Heimlich Maneuver for Adults: Step-by-Step Choking Rescue Protocol

For a responsive adult with severe airway obstruction (universal sign: clutching throat, unable to speak/cough/breathe):

Immediate Action Sequence

1. Ask: "Are you choking? Can you speak?" If they can cough/ speak → Encourage coughing. Do not intervene.
2. Call 911 / Activate EMS (or direct bystander) — do not delay.
3. Perform Abdominal Thrusts (Heimlich):
   • Stand behind; wrap arms around waist.
   • Make fist; thumb side against abdomen, midline, slightly above navel, well below xiphoid.
   • Grasp fist with other hand.
   • Quick, upward thrusts (distinct, separate movements) — 6–10 per sequence.
   • Repeat until object expelled or patient becomes unresponsive.

If Patient Becomes Unresponsive

1. Lower gently to floor; call 911 if not done.
2. Begin CPR (30 compressions : 2 breaths).
3. Before each breath attempt: Look in mouth — if object visible, remove with finger sweep. No blind finger sweeps.
4. Continue CPR until object removed, chest rises, or EMS takes over.

Special Populations

• Pregnant / Obese: Chest thrusts (fist on lower sternum) instead of abdominal.
• Wheelchair/Seated: Kneel behind; same technique.

Post-Event

• Even if object expelled, medical evaluation required (mucosal injury, aspiration risk, rib fracture).
• Document in medical record.

Training: AHA Heartsaver or Red Cross certification — practice on manikin. Refresh annually.