What Happens When a Choking Incident Occurs and What You Need To Do

Mark: This podcast provides general information and guidance on first aid treatment. It is not a substitute for professional medical advice or certified first aid training. Always seek the advice of a qualified healthcare professional for any medical concerns or before making any decision related to your health or treatment. In a medical emergency, always call for immediate medical help. Hi and welcome to episode 21, yes I know, 21, of First Aid Unboxed, the podcast that helps demystify first aid for you. I am the producer and the idiot in the room as usual, Mark Wakeley, but the real expert here and the person who knows all about stuff is my lovely first aid person, Louise Madeley from Madeley's First Aid Plus. Hello Louise. Good morning. Right then, we had a little meeting the other day and we thought, right, what have we not covered yet? And Louise was shocked that we had not talked about choking, which is quite a common thing, as we all know. So she said, right, I need to do one about choking. So what we've got, we've got a choking episode for you. We're going to be talking about it, why it happens, what to do. Obviously with various people, adults and children are going to be slightly different. But also at the end, we've got a whole myth busting bit. which busts all the myths that you think you might have about choking. And we will put you as straight as we possibly can within the realms of the podcast anyway. So let's start off sort of not at the beginning, but a little way in, but then we'll go back to the beginning. So tell me about guidelines. There are a set of government guidelines for this, aren't there, or NHS guidelines for choking.

What Are the UK Resuscitation Council Guidelines for Choking (Updated 2025)?

‍Louise: Yeah, we work on the Resource Council UK guidelines, which changed in October 2025. Really when it comes to choking, it's not so much the act of what we do, it's more when we call for help when it comes to choking. There are a lot of changes that have occurred over the last six months relating to resus, etc. But when it comes to choking in particular, really it's that need to make that call. You are the chain of survival. You're the first person on scene, the first person to do something. The important thing is that A, you do it fast, promptly, but also that you make that phone call. And now that's what we're seeing through the recess council that they're talking about. You want the next stage, the medical professionals with you as early as possible. So as soon as you identify something, you need to start making that call.

Mark: And for those of you listening in the UK, I know we've got listeners all over the world, but those of you listening in the UK, those details are on the NHS website and you'll be able to get details there if you need to know more. Right then, can you explain to me in simple terms what's happening to the body when someone is choking? Because we've all seen things on the television and we might have been involved in incidents ourselves in various places, but what's actually happening in your body when you're choking or when someone's choking?

How Does the Respiratory System Work? Understanding Your Airways

Louise: When I start talking about the lungs and I refer to it as being like an upside down tree. So your respiratory system, imagine a tree, you've got the roots at the top, then you've got your trunk, which leads into the branches. At the end of the branches, you've got your twigs, at the end of your twigs, you've got your leaves. And that's where chlorophyll, you know, all the good stuff happens. Oxygen goes out, carbon dioxide comes into the tree and so on. So imagine the trunk coming down. That's actually your trachea. Right. Okay. And it leads into the bronchi. And the bronchi are the bits where it splits off.

Mark: So these are the branches coming off of the trunk.

Louise: Yeah. It then goes further into these bronchioles, which are your twigs. And at the end of those, you've got your alveoli, which are your leaves.

Mark: And is that where the oxygen actually passes into your bloodstream at the very end there?

Louise: The little capillaries on the end of these little grape-like structures. And those capillaries are where you get that gas exchange. Oxygen goes in, carbon dioxide comes out.

Mark: Right, okay.

Louise: Simple as that. Does that make sense?

Mark: It makes a lot of sense. And I could see it in my head as well when you're seeing pictures of, again, just Google lungs. And I'm sure there's plenty of pictures on the internet which will explain and show what Louise is talking about. So when we're choking.

What Happens to Your Body When You're Choking?

Louise: When you're choking, what's happened is you've taken the food into your mouth, which is the start point, it has then gone down the wrong tube. Instead of going down your oesophagus and into your stomach, it's gone down your windpipe. So that trunk of the tree, it's got lodged there.

Mark: So you've got two pipes here, haven't you? You've got your air pipe and you've got your food pipe.

Louise: Absolutely.

Mark: And they both go to obviously different parts of your body.

Louise: Yeah, it goes to your stomach, fantastic, it gets digested, that's what you want. If it goes down the other pipe, which is why when we talk about what you can do to prevent choking, which we'll talk about in a minute, it'll make sense why. It's gone down into that air pipe and it's got lodged. Now if you get lodged in that part, it's past your nose and your mouth, it's down in the centre part of your chest, which means no air is going to get down into those lungs.

The Role of the Epiglottis: Why Eating With Your Mouth Open Is Dangerous

Mark: Okay, now obviously to stop this happening normally, there is a sort of a one-way valve, isn't there, or a valve that opens and closes. What's that called?

Louise: The epiglottis.

Mark: Okay, and that will, it closes off the windpipe when you're eating?

Louise: Yeah.

Mark: And it closes off the eating pipe when you're breathing, when you're not eating, should I say?

Louise: Precisely. Yeah, so that's why we say people who are most at risk are people who are, for example, children. Children talk and eat at the same time. Mine certainly do. Frequently.

Mark: Yeah, show me a child who doesn't.

Louise: Exactly. They eat with their mouth open. Again, that's quite dangerous because if your mouth is open whilst you're eating, you've got that airway open. So it means that it hasn't closed off. As soon as you close your mouth, that's when it guesses that you've got food in there and therefore it'll go down into your...

Mark: So my mum telling me to eat with my mouth closed wasn't just about politeness.

Louise: Pray not.

Mark: Right, okay. So that's why you need to say that to your kids.

Louise: Absolutely. It's not just because you're spitting food all over the table. It is for a really good reason. And the same if you're talking and eating at the same time, your epiglottis can't be in two places at once. It can only go one way. In which case, if you're talking, then you've got the wrong pipe open, which means the food is more likely to go down the wrong way.

Mark: If the food does keep going down, what's the scenario then?

Partial Choking vs Full Choking: How to Tell the Difference

Louise: There's 2 scenarios really. If it's gone down into the airway, then you're either partially choking or fully choking.

Mark: Yeah, because there's severities of choking.

Louise: Absolutely. You have choked. It's as simple as that. If it's water, then you're not choking as such, but it goes down into your lungs. And as a result, you can end up with aspiration pneumonia and lung infections. So you get two different types of choking. Firstly, you get partial choking, which is exactly what it sounds like. It has blocked a part of the airway. So depending on what it is, whatever it is, has gone down so far, but you still have some airway there. So you can still get some air past it. Follow on from that and you've got full choking. In other words, nothing is going down into that airway.

Mark: And this is where you start turning off any colour and things like that.

Louise: Absolutely.

Mark: Yeah.

Louise: That's why when you see the chain that we use as to what we do, that's why it's in the order that it's in.

Mark: Right, okay, because you've got to establish what kind of choking that you've got involved here.

Could It Be Anaphylaxis? Why You Should Always Ask "Are You Choking?"

Louise: And the first thing to ask is, are you choking? Because they may look as though they're choking to you, but it might not be. It could be something else. That person will probably know, A, if they've just eaten something or swallowed something. With children, it's different, you know, are you choking? I don't know. it could be that they've swallowed a toy, for example, something else, a pebble. I had one youngster who'd swallowed a pebble. So it can be lots of different things. But when it comes to adults in particular, always ask if they're choking. It could be something else. It could be anaphylaxis. It could be that their first reaction in anaphylaxis is that their throat.

Mark: Yeah, because the body does automatic things, doesn't it, which tries to protect itself.

Louise: Absolutely.

Mark: Which aren't always the best thing for you.

Louise: Yeah, absolutely. And anaphylaxis is exactly that. It's a huge amount of histamines going to the area and having a massive Benny, basically, going into hyperdrive. And as a result, it causes death if it's not treated quickly enough. but it can be mistaken for choking. People who have anaphylaxis may have many different situations and their body may react in many different ways. It's not just closing of the throat. That can be the end stage, it can also be the first stage for some people. Those who have the most horrific type of anaphylaxis where their first reaction is that their throat closes, you know, obviously it's exceptionally time critical, as is this. So always ask them if they're choking. First question. And it will tell you whether they can talk or not as well. Which again, that will determine whether it's partial or full choking.

Mark: If it's full choking, they can't talk.

Louise: No, absolutely.

Mark: Because the air that you need to talk doesn't come up.

When to Encourage Coughing and When to Intervene

Louise: Yeah. If somebody's choking, ask them if they're choking. If they can cough, talk or breathe, then it's very simple. Encourage them to cough. At all times, coughing, their own reflex of coughing is better than your intervention. whilst it's partial. It's only if it becomes full that you need to go on to the next stage. So never start giving back blows to somebody if they're partially blocked. Chances are you'll just make them fully blocked. What I advise is that if you can get them, and obviously they are in panic situation as much as you are, if there's any way that they can take a slow, stable breath down into their lungs and then cough, a sort of type, you know, sort of belly cough, then that's great. But to be honest, they're in panic mode at this point. Or they may freeze, fight and flight. Whether you can get it again, if you tell them to take a sharp intake, chances are they're going to get fully blocked. So just ask them to cough, keep coughing.

Mark: Yeah, because the coughing I've seen just pushes air up really quickly back through the system.

Louise: Yeah. It just increases the pressure behind the blockage and pushes it upwards. It's effectively doing the same as if you were doing the abdominal thrusts, but their body doing it is much better than your body externally doing it.

Mark: We're going to talk about abdominal thrusts in a little while.

Louise: Yeah.

Mark: And also during our myth busting bit at the end as well. Indeed. So we've established, you know, it's one type of choking or the other, it's a partial blockage or a full blockage. What happens when you've established, yes, this is now a full blockage and they can't cough anymore?

How to Perform Back Blows Correctly

Louise: Yeah, so full blockage, they can't cough, they can't breathe and they can't speak. And you will literally see their lungs trying to force outwards, their rib cage trying to come out and it won't. It's as simple as that because they've got this blockage here. This is exceptionally time sensitive, obviously, because at this point no oxygen is getting into their system at all. they can't make any sound, it's completely silent, which is why we then need to escalate. Obviously they can't cough, therefore that's out the window now. The only thing that you can do are five back blows first. So it's centre of the back, 5 back blows. in between the two scapula, so in between your two shoulder blades, right in the centre, 5 back blows as hard as you can, using the ball of your hand.

Mark: The ball of your hand, that's what I was thinking. Yeah. That's where the strength is in your hand, isn't it?

Louise: Absolutely, yeah, because you're trying to use the strength from your shoulder and your elbow as hard as you can. Your other hand goes round the front of them to hold them in place.

Mark: So you're not pushing them away?

Louise: Exactly. Otherwise, all you do is hit them not very hard and they'll just fall forwards. You need something, whether it's your hand or against a table or something, to hold them upright in order for you to give those back blows. Whatever works in the front.

Mark: Five back blows.

Louise: Five back blows. Each time, have a look, see if it's popped out. It could be that one back blow and it's popped out. So make sure you check each time. You will probably notice because they'll suddenly take that big intake.

Mark: And you'll hear that breath, won't you? Because of the panic state they'll probably be in.

Louise: Yeah, absolutely. So keep checking each time. Do that five times. Once you've done that, if it hasn't come out, then it's the abdominal thrust.

How to Perform Abdominal Thrusts (The Heimlich Manoeuvre)

Mark: Okay. Which is what people call the Heimlich manoeuvre.

Louise: Yes.

Mark: But. It's actually an abdominal thrust.

Louise: Yeah, the true term for it is abdominal thrust.

Mark: Okay.

Louise: And the reason we call it that is because that's exactly what you do. So you go round the back of somebody, both your arms round their middle, and you are aiming just underneath the rib cage.

Mark: Right, that was my next thing about, you know, where do you position your hands? So yeah, so that's why it's abdomen and not chest.

Louise: Exactly. Yeah. So you're just going underneath. What you're trying to do is reach that huge bit of diaphragm, you know, that big muscle that we talk about. Yeah, that's what you want to.

Mark: The bit that actually draws the breath in and pushes the breath out again.

Louise: Yeah. So you pushing your hands into that area, what you're doing is the other organs that are there will then push up against the diaphragm. You can't get to the diaphragm, it's under the rib cage. But you can push other organs onto it, which causes a massive reaction from the diaphragm, huge amount of pressure in those lungs, which hopefully, when you hit, that will help to knock it out. You do that five times.

Mark: Okay, five times again.

Louise: Yeah, five times, each time, take your head around, have a look, see if you can see it's come out. If that doesn't work, it's back to 5 back blows. It's just five, then five, 5, then five.

Mark: And do you do this as hard as you can or as hard as you feel is safe?

Louise: As hard as you can.

Mark: Literally as hard as you can.

Louise: Yeah. Bearing in mind, you've got your hands around somebody's middle. So it's not like you're hitting somebody. It's not like punching someone where you've got all the force of your shoulder and so on. You've already got your arms around them, you're holding on to them and you hit and it's a sort of in and up. It's like a swinging mode.

Mark: So you're sort of pushing everything up.

Louise: Yes.

Mark: In a way, into the lungs.

Louise: You go in first and then upwards.

Mark: Right, okay.

Louise: And by doing that, you're pushing those organs at the bottom and create pressure in the lungs to push out the blockage. Your diaphragm's an amazing piece of kit. When you think of just having the hiccups, it's just a spasm in the diaphragm.

Mark: Oh, that's annoying.

Louise: I know, but how powerful that is when?

Mark: You do a hiccup. Yeah, incredibly powerful. I mean, you can get almost like an ache, can't you?

Louise: Exactly. Absolutely. But that's your diaphragm working. It's a heavy piece of kit and it's there for a purpose. So when you hit on it, it's going to have a violent reaction, which causes this massive pressure and pushes everything upwards up the airway and hopefully behind the blockage to knock that blockage out. It may be that you need to do those five abdominal thrusts and then when you turn around and give another back blow, that might be the next one to hoik it out.

Mark: Right, okay.

Louise: But always look, whether it's back blows, every time, or abdominal thrusts, every time. Check to see if it's come out. You might not realise. And just keep going doing that.

When Should You Call 999 During a Choking Incident?

Mark: One of the questions I wanted to ask you about this is, and we talk about this all the time in this podcast, about at what point you call the emergency services. Now, we were discussing this before we started this. And as you rightly pointed out, I think I worked out really. By the time the ambulance turns up, it's either too late or it's all the situation has resolved itself to a certain extent.

Louise: Yeah, paramedics tend to say that they never go to a choking and they're absolutely right. And that's why it didn't come up on our list of when we sat down before we started these podcasts and went, right, think of the things that come through A&E, what's the most likely to come through? And that's what we'll start talking about.

Mark: How many years in A&E did you do?

Louise: In total, about 15, 16.

Mark: Yeah, so this is where Louise comes from. It's the reason why we talk about this. It's because these are the things that came through the door when you worked in London in the A&E and the most common ailments basically. So this is why. But of course choking didn't come through the door because by the time they get to A&E, you're dealing with the aftermath of the choking incident, aren't you? Exactly.

Louise: The times when I've dealt with somebody who initially had been choking has been in intensive care more than anything. And that's because they've had hypoxic brain injury. So the brain hasn't had enough oxygen. They were having CPR and still they didn't manage to get enough oxygen to the brain. That tends to be, unfortunately, generally the prognosis isn't great if they're with us for that reason. And certainly the quality of life has changed permanently for that person. And that tends to be when it's choking related, but certainly not during abdominal thrusts, back blows or any of the initial stages of choking. And the same with paramedics, it's either that it's got out, somebody's been there and got it out for them, or that they're doing CPR and that's the moment when they walk in. It's so time critical, you've got two minutes and that person's probably on the floor unresponsive, in which case you treat it as an unresponsive, non-breathing person. It's basic life support, airway, breathing, CPR.

Do You Need Medical Attention After Abdominal Thrusts?

Mark: So if there's been a severe choking incident, you know, where the airway was completely blocked and you've managed to remove the blockage, should the person still have some sort of medical check over?

Louise: Absolutely.

Mark: Yeah.

Louise: Yes. Any abdominal thrusts, then they need to seek medical help. If you're doing abdominal thrusts and there's somebody else around to make the call, make the call then to the paramedics. If you're on your own, as soon as they become unresponsive, that's the time to make that call, because obviously you're too busy doing it to make the call before that. but the first opportunity you've got or somebody else has got, make that call.

Mark: So if it's gone as far as abdominal thrusts, you're looking at, they will need to be checked over afterwards if you can remove the blockage.

Louise: Yeah, I mean, what you can do, because you're doing abdominal thrusts, you can get a little tear in the peritoneum. So it's a bit like having a hernia, basically. When somebody's got a hernia, they've got a tear in the peritoneum and a little bit's poking out, so to speak, instead of sitting where it's supposed to. It's a similar concept. So because you're doing abdominal thrusts, you're hitting against this area and you can get a little tear. All that happens is that they just need an ultrasound checking over. Let's see. They heal on their own. I've never heard of anybody going further than that. Again, you've got to remember we have the Sarah Act. It's the Heroism Act that keeps us in Social Responsibility Act, which means that you are safe if you are doing abdominal thrusts because somebody's choking, you're not going to get sued for it.

Mark: Yeah, we talked about this in the CPR episode as well, didn't we? That you know, you're not going to get sued for trying to save someone's life. That's the long and the short of it.

Louise: We do talk a lot about scope of practice and should you do something if you're not trained to do it, actually just get on and do it. This is a life-saving situation. It doesn't matter.

Mark: You're not going to get a second option to have a discussion about it, are you?

Louise: Exactly. Yeah.

Mark: So obviously adults is one thing, they can take a lot of the punishment that you're going to mete out. We talked about this again with CPR and it's the same with doing the abdominal thrust as well because you're using an awful lot of power there and you can cause a little bit of damage to an adult. What do we do with youngsters and children, you know, and babies basically.

Choking in Children and Babies: What You Need to Know

Louise: Yeah, well, choking still is the biggest killer in children.

Mark: Is it really? I didn't know that.

Louise: Yep, still is. Has been for many years and that hasn't changed. At the end of the day, children shouldn't die. It's as simple as that. They've just arrived on the planet. They really shouldn't die. Unless there's a congenital condition, something underlying that causes them to pass away. Children just don't die.

Mark: We talked about this again before, we were having a discussion before we started recording. And I'm saying that the incredible thing about the human body is it doesn't want to die and it'll do anything not to die, won't it?

Louise: Yeah, absolutely. It didn't kill itself.

Mark: Yes. And if it's a brand new human body, even less so.

Louise: Yeah, absolutely. Children aren't supposed to pass away for any reason internally. If we have children that have died, it's usually because of something external as a rule. Hit by a car, for example, choked or infection related, something along those lines.

Mark: Choking, as you say, is the biggest killer of children in the country. So what do we do when this starts to happen? And it always scares me when my grandchildren come to stay and stuff like that. You know, what would I do? What would I do?

Louise: One of the main things is prevention, obviously.

Mark: Stop them talking while they're eating. Eat with your mouth closed, child.

Louise: All the disgusting things that kids do while they're eating. Tell them to stop it.

Mark: Don't eat it like a lollipop was the thing my dad used to say.

Louise: Yeah, that brings back memories. Yeah. Absolutely. Prevention is always the best thing to do. However, that's not always possible, as we know. And kids pick up all sorts of things. It's not just food with children. Like I said, there was a baby that I dealt with years ago, and it was a pebble that she'd picked up. It was on her blankie in the garden. She picked it up and stuck it in her mouth and choked on that. You know, toys in particular. And kids are classic for sticking peas and things like that.

Mark: Lego, I think, is one of those things, isn't it?

Louise: Lego's always a good one. Yeah. But generally, it tends to be that they've swallowed something. It could be a toy, it could be anything. So really it's having a look in the surrounding area. If it's a child that can't tell you what they've swallowed to work out what it is that's gone down there. But it is different when it comes to children and babies as to what we do. With children, it's pretty much the same. If you can get them over your knee to do the back blows, then great.

Mark: Right, yeah.

How to Help a Choking Baby Under 12 Months

Louise: Gravity is a great thing with children that you can't do with an adult. So if they're small enough to go over your knee and hold their head down as you're hitting their back, then that's great. The abdominal thrusts are the same though. There's no difference in that. The difference is babies under the year of, under the age of 1.

Mark: Right, okay. So they're still developing the bones and so on and so forth.

Louise: Yeah, they're completely different. What you can't do, I mean, you still do the back blows the same, pop them on the knee. You need to get, because remember when we talked about paediatrics, children have to be flat. If their head is backwards in the head tilt chin lift, then their airway gets blocked, right? So they need to be flat. The only way to do that is to put them across your arm, OK, or on your knee with your hand underneath their chin to make sure that their back and their head.

Mark: Okay, yeah, so it needs to be completely straight.

Louise: Yeah, absolutely. Once you've got them in that position, facing downwards so that you've got gravity again, then it's 5 back blows, centre of the back, same place. Once you've done that, you then turn them over, still on either your arm or your knee. and you do a chest thrust. And this is where it's different. So still abdominal thrust in that sense, but it's a chest thrust and you are thrusting using two fingers onto their chest. One, two, three, 4, 5. Then you turn them over, do the back blows. Hopefully that chest thrust has been enough that it'll just dislodge it slightly. Turn them over, do the back blows and at that it'll pop out. But again, every time you do it, check to see if it's come out. Do 5 back blows, turn them over, 5 chest thrusts, turn them over, 5 back blows, just keep going.

Mark: So the whole winding thing is no good to you at all, really, because obviously they're on your shoulder and that.

Louise: Yeah, we're way beyond that stage.

Mark: It's interesting because you remember talking about CPR with little children, little babies, and you were saying about, you know, it's about the fingers, not about using the whole hand and stuff like that. It's the same thing with the abdominal thrusts as well.

Louise: Yeah. Absolutely. Keep going. If that doesn't work, then you're down to CPR, in which case it's the thumb encircling technique.

Mark: Yeah, we talked about this in the CPR episode, didn't we?

Louise: Yeah, absolutely. Well, the CPR episode was actually before the new guidelines. We did it in the new guidelines.

Mark: Yeah. Oh, yes, of course we did. Sorry.

Louise: So we go hands around, two thumbs into the centre of the chest and push down.

Mark: And with the CPR, you're really just keeping oxygen going through the system, aren't you?

Louise: Yeah.

Mark: It's a holding pattern.

Louise: You are just getting oxygen up to the brain. That's all you can do. You're just moving the blood up to the brain, keep the brain alive.

Mark: 999.

Louise: Absolutely.

Mark: Yeah.

Louise: The sooner you can phone it, especially if it's a child that's choking, the sooner you can make that call, the better.

Step-by-Step: What to Do in a Choking Emergency

Mark: Yeah. Okay, very quickly, something that people can have in their head. Let's have a little, the order that things need to be done.

Louise: Yes.

Mark: So give me a quick rundown of an order of things that need to be done here.

Louise: Okay, so firstly, act fast. At the end of the day, delays cost lives, end of. So act fast, call early as well. 999 must be activated as soon as somebody becomes unresponsive. However, I would say if there's another person there to make the call, you're doing abdominal or chest thrusts, that's the time to call. and do something, back blows, thrusts, CPR. Action is better than hesitation. You will know if somebody's choking, you really will. When it's full choking, they go bright red and then they go... white, literally. They will go blue very quickly, especially with children. Remember in other sessions with talking about children, children lose their oxygen in their blood immediately. So they will go blue instantly, very, very quick, which means there's no oxygen going up into their brain. So you need to act fast. So do something, back blows, thrusts, CPR, action is better than hesitation. And anyone can save a life. You don't need to be medically trained to do this at all. You don't need to do any training. Training on what to do when someone is chocking is always the best thing to do. But if you're walking down the street and suddenly a child starts choking and nobody's acting on it, then go in and do something. You know, even if just listening to this, you go and do the back blows. You go around the front and start having a go at your abdominal thrust. If somebody else who's more competent comes along and takes over from you, fantastic. Let them do it. That's not a problem. But something is better than nothing every time. And get that help to you as fast as possible. If in doubt, make the call.

Mark: Yeah, just like we've said before, you can't do anything bad in this situation, can you?

Louise: These are life-saving techniques. It's end of.

Mark: Yeah.

The Golden Rule: Always Call 999 — You Can Cancel, But You Can't Undo a Delay

Louise: You know, it's this or the person dies. So from that point of view, no. But what I would say is, always make that call. At the end of the day, you can always cancel a paramedic coming to you. Can cancel an ambulance, but you can't do anything about the fact that you've hesitated for three minutes before making the call, and therefore they're going to be 3 minutes longer than you want them there. You want them there as fast as possible. And if necessary, just say, oh, it's out and he's absolutely fine. Didn't do an abdominal thrust. He's a happy man. The ambulance crew will say, right, well, can I speak to whoever and they'll have a chat to him. You know, you can cancel any ambulance. Just make the call.

Choking Suction Devices: Are They Safe and Effective?

Mark: So there has been some talk and you talked to me before we, again, before we started, that there is equipment that can be used to help with choking situations. I find that quite weird because you're not going to have the thing in your pocket in all the situations. But is there, you know, is there equipment and if so, what's the situation with it?

Louise: Yes, there is. So there is something called a choking suction device. Now, MHRA at the moment recognise these devices. They are class 1 medical devices. They're legally allowed on the UK market. The manufacturers self-certify them. However, the MHRA does not endorse routine public use of them, mainly due to lack of clinical evidence is what it boils down to. And as a medical professional, I can't endorse that people use them. Having said that, they're not part of the Resus Council guidelines when it comes to choking at all. It is purely cough, back blows, abdominal thrusts and then CPR. However, if you do happen to have one of these devices, then they can be used once all of that has been done, so to speak. Now what they are, it's a mask. At the end of the mask, it's a bit like a toilet plunger at the end of the day. On the end of the mask, you've got a plunger and the whole idea is that you plunge it and it creates a suction inside the mouth and inside the throat. And as a result, it pulls out whatever it is that's choking.

Mark: So the same theory as unblocking a toilet, really.

Louise: Yes, exactly the same.

Mark: Yeah, although I don't like the thought of that, but...

Louise: No, but there you go.

Mark: But it is that same sort of suction cup thing.

Louise: Absolutely. There's a lot of evidence out there to suggest that as the end stage, when everything else has been done, that it can, that it works and that it does produce what you want, which is that they're no longer choking. And as a result, back in 2017, manufacturers were given voluntary restrictions, which means healthcare professionals trained in advanced life support can use them. Patients in moulded wheelchairs they can be used for and situations where emergency services cannot respond is basically what they came out with. Now, I know a lot of nurseries do have them and that's absolutely fine. If they do their risk assessment and find that it is a benefit for them to have one on their premises, then they can have them. There's nothing to say that they can't have them. But again, I would say read the evidence before deciding whether or not to purchase them. Yes, as an end stage, nothing else has worked. This is better than the alternative, which is just chest compressions at that point. You don't know how long the medical professionals are going to get to you, for example. Then by all means, there's no reason why you can't use it. But as things stand at the moment, we cannot legally endorse these devices.

Mark: We thought we'd give them a bit of time and mention them just because they're out there and people have got them in certain situations.

Louise: What I would say as well is be extremely careful. There's a lot of evidence out there. What I would say though, and I know that ILCOR and MHRA, etc. are putting a lot of information out there because there's a lot of counterfeit devices that you can get online. They look the same, they feel the same, they may even have the CE kite marks on. However, they're not the same. They will fall apart, they will not work in situations, etc. So it's very much buyer beware. Make sure that you are buying from a reputable source.

Mark: That was what I was going to say, reputable source and do your research beforehand.

Louise: Yeah.

Choking First Aid Myths Busted: What You Think You Know May Be Wrong

Mark: Okay then. Now I know that you were doing a presentation a little while ago and your question and answer session at the end went on for quite a long time. And it's about, there's a lot of myths around choking. Some of these are very interesting, almost conspiracy theory type things to a certain extent. So shall we start, shall we just go down the list and then you can tell me what you think?

Louise: Go on then. Let's have it.

Mark: Okay.

Louise: I love myths.

Mark: Yeah, well, this one's, we said we were going to talk about the Heimlich. You can't say Heimlich manoeuvre in the UK. True or false?

Louise: Well, you can say it very well then.

Mark: What have I done there? Have I broken the law?

Louise: Yeah. Can you say Heimlich manoeuvre in the UK? Yes, of course you can. People believe that it was a name that's been copyrighted. It was Dr. Heimlich that came up with the manoeuvre. We use the term abdominal thrusts because it's clearer. It is what it says on the tin, as opposed to Heimlich manoeuvre. It could be Jones's manoeuvre. It could be anything. Doesn't mean anything. Abdominal thrust does.

Mark: Okay. Let's have a look at the next one. A suction device works best. I think we talked about this already.

Louise: Yeah, the answer is no. RCUK in particular warns suction devices may be ineffective and delay proven treatments. Do the treatments first. Back blows, abdominal thrust, CPR. If after CPR you have one of these devices, then you can start looking at using one of these devices, but you do not use it as a front line. Use that first.

Mark: Okay, tilt your head back for a nosebleed or you'll choke. True or false?

Louise: No, firstly, lean forwards, not backwards. If you lean forwards, it doesn't go down there. It's great. No, always lean forwards. No, you won't choke, but yes, some of that blood is going to go down both pipes, potentially. So you're either going to sick it back up or it'll go into your lungs, which both are not what you want. Lean forwards.

Mark: You can swallow your tongue during a seizure. True or false?

Louise: False. No, you can't. You can't swallow your tongue. Your tongue is a muscle that sits in your mouth, as you know. It's the only muscle in the body that's only attached at one end. So because of that, it will flop, unlike your other muscles. They don't go floppy in the same way. They're still attached at 2 ends. This one's only attached at one end and as a result, it will fall backwards and that's how it blocks your airway. However, as soon as you do the head tilt chin lift or put somebody in the recovery position, depending on what you're needing to do, the airway will open.

Mark: Because the tongue will get out of the way. By the way, I'll say true or false to all these, they're all false. I'll tell you that at the start. CPR restarts the heart during choking. True or false?

Louise: False. CPR is there to circulate the oxygen up to the brain. That is the point of doing CPR. It moves the oxygen that you've already got in your system up to the brain, or around the body and up to the brain is where you need it.

Mark: Bend forward if you feel faint or you'll choke. True or false?

Louise: No, if you feel faint, then lie down, lift your legs up. Face is pale, raise the tail. Lie down, lift your legs up. If somebody becomes unresponsive, then you don't want them on their back. Put them in the recovery position. But as long as they've come round as soon as they faint, or they feel faint, then lie them down, lift their legs up.

Mark: This is one of Louise's mantras, isn't it? The face is pale, raise the tail. If you've listened to the podcast, you'll know exactly that one. You probably said it with her at the time. Give food or drink to help someone swallow. True or false?

Louise: No. Firstly, if it's choking, then if you give them something to eat or drink, it's just going to sit on top of whatever they've already choked on. So no.

Mark: It's going to make the situation worse, basically.

Louise: Absolutely, yes. It's not going to help it go down further.

Mark: And this is the last one we've got, although there has been others, but these are the ones we've got. The ambulance will arrive instantly. So don't intervene, true or false.

Louise: Absolutely false. As I've said from day one, those first 5 to 10 minutes are everything in how this outcome is going to be every time. Immediate first aid saves lives. Paramedics are there as the end of the chain of survival, not the beginning. You are the beginning of the chain of survival. You do nothing. Paramedics can't do a whole lot by the time they get there. You have to start, initiate first aid immediately.

Mark: And we've said this on virtually everything we've ever talked about on the podcast. It is about if you're in any doubt whatsoever, it's certainly in the UK, call 999, call the emergency services. As you say, you can cancel if you need to, but you can't cancel the event if you don't.

Louise: Exactly.

Mark: Louise, that's been fantastic. Choking a really interesting subject. I didn't really, I didn't know the statistic about babies. That is quite frightening really.

Louise: Children, yeah. Biggest killer.

Mark: If anybody wants to get in contact with you about what we've talked about or anything at all that we talk about on the podcast, what's the best way to do that?

Louise: You can contact me through my website, which is madeleysfirstaidplus.co.uk, or you can e-mail me on enquiries@madeleysfirstaidplus.co.uk.

Mark: OK, that is brilliant. If you want to see what Louise does in her real life when she's not behind the microphone, then go onto the Madeley's First Aid Plus website and all the details are on there. And people certainly can book onto courses through that way as well, can't they?

Louise: Yes, what we've done at the moment is I've got a WhatsApp icon there. Click on there, tell me what it is you need and I will get straight back to you.

Mark: There we go. That's all you need to do. Dead easy, dead easy. So we'll be back next month with another First Aid Unboxed. And what we're going to be talking about next time, Louise.

Louise: Head injuries and concussion.

Mark: So, you know, information on that for you as well. Like we always do, we're trying to demystify every day first aid for you here on First Aid Unboxed. Thank you very much, Louise. Lovely talking to you and we will speak to you very soon.

Louise: Absolutely. Take care.

Mark: This is a 1386 audio production.