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Choking continues to demand attention as one of the leading causes of accidental death in the United States and the European Union.

A danger at all ages, choking deaths are most common in the elderly. A recent American report showed that between 2007 and 2010, there were more than 2,200 deaths or 550 cases per year, among people aged 65 or older. The incidence of choking is also trending upwards, with the latest findings reporting a 4% increase from 2009 – 2010. Similar percentages are found across Europe.

Considering this and with a rapidly growing age segment of 65 years and over in the US and global populations, choking death rates are likely to rise in the both the near term and for decades to come.

Upper airway foreign body obstructions were examined in 78 forensic autopsies and in a large number of cases, the occluding bolus was non-masticated meat or meat product.

The time to treatment is critical, especially during “penetration syndrome”, which is when a sudden onset of choking and unproductive cough with or without vomiting occurs. Hypoxia, which is a lack of oxygen, of only four to six minutes duration may result in irreversible brain damage. With an ambulance call out time of at least eight minutes, death can occur very quickly.

It has been over 160 years since Dr Samuel Gross published the first significant medical review on airway obstruction. Early choking interventions of this era consisted primarily of back blows, and then in 1975, Dr Henry Heimlich published the paper “A Life-Saving Maneuver to Prevent Food-Choking” in the Journal of the American Medical Association.

The Heimlich manoeuvre was then created, a method that Dr Heimlich invented after noticing that people were dying in restaurants not from heart attacks as suspected, but due to foreign body airway obstructions as revealed by subsequent autopsies. Dr Heimlich died of a heart attack in December 2016, aged 96.

In 1985, Surgeon General C. Everett Koop stated that while many Americans had been taught to treat choking by giving back blows, they must now learn that the best rescue technique in any choking situation is the Heimlich manoeuvre.

There has been some controversy between Dr Heimlich and the American Red Cross (ARC) regarding back blows, with some believing these should be performed before the Heimlich manoeuvre and others stating that this intervention may actually drive a foreign object deeper down the throat. This has resulted in the term “abdominal thrusts” being used in some protocols to describe the Heimlich manoeuvre. Some organisations do not use the term Heimlich manoeuvre, while others continue to do so. In first aid terms, you would follow the guidelines in your country.