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Choking – adult casualty
What is choking?
Choking happens when a solid object, usually food or a foreign body, becomes stuck in the airway and partially or completely blocks airflow to the lungs. First aid aims to recognise the signs early, encourage effective coughing where possible and use back blows and abdominal thrusts to dislodge the obstruction.
We distinguish mild choking, where the casualty can still cough, speak and breathe, from severe choking, where they cannot cough effectively, speak or breathe and may appear panicked or silent; severe choking is a medical emergency requiring immediate first aid. If the obstruction is not cleared, the casualty may become unresponsive and then requires CPR.
Severe choking can completely block the airway, meaning the casualty cannot cough, speak or breathe; without prompt treatment this can quickly lead to unconsciousness and cardiac arrest.
Who needs this skill?
Health & Social Care
In health and social care, residents and patients may have swallowing difficulties, dental problems, dementia or sedation that increase choking risk, so staff must follow local dysphagia and nutrition policies and know how to respond to both mild and severe choking. Providers are expected to assess choking risk and train staff in prevention and emergency response as part of safe, person-centred care.Licensed venues & nightlife
In licensed venues and nightlife, people often eat, drink and take substances while standing, dancing or talking in loud environments, which can delay recognition of choking and make it harder for the casualty to signal distress. Door teams and bar staff should be trained to spot the signs of severe choking in crowded, low-light conditions and to act decisively rather than assuming someone is just drunk or coughing.Schools
Schools are also workplaces, so staff may choke in staffrooms, meetings or events; staff who can manage adult choking alongside paediatric techniques add resilience across the site.Workplaces
In workplaces, especially those with canteens, hospitality facilities or staff eating at their desks, first aiders should be competent to recognise choking and deliver back blows and abdominal thrusts while someone calls 999 if the obstruction is not quickly relieved. A first aid needs assessment should consider whether staff or visitors are at particular risk, for example older workers, people with disabilities or those working alone.How to manage choking
- 1Recognise mild vs severe chokingCheck if the casualty can cough, speak and breathe: if they can cough forcefully and talk, treat this as mild choking and encourage them to keep coughing while monitoring closely. If they cannot cough effectively, cannot speak or are silent and struggling to breathe, treat this as severe choking and move to back blows.Mild choking: encourage coughing; severe choking: start the sequence.
- 2Give up to 5 back blowsStand to the side and slightly behind the casualty, support their chest, lean them forwards and deliver up to 5 sharp back blows between the shoulder blades with the heel of your hand, checking the mouth after each blow to see if the object has cleared.The aim is to relieve the obstruction with each blow, not to automatically give all five.
- 3Give up to 5 abdominal thrustsIf back blows do not clear the blockage and the casualty is still severely choking, stand behind them, place a clenched fist just above the belly button, grasp it with your other hand and pull sharply inwards and upwards up to 5 times.Do not give abdominal thrusts to babies under 1 or to visibly pregnant casualties; use chest thrusts instead following appropriate guidance.
- 4Call 999 and continue cyclesIf the airway remains blocked after back blows and abdominal thrusts, have someone call 999 immediately or do it yourself on speakerphone, stating that the person is choking, then continue alternating cycles of up to 5 back blows and 5 abdominal thrusts until the obstruction clears or the casualty becomes unresponsive.Even if the blockage appears to clear, advise the casualty to be medically reviewed because internal injuries or residual obstruction are possible.
- 5Start CPR if they become unresponsiveIf the person who is choking becomes unresponsive, carefully support them to the floor, call 999 if not already done, and start CPR with chest compressions, checking the mouth for visible objects before each set of breaths if you are giving rescue breaths.Follow standard adult CPR guidance and continue until the casualty recovers, a defibrillator and help arrive, or you are told to stop by a healthcare professional.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 2 Award in Basic Life Support and Safe Use of an Automated External Defibrillator (RQF)
Half day
1 year
Common questions
Practical answers for employers, venue managers, and healthcare teams about choking training.
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Mild choking means the casualty can speak, cough and breathe and may clear the obstruction themselves if you encourage effective coughing and stay with them. Severe choking means they cannot cough effectively, cannot speak or are silent and obviously struggling to breathe, which requires immediate back blows and abdominal or chest thrusts and early 999 activation.
Abdominal thrusts are recommended for conscious adults and children over 1 year with severe choking, but they should not be used on babies under 1 year or on pregnant casualties; in those cases, chest thrusts and back blows are used instead. Because abdominal thrusts can cause internal injury, anyone who has received them should be assessed by a healthcare professional afterwards, even if they feel well.
If you are alone and think you are severely choking, call 999 on speakerphone if you can and try to perform self-administered abdominal thrusts by leaning your upper abdomen over a firm surface such as a chair back or countertop and pulling your body downwards. Whenever possible, get someone’s attention quickly so they can assist with back blows and call an ambulance for you.
If the airway remains blocked and oxygen cannot reach the lungs, choking can progress rapidly to loss of consciousness and then cardiac arrest within minutes. That is why it is critical to move quickly from encouraging coughing to back blows, abdominal thrusts and calling 999, and to start CPR immediately if the casualty becomes unresponsive and is not breathing normally.
Workplaces and venues can reduce choking risk by considering it in their first aid needs assessment, training staff in choking recognition and response, supervising high-risk activities such as eating while intoxicated, and following any specific guidance for vulnerable groups such as children or people with swallowing difficulties. Clear incident reporting and debriefing after choking episodes also helps improve future prevention and response.