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Choking continues to demand attention as one of the leading causes of accidental death across the world.

A danger at all ages, choking deaths are most common in the elderly. The Office for National Safety (also known as the ONS) have released figures showing that around 350 people die each year from choking, and that figure is continuing to rise. Considering this and the fact that we have a rapidly growing age segment of those 65 years and over, choking death rates are likely to rise in the both the near term and for decades to come. There are a number of reasons which put the elderly more at risk, including having less teeth in their mouth to chew food, as well as having less moisture in the mouth, which makes food less likely to be swallowed easily. ONS statistics show that in 2018, nearly double the amount of people died from choking aged 65 or over compared to their younger counterparts.

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

The British Medical Journal conducted a study in 2016 using data from the London Ambulance Service and in that year alone, there were 1916 incidences in London which required emergency assessment. This averages out at just over 5 per day, and one of the major conclusions of the study states that “Choking is more frequent at the extremes of age, with a higher incidence at lunch and dinner time”.

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 Manoeuvre 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.

From this point on, it was considered that the Heinrich manoeuvre was the best way to deal with a choking situation.

There had 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.