Heimlich Maneuver: How to Perform It in a Choking Emergency

In a choking emergency, you can use a technique called the Heimlich maneuver to deliver abdominal thrusts, clear a blocked airway, and potentially save a life.

Mass General Brigham emergency medicine doctor Wendy Macias-Konstantopoulos, MD, describes when you should use the Heimlich maneuver in a choking emergency and walks through step-by-step instructions.

Step 1: Call 9-1-1 for help in a choking emergency.

If you suspect someone is choking, call 9-1-1 to get help and relay the situation.

If another person is present, one of you should try to help the choking person while the other dials 9-1-1.

Step 2: Assess the situation and try sharp blows to the back.

The Heimlich maneuver should not be performed on someone who can still talk, breathe, or cough.

Here’s what you can do:

• Encourage further coughing to dislodge any obstruction or cause of choking.
• Determine if the person can talk, cough, or breathe.
• Look for the universal choking sign (holding the throat).

If a person can’t talk, breathe, or cough:

• Try up to 5 sharp blows to the back with the heel of your hand, between the person’s shoulder blades.

Step 3: How to do the Heimlich maneuver

If blows to the back don’t clear the blockage, perform abdominal thrusts. Here’s how:

• Stand behind the choking person (or kneel if you are helping a young child).
• Wrap your arms around their torso, from the back.
• Make a fist with one hand and grab it with the other.
• Place your hands just above the belly button and below the ribcage.
• Pull inward and upward on the diaphragm to force air out of the lungs to expel the blockage.
• Repeat up to 5 times.

Step 4: Alternate back blows and Heimlich maneuver if choking continues.

If the person still can’t breathe, talk, or cough, continue giving 5 back blows followed by 5 abdominal thrusts until you clear the blockage or help arrives.

Using the Heimlich maneuver on pregnant or obese people

Give 5 chest thrusts to breastbone (middle of the chest) instead of the abdomen when trying to clear the airway of a pregnant or obese person.

When not to use the Heimlich maneuver

Infant Heimlich maneuver

Using the Heimlich maneuver (abdominal thrusts) is not recommended for infants 12 months or younger. To clear a blockage from a choking baby or infant:

• Hold the baby face down along the length of your arm or thigh.
• Keep their head lower than their bottom.
• Hit them sharply on the back up to 5 times to dislodge the blockage. Hit firmly but not hard enough to cause injury.
• Check the baby’s mouth and remove any visible objects with a finger.

If the airway is still blocked, try chest thrusts:

• Hold the baby face up along the length of your arm or thigh.
• Keep their head lower than their body and support their neck and head by cradling it in your hand.
• Place 2 to 3 fingers on the breastbone (middle of the baby’s chest).
• Press 1 inch downward and upward sharply up to 5 times.

Hopefully these actions clear the blockage in a choking baby. If they don’t, call 9-1-1 if this has not already been done and attempt abdominal and chest thrusts again.

Using the Heimlich Maneuver on yourself

If you’re alone and choking, you can use the same technique described above:

• Place your fists just above your navel.
• Pull inward and upward into your own diaphragm.

You can also bend over a hard surface, like a countertop or chair back, and shove yourself into it to create a similar upward force on your lungs.

If you’re choking, alone, and can’t talk or easily reach another person:

• Text-to-911 is available in many states.
• Type the numbers “9-1-1” into the “to” or “recipient” field.
• Text your location and the nature of your emergency right away.

Choking prevention and education

Young children have a high risk for choking. You can do a lot to prevent your child from choking by following these simple steps:

• Cut children’s food into small pieces before they eat.
• Be especially careful with foods like popcorn, nuts, grapes, hot dogs, and hard candy.
• Keep choking hazards out of children’s reach (small objects, high-risk foods).
• Keep a close eye on your child while they eat and supervise play time.

The Heimlich maneuver and the other emergency choking response techniques are taught in choking safety courses around the world. They are considered basic first aid, can be learned easily by anyone, and can save a life if they are confidently applied in an emergency choking situation.