Why YSK:
Despite choking being an emergency, until recently there has been limited high-quality evidence to guide bystanders on the most effective way to help. Techniques like abdominal thrusts (formerly known as the Heimlich maneuver), back blows and chest compressions or thrusts have existed since the mid-1900s but, until recently, recommendations were largely based on case reports rather than rigorous scientific data. This evidence gap is dangerous.
Bystander response is the primary driver of a choking person’s outcome, so ensuring people know the safest and most effective way to care for a choking person can save lives.
Please see the article for the full piece, it’s not long.
Article authors:
- Cody Dunne - Emergency Medicine Physician and PhD Candidate, University of Calgary
- Andrew McRae - Associate Professor, Departments of Emergency Medicine and Community Health Sciences, University of Calgary
- Khara Sauro - Associate professor, Cumming School of Medicine, Department of Surgery, University of Calgary
If you need more motivation to open the article, here is an interesting fact:
New research suggests back blows cleared choking obstructions in 72 per cent of cases, superior to both abdominal thrusts (59 per cent) and chest thrusts (27 per cent).


Interesting because all of my first aid instructions say not to slap people on the back. Why should I believe this over instructors and doctors?
I recently took a first air course. I was told abdominal thrusts were the first course of action. If the person is obese and you can’t get your arms around them, you should try back blows first. You have the person bend over and give them hard palm strikes in the back, not slaps. If you still can’t get the obstruction out, the last option is chest compressions, but that’s likely to break ribs in the process.
Chest compressions is for when the heart stops, and actually won’t do anything for choking. Abdominal thrusts, where you put pressure on the diaphragm (not the ribs) is for choking. Also, if you do chest compressions for a stopped heart, you’re going to break a few ribs. Unless you’re doing it wrong.
You can read the wikipedia about the abdominal thrusts that another comment linked. There’s a line in there about heimlich not being ‘scientific’ in his pushing of the abdominal thrusts and denigration of back blows.
The sources for this are also instructors and doctors, OP listed them. It sounds like this is new research and best prescribes may be in the process of changing if further research bears these findings out.