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During an emergency situation, the timely resolution of the most life-threatening cause is paramount and choking is certainly one of those instances. Hence, the damage caused by the use of aggressive and forceful compressions, thrusts, and back blows, warrant the collateral injury or damage from these interventions and can be considered irrelevant if the person dies. It is better to prevent death even if the injury has occurred, as the injury is treatable but death is irreversible.

While thousands of lives have been saved due to the Heimlich manoeuvre since its inception in 1975, one thing that becomes apparent after a review of the review of reports is the number of injuries and trauma caused by choking emergency treatment.

Properly performing the Heimlich manoeuvre has a direct effect on the incidence and severity of collateral trauma. Damage often occurs due to the level of treatment needed.

Multiple research groups have done a good job of reviewing the topic of post-Heimlich trauma and the Heimlich manoeuvre or any choking emergency treatment performed on them needs to seek further medical evaluation immediately to ensure that there are no collateral trauma or injuries. This applies especially to those over age 65, as most injuries occurred in this population group.

While complications are typically low, one injury that does occur is a gastric or stomach rupture, which has been cited as one of the more common injuries sustained after the Heimlich procedure and it has a high mortality rate. Contributing factors include individuals being over 65 years of age, or the ingestion of large amounts of food and alcohol. A case study of two individuals experiencing gastric rupture stressed that the improper application and over application of the Heimlich manoeuvre was a significant factor in causing the rupture.

Another injury caused by choking treatment is lacerated liver and a large subscapular hematoma draining into the pelvis. Reports have shown this to be the result of multiple Heimlich manoeuvres, often which failed to dislodge the obstruction in the airway.

Another case study found that the first responder must also show care when performing the Heimlich manoeuvre as one emergency caregiver reported a rotator cuff tear while rendering aid.

Finally, chest thrusts were examined in 323 children who died after receiving CPR of which 80% performed in the hospital and 44% of them had rib fractures, 21% of which were bilateral. As we perform chest thrusts with choking, similar results could occur.