News – February 3, 2011
New choking response guidelines –
information for Water Safety Instructors
As part of our Red Cross Swim program revision, the choking response procedure has been updated to reflect
the 2010 treatment guidelines from the International Liaison Committee on Resuscitation (ILCOR).
ILCOR’s scientific research assists us in the creation of our response guidelines for choking and also provides
the rationale for teaching rescue breathing to swimmers in our Red Cross Swim programs. The science indicates
that performing rescue breaths is the appropriate response protocol for situations where there is an absence of
oxygen resulting from submersion. As rescues in the Red Cross Swim programs are focused on the aquatic
environment, rescue breathing remains an integral part of our water safety skills and knowledge.
The revised choking response procedure includes both abdominal thrusts and back blows for a conscious
choking adult or child, in contrast to the 2005 procedure which performs only abdominal thrusts. Scientific
evidence has shown that a combination of techniques is most effective in relieving obstructions.
The choking response procedure is taught in Red Cross Swim Kids 7 and the water safety instructor provides a
demonstration to caregivers in Red Cross Swim Preschool, Starfish and Duck levels.
Choking response procedures were introduced into the AquaQuest program in 1995. Rescue breathing has
been included in all versions of our swimming and water safety programs: Red Cross Learn to Swim; Colours;
AquaQuest; and Red Cross Swim.
2010 Performance Criteria – RCSK 7
2005 Performance Criteria – RCSK 7
CHOKING RESCUE, MILD AND SEVERE AIRWAY
OBSTRUCTION, CONSCIOUS PERSON
„ Recognizes person with airway obstruction
CHOKING RESCUE, MILD AND SEVERE AIRWAY
OBSTRUCTION, CONSCIOUS PERSON
„ Shows universal sign for choking: clasping both
hands at throat
„ Determines whether blockage is mild or severe
by asking the person “Are you choking?”
„ Encourages person to stay calm and continue
coughing
„ Describes why it is important to stay with the
person and call for help
„ If severe blockage, calls for help and:
1. Stands behind person and wraps arms around
waist;
2. Makes fist with one hand and places thumb
side of fist on middle of abdomen, slightly
above navel;
3. Grasps fist with other hand and gives quick,
inward and upward thrusts; and
4. Continues giving abdominal thrusts until the
object is forced out, the person starts to
breathe or cough forcefully, and/or the person
becomes unconscious.
Check:
„
„
Checks the scene for danger
If it is safe to do so, checks the person
Call:
„
Shouts for help
Care:
1. Determines if choking is mild or severe by
asking “Are you choking?” If the person can
speak, cough, or breathe, it is mild choking.
2. Encourages the person to continue coughing
and does not interfere. The obstruction might
clear itself.
3. If the person is unable to speak or breathe or
has wheezing breathing, it is severe choking.
Stands (or kneels for a small child) behind
the person and wraps one arm diagonally
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2010 Performance Criteria – RCSK 7
2005 Performance Criteria – RCSK 7
across the person’s chest. Bends the person
forward at the waist until the person's upper
airway is at least parallel to the ground, and
with the heel of the other hand, delivers 5
back blows between the shoulder blades.
4. If the object still has not dislodged, makes a
fist and places it just above the person’s belly
button.
5. Places other hand over the fist and pulls
sharply in and up, doing 5 abdominal thrusts.
6. Continues the cycle of 5 back blows and 5
abdominal thrusts until the object comes out
or the person becomes unconscious.
In many countries, the combination of back blows and abdominal thrusts has been used since the 2005
guidelines. In North America, using only abdominal thrusts was decided upon as it was easier for the lay rescuer
to remember, not due to supporting evidence. Evidence now supports the combination of techniques as more
successful than using only one method.
Canadian Red Cross and the other national first aid training agencies (St. John Ambulance, Lifesaving Society
and Canadian Ski Patrol), share a common goal to provide the most up to date, effective first aid and
resuscitation training to Canadians who provide care to an ill or injured person. We have issued a joint
communication to demonstrate our commitment to the health and safety of Canadians as well as inter-agency
collaboration. All four agencies are adopting the revised choking response guidelines outlined above and are
working on incorporating these into our respective programs.
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