Foreign Body Airway Blockage (FBAO)

By Brian Low, National Manager – Instructor Certification Program (brian.low@skipatrol.ca)

There has been confusion expressed by different ITs and instructors regarding the instructional and evaluation approach regarding Complete choking treatment AFA 6-97 for adults and children. This bulletin is intended to provide clarity and direction for both instruction and evaluation. 

Current references in our training resources include: CSP Patrollers Manual 2022 Revision 2 (AFA 6-97) and CSP eLearning courses on Moodle, module eAFA127B (Slide 6) found in both the AFA 2024 New Recruit and AFA Requalification courses.  

The Patroller Manual 2022 Revision 2 reflects changes based on the ILCOR (International Liaison Committee on Resuscitation) 2020 revisions, and also the First Aid, Resuscitation, and Educational Guidelines 2020 Clinical and Educational Updates for Canada, prepared by the Canadian Red Cross (CRC). The CSP reviews and revises protocols based on these evidence based–findings. 

The excerpt from the Patroller Manual is copied below, with the two sections requiring clarification bolded. The two topics are identified, and instructional and evaluation direction is provided here. 

1. The Patroller Manual and module eAFA127B states: Abdominal thrusts, back blows, and chest thrusts should be applied in quick succession until the object has been cleared from the airway or the patient becomes unresponsive. 

This has often been interpreted to mean all three techniques are to be used in succession. In other words, five abdominal thrusts; five back blows; five chest thrusts, with the three techniques being repeated in sequence. 

Research evidence has demonstrated that each of the techniques is equally effective. Treatment protocols may differ, however, the CSP and CRC in Canada provide treatment guidance as follows: 

If the patient is suffering from complete choking as determined by the following signs: 

    • Inability to speak, breathe or cough.  
    • Absence of chest movement or air exchange.  
    • Increased cyanosis. 

Treat the choking adult or child alternating between any two of the three techniques described in the manual or module until the object has been cleared from the airway or the patient becomes unresponsive.   

There is no evidence to indicate one technique is best to start with. If no success is being achieved, then the third technique may be utilized. For instance if the sequence being used is: five back blows; five abdominal thrusts, repeated with no success, the sequence may be changed to include five chest thrusts replacing a technique, or in addition to the other techniques, to achieve success.  

The desired outcome is to expel the object and clear the airway. 

2. The Patroller Manual and module eAFA127B states: There is not enough evidence to suggest a different approach for an obese or pregnant person who is choking. 

This statement has been interpreted to include using the abdominal thrust technique. Evidence–based recommendations continue to advise the use of chest thrusts for pregnant women or where the patroller cannot get their arms around the patient’s stomach. In these instances, provide instructional guidance as follows: 

If the patient is a pregnant woman or a person where the patroller cannot reach around the stomach, use five back blows and five chest thrusts in sequence, continuing until the object has been cleared from the airway or the patient becomes unresponsive.   

The clarification provided in this bulletin will be shared by instructors at face–to–face sessions in 2024. The manual and eLearning module will not be revised this year.  

During evaluation, if a requalifying patroller demonstrates all three techniques in sequence, or indicates abdominal thrusts may be used with pregnant women or obese individuals, the patroller will not be penalized. The patroller will receive the clarification provided here by the evaluator who will confirm their understanding.  

Manual Reference: CSP Patrollers Manual 2022 Revision 2 (AFA 6-97)

Complete choking

Signs of complete choking:  

Determine if the patient is suffering from complete choking by looking for the following signs:  

  • inability to speak, breathe or cough 
  • absence of chest movement or air exchange 
  • increased cyanosis 

The inability to produce any sound indicates complete choking and the need for immediate action. Without oxygen the patient may soon become unresponsive. Within four to six minutes brain damage may occur. Activate EMS in all cases of complete choking.  

Complete choking treatment – responsive adult and child  

If an obstruction cannot be removed willingly by a responsive patient (e.g., by coughing), it must be expelled by making use of the trapped air that remains in the patient’s lungs.  

In responsive adults and children who are choking, abdominal thrusts, chest thrusts, and back blows are equally effective.  

Abdominal thrusts, back blows, and chest thrusts should be applied in quick succession until the object has been cleared from the airway or the patient becomes unresponsive. Each thrust should be distinct and delivered in such a way to expel the foreign body out of the airway. More than one technique may be needed in responsive adults and children.  

Although injuries have been reported after using an abdominal thrust, there is not enough evidence to determine whether chest thrusts, abdominal thrusts or back blows should be used first on responsive adults and children.  

With the exception of positioning and applied force, abdominal thrusts, chest thrusts, and back blows are administered in the same fashion for both adults and children.  

There is not enough evidence to suggest a different approach for an obese or pregnant person who is choking. 

Foreign Body Airway Blockage (FBAO)

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