Life-Saving Training Blog

 

Recent Advances in Choking Management

by  Bob Elling     Jan 22, 2025
anti-choking devices

The conversation around health and safety is increasingly focusing on the topic of choking emergencies. While manual choking management techniques have stood the test of time, I was curious to explore the latest developments in this area. Typically, the International Liaison Committee on Resuscitation (ILCOR) plays a pivotal role in this field by conducting ongoing evidence evaluations. They periodically publish their consensus on the science and treatment recommendations (CoSTR) for various resuscitation and first aid topics. 

Following the release of the CoSTR, organizations worldwide, such as the American Heart Association (AHA) and the American Red Cross (ARC) in the United States, often update their guidelines accordingly. At the Emergency Care & Safety Institute (ECSI), we align with ILCOR's guidance when creating and revising our educational courses and materials. 

Background on Choking
 Worldwide, despite being preventable, foreign body airway obstruction (FBAO) events are a significant source of injury and mortality. More than 5,000 choking deaths are reported each year in the USA alone. It is also estimated, for each pediatric choking death, another 110 non-fatal events present to EDs.

Prehospital choking management techniques have remained largely unchanged for several decades. The evidence for these techniques was almost entirely case series data leaving uncertainty over which intervention (if any) is superior. 

ILCOR CoSTR
Current ILCOR treatment recommendations, based on weak evidence and a very low certainty of evidence include: 

  • Back slaps, used initially in patients with a FBAO and an ineffective cough. 

  • Abdominal thrusts, used in adults and children with a FBAO and an ineffective cough, where back slaps are ineffective. 

  • Rescuers consider manual extraction of visible items in the mouth. 

  • Suggest against the use of blind finger sweeps in patients with a FBAO. 

  • Appropriately skilled individuals consider the use of Magill forceps to remove FBAO in out of hospital cardiac arrest (OHCA) patients with a FBAO. 

  • Chest thrusts are used in unconscious patients with a FBAO. 

  • Bystanders undertake interventions to support FBAO removal as soon as possible after recognition. 

The ILCOR task force made this statement concerning current “knowledge gaps” needing further study: “There is a need for high-quality observational studies that accurately describe the incidence of FBAO, patient demographics (age, setting, comorbidities, food type, conscious level), full range of interventions delivered, who delivered interventions (health professional/ lay responder), success rates of interventions, harm of interventions, and outcomes.” 

The specific consensus on science on “suction-based airway clearance devices” reveals the following: 

  • For the critical outcome of survival and outcome of relief of FBAO only observational studies were identified.  

  • Overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias.  

  • Individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies were difficult to interpret. 

  • For critical outcome of survival and outcome of relief of FBAO very low certainty of evidence downgraded for very serious risk of bias from one case series study which survival in 10 patients treated with a suction-based airway clearance device were identified. 

The task force also made this statement on “knowledge gaps” needing further study. “There is a need for further evidence on benefits and harms of suction-based airway clearance devices. The task force encourages prospective registration of all device uses. Reports should detail key demographics (e.g. age, setting, comorbidities, food type, conscious level), full range of interventions provided, who provided intervention (lay versus healthcare professional) and outcomes. This evidence may initially come in the form of published case series.” 

Recent Press on Anti-Choking Devices
A press release was sent out on October 23, 2024, titled, “LifeVac© Applauds American Red Cross’ First Major Update to Airway Obstruction Protocols in 47 Years, Now Including Anti-Choking Devices.” The release made a few points: 

  • The last update to airway obstruction protocols occurred in 1976, making this the first significant revision in 47 years.  

  • Based on the findings of the American Red Cross Scientific Advisory Council, an anti-choking device is now part of the recommended guidelines to be used in the event of protocol failure or when traditional methods cannot be administered.  

  • Given these updated guidelines, all individuals and institutions adhering to ARC protocols are advised to equip themselves with an anti-choking device. 

  • The press release goes on to suggest that the LifeVac© should be the device of choice.  

  • This update provides EMS and EMT personnel with advanced tools to save more lives, while also marking a significant step forward for individuals with disabilities, who now have an option in choking emergencies—something that was previously unavailable to this vulnerable group.  

Actually, the ARC guidelines for the management of FBAO (ie; a person who cannot breathe or has an ineffective cough) are unchanged by the current American Red Cross Scientific Advisory Council 2023 review, except for the option to consider using an anti-choking device (negative pressure anti-choking device) if recommended standard interventions have been exhausted and fail to work, or those interventions are not feasible.

Recent Analysis
In 2022, the paper “Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis,” started to highlight the management of FBAO. 

This retrospective study evaluates anti-choking devices (ACD) interventions from 2016 to mid- 2021, globally. This is the first study of a multi-phase global evaluation of ACDs that aims to determine their effectiveness and clarify their role in future choking intervention algorithms. Prior to this paper, most published data was limited to mannequin studies, case reports with few entries, or only focused on a subset of the population. This study included all ACD intervention data available, incorporating all ages from all world regions. 

The following two devices were reviewed in the study, one non-invasive and one minimally invasive due to its intraoral component: 

  • LifeVac LLC produces the non-invasive LifeVac© ACD, which consists of a facemask attached to compressible bellows and a one-way valve. 

  • DeChoker LLC produces the minimally invasive DeChoker© ACD, which is designed with a face mask attached to a cylinder with a plunger. In the face mask is a 3-inch (7.6 cm) tube that is directed into the oropharynx to act as a tongue depressor. The tube also is the passageway for the negative pressure suction and has a diameter of 0.75-inch (1.9 cm). 

Both devices are FDA registered, which does not imply FDA cleared or approved. The analysis of choking events treated with ACDs included data solicited from persons who self-identified to manufacturers as having used an ACD before July 1, 2021. Resolution of choking symptoms was reported for the LifeVac© in 123 events and for the DeChoker© in 60 events. Abdominal thrusts were used as co-interventions in 37.9% of cases with the LifeVac© and in 31.1% with the DeChoker©, while back blows were co-interventions in 39.5% of cases with the LifeVac© and 41% with the DeChoker©. Adverse events that were reported included disconnection of mask or bellows during intervention, one lip laceration and one avulsed tooth. 

The authors concluded that despite the increasing popularity of ACDs, there is not yet sufficient data available in academic literature to fully assess their safety and effectiveness. Non-invasive and minimally invasive ACDs are novel interventions with positive initial findings. The second phase of this study should include a prospective evaluation, independent of manufacturers, that improves data quality and will further determine the devices respective roles in the response of healthcare workers and lay rescuers to a choking person. 

Comparison Between Available ACDs
Both devices have a mask similar to the type on a BVM. The major difference between the DeChoker© and the LifeVac© is that the LifeVac© pushes on the victim’s face during use, while the DeChoker© pulls back and away from the victim’s face. The DeChoker© also utilizes an actual canister where the recovered object goes after it is dislodged, and in addition, has a built-in tongue depressor, making it minimally invasive. 

Adult resuscitation guidelines say to deliver back slaps and abdominal thrusts until the victim goes unconscious and then when no longer conscious start CPR compressions. When in this cycle is the ACD used? The resuscitation guidelines support a legacy standard of care. ACDs are currently designed to be used, by a properly trained rescuer, when current protocol standards have failed.  

I found a helpful article, which includes a number of demonstrations, comparing the two ACDs, at: https://pixoneye.com/dechoker-vs-lifevac/  

A key point is made that neither device is a substitute for professional medical help but rather a helpful substitute while waiting for rescue’s arrival on the scene. Once again remember to call or assign someone to call 9-11 ASAP then do manual FBAO techniques per latest Guidelines and if time and immediately available consider trying an ACD. They also reaffirm that whatever device you choose to purchase requires training per the manufacturer’s instructions and practice for rapid deployment. 

As I see it…for what it’s worth!
There are plenty of studies that have shown EMS providers have difficulty attaining an adequate mask seal using a BVM device when they use one hand to seal the mask. I was a co-author of one such study back in 1983, which has been referenced in many papers and guidelines since first published in the Annals of Emergency Medicine.

As EMS educators we know that sealing a mask is best done by a well-practiced two-handed mask seal combined with the proper jaw thrust technique. We also know that a one-handed mask seal is possible with a lot of practice and the proper hyperextension to open the airway. In the scenario of a potential neck injury, where hyperextension is inappropriate and opening the airway is reliant on jaw thrust technique, this is not accomplished using a one-handed mask seal.

Both of the ACDs discussed involve a one-handed mask seal. The “citizen rescuer” is likely to have very little training with the device, let alone sealing a mask. For this reason, I strongly suggest we initially deploy ILCOR’s FBAO manual techniques. If an ACD is available with a properly trained operator, it only be employed AFTER the current manual methods have been tried.  

To review the current procedures for FBAO: 

  • You suspect an infant is choking:  

  • Confirm obstruction (infant cannot make sounds, breathe, cry, or is cyanotic). 

  • Invert infant on arm (support head by cupping face in hand): perform 5 back slaps and 5 chest thrusts until object is expelled. 

  • Repeat until successful. 

  • If infant becomes unconscious, start CPR chest compressions. 

  • You suspect an adult or child is unresponsive and choking: 

  • Call for help and position patient supine on hard, flat surface. 

  • Perform chest compressions (30:2). 

  • Open airway (head-tilt/chin-lift) look for and remove object if visible. 

  • Attempt to ventilate. If unable…  

  • Reposition head and chin: attempt to ventilate. If unable… 

  • Perform chest compressions (30:2). 

  • Repeat: inspect mouth…remove object…ventilate…chest compressions until successful. 

  • ALS providers, on arrival, should consider laryngoscopy and removal of object by Magill forceps. 

  • Do not attempt blind “finger sweeps” in any age group. 

In places serving food, displaying an easy-to-follow choking poster in an obvious location continues to be an excellent idea. Clearly, as the ILCOR task forces have already identified, more research is needed at this point.  

The Best Solution is Prevention
Keep teaching our kids and sharing useful prevention tips with our friends, family, coworkers, and patients. For example: 

  • Small bites, cut your food, eat slowly, and stop talking while you have food in your mouth. 

  • One formula for choking often includes a stressful heated “discussion” at the dinner table with meat and alcohol! 

  • Patients with chronic disabilities causing difficulty swallowing are at risk of FBAO.  

  • Toddlers explore the world by inserting small items in their mouth. Be especially careful that the 2-year-old does not have access to the older child’s toys which often have removable small parts (choking hazards). 

Summary
In summary, keep the following key points in mind:  

  • There are no current high-quality studies recommending updates to the techniques for treatment of FBAO. Experts do agree that it is a topic worth studying to finally have strong data on the most effective techniques and potential devices to manage FBAO. 

  • Don’t confuse the ACD with the AED!  

  • Before reacting to any new commercial product do your research and discuss with your service medical director before diving right in! 

  • Review the steps for FBAO treatment for infants, children and adults in your next drill and then go home and share this info with your family. 

  • Sharing choking prevention tips with your family, friends and coworkers can only help. 

  • As always stay situationally aware, (especially when eating at restaurants). Watch for the choking victim who heads into the restroom along! 

References/Resources: 

  • Couper K, Abu Hassan A, et al. - on behalf of the ILCOR Basic and Pediatric Life Support Task Forces. Foreign body airway obstruction in Adults and Children Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: ILCOR Basic Life Support Task Force, 2020 Jan 1. Available from: http://ilcor.org 

  • Saperstein D, Pugliesi P, et al. Successful Use of a Novel device called the LifeVac to Resuscitate Choking Victims. International Journal of Clinical Skills. 2018;12. 

  • LifeVac Applauds American Red Cross’ (ARC) First Major Update to Airway Obstruction Protocols in 47 Years, Now Including Anti-Choking Devices, Press Release sent out by Arthur Lih on October 23, 2024.  

  • "An Evaluation of EMT's Ability To Use Manual Ventilation Devices," Elling, B., Politis, J., Annals of Emergency Medicine, December 1983. 

  • EMS Field Guide BLS Version 10th Edition. 2025 Jones & Bartlett Publishers. 

  • Dunne CL, Osman S, et al. Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis. Int J Environ Res Public Health. 2022 Mar 24;19(7):3846. doi: 10.3390/ijerph19073846. PMID: 35409529; PMCID: PMC8998090. 

About the author:
Bob Elling, MPA, Paramedic (retired) – has been a career paramedic, educator, author, and EMS advocate since 1975. He was a paramedic with the Town of Colonie EMS Department, Albany Times Union Center, and Whiteface Mountain Medical Services. He was also an Albany Medical Center Clinical Instructor at the Hudson Valley Community College Paramedic Program. Bob has served as AHA National/Regional Faculty and participated in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, a paramedic program director, and associate director of New York State EMS Bureau. He has authored hundreds of articles, videos, and textbooks to prepare EMS providers for their career. Bob is the ECSI Medical Editor for the CPR and First Aid Series, Co-Author of EVOS-2, and Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets.

Standard First Aid, CPR, and AED Eighth Edition

Standard First Aid, CPR, and AED, Eighth Edition is ideal for use within training courses designed to certify individuals in first aid, CPR, and AED. This student manual is the center of an integrated teaching and learning system that offers many resources to better support instructors and prepare students to learn life-saving skills.

Request More Information
Standard First Aid, CPR, and AED Eighth Edition

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Recent Advances in Choking Management

by  Bob Elling     Jan 22, 2025
anti-choking devices

The conversation around health and safety is increasingly focusing on the topic of choking emergencies. While manual choking management techniques have stood the test of time, I was curious to explore the latest developments in this area. Typically, the International Liaison Committee on Resuscitation (ILCOR) plays a pivotal role in this field by conducting ongoing evidence evaluations. They periodically publish their consensus on the science and treatment recommendations (CoSTR) for various resuscitation and first aid topics. 

Following the release of the CoSTR, organizations worldwide, such as the American Heart Association (AHA) and the American Red Cross (ARC) in the United States, often update their guidelines accordingly. At the Emergency Care & Safety Institute (ECSI), we align with ILCOR's guidance when creating and revising our educational courses and materials. 

Background on Choking
 Worldwide, despite being preventable, foreign body airway obstruction (FBAO) events are a significant source of injury and mortality. More than 5,000 choking deaths are reported each year in the USA alone. It is also estimated, for each pediatric choking death, another 110 non-fatal events present to EDs.

Prehospital choking management techniques have remained largely unchanged for several decades. The evidence for these techniques was almost entirely case series data leaving uncertainty over which intervention (if any) is superior. 

ILCOR CoSTR
Current ILCOR treatment recommendations, based on weak evidence and a very low certainty of evidence include: 

  • Back slaps, used initially in patients with a FBAO and an ineffective cough. 

  • Abdominal thrusts, used in adults and children with a FBAO and an ineffective cough, where back slaps are ineffective. 

  • Rescuers consider manual extraction of visible items in the mouth. 

  • Suggest against the use of blind finger sweeps in patients with a FBAO. 

  • Appropriately skilled individuals consider the use of Magill forceps to remove FBAO in out of hospital cardiac arrest (OHCA) patients with a FBAO. 

  • Chest thrusts are used in unconscious patients with a FBAO. 

  • Bystanders undertake interventions to support FBAO removal as soon as possible after recognition. 

The ILCOR task force made this statement concerning current “knowledge gaps” needing further study: “There is a need for high-quality observational studies that accurately describe the incidence of FBAO, patient demographics (age, setting, comorbidities, food type, conscious level), full range of interventions delivered, who delivered interventions (health professional/ lay responder), success rates of interventions, harm of interventions, and outcomes.” 

The specific consensus on science on “suction-based airway clearance devices” reveals the following: 

  • For the critical outcome of survival and outcome of relief of FBAO only observational studies were identified.  

  • Overall quality of evidence was rated as very low for all outcomes primarily due to a very serious risk of bias.  

  • Individual studies were all at very serious risk of bias due to confounding. Because of this and a high degree of heterogeneity, no meta-analyses could be performed and individual studies were difficult to interpret. 

  • For critical outcome of survival and outcome of relief of FBAO very low certainty of evidence downgraded for very serious risk of bias from one case series study which survival in 10 patients treated with a suction-based airway clearance device were identified. 

The task force also made this statement on “knowledge gaps” needing further study. “There is a need for further evidence on benefits and harms of suction-based airway clearance devices. The task force encourages prospective registration of all device uses. Reports should detail key demographics (e.g. age, setting, comorbidities, food type, conscious level), full range of interventions provided, who provided intervention (lay versus healthcare professional) and outcomes. This evidence may initially come in the form of published case series.” 

Recent Press on Anti-Choking Devices
A press release was sent out on October 23, 2024, titled, “LifeVac© Applauds American Red Cross’ First Major Update to Airway Obstruction Protocols in 47 Years, Now Including Anti-Choking Devices.” The release made a few points: 

  • The last update to airway obstruction protocols occurred in 1976, making this the first significant revision in 47 years.  

  • Based on the findings of the American Red Cross Scientific Advisory Council, an anti-choking device is now part of the recommended guidelines to be used in the event of protocol failure or when traditional methods cannot be administered.  

  • Given these updated guidelines, all individuals and institutions adhering to ARC protocols are advised to equip themselves with an anti-choking device. 

  • The press release goes on to suggest that the LifeVac© should be the device of choice.  

  • This update provides EMS and EMT personnel with advanced tools to save more lives, while also marking a significant step forward for individuals with disabilities, who now have an option in choking emergencies—something that was previously unavailable to this vulnerable group.  

Actually, the ARC guidelines for the management of FBAO (ie; a person who cannot breathe or has an ineffective cough) are unchanged by the current American Red Cross Scientific Advisory Council 2023 review, except for the option to consider using an anti-choking device (negative pressure anti-choking device) if recommended standard interventions have been exhausted and fail to work, or those interventions are not feasible.

Recent Analysis
In 2022, the paper “Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis,” started to highlight the management of FBAO. 

This retrospective study evaluates anti-choking devices (ACD) interventions from 2016 to mid- 2021, globally. This is the first study of a multi-phase global evaluation of ACDs that aims to determine their effectiveness and clarify their role in future choking intervention algorithms. Prior to this paper, most published data was limited to mannequin studies, case reports with few entries, or only focused on a subset of the population. This study included all ACD intervention data available, incorporating all ages from all world regions. 

The following two devices were reviewed in the study, one non-invasive and one minimally invasive due to its intraoral component: 

  • LifeVac LLC produces the non-invasive LifeVac© ACD, which consists of a facemask attached to compressible bellows and a one-way valve. 

  • DeChoker LLC produces the minimally invasive DeChoker© ACD, which is designed with a face mask attached to a cylinder with a plunger. In the face mask is a 3-inch (7.6 cm) tube that is directed into the oropharynx to act as a tongue depressor. The tube also is the passageway for the negative pressure suction and has a diameter of 0.75-inch (1.9 cm). 

Both devices are FDA registered, which does not imply FDA cleared or approved. The analysis of choking events treated with ACDs included data solicited from persons who self-identified to manufacturers as having used an ACD before July 1, 2021. Resolution of choking symptoms was reported for the LifeVac© in 123 events and for the DeChoker© in 60 events. Abdominal thrusts were used as co-interventions in 37.9% of cases with the LifeVac© and in 31.1% with the DeChoker©, while back blows were co-interventions in 39.5% of cases with the LifeVac© and 41% with the DeChoker©. Adverse events that were reported included disconnection of mask or bellows during intervention, one lip laceration and one avulsed tooth. 

The authors concluded that despite the increasing popularity of ACDs, there is not yet sufficient data available in academic literature to fully assess their safety and effectiveness. Non-invasive and minimally invasive ACDs are novel interventions with positive initial findings. The second phase of this study should include a prospective evaluation, independent of manufacturers, that improves data quality and will further determine the devices respective roles in the response of healthcare workers and lay rescuers to a choking person. 

Comparison Between Available ACDs
Both devices have a mask similar to the type on a BVM. The major difference between the DeChoker© and the LifeVac© is that the LifeVac© pushes on the victim’s face during use, while the DeChoker© pulls back and away from the victim’s face. The DeChoker© also utilizes an actual canister where the recovered object goes after it is dislodged, and in addition, has a built-in tongue depressor, making it minimally invasive. 

Adult resuscitation guidelines say to deliver back slaps and abdominal thrusts until the victim goes unconscious and then when no longer conscious start CPR compressions. When in this cycle is the ACD used? The resuscitation guidelines support a legacy standard of care. ACDs are currently designed to be used, by a properly trained rescuer, when current protocol standards have failed.  

I found a helpful article, which includes a number of demonstrations, comparing the two ACDs, at: https://pixoneye.com/dechoker-vs-lifevac/  

A key point is made that neither device is a substitute for professional medical help but rather a helpful substitute while waiting for rescue’s arrival on the scene. Once again remember to call or assign someone to call 9-11 ASAP then do manual FBAO techniques per latest Guidelines and if time and immediately available consider trying an ACD. They also reaffirm that whatever device you choose to purchase requires training per the manufacturer’s instructions and practice for rapid deployment. 

As I see it…for what it’s worth!
There are plenty of studies that have shown EMS providers have difficulty attaining an adequate mask seal using a BVM device when they use one hand to seal the mask. I was a co-author of one such study back in 1983, which has been referenced in many papers and guidelines since first published in the Annals of Emergency Medicine.

As EMS educators we know that sealing a mask is best done by a well-practiced two-handed mask seal combined with the proper jaw thrust technique. We also know that a one-handed mask seal is possible with a lot of practice and the proper hyperextension to open the airway. In the scenario of a potential neck injury, where hyperextension is inappropriate and opening the airway is reliant on jaw thrust technique, this is not accomplished using a one-handed mask seal.

Both of the ACDs discussed involve a one-handed mask seal. The “citizen rescuer” is likely to have very little training with the device, let alone sealing a mask. For this reason, I strongly suggest we initially deploy ILCOR’s FBAO manual techniques. If an ACD is available with a properly trained operator, it only be employed AFTER the current manual methods have been tried.  

To review the current procedures for FBAO: 

  • You suspect an infant is choking:  

  • Confirm obstruction (infant cannot make sounds, breathe, cry, or is cyanotic). 

  • Invert infant on arm (support head by cupping face in hand): perform 5 back slaps and 5 chest thrusts until object is expelled. 

  • Repeat until successful. 

  • If infant becomes unconscious, start CPR chest compressions. 

  • You suspect an adult or child is unresponsive and choking: 

  • Call for help and position patient supine on hard, flat surface. 

  • Perform chest compressions (30:2). 

  • Open airway (head-tilt/chin-lift) look for and remove object if visible. 

  • Attempt to ventilate. If unable…  

  • Reposition head and chin: attempt to ventilate. If unable… 

  • Perform chest compressions (30:2). 

  • Repeat: inspect mouth…remove object…ventilate…chest compressions until successful. 

  • ALS providers, on arrival, should consider laryngoscopy and removal of object by Magill forceps. 

  • Do not attempt blind “finger sweeps” in any age group. 

In places serving food, displaying an easy-to-follow choking poster in an obvious location continues to be an excellent idea. Clearly, as the ILCOR task forces have already identified, more research is needed at this point.  

The Best Solution is Prevention
Keep teaching our kids and sharing useful prevention tips with our friends, family, coworkers, and patients. For example: 

  • Small bites, cut your food, eat slowly, and stop talking while you have food in your mouth. 

  • One formula for choking often includes a stressful heated “discussion” at the dinner table with meat and alcohol! 

  • Patients with chronic disabilities causing difficulty swallowing are at risk of FBAO.  

  • Toddlers explore the world by inserting small items in their mouth. Be especially careful that the 2-year-old does not have access to the older child’s toys which often have removable small parts (choking hazards). 

Summary
In summary, keep the following key points in mind:  

  • There are no current high-quality studies recommending updates to the techniques for treatment of FBAO. Experts do agree that it is a topic worth studying to finally have strong data on the most effective techniques and potential devices to manage FBAO. 

  • Don’t confuse the ACD with the AED!  

  • Before reacting to any new commercial product do your research and discuss with your service medical director before diving right in! 

  • Review the steps for FBAO treatment for infants, children and adults in your next drill and then go home and share this info with your family. 

  • Sharing choking prevention tips with your family, friends and coworkers can only help. 

  • As always stay situationally aware, (especially when eating at restaurants). Watch for the choking victim who heads into the restroom along! 

References/Resources: 

  • Couper K, Abu Hassan A, et al. - on behalf of the ILCOR Basic and Pediatric Life Support Task Forces. Foreign body airway obstruction in Adults and Children Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: ILCOR Basic Life Support Task Force, 2020 Jan 1. Available from: http://ilcor.org 

  • Saperstein D, Pugliesi P, et al. Successful Use of a Novel device called the LifeVac to Resuscitate Choking Victims. International Journal of Clinical Skills. 2018;12. 

  • LifeVac Applauds American Red Cross’ (ARC) First Major Update to Airway Obstruction Protocols in 47 Years, Now Including Anti-Choking Devices, Press Release sent out by Arthur Lih on October 23, 2024.  

  • "An Evaluation of EMT's Ability To Use Manual Ventilation Devices," Elling, B., Politis, J., Annals of Emergency Medicine, December 1983. 

  • EMS Field Guide BLS Version 10th Edition. 2025 Jones & Bartlett Publishers. 

  • Dunne CL, Osman S, et al. Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis. Int J Environ Res Public Health. 2022 Mar 24;19(7):3846. doi: 10.3390/ijerph19073846. PMID: 35409529; PMCID: PMC8998090. 

About the author:
Bob Elling, MPA, Paramedic (retired) – has been a career paramedic, educator, author, and EMS advocate since 1975. He was a paramedic with the Town of Colonie EMS Department, Albany Times Union Center, and Whiteface Mountain Medical Services. He was also an Albany Medical Center Clinical Instructor at the Hudson Valley Community College Paramedic Program. Bob has served as AHA National/Regional Faculty and participated in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, a paramedic program director, and associate director of New York State EMS Bureau. He has authored hundreds of articles, videos, and textbooks to prepare EMS providers for their career. Bob is the ECSI Medical Editor for the CPR and First Aid Series, Co-Author of EVOS-2, and Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets.

Standard First Aid, CPR, and AED Eighth Edition

Standard First Aid, CPR, and AED, Eighth Edition is ideal for use within training courses designed to certify individuals in first aid, CPR, and AED. This student manual is the center of an integrated teaching and learning system that offers many resources to better support instructors and prepare students to learn life-saving skills.

Request More Information
Standard First Aid, CPR, and AED Eighth Edition

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