Choking

Choking is the emergency most likely to happen in front of you with food on the table. The AHA's 2025 adult guideline calls it one of the leading causes of accidental death in the United States, with over 5,000 cases in 2021, and says that a severe obstruction can run on quickly to unconsciousness and cardiac arrest if the object stays where it is.¹ It also says that prompt action by bystanders has been associated with better survival.¹

What you do turns on one question, whether the cough still works, and then on who is choking: an adult, a child, a baby, or someone the usual squeeze won't suit. And if you learned first aid in the US, one thing has changed: since October 2025 the American and British guidelines teach an adult the same order.

The cough decides

A piece of food in the airway can block it partly or completely, and what you should do depends on which. The guidelines call them mild and severe.

Mild. The AHA's adult guideline says mild obstructions "often present with coughing and difficulty breathing".¹ Its paediatric guideline puts the test in one line: mild is "the patient is coughing and making sounds".²

Severe. The adult guideline's description: severe obstruction presents "with weak or absent coughing, inability to speak, changes in color (cyanosis), and altered level of consciousness".¹ Cyanosis is the change the American Red Cross describes: skin going pale or bluish as the body runs short of oxygen.¹² For children the AHA again has it short: severe is "the patient cannot make sounds".² RCUK's 2025 first aid guideline gives the cue to look for: "Suspect choking if a person is suddenly unable to speak or cough, particularly if eating."⁴ Its first step is to ask the person "Are you choking?"⁴ Someone who answers you in words isn't the person that cue describes. Someone who nods, clutches their throat and makes no sound is.

The AHA gives the reason for letting the cough work in its supporting text: "Coughing can produce high airway pressures", which is what makes it effective at clearing a partial blockage.¹ The same text gives the reason to stay: a mild obstruction can quickly become a severe one, so watching for the signs is part of the instruction, not an afterthought.¹ The signs you're watching for are the ones above: the cough going weak or silent, no words, a colour change.

Severe choking in an adult: five and five

What changed in 2025

The change is one sentence. The AHA's 2025 adult guideline: "For adults with severe FBAO, repeated cycles of 5 back blows (slaps) followed by 5 abdominal thrusts should be performed until the object is expelled or the person becomes unresponsive." (AHA 2025, COR 1, LOE B-NR).¹

That sentence is new. The AHA's announcement of the 2025 guidelines says: "Choking guidance for adults was not included in the previous guidelines, and earlier guidance for children called for performing abdominal thrusts only."³ Abdominal thrusts are the squeeze from behind that many people know as the Heimlich manoeuvre. The American Red Cross also teaches back blows and thrusts; its page does not say since when.¹²

The UK and European order was already back blows first, and RCUK's 2025 first aid guideline keeps it:⁴

1. "Encourage the person to cough."
2. "If the person is unable to cough or the cough becomes ineffective, give up to five back blows."
3. "If back blows are ineffective, give up to five abdominal thrusts."
4. "If choking has not been relieved after five abdominal thrusts, call 999 and continue alternating five back blows with five abdominal thrusts until choking is relieved, or the person becomes unresponsive."

For a conscious adult, then, the two countries now teach one sequence. RCUK writes "up to" five of each, which spells out what the AHA's "until the object is expelled" already implies: you stop the moment it clears.¹⁴ What remains is a difference over the call, and one about afterwards that comes up in a moment.

AHA 2025 Part 7, section 10.1;¹ RCUK 2025 First aid, "Choking in an adult", and the RCUK adult choking algorithm.⁴⁶

The call. RCUK's step-by-step text puts the 999 call after five blows and five thrusts have failed. Its adult flowchart shows "Call ambulance service/resuscitation team" as soon as the cough is judged ineffective, with a note that a single rescuer should use the speaker function on a mobile phone, and the guideline's own key points say to "call for help early and, ideally, use a speakerphone, especially if alone".⁴⁶ The AHA wants the emergency system activated for any severe obstruction (COR 1, LOE C-EO), because severe cases often need the ambulance crew or a hospital.¹ This course teaches the earlier moment, the one the AHA, RCUK's flowchart and its key points share. If someone else is there, they call as you start the back blows. If you're alone, the phone goes on speaker beside you and you carry on.

Why back blows first

The AHA answers this in its supporting text, and starts with what it lacks: "There are no RCTs comparing the efficacy or safety of different interventions for FBAO".¹ (RCTs are randomised controlled trials.) Then it gives three things:

• A cohort study of 709 people with choking "showed back blows were associated with improved rates of FBAO relief and fewer injuries compared to abdominal thrusts".¹ That is Dunne and colleagues' 2024 study; this course read its abstract only.¹³
• Case reports have described fatal injuries from abdominal thrusts, "including aortic dissection and gastric rupture".¹ In plainer words, which are this course's and not the AHA's: a torn main artery and a burst stomach.
• And: "The recommendation for alternating sets of 5 back blows and 5 abdominal thrusts is based on the value of consistency with existing infant and pediatric guidelines that use this approach."¹

None of the guidelines says how a back blow moves an object. The British Red Cross, a public page and not a guideline, gives the short answer: back blows "create a strong vibration and pressure in the airway, which is often enough to dislodge the blockage".¹¹ Nothing read here measures that. For children the AHA's paediatric text cites an observational study of adults and children that suggests back blows clear an object better than abdominal thrusts, then says back blows now come first "to create consistency for instructional purposes, and in the absence of inferiority from pediatric data".²

This course did not read the reasoning behind the older US order, thrusts alone, so it does not describe the case for it.

How each one is done

The guidelines give the sequence and the public pages give the hands. St John Ambulance puts the whole thing in three phrases: "Cough it out", "Hit it out", "Squeeze it out".¹⁰

Back blows. Help the person lean forward, supporting their upper body with one hand (St John).¹⁰ The American Red Cross has you bend them over until "the upper body is parallel to the ground".¹² Then, with the heel of your other hand, give up to five sharp blows between the shoulder blades (St John; RCUK's paediatric guideline gives the same place for a child).¹⁰⁵ St John says to check the mouth after each one.¹⁰ None of the sources read explains why the person leans forward, so this course offers none.

Abdominal thrusts. Stand behind them and put your arms round their waist. Make a fist and place it "between their belly button and the bottom of their chest" (St John);¹⁰ the American Red Cross finds the spot by locating the navel with two fingers and putting the thumb side of the fist just above them.¹² Grasp the fist with your other hand and "pull sharply inwards and upwards" (St John), up to five times, checking the mouth again after each.¹⁰

What the thrust does, the British Red Cross puts in one sentence: abdominal thrusts squeeze the air out of the lungs and may dislodge the blockage.¹¹ It says it may, not that it will. The NHS, writing about children, calls a thrust "an artificial cough, increasing pressure in the chest".⁹ The AHA's case reports of injury, above, are about this manoeuvre; they describe single cases, not a rate.¹

The canteen

Start with the plain case, one round at a time. The two countries now agree, so one telling covers both; only the call differs.

It's lunchtime in a works canteen. Across the table, Grace has taken a big bite of a sandwich, and now she's half standing, one hand at her throat. Her mouth is open and no sound is coming out. You ask her "Are you choking?" and she nods, wide-eyed. She can't cough.

Step 1: decide. No cough, no voice. That is severe, in both countries' terms.¹⁴

Step 2: the call. You point at the person beside you and say "Ring 999, on speaker" (or 911 in the US). The AHA wants the emergency system activated for a severe obstruction, and RCUK's algorithm shows the call as soon as it's severe.¹⁶

Step 3: five back blows. You help her lean well forward, one hand supporting her upper body. With the heel of your other hand you give a sharp blow between her shoulder blades, look in her mouth, and give another. After five, nothing has come out.¹⁰⁴

Step 4: five abdominal thrusts. Nothing on the first, nothing on the second. On the third a lump of bread comes out onto the table and she draws a whooping breath.

Step 5: stop. RCUK's "up to five" means you stop the moment it clears.⁴ Had the thrusts failed, you'd have gone back to five back blows and kept alternating. Grace is breathing, and she wants to get back to work. She had abdominal thrusts, so, as you saw above, she's seen by a healthcare practitioner first (RCUK 2025).⁴ The colleague who called tells the call handler it has come out, and does what the call handler says.

When the usual thrust won't work

Three kinds of adult make an abdominal thrust impossible or wrong. The AHA covers the first two with the same fix: keep the back blows and swap the abdominal thrusts for chest thrusts.

Late pregnancy. "For adults in the late stages of pregnancy with severe FBAO, repeated cycles of 5 back blows (slaps) followed by 5 chest thrusts should be used until the object is expelled or the person becomes unresponsive." (AHA 2025, COR 1, LOE C-EO).¹ The American Red Cross uses chest thrusts for anyone "obviously pregnant or known to be pregnant".¹²

Too large to reach round. "If the rescuer is unable to encircle the person's abdomen, repeated cycles of 5 back blows (slaps) followed by 5 chest thrusts should be used for adults with severe FBAO until the object is expelled or the person becomes unresponsive." (AHA 2025, COR 1, LOE C-EO).¹

A wheelchair user. The AHA's synopsis names the wheelchair as a case where abdominal thrusts may be impossible.¹ The American Red Cross gives the practical version: kneel behind the chair, remove the armrests if you need to, use chest thrusts if abdominal thrusts are difficult, and take the person out of the chair only "As a last resort".¹²

Three gaps, stated plainly. The AHA's supporting text says there are no high-quality data for these special circumstances, and both recommendations are C-EO, expert opinion.¹ RCUK's 2025 first aid guideline does not address pregnancy or a large body at all, so the guidance here is American.⁴ And the texts read here do not say where the hands go for a chest thrust on a standing adult, so this course leaves that placement to a class and a manikin.

Choking alone

The American Red Cross is the only source read here with advice for someone choking with nobody near.¹² It says to call 911 from a landline or a GPS-enabled mobile even if you can't speak, because "the open line will cause the dispatcher to send help", and then either to give yourself abdominal thrusts or to press your abdomen against "the back of a chair or a railing", avoiding sharp edges and taking care with a railing that is raised.

Neither the AHA's 2025 guidelines nor RCUK's make a recommendation on self-rescue, and nothing read cites any data on it: this is the American Red Cross's advice, with no evidence cited.¹² Whether a silent 999 call in the UK is handled the same way as a silent 911 call is something this course did not research, so it makes no claim. The exercise at the end asks you to plan it for your own home, with that gap in mind.

When they stop responding

If the blows and thrusts fail, the person will eventually stop responding. Then both countries say the same thing: start CPR straight away. Neither guideline asks you to check their breathing first. A choking person who has collapsed may still snore or gasp, and lessons 2 and 7 showed that neither is normal breathing. The AHA gives its reason in its supporting text: observational data support starting compressions at once "regardless of whether or not the patient has a pulse", and compressions carry a low risk of injury in someone who turns out not to be in arrest.¹

The AHA: "If adults with severe FBAO become unresponsive, rescuers should start CPR, beginning with chest compressions, and activate the emergency response system if no one has done so." (AHA 2025, COR 1, LOE C-LD).¹ RCUK: "If the person becomes unresponsive, start CPR and ensure 999 has been called."⁴ The same adult CPR you met in lessons 2 to 4, in your country's order.

The compressions aren't only for circulation. The AHA's synopsis: "Chest compressions can provide sufficient airway pressure to expel a foreign body."¹ It also says why the back blows stop: once someone is unconscious, blows and thrusts become impractical and cardiac arrest is imminent.¹

Lesson 4 gave the other way in. If two breaths won't make the chest rise, RCUK says to "consider foreign body airway obstruction" (RCUK 2025).¹⁹

Two rules for the mouth, once CPR is under way, whichever way you got there:

• Look before a breath. "For adults with FBAO receiving CPR, rescuers should remove any visible foreign body when opening the airway to provide breaths." (AHA 2025, COR 1, LOE C-EO).¹ If you can see it, take it out.
• Never feel for it. A finger sweep is hooking a finger into the mouth to drag something out; blind means doing it without seeing the object. The NHS puts it as not poking blindly with your fingers, which could push the object further in.⁹ The AHA: "Blind finger sweeps should not be performed for adults with FBAO." (AHA 2025, COR 3: Harm, LOE C-LD).¹ RCUK: "Do NOT use blind finger sweeps to try and remove a foreign body from the mouth or airway."⁴ The AHA's supporting text gives the reason: observational data suggest the risk of making the obstruction worse outweighs any benefit when nothing can be seen.¹

For a child or a baby who goes limp, the CPR follows lesson 6, which means the two countries part company at the first action. More on that below.

Children over one

A child over one gets the adult sequence. The AHA's 2025 paediatric guideline: "repeated cycles of 5 back blows alternating with 5 abdominal thrusts" (AHA 2025, COR 1, LOE C-LD).² RCUK's 2025 paediatric guideline says the same, "up to" five each time.⁵ RCUK adds that the cue in a child is being unable to speak, or in a younger child to cry aloud, especially while feeding, eating or playing unsupervised, and that the ambulance should be called as soon as possible.⁵

RCUK's technique for a child matches St John's for an adult: lean them forward for the back blows; for the thrusts, stand behind, fist between the navel and the bottom of the breastbone, and pull sharply in and up.⁵ It adds a stop rule: stop at once at any sign the obstruction is clearing, which it lists as coughing, loud breathing or crying.⁵ Two cautions come from the public pages. The British Red Cross says to reduce the force of the back blows for a smaller child, and the NHS warns against pressing on the lower ribcage during the thrusts, which may cause damage.¹¹⁹

If the child goes unresponsive, the countries differ. Lesson 6 gave the reason: a child's arrest is usually a breathing arrest, and the two bodies weigh that differently.

AHA 2025 Part 6, FBAO section;² RCUK 2025 Paediatric basic life support, FBAO section.⁵

After those first seconds the CPR is lesson 6's, at lesson 6's depths and ratios. The AHA's paediatric text adds a reason for speed: a child with a severe obstruction can deteriorate rapidly into cardiac arrest, so the emergency services should be called promptly.²

Babies under one

A baby is where the sequence changes most, and where the most out-of-date advice is still in circulation.

The sequence. "For infants with severe FBAO, repeated cycles of 5 back blows alternating with 5 chest thrusts should be performed until the object is expelled or the infant becomes unresponsive." (AHA 2025, COR 1, LOE C-LD).² RCUK gives the same pairing, up to five of each.⁵

Never give a baby abdominal thrusts. The AHA: "Abdominal thrusts are not recommended for infants, given the potential to cause abdominal organ injury."² It gives no other reason.

Back blows. Lay the baby face down along your forearm, with your forearm resting on your thigh, or along your thigh itself; support the head with your hand; keep the head lower than the body; and give up to five sharp blows between the shoulder blades with the heel of your other hand (RCUK; NHS; British Red Cross).⁵⁹¹¹ The British Red Cross gives the reason for head-down: babies commonly choke on liquid, such as mucus or curdled milk, and keeping the head lower than the bottom lets gravity help it drain.¹¹ How hard? The British Red Cross says to match the force to the baby's size, gentler with a smaller baby, and relative to your own strength.¹¹ Feeling that is what a class with an infant manikin teaches.

Chest thrusts. RCUK says to turn the baby onto their back and lay them on your knees, then push sharply on the breastbone up to five times.⁵ How you push is where the sources disagree, three ways.

AHA 2025 Part 6;² RCUK 2025 Paediatric basic life support;⁵ NHS "How to stop a child from choking", reviewed 28 October 2024; British Red Cross "Choking baby"; American Red Cross "Infant choking".⁹¹¹¹²

The AHA's reason, in its supporting text: current CPR research suggests the heel of the hand pushes deeper than the two-finger technique it used to recommend.² RCUK's thumbs are its infant compression method from lesson 6, pushed more sharply. Neither guideline teaches two fingers any more.

The three public pages in the bottom row still do, and one of them gives a depth: the American Red Cross infant page says to press "about 1 ½ inches" (about 4 cm).¹² Those pages were written or reviewed before the October 2025 guidelines or have not caught up with them. When the page and your country's guideline disagree, follow the guideline. The same goes for two videos: a St John Ambulance video from 2016 and a British Red Cross video from 2024 both show two fingers on the chest, so this course doesn't use them.¹⁴

Afterwards, St John Ambulance says: "All babies who have received chest thrusts should be seen in hospital."¹⁰ The NHS child choking page goes further: "Even if the object has come out, get medical help."⁹ Its reasons are that part of the object may have been left behind, or the child may have been hurt by the rescue.⁹

Asked whether a choking baby should be held upside down by the feet, the British Red Cross answers: "No. This is not effective."¹¹ It goes on to say that you might drop the baby, and that tipping them may move the blockage further down.¹¹ The American Red Cross says the same for children.¹²

One line on the same NHS page needs a caution. It tells parents: "It doesn’t matter which order you do them in. If one method doesn’t work, try the other method."⁹ Every guideline read for this course puts back blows first, for every age, so this course teaches back blows first.

The baby on the sofa

Now a baby, and a rescuer on his own. Tom, twenty-four, is looking after his sister's nine-month-old, Isla, at her flat in York. She's sitting on the sofa with a teething biscuit. He looks up and she's silent, red-faced, mouth open, arms waving. No cry. No cough.

1. Decide. A baby who can't cry or make a sound has a severe obstruction.²⁵

2. The call. He's alone. He puts the phone on speaker, dials 999 and puts it down beside him. RCUK says the ambulance should be called as soon as possible, and at the latest when the child loses consciousness.⁵

3. Five back blows. He sits down, lays Isla face down along his forearm with the forearm resting on his thigh, supports her head with his hand, keeps her head lower than her body, and gives five sharp blows between her shoulder blades.⁵ Nothing.

4. Five chest thrusts. He does. Still nothing. He goes back to back blows, and alternates.

5. She goes limp. Her arms drop and she stops responding. The call handler is on speaker. Now lesson 6's sequence takes over: RCUK says start CPR immediately with five rescue breaths as soon as a choking child becomes unconscious.⁵ He lays her on her back on the floor, opens her mouth and looks: if he can see the piece of biscuit, a single sweep takes it out; if he cannot, he does not go feeling for it.⁵ Five breaths over her mouth and nose, watching for the chest to rise, then two-thumb compressions at lesson 6's rate and depth, with the ratio the call handler gives him.

In Albuquerque, the same moment would start with compressions, not breaths (AHA 2025, COR 1, LOE C-LD).²

Had the biscuit come out after the chest thrusts instead, Isla would still be going to hospital: St John says every baby given chest thrusts should be seen there, and the NHS gives the reasons above.¹⁰⁹

Suction devices

Suction-based airway clearance devices are sold for home use under names such as LifeVac and Dechoker. Whether a household should buy one is a live question, and the bodies' answer has changed. (This course read no maker's instructions, so it does not describe how either is used.)

The bodies' positions, oldest first:

• ILCOR, 2020: "We suggest against the routine use of suction-based airway clearance devices (weak recommendation, very-low-certainty evidence)."⁷ The evidence then was one case series of nine adults.⁷
• ILCOR, 2025: an evidence update found 17 new publications, and ILCOR wrote: "Airway clearance devices are increasing in prevalence. Currently, there are no treatment recommendations regarding these devices. An updated SysRev is warranted."⁸ (A SysRev is a systematic review.) The 2020 "suggest against" wasn't reprinted, so ILCOR now has no recommendation either way.
• AHA 2025: "Effectiveness and safety of suction-based airway clearance devices have not been established in adults with FBAO. There is insufficient evidence to make a recommendation." (AHA 2025, COR 2b, LOE C-LD).¹ The paediatric guideline says the same for children, adding that the only paediatric evidence comes "from voluntary reporting to an industry-sponsored registry" (AHA 2025, COR 2b, LOE C-LD).²
• RCUK, reviewed July 2026: its position statement says "RCUK makes no recommendation for or against the use of suction-based airway clearance devices whilst awaiting the findings of an updated ILCOR systematic review."¹⁵ And: "established choking treatments for adults and children should be prioritised".¹⁵ The reason RCUK gives is that those treatments can be delivered immediately, need no specialist equipment, and form the basis of current practice.¹⁵

The case for the devices, in its strongest form, rests on two studies, both by Dunne and colleagues, and this course read the abstracts only. A two-year prospective study of device users, recruited with industry help and self-reporting, found the LifeVac was the last intervention before relief in 151 of 157 cases.¹⁶ A 2025 randomised crossover trial put 132 lay people in front of a choking manikin: relief at one minute was 86% with the LifeVac, 62% with the Dechoker and 49% with abdominal thrusts.¹⁷ On a manikin, then, lay people cleared the obstruction more often with either device than with thrusts.

The case for caution, in its strongest form: the real-world data are self-reported by users who were recruited with industry help, and the trial's patient was a manikin, not a person. The 2023 study recorded possible adverse events, including one tear of the gullet (an oesophageal perforation) that could not be attributed to the device.¹⁶ And a device has to be within reach, while back blows need nothing but your hands; RCUK's statement puts its weight on exactly that.¹⁵

This is a contested empirical question, and the bodies have left it open on purpose. ILCOR has said what it needs next: an updated systematic review.⁸ This course's own reading is that the gap such a review would have to fill is data on real people, collected without industry help. What the bodies agree on today is that none of them recommends a device over back blows and thrusts. RCUK says those should come first; the AHA grades them COR 1 and finds too little evidence to make any recommendation on the devices (COR 2b).¹⁸¹⁵

What people get wrong

"Abdominal thrusts first." The older US teaching for children. Since October 2025 the US and the UK both start a conscious adult, and a child over one, with back blows (AHA 2025, COR 1; RCUK 2025).¹²⁴

"Slap anyone who's coughing on the back." For a cough that works, both countries say encourage it and watch (AHA 2025, COR 1, LOE C-EO; RCUK 2025).¹⁴

"Reach in and hook it out." Only if you can see it. Blind sweeps are COR 3: Harm for the AHA, and RCUK says "Do NOT".¹⁴

"Hold a choking baby upside down by the feet." The British Red Cross: it isn't effective, and you might drop them.¹¹

"Once it's out, they're fine." RCUK wants anyone given abdominal thrusts or compressions checked by a healthcare practitioner, and St John wants every baby given chest thrusts seen in hospital.⁴¹⁰

"The order doesn't matter." Every guideline read here says back blows first, at every age.¹²⁴⁵

"Buy a suction device instead of learning the technique." No body recommends a device. The AHA finds no evidence it beats blows and thrusts, and RCUK says blows and thrusts come first.¹¹⁵

Practice

Where to learn with your hands

How hard a blow lands, how far in and up a thrust goes, how a baby is held with the head low: this is what the callout at the top means by a page not teaching your hands. A class puts them on a manikin with an instructor watching. For the CPR that follows if a choking person stops responding, the BHF's free RevivR and RCUK's Lifesaver are the course's two practice tools; neither was taken for this course, and neither is a class.¹⁸ Lesson 16 lists where to find one.

Connections

Lesson 2's CPR takes over the moment a choking person stops responding, with no breathing check first, and lesson 3's compressions gained a second use: the AHA says they can build enough airway pressure to expel the object. This lesson used lesson 4's grading key to read a COR 1 that rests on one cohort study and a wish for consistent teaching, beside an older ILCOR grade of weak, very low certainty. Lesson 6's split between compressions first and five breaths first came back for the unresponsive choking child, along with its verdict on two fingers.

Lesson 9 turns to severe bleeding, the other emergency where the first minutes are yours. Cooking Fundamentals, earlier on the Core, is where most of the eating happens, and the AHA says most adult choking is on food.¹ Relationships and Family, later on the Core, will build on the infant sequence.

Go deeper

• AHA, Part 7: Adult Basic Life Support, 2025, section 10 ("Adult FBAO"), which this course read in full from an archived copy. Three short sections: the new adult sequence, the supporting text on why back blows now come first, and the special circumstances.
• RCUK, 2025 Resuscitation Guidelines: Paediatric basic life support, the "Foreign body airway obstruction" section, read here in full. The UK sequence for babies and children in about twenty short lines, including how to hold an infant.
• RCUK, position on suction-based airway clearance devices, reviewed July 2026, read here in full. One page, and a clear case of a body explaining why it has chosen to say nothing yet.

Sources

1. M. E. Kleinman, J. E. Buick, N. Huber and colleagues, "Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care", Circulation 152, 2025, S448 to S478 . Read level: full, direct (Wayback 20260920001857), section 10 (Adult FBAO), re-read on 2026-09-25. Every adult recommendation here with its COR and LOE, and the synopses and supporting text quoted or paraphrased.
2. B. L. Joyner Jr, M. Dewan, A. Bavare and colleagues, "Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines", Circulation 152, 2025, S424 to S447 . Read level: full, direct (Wayback 20260917094944), the FBAO section. The infant and child recommendations with their grades, and the supporting text on back blows first, abdominal organ injury and the heel of the hand.
3. American Heart Association newsroom, "Updated CPR guidelines tackle choking response, opioid-related emergencies and a revised Chain of Survival", 22 October 2025 . Read level: full, direct.
4. Resuscitation Council UK, 2025 Resuscitation Guidelines: First aid, 27 October 2025 . Read level: full, direct; "Choking in an adult" re-read on 2026-09-25.
5. Resuscitation Council UK, 2025 Resuscitation Guidelines: Paediatric basic life support, 27 October 2025 . Read level: partial, direct (FBAO section), re-read on 2026-09-25. Paraphrased here except where quoted.
6. Resuscitation Council UK, Adult choking algorithm 2025 and Paediatric choking algorithm 2025. **Read level: full, direct.**
7. T. M. Olasveengen, M. E. Mancini, G. D. Perkins and colleagues, "Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations", Resuscitation 156, 2020, A35 to A79 . Read level: partial, direct (FBAO section only).
8. T. Djärv, M. J. Douma, J. N. Carlson and colleagues, "First Aid: 2025 International Consensus on Science With Treatment Recommendations", Circulation 152, 2025, S250 to S282 . Read level: full, direct, from the accepted manuscript on ilcor.org; the suction passage quoted here checked word for word against the typeset text. The reprinted 2020 choking recommendations and their strengths.
9. NHS, How to stop a child from choking, page last reviewed 28 October 2024 . Read level: full, direct, re-read on 2026-09-25.
10. St John Ambulance, Choking and Baby choking, clinically reviewed 28 April 2025 . Read level: full, direct, re-read on 2026-09-25.
11. British Red Cross, Choking and Choking baby, undated . Read level: full, direct, re-read on 2026-09-25.
12. American Red Cross, Adult and child choking and Infant choking, live pages read 2026-09-24 . Read level: full, direct.
13. C. L. Dunne, J. Cirone, I. E. Blanchard and colleagues, "Evaluation of basic life support interventions for foreign body airway obstructions: a population-based cohort study", Resuscitation 201, 2024, 110258 . Read level: abstract only. The findings given here are the AHA's description of it.
14. St John Ambulance, "What to do if Your Baby is Choking" (2016), and British Red Cross, "Baby first aid: Choking" (2024), YouTube . Read level: still frames and on-screen text checked, audio not heard.
15. Resuscitation Council UK, "RCUK's position on the use of suction-based airway clearance devices in choking individuals", reviewed and updated July 2026 . Read level: full, direct, re-read on 2026-09-25.
16. C. L. Dunne, K. Viguers, S. Osman and colleagues, "A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions", Resuscitation Plus 16, 2023, 100496. **Read level: abstract only.**
17. C. L. Dunne, N. Mannani, J. Cirone and colleagues, "Comparison of foreign body airway obstruction interventions among laypersons: a simulation-based, crossover, randomized controlled trial", Resuscitation Plus 26, 2025, 101156 . Read level: abstract only.
18. British Heart Foundation, RevivR, and Resuscitation Council UK, Lifesaver. **Read level: both pages full, direct**; neither course was taken.
19. Resuscitation Council UK, 2025 Resuscitation Guidelines: Adult basic life support, 27 October 2025 . Read level: full, direct. Only its line on breaths that won't make the chest rise is used here.