What Is the Heimlich Maneuver & How Do You Perform It?

A Comprehensive Guide to Handling Any Choking Emergency

1. The Invention & Naming of the Heimlich Maneuver
2. How to Identify Choking
3. How to Do the Heimlich Maneuver for Adults, Children & Infants
4. Special Cases: How to Do the Heimlich Maneuver on Individuals Who Are Pregnant, Obese, or in a Wheelchair
5. How to Do the Heimlich Maneuver on a Pet
6. How to Do the Heimlich on Myself in 3 Steps
7. How to Care for Someone After a Choking Incident
8. How to Prevent Choking
9. Knowing the Heimlich Maneuver Can Save a Life!
10. Heimlich Maneuver FAQs

On an average Monday in May 2016, a woman in a senior living community began to choke on the food she was eating. According to her rescuer, the woman’s lips began to become puffy and she was clearly unable to breathe. She needed immediate help.

Luckily for her, the man next to her, Dr. Henry Heimlich, was able to rescue her by performing the Heimlich maneuver to dislodge the food causing her to choke. Yes, it was that Dr. Heimlich — the very one who invented the technique used to save her life. But what exactly is this technique he pioneered? 

The Heimlich maneuver is a popular and internationally known technique used to help someone who is choking, including how to do CPR on someone who is choking and has become unconscious. This technique uses the pressure of remaining air left in the lungs to help force an object out of the airway through the application of quick, forceful upward thrusts. 

The Invention & Naming of the Heimlich Maneuver

Dr. Henry Heimlich was a thoracic surgeon who spent much of his career observing the pressing issues he faced in his day-to-day experience and setting about finding solutions for them. 

Fun Fact: The invention of the Heimlich Maneuver was inspired by rescuing dogs from choking.

In the 1960s, according to a journal published in the National Library of Medicine, the sixth most common cause of accidental death was choking on food, toys, and other various objects. 

In his search for a solution, Dr. Heimlich observed that canines with an obstruction in their airway were able to be saved with a rapid thrust to the abdominal cavity that helped propel the foreign object out of the body. This allowed normal respiration to resume. 

Subdiaphragmatic Pressure

It was this realization that led to the original 1974 naming of the abdominal thrust technique: “subdiaphragmatic pressure.” While the technique and importance of this skill were no less valuable at the time, Dr. Heimlich shared with NPR in an interview before his death that he believed the technique wouldn’t have caught on as well without a new name. 

In his interview with NPR, Dr. Heimlich explained that when formally reviewing the procedure, the American Medical Association shared with him that so many lives had been saved by the procedure in less than two months that they wanted to name the procedure after him. It was at this time the name was officially changed to the Heimlich maneuver.

How to Identify Choking

According to the National Safety Council, approximately 3,000 deaths in the U.S. in 2020 were due to choking. This is a small fraction of the tens of thousands of people who require first aid for some degree of choking each year but are successful in restoring normal respiration. 

Common causes of choking include food particles, especially large or tough pieces, and small objects that children may put in their mouth.

The concept of choking typically conjures images of a person gasping for air. While a person may experience trouble breathing due to an obstruction in their airway, this example is often mischaracterized as choking, which requires the Heimlich maneuver. 

To prevent long-term or fatal outcomes,
it’s important to act quickly.

Key signs of choking include:

• Inability to speak, breathe, or cough: The person may struggle to get air and cannot talk or cough effectively.
• Blueish skin or lips: Lack of oxygen can cause the skin, especially around the lips and face, to turn a bluish color. This can be a later sign.
• Panicked behavior: People in distress will often show signs of fear or panic, such as clutching at their throat.
• Universal choking sign: If the person is conscious, they may instinctively bring their hand to their throat to indicate choking.

When the airway is blocked, the lack of oxygen flow can lead to unconsciousness within minutes. In severe cases, choking can lead to cardiac arrest and brain damage due to the lack of oxygen. 

When to Use the Heimlich Maneuver

You might have observed a cartoon character who knows how to do the Heimlich maneuver springing into action when another character is unable to breathe and beginning to change colors. This picture is mostly correct, although the color changing of victims to plaid and polka dots hasn’t been observed by our experienced trainers!

A few key characteristics of someone who is choking and should receive the Heimlich maneuver are as follows: 

• The person is conscious, but can’t breathe. They may sputter or wheeze but cannot effectively expel air on their own. 
• Due to lack of oxygen, the person’s lips may become bluish or gray. This is a clear sign that their life is in danger and immediate first aid is needed. 
• The person will likely be unable to speak to ask for help. Due to the inability to expel air, speaking will be extremely difficult or impossible. 

The internationally recognized sign of choking is the use of one or both hands clutching the throat. 

The Heimlich maneuver should be reserved for life-threatening events to avoid causing unintentional abdominal injury to the victim. When a person is completely unable to breathe or speak but still conscious, use the Heimlich maneuver.

If, on the other hand, a person is still able to wheeze or cough, that means there’s still partial airflow occurring. In this case, encouraging the victim to cough is the best course of action. Often, a hard cough can help dislodge the foreign object and allow a person to breathe freely. 

If a person is still able to wheeze or cough, it’s best to encourage the victim to cough up the obstruction. 

If you’re alone, choking, and completely unable to breathe, you can quickly self-administer a modified Heimlich. Be aware that you can lose consciousness in as little as one minute, so timely first aid is essential. You don’t want to be panic-searching “how to do Heimlich on myself” in an emergency, so it’s wise to brush up on the steps sooner than later.

When to Wait to Do the Heimlich Maneuver

Often, when someone begins to cough and utter the words, “I’m choking,” it can be instinctual to use your training to help dislodge the object. However, as well-intentioned as this is, if a person is still able to cough or speak, then encouraging them to try to cough up the object on their own is the best practice. 

When a person is still able to cough forcefully, it indicates a partial obstruction, meaning that enough air is still passing through their airway to expel the object naturally. Coughing is the body’s first line of defense in removing blockages, and a strong, self-generated cough can often clear the airway more effectively than an external intervention. 

In contrast, stepping in with the Heimlich maneuver at this stage could accidentally worsen the situation, potentially shifting the object into a fully obstructed position, which could make breathing impossible. Performing the Heimlich maneuver could also cause unnecessary abdominal injury, even when performing it correctly.

If a person is in distress and cannot make a sound, cough, or breathe, perform the Heimlich Maneuver. 

Observing closely and waiting for signs of distress such as the inability to make any sound or breathe or continued signs of struggle ensures that the Heimlich maneuver is used only when necessary. Since a partial obstruction can turn into a full airway obstruction, it is appropriate to consider calling emergency services at any point you are concerned.

Stay calm and support the individual through their coughing efforts to allow their body to handle the obstruction without unnecessary intervention. Do not leave them until emergency services arrive or their airway is completely cleared.

For a step-by-step resource on handling any choking emergency, be sure to download the “How to Handle Any Choking Emergency” PDF.

How to Do the Heimlich Maneuver

Once you’ve identified that a person is in danger and needs immediate lifesaving measures, knowing how to do the Heimlich maneuver properly is crucial, as every second counts in an emergency.

How to Do the Heimlich Maneuver on an Adult

If you notice that an adult is choking, you should begin the Heimlich maneuver. Follow these steps:

1. With the person standing up, position yourself behind them with your arms around them at waist level. 
2. Make a fist with one hand, and place it right above their navel (belly button) with your thumb touching their abdomen. 
3. With your other hand, grasp your fist and pull upward and in toward the person with five quick abdominal thrusts. 
4. This can be repeated until the person is able to breathe independently or the object is removed.

If attempts to dislodge the object are unsuccessful, the person will become unconscious. They should then be placed on the ground carefully, protecting their head. Emergency services need to be called, and chest compressions should be started.

How to Do the Heimlich Maneuver on a Child

A child who is over one year old should be approached in a similar process to an adult, although the adult should kneel to match the child’s height so that appropriate upward abdominal thrusts can be performed. 

One key distinction in how to do the Heimlich maneuver on a child is to be aware of using less force so as to not lift the child off the ground when performing abdominal thrusts.

How to Do the Heimlich Maneuver on an Infant

An infant (less than one year old) needs a completely different approach to remove a lodged object due to their size, more fragile organs, and weaker bone structure. If an infant is choking, follow these steps:

1. Hold the infant face down along your forearm with the head and jaw supported in the palm of your hand. The head should be below the torso to help encourage gravity to expel the object. 
2. Give five back blows with the heel of your hand between the shoulder blades to try to dislodge the object. 
3. If the back blows are unsuccessful, turn the infant over, supporting their torso along your forearm and their head in your hand, and give five chest thrusts with two fingers on the breastbone to a depth of 1.5 inches. This is similar to CPR compressions for an infant. 
4. Repeat this process until the child is able to breathe or cry independently.

As with anyone who is choking, if the infant becomes unconscious, call 911 and immediately begin CPR. 

How to Do the Heimlich Maneuver on Someone Who Is Pregnant

Performing the Heimlich maneuver on a pregnant individual requires careful adjustments to avoid applying pressure to the abdomen, which could harm both the mother and the baby. If someone who is visibly pregnant is choking and cannot cough, speak, or breathe, follow these adapted steps to clear the airway:

1. With the pregnant person standing up, position yourself behind them, wrapping your arms around their upper torso, avoiding the abdomen.
2. Make a fist with one hand and place it on the center of the chest, just above the lower half of the breastbone (sternum). Avoid placing your hands on their belly.
3. Using your other hand, grasp your fist and perform quick inward thrusts against the chest. Apply firm but controlled pressure, aiming to create enough force to expel the obstruction without pressing on the abdomen.
4. Repeat chest thrusts as needed until the object is dislodged or the person begins to breathe independently.

If the person becomes unresponsive, gently lower them to the ground, call 911 if not already done, and begin CPR. 

This modified technique can effectively remove the obstruction without compromising the victim’s safety or the safety of the unborn baby. After any choking incident, even if the object is successfully dislodged, the victim should seek medical evaluation to rule out any possible complications.

How to Do the Heimlich Maneuver on Someone Who Is Obese

In cases where you need to perform the Heimlich maneuver on someone who is obese and you are unable to wrap your arms around the abdomen, then, the technique is generally the same as for a woman who is pregnant.

1. Position yourself behind the person, ensuring they are standing upright. If they are seated, encourage them to sit upright with their back straight.
2. Make a fist with one hand and place it on the center of the chest, just above the lower half of the breastbone (sternum).
3. Using your other hand, grasp your fist and perform quick inward thrusts against the chest. Apply firm but controlled pressure, aiming to create enough force to expel the obstruction.
4. Repeat chest thrusts as needed until the object is dislodged or the person begins to breathe independently.

If the person becomes unresponsive, call 911 and start CPR immediately.

How to Do the Heimlich Maneuver on Someone in a Wheelchair

Performing the Heimlich maneuver on someone in a wheelchair can be more challenging due to the seated position and the limited ability to apply force as effectively as when standing. However, with proper technique and these steps, you can still perform the maneuver effectively. 

1. Position yourself behind the individual in the wheelchair, and lock the wheelchair’s wheels to prevent it from moving during the maneuver.
2. Wrap your arms around the person’s waist from behind, just above their belly button.
3. Make a fist with one hand, and position the thumb side against the person’s abdomen.
4. Grasp your fist with your other hand, and perform quick inward and upward thrusts.
5. Continue performing these thrusts until the object is expelled or the person is able to breathe on their own again. 

If you can’t reach around the wheelchair, you can move your hands to the lower half of the breastbone as you would do with an obese or pregnant person. Alternately, if you’re able, you can try to turn the victim sideways in the wheelchair, making sure they don’t fall. 

If the obstruction isn’t cleared and the person becomes unresponsive, call 911 and begin CPR immediately.

How to Do the Heimlich Maneuver on a Pet

Performing the Heimlich maneuver on a pet is a different process than for humans. Animals, including dogs and cats, have different body structures and airway mechanics, so it’s essential to approach the situation with care and the right techniques. 

For more detailed guidance on handling choking emergencies with pets, we recommend taking our cat and dog first aid course for essential training. Additionally, you can check out our article ”What to Do if Your Dog Is Choking” for more specific advice and instructions.

How to Do the Heimlich on Myself in 3 Steps

Administering the Heimlich on yourself is similar to administering it on another person. Here’s how to do it in three steps:

1. Make a fist with one hand, and place your thumb next to your abdomen, between your belly button and rib cage. 
2. Firmly grasp your fist with your other hand, and make quick upward thrusts while pulling into your abdomen. This helps leverage the air contained in your lungs to force the object out.
3. Repeat this process several times if needed to dislodge the object.

If you feel you’re unable to effectively perform this action, you can lean yourself over the back of a sturdy chair or railing, pressing into your abdomen in the same area. You will use your body weight with the chair to create an upward force in hopes of dislodging the object. 

After performing the Heimlich to restore breathing, you should always be seen by a doctor to make sure there are no further complications. Sometimes an underlying medical condition can increase the risk factors for choking and can be addressed by a physician. 

Learning How to Do Heimlich on Myself

Few things can grab your attention quite as quickly as feeling something going down the wrong pipe. Choking is a serious and immediately life-threatening event. All of these risks and feelings of panic are compounded when you’re alone, which makes being prepared even more valuable. 

Learning to do the Heimlich before you’re in an emergency is a much better option than Googling “how to do the Heimlich on myself” as you’re struggling to breathe. Knowing how to perform the Heimlich is a great foundation, but quality CPR classes and first aid training can prepare you to confidently step in and help save a life in any emergency. 

How to Care for Someone After a Choking Incident

After performing the Heimlich maneuver or any other method to clear an obstruction from someone’s airway, proper aftercare is a must, even if the person seems to be okay. 

Even after the object is removed and the person can breathe again, the choking incident can still have serious repercussions. The forceful abdominal thrusts used during the Heimlich maneuver can cause bruising, soreness, or even internal injuries, especially if performed on someone with a delicate body or in certain positions. 

Additionally, the stress of the incident may lead to heightened risk factors like aspiration pneumonia, where food or fluid enters the lungs.

It’s important to stay with the person after the Heimlich maneuver and continue to monitor their condition. Even if they appear fine, keep an eye out for any delayed symptoms such as persistent coughing, pale skin, difficulty swallowing, or shortness of breath. Encourage them to rest and regain their composure, as choking incidents can be traumatic. 

If any unusual symptoms arise or if you’re unsure whether they need further medical care, don’t hesitate to seek professional help.

How to Prevent Choking

Reducing the risk of choking starts with proactive measures in food preparation, mindful eating habits, and monitoring potentially hazardous items. 

Here are essential tips for preventing choking in both children and adults:

1. Chew food thoroughly.
2. Avoid distractions while eating.
3. Cut items into small, manageable pieces for children.
4. Supervise the use of small objects and toys.
5. Avoid sticky or hard-to-chew foods.
6. Teach safe eating practices to children and other family members.

These preventive steps and safe eating habits reduce the risk of choking for yourself and those around you. A few simple precautions can make a big difference!

Knowing the Heimlich Maneuver Can Save a Life!

Performing the Heimlich have saved countless victims from choking in the 50 years since the maneuver’s introduction. Knowing how to perform the Heimlich on others, as well as yourself, is invaluable.

Completing a basic CPR course — or even a more thorough CPR, AED & First Aid course — in as little as 90 minutes to 4 hours can be the difference between someone having a scary choking emergency and surviving, or losing their life. 

At ProTrainings, we believe life-saving skills should be available to and learned by everyone. That’s why we make all of our trainings available for free! You only pay after you pass the test if you need a CPR certification card! 

Whether you’re required to maintain first-aid certification, are simply a concerned citizen who wants to be prepared, or are tasked to oversee the safety of staff and the public alike, complete your CPR training and learn the Heimlich Maneuver today!

Heimlich Maneuver FAQs

Whether you’re unsure about the Heimlich maneuver itself, its differences from CPR, or how to handle potential complications, it’s important to have clear answers to help you feel confident in an emergency. 

Below, we’ve addressed some of the most common questions people have about performing the Heimlich maneuver to ensure you’re fully prepared to act when needed.

1. What is the difference between CPR and the Heimlich maneuver?
   The Heimlich maneuver and CPR are both life-saving techniques, but they serve different purposes. The Heimlich maneuver is used to clear an obstruction from a conscious person’s airway when they are choking. It works by applying quick, forceful pressure to the diaphragm by way of the abdomen to expel the object blocking the airway. CPR, on the other hand, is used when a person has stopped breathing or their heart has stopped beating. It involves chest compressions and rescue breaths to keep the blood circulating and oxygen flowing to essential organs.
   
2. What if I hurt someone while performing the Heimlich maneuver?
   While the Heimlich maneuver is generally safe, it can sometimes cause injury, especially if performed with too much force or if the person is particularly frail. Injuries can include bruising, broken ribs, or soreness in the abdomen. If you notice any signs of injury, it’s important to seek medical attention even if the object has been cleared. The benefits of performing the Heimlich maneuver usually outweigh the risks, but always monitor the person after the procedure for any unusual symptoms or discomfort.
   
3. How do I know if the Heimlich maneuver worked?
   The Heimlich maneuver is typically successful if the object causing the choking is dislodged and the person starts to breathe, cough, or speak. If the individual begins to show signs of relief such as taking a deep breath or speaking normally, the maneuver has likely worked. However, if they still have difficulty breathing or continue to show signs of choking, continue to administer the Heimlich maneuver. If they become unresponsive, call emergency medical services and begin CPR while waiting for emergency medical help to arrive.
   
4. What should I do if the Heimlich maneuver doesn’t work?
   If the Heimlich maneuver doesn’t clear the airway, and the person is still choking, call 911 immediately. Keep performing the Heimlich maneuver until the object is dislodged or the person can breathe again. If the person loses consciousness, start CPR while waiting for emergency responders.
   
5. What if the object causing the choking isn’t visible?
   When someone is choking, the goal is to use the best practice of removing the object, and seeing the object while the victim is conscious isn’t part of the skill. So continue the Heimlich maneuver until the object is dislodged, the victim can breathe, or they go unresponsive. If the victim becomes unconscious, call 911 and begin CPR immediately.

The Heimlich maneuver can save lives in choking emergencies, but understanding when and how to use it (and being aware of potential complications) is key to effectively managing the situation. 

With the proper education and preparation for different scenarios, you’ll be better equipped to respond confidently in an emergency. Continuing your education with CPR and first aid courses is invaluable and will equip you to save a life anytime, anywhere.