training Makes the Difference
Most people have a rough idea of what to do for someone who is choking. Very few have practised it under pressure.
In a real emergency, your brain defaults to what it has done before. If you have never practised back blows, you will hesitate, and that hesitation costs time.
First aid training does not just teach you what to do. It builds your hands and your instincts so that when it matters, you act without freezing.
If someone near you started choking right now, would you know exactly what to do? Training answers that before the emergency happens, not during it.
REACHAU first aid training focuses on understanding what to do, why it matters and how to act when someone needs help.
View upcoming first aid sessionsTraining and Assessment is delivered by Britt at Regional Education and Career Help Australia on behalf of ABC First Aid RTO 3399.
This article is general first aid information and does not replace a first aid course or medical advice. In an emergency, call 000.
