The Resuscitation Council UK has updated its guidance on the management of choking in elderly patients, following a review of evidence on the relative effectiveness of back blows and abdominal thrusts (the Heimlich manoeuvre) in this population group. The updated guidance introduces important modifications for first aiders working with elderly patients, particularly those with osteoporosis or other conditions that increase the risk of rib fractures.
The Updated Guidance
The RCUK's updated guidance for choking in adults remains broadly consistent with previous recommendations: five back blows followed by five abdominal thrusts, repeated until the obstruction is cleared or the patient becomes unconscious. However, the updated guidance introduces specific modifications for elderly patients:
- Back blows should be delivered with reduced force in patients who are frail or have known osteoporosis, as forceful back blows can cause vertebral fractures
- Abdominal thrusts should be delivered with caution in patients with recent abdominal surgery or known abdominal aortic aneurysm
- For patients who cannot stand or are wheelchair users, modified positioning techniques are described in detail
- If abdominal thrusts are contraindicated, chest thrusts may be used as an alternative
Why This Matters for First Aid Trainers
The updated guidance has direct implications for first aid training programmes, particularly those delivered in care homes, hospitals, and community settings where elderly patients are the primary client group. Trainers should review their training materials and ensure that the modifications for elderly patients are clearly communicated and practised.