What to do if someone is choking on food

Dear Editor,

Across North America close to 4000 perfectly healthy people annually die from choking on food. In fact, food-choking kills more people than firearms or airplane accidents. Often the victim, anxious to avoid an embarrassing scene runs alone to the bathroom, where he is later discovered dead. His companions often think their friend suffered a heart attack. Don’t be deceived – their friend died because he could not breathe. What, then, should you do when confronted by a choking victim?

The first problem is recognition. Food-choking is a life-threatening medical emergency that is fatal in minutes unless action is taken. Instinctively, a victim will clutch his throat – a universal symbol of choking. A person with food stuck in his windpipe will not be able to talk. Before doing anything, simply ask the person to speak. If there’s a response, do nothing further except stay with the person and encourage coughing as a way of independently clearing the airway. When the choking has worsened to the point where the person can no longer speak, you should tell him/her that you understand what’s happening and that you are going to help.

Get behind the person and give three or four firm blows between the shoulder blades with the heel of your hand. This may dislodge the obstruction; check by asking the person to speak. If there is no response you must proceed with a simple but effective procedure known as the ‘Heimlich Manoeuvre.’ Stand behind and encircle the person with your arms. Make a fist with one hand and place the thumb side over the part of the belly, just below the breast bone. Place your free hand over your fist, then give three or four sharp, hard squeezes, upward and back. Again check whether you have been successful by asking the person to speak; if silence, then repeat the back blows, followed by the abdominal thrusts.

If the victim is too big for you to get your arms around, or is pregnant, the technique needs to be altered slightly; instead of putting your fist over the upper part of the belly, place it over the lower third of the breast bone. If sitting instead of standing, simply crouch behind and put your arms around the person who’s in the chair.

What if the person becomes unconscious and has fallen to the floor? The lifesaving process remains very much the same. Kneel beside and roll the person towards you and onto your lap. Give four hard blows between shoulder blades to dislodge the obstruction and then roll the person onto his back. Place the heel of one hand over the lower third of the breast bone, and your other hand directly over it. Give four vigorous thrusts and hopefully, the food will pop out. Finally, scoop out the victim’s mouth with your finger to remove any food which may have been dislodged.

Can you do it yourself? Certainly! There are many people who have successfully saved their own lives by putting their fist over the upper part of their bellies, and then compressed their abdomens by leaning forward forcibly over a firm object such as the back of a chair or edge of a table.

Let’s review the steps:

(1) Identify the problem; ask can you
speak?

(2) Reassure the victim; don’t let him/her
run away.

(3) Give four firm back blows.

(4) Check again,”Can you speak?”

(5) Give four vigorous abdominal or chest
thrusts.

(6) If he/she continues to choke, repeat the
sequence.

Yours faithfully,
George L Munroe
Executive Member Canadian College of
Health Service Executives

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