If someone is choking and can’t speak, stand behind them and perform 5 back blows followed by 5 abdominal thrusts; if they collapse, start CPR immediately.

26. If someone is choking and can’t speak, stand behind them and perform 5 back blows followed by 5 abdominal thrusts; if they collapse, start CPR immediately.

Cost: No cost involved. To perform the technique: make a fist with one hand and place it just above the navel, then wrap the other hand around it and deliver quick inward and upward thrusts.

In plain terms: First ask, “Are you choking? Can you speak?” If the person can still cough forcefully or make sounds, let them keep coughing — coughing often dislodges the object on its own. If they can’t speak, stand behind them and give 5 back blows followed by 5 abdominal thrusts, repeating this sequence until the object comes out or the person loses consciousness. Once they collapse, begin CPR right away and call emergency services. For pregnant women or very overweight individuals, perform chest thrusts instead. Never reach into someone’s mouth to try to remove an unseen object.

Benefit: According to the original text from the U.S. National Library of Medicine: First ask, “Are you choking? Can you speak?” It also states that “if the person can still cough forcefully or speak, do not intervene” since coughing often removes the obstruction on its own. If they can’t speak, “repeatedly perform 5 back blows followed by 5 abdominal thrusts until the object is dislodged or the person loses consciousness.” At that point, “begin CPR immediately” while calling emergency services. Chest thrusts are recommended for pregnant women and those with obesity.

Evidence grade: B

Sources: US National Library of Medicine, MedlinePlus. Choking – adult or child over 1 year. <https://medlineplus.gov/ency/article/000047.htm>; Fuzhou Municipal Health Commission (2026). Heimlich maneuver updated: "Children over 1 year old, children and adults: From the old version of single abdominal shock to a cycle of "5 back slaps + 5 abdominal shocks", the first aid training of the Chinese Red Cross system has always been taught in a cycle of "5 back slaps + 5 abdominal shocks". <https://www.fuzhou.gov.cn/zgfzzt/swjw/fzwj/jkkp/202601/t20260108_5268351.htm>

Notes: Never reach into someone’s mouth to remove an unseen object — this can push it deeper. Do not perform this technique on anyone who is still able to cough. Choking incidents most often occur at home, so these steps are especially useful for family members. This same method is taught in China: The Fujian Red Cross Emergency Rescue Training Center notes that for children over 1 year old and adults alike, the Red Cross system has long taught a cycle of 5 back blows followed by 5 abdominal thrusts. Many older online tutorials only cover abdominal thrusts; those are outdated versions of this procedure.