Heimlich Maneuver: Correct Fist Placement & Technique for Choking Rescue

The Heimlich maneuver (abdominal thrusts) uses a fist — not "first" — to generate intra-abdominal pressure and expel a foreign body from the airway.

Correct Technique (Adult/Child >1 yr)

1. Stand behind the person; wrap arms around waist.
2. Make a fist with one hand. Thumb side against abdomen.
3. Position: Midline, slightly above navel, well below xiphoid process (sternum tip).
4. Grasp fist with other hand.
5. Thrust: Quick, upward and inward (J-motion), 6–10 times. Each thrust distinct.
6. Repeat until object expelled or person becomes unconscious.

Special Populations

• Pregnant / Obese: Chest thrusts (fist on lower sternum, same motion).
• Infant (<1 yr): 5 back blows (face down, head low) → 5 chest thrusts (2 fingers, midsternum). Repeat.
• Unconscious: Lower to floor, start CPR (chest compressions may dislodge). Check mouth before breaths.
• Self-administration: Fist above navel, other hand over fist, thrust against fixed object (chair back, counter).

Common Errors

• Placing fist too high (xiphoid) → liver/spleen injury, rib fracture.
• Too low → ineffective.
• Jerky, weak, or sideways thrusts.
• Not calling 911 simultaneously (if alone, do 5 cycles first).

Training with manikin and certification (AHA, Red Cross) builds muscle memory. Refresh annually.