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Performing the Heimlich Manoeuvre

Introduction
This article was originally sourced from Learn2 network in 1997 (with their permission of cos!) when it was still a free service. It is not free anymore though, what a pity... but at least this article still remains to see the light of day! Enjoy! Do check out their site at http://www.learn2.com

Take a deep breath...

There's never a warning before a person gets an object caught in their throat and starts choking--it's a surprise to the victim and bystanders alike. And make no mistake: choking is a life-threatening situation, and requires some quick thinking and acting by the bystander (who's now a lifesaver). As with any emergency situation, prior preparation on your part will enable you to think clearly and take the right course of action. Fortunately, there are effective techniques to deal with this emergency.

The Heimlich manoeuvre is the most effective way to remove something stuck in an adult's or older child's throat. (Note: another technique is used for small child and infants.) It isn't difficult, it doesn't require great strength or intelligence, and you could save a person's life with it. Since you'll also learn two techniques that you can perform on yourself, the life you save may be your own.

Before you begin...

Although the Heimlich manoeuvre is simple and effective, it can be painful for and even injurious to the victim. It's something to be reserved for genuine emergencies, and should be performed only when the situation meets the following guidelines:

1. The person cannot talk, cough or breathe. (If the person is coughing, they're not choking, so don't perform it.)
   
2. The person nods yes to the question, "Are you choking?"
   
3. The person is unconscious and your attempts to breathe for them are blocked.
   

You'll also need to consider the age of the victim. Performing the Heimlich manoeuvre on small children or infants can do more harm than good, so follow the guidelines for the different age groups. And a final consideration: people come in all shapes and sizes. The force applied to a person's abdomen must be sufficient to dislodge an object, but it's appropriate to adjust the strength of the thrust depending on the body type. Use a bit less force with a skinny ten-year-old than with a heavyset forty-year-old.

Since the Heimlich manoeuvre can be traumatic for the victim, you can't practice the full manoeuvre on another person to prepare for the real event. But you can and should practice the handholds, the stance, and finding the proper location to thrust. Practicing these will prevent you from panicking in an emergency. But remember, never perform the full technique except on a choking victim.

Method 1: Perform it on a conscious person

1. Stand close behind the victim with your thigh between their legs. Some experts recommend that you stand sideways behind the victim (with your hip at a 90 degree angle to the victim's back). This enables you to brace your hip against their lower back or buttocks.
   
   
2. Make a fist with one hand, and place it thumb-first against the person's abdomen, an inch (about 3 cm) above the belly button.
   
   
3. Cover that fist with your other hand. Keeping your elbows out, sharply and quickly pull your fist inwards and upwards.
   
4. Be sure to perform this motion with sufficient force to dislodge the object; it often must be repeated up to six times. If the object remains stuck, lie the person on their back, and continue as if the person were unconscious (see Method 2). If someone else is present, have them call 911. (991 in Malaysia) If you're alone, proceed directly to Method 2.

Method 2: Perform it on a unconscious person

1. Lower the person to the floor and onto their back. If another person is present, have them call 911. (991 in Malaysia)
   
2. Open their mouth and try to see the object.
   
3. Sweep your hooked finger across the back of their throat. Remove the object if you find it.
   
4. Straddle the person's thighs. This will put you in the correct position to do the thrust.
   
5. Place the heel of your hand over the person's abdomen just above their belly button, and cover that hand with your other one.
   
6. Keeping both arms straight, press down and forward into the abdomen with a quick thrust. It may be necessary to repeat this up to four more times.
   
7. If the object hasn't popped out, again sweep your hooked finger across the back of their throat. Remove the object if you find it. Call 911. (991 in Malaysia)
   
8. If the person vomits, turn them on their side to avoid further blockage of the air pipe.

Method 3: Perform first aid for a choking small child or infant

Small children and infants have much more fragile bodies than the rest of us. The two methods below are designed to minimize damage to very young bones and tissue. Go to Step 2 if only if Step 1 is ineffective.

Step 1: The "Over your Lap" method

1. Find a chair and sit on it.
   
2. Place the child/infant face-down across your lap, with their upper torso hanging over the side of your knee.
   
3. Using the heel of your hand, thump the child/infant firmly but gently four times between the shoulder blades. Be especially careful with infants. Increase the amount of force only if a gentle thump doesn't dislodge the object.
   
4. If you haven't dislodged the object with several thumps, call 911. (991 in Malaysia) If the victim is an infant or very small child, go on to Step 2.

Step 2: The "Upside Down by the Ankles" method

1. Hold the victim upside-down by the ankles. You'll need to hold the both ankles in one hand, with your thumb around one leg, your three last fingers around the other leg, and your index finger in between their legs.
   
2. Thump the victim's back between the shoulder blades firmly but gently
   
3. Caution: Don't search blindly in a small child or infant's mouth. You can accidentally push the object further down their throat. (Although you should remove the object if it's readily visible.) If the child vomits, turn their head to the side to keep them from choking further. If the child is unconscious, call 911. (991 in Malaysia)

Method 4: Perform it on yourself

Your first move is to call 911. (991 in Malaysia) Even though you can't speak, most 991 systems can trace you to your address. Leave the phone off the hook and perform one of the methods below. It requires some willpower to administer this painful technique on yourself, but your life may be at stake. You have a bit less than two minutes before you pass out.

Step 1: Use your own hands

1. Make a fist with one hand, and place it thumb-first against your abdomen, just above the belly button.
   
   
2. Cover that fist with your other hand, and pull your fist inwards and upwards sharply, quickly and forcefully. Repeat several times if necessary.

Step 2: Use a sharp-edged object

Use this method if Step 1 doesn't dislodge the object.

1. Locate a straight-backed chair and place it firmly against a wall or angle it in a corner.
   
2. If a chair isn't available, use a sharp counter top, deck railing, staircase railing, or the sharp edge of a table, stove, or piano.
   
3. Run into the object. Attempt to meet it at the spot just above your belly-button. Run at the object repeatedly and with as much force as you can muster until the object is dislodged.

The Heimlich manoeuvre is simple and effective on choking victims when used by itself. If you also know CPR, you'll have another powerful life-saving technique to use on an unconscious person. Your local hospital or city administration offices should be able to provide you with the location of CPR classes near you