When Choking Becomes Collapse: Practise the Change in Response
Choking
When Choking Becomes Collapse: Practise the Change in Response
What a Western Australian coronial finding teaches us about the moment a choking emergency changes, and how to rehearse it.
By Britt Brennan, REACHAU | 30 October 2026
Quick answer: A choking emergency can change in seconds. A person who can still tell you what is wrong can quickly become unresponsive. Check whether they have an effective cough, use back blows and chest thrusts if they do not, and start CPR if they stop responding and are not breathing normally. Practise the change, not just the first step.
A first aid situation can change while you are helping.
Someone may be able to tell you what is wrong one moment and be unable to respond the next. Your response has to change with them. That is why practising only the first step of choking care leaves a gap that matters.
This article looks at a published Western Australian coronial finding to open up that conversation. It is not about blame. It is about understanding how fast a choking emergency can move, and how to be ready for the part most people never rehearse.
What the coroner found
What the finding says
The inquest into the death of Andre Walter Bond was heard in the Perth Coroner's Court, and the finding was delivered on 10 May 2021. He died in May 2019 after choking on a meal at home. The coroner found the cause of death was upper airway obstruction (choking), and the manner of death was accident. The finding records that his father called emergency services and began effective CPR. Ambulance officers removed pieces of food from his throat and inserted an airway. The coroner made no formal recommendations.
An inquest was required in this case because of a legal rule about people who are subject to certain mental health orders. That is a routine requirement. It is not a sign that anything about the first aid was questioned.
The finding does not criticise the family or the emergency response. It also does not say which choking technique was used, or whether a particular technique would have changed the outcome. Those details are not in the record, so I will not guess at them.
Any lessons in the rest of this article are my teaching suggestions. They are not findings of the coroner.
Why choking changes so quickly
Choking is an airway problem. When something blocks the airway, the body is starved of oxygen, and a person can go from talking to collapsing in a very short time.
In the finding, the person said he was choking and then collapsed. That is the pattern many first aiders fear most. The early signs can be easy to miss, and the change can be fast.
This is why ANZCOR guidance starts with a simple question: can the person cough effectively?
Step one: check the cough
An effective cough is loud, and the person can usually still breathe, speak or cry. If the cough is effective, ANZCOR guidance is to reassure the person and encourage them to keep coughing. Stay with them and watch closely. If the blockage is not relieved, call an ambulance.
An ineffective cough looks different. The person may be silent, unable to speak or breathe, or making a high pitched noise. Their cough may be weak or absent. This is severe choking, and it needs action straight away.
Step two: responsive but not coughing effectively
If the person is conscious but their cough is not working, ANZCOR guidance is to:
Send for an ambulance. Call 000 or ask someone else to do it.
Give up to five sharp back blows between the shoulder blades, checking after each one to see if the blockage has cleared.
If the back blows do not work, give up to five chest thrusts, checking after each one.
Keep alternating back blows and chest thrusts while the person stays responsive.
You may notice that abdominal thrusts, sometimes called the Heimlich manoeuvre, are not on that list. ANZCOR does not recommend them for first aiders. Back blows and chest thrusts are the method to learn. If you were taught something different years ago, it is worth refreshing your skills.
Infants need a different technique again, with a smaller, gentler approach. That is best learned hands-on with an infant manikin.
Step three: when they become unresponsive
This is the part that is easiest to freeze on, and it is the heart of this article.
If the person becomes unresponsive and is not breathing normally, the plan changes. ANZCOR guidance is to follow the Basic Life Support steps, which means:
Call 000 if you have not already, and put the phone on speaker so you can keep your hands free.
Start CPR with 30 compressions and 2 breaths.
Use an AED as soon as one is available, and follow its voice prompts.
Keep going until help arrives or the person starts breathing normally.
ANZCOR suggests against blind finger sweeps in the mouth of an unconscious person, because they can push an object further in. If you can clearly see something in the mouth, you can remove it. Do not give an unconscious person anything to eat or drink.
In this finding, the father called for help and began CPR when his son collapsed. The coroner described the CPR as effective. That is worth saying plainly, because many people fear they would not know what to do. A family member who calls for help and starts compressions is doing exactly what the guidance asks.
The person in front of you guides the next action
The reason for reassessing is practical. An action that suits a responsive person does not stay right just because that is where you started.
You are following the person's condition, not finishing a sequence regardless of what happens. Check, act, check again. If the situation changes, your action changes.
Rehearse the transition
Most people practise the first step and stop. Here is a training exercise you can use at home, at a club or at work.
A fictional scenario to talk through
Someone at the table signals that they are choking. They cannot cough or speak. A few moments later, they stop responding and slump. Walk through what changes at that moment.
Ask each other:
Who calls 000 and stays on the line?
Where will we lay the person so we can give CPR?
Who fetches the AED, and where is it kept?
Who will meet the ambulance and show them in?
What do we say to the call taker when the person's condition changes?
Practise those decisions as well as the physical technique. The aim is to make the change in response familiar, so it is not a surprise.
Never practise forceful choking manoeuvres on another person. Use proper training equipment, with a qualified trainer supervising.
You do not need a perfect performance to begin
People worry about forgetting a step. That fear is normal, and it should not stop you acting.
A clear starting point, practical repetition and the ability to follow a call taker's instructions give you plenty to work with. Call 000 early, say what is happening, and tell them when things change.
If you have been through a choking emergency, whatever the outcome, it is normal to feel shaken afterwards. Our guide on looking after yourself after giving first aid explains what is common and when to get support.
Frequently asked questions
What is the first thing to do when someone is choking?
Check whether they can cough effectively. If they can, encourage them to keep coughing and stay with them. If their cough is weak or absent, or they cannot breathe or speak, call 000 and begin back blows.
How many back blows and chest thrusts do I give?
ANZCOR guidance is up to five back blows between the shoulder blades, checking after each. If those do not work, give up to five chest thrusts, checking after each. Keep alternating while the person stays responsive.
Should I use abdominal thrusts or the Heimlich manoeuvre?
No. ANZCOR does not recommend abdominal thrusts for first aiders. Back blows and chest thrusts are the recommended method.
What if the person collapses and stops responding?
Call 000, start CPR with 30 compressions and 2 breaths, and use an AED as soon as one is available. Keep going until help arrives or the person starts breathing normally.
Should I put my fingers in their mouth to clear the blockage?
Not blindly. ANZCOR suggests against blind finger sweeps in an unconscious person. If you can see an object in the mouth, you can remove it.
Can a coroner's finding tell me the best way to respond to choking?
A finding explains what happened in one case. Current first aid steps come from ANZCOR guidelines, and the best way to learn them is hands-on training with a qualified trainer.
Sources and current guidance
Learn the skills. Build the confidence. Be ready to help.
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 sessions
Training and Assessment is delivered by Britt at Regional Education and Career Help Australia on behalf of ABC First Aid RTO 3399.
Related reading
This article shares learning points from a published coronial finding and current ANZCOR guidance. It is general information, not a complete treatment guide or medical advice, and it does not replace hands-on training. In an emergency, call 000.
