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Choking Response for Lifeguards
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Choking response for lifeguards is a first aid skill that shows up at aquatic facilities more often than people expect, because pools have cafes, vending machines and children eating on the deck.
What is the choking response for lifeguards by casualty type?
Conscious adult or child, severe obstruction. They cannot speak, cough effectively or breathe. Alternate five back blows between the shoulder blades with five abdominal thrusts, and continue until the obstruction clears or they become unresponsive.
Mild obstruction. They can still cough. Do not intervene. Encourage coughing and stay with them, because a forceful cough is more effective than anything you can do.
Unresponsive casualty. Lower them to the ground and begin CPR. Look in the mouth each time you open the airway to ventilate, and remove any object you can see. Never sweep blindly.
Infant under one year. Five back blows and five chest thrusts, supported head-down along your forearm. Never abdominal thrusts on an infant, because the liver sits low and unprotected and abdominal thrusts cause serious internal injury.
Pregnant or large casualty. Chest thrusts in place of abdominal thrusts.
The difference that matters most
Whether the casualty can cough. A coughing person has a partial obstruction and a working airway; back blows on them can convert a partial obstruction into a complete one. The intervention starts when effective coughing stops.
Choking in the water
A swimmer choking in the water is removed first. You cannot deliver back blows or thrusts to someone you are also keeping afloat, and the effort spent trying is time not spent extricating them.
After it clears
Anyone who has received abdominal thrusts is assessed medically, because the technique can cause internal injury even when performed correctly. Choking response for lifeguards includes that referral, not just the clearance.
Choking response for lifeguards: frequently asked questions
What is the choking response for lifeguards?
For a conscious casualty with a severe obstruction, alternate five back blows with five abdominal thrusts until it clears or they become unresponsive, then begin CPR checking the mouth at each ventilation. Infants receive back blows and chest thrusts, never abdominal thrusts.
When should you not intervene?
While the casualty can still cough effectively. A forceful cough clears more than any technique, and intervening can convert a partial obstruction into a complete one.
Why never abdominal thrusts on an infant?
Because an infant liver sits low and largely unprotected, so abdominal thrusts cause serious internal injury. Use five back blows and five chest thrusts instead.
Reviewed by Jackie Stern, Lifeguard Instructor, Firefighter and EMT. Jackie Stern has taught lifeguarding for more than 20 years and works as a firefighter, EMT and swim instructor. She reviews course content, prerequisites and rescue standards against current certification requirements.
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