For an adult who can't cough, speak or breathe (American Red Cross, MedlinePlus): 1. Have someone call 911. 2. Give 5 back blows: lean the person forward and strike firmly between the shoulder blades with the heel of your hand. 3. Give 5 abdominal thrusts: put your fist just above the navel, cover it with your other hand, and pull inward and upward. 4. Repeat 5 and 5 until the object comes out or the person can cough, speak or breathe. 5. If the person becomes unresponsive, lower them to the floor and start CPR. Look in the mouth before giving breaths, and remove an object only if you can see it. Never do a blind finger sweep.
If the person is coughing forcefully, let them cough and stay with them (MedlinePlus).
In a wheelchair: kneel behind the chair and give abdominal thrusts. If that's difficult, use chest thrusts, and remove the armrests if needed (Red Cross).
Too large to reach around: use chest thrusts (Red Cross).
Afterward: everyone who choked should see a healthcare provider afterward (Red Cross BLS card).
Here's what the evidence says:
FDA: In a September 18, 2025 warning letter to LifeVac LLC, the FDA said the safety and effectiveness of over-the-counter anti-choking devices haven't been established, and that using one could delay proven first aid.
Cadaver study (2023, PMC10278115): The devices removed some food types but not others, and caused airway pressure or injury in testing.
A 2-year prospective report (Resuscitation Plus, 2023): In 151 of 157 reported cases, the device was the last thing used before the airway cleared. Most rescuers had already tried back blows or other basic life support first, and the data is reported by users, not from controlled trials.
Our view: A device is at most a backup after back blows and thrusts fail. It's never a replacement for learning them. If you buy one, keep it where meals happen and make sure every caregiver has practiced with it.
If your parent coughs or clears their throat often during meals, ask their doctor about a swallowing evaluation with a speech-language pathologist, who can recommend food textures and eating strategies that fit them.
American Red Cross, Adult & Child Choking: https://www.redcross.org/take-a-class/resources/learn-first-aid/adult-child-choking
Red Cross Guidelines, Foreign Body Airway Obstruction: https://guidelines.redcross.org/guidelines-database/foreign-body-airway-obstruction/
MedlinePlus, Choking, adult or child over 1 year: https://medlineplus.gov/ency/article/000049.htm
FDA warning letter, LifeVac LLC, 09/18/2025: https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/lifevac-llc-713455-09182025
Cadaver study: https://pmc.ncbi.nlm.nih.gov/articles/PMC10278115/
Prospective evaluation: https://doi.org/10.1016/j.resplu.2023.100496
Not medical advice. Take a hands-on first aid/CPR class. Affiliate disclosure: we may earn a commission on purchases through links on this page.
Photo: Traditional Vegetable Soup from Argentina.jpg by Horacio Cambeiro, CC BY-SA 3.0, via Wikimedia Commons (cropped/resized).
