Even in the fresh air of the wilderness, a good appetite hits hard, and eating at a camp or rest stop is one of the great pleasures of hiking. But in the mountains or forest, whether you're in a hurry or just distracted by conversation, it's easy to forget to chew your food thoroughly. It's in these moments that choking is most likely to happen: a piece of food goes down the wrong pipe, blocking the trachea and cutting off the airway.

This is a critical situation. Every second counts, and an ambulance could be hours away. This guide provides a clear algorithm of actions that can help you save your companion's life.

Step 1: Assess the Situation: Are They Coughing or Not?

The most important rule, often forgotten in a panic, is: do not interfere if the person can breathe!

If the victim is coughing forcefully, can speak, or is breathing, their airway is only partially blocked. In this case, the best help you can give is not to hit them on the back. Sharp movements can dislodge the object and make the blockage worse. Simply ask them to breathe slowly and make a few strong coughing exhalations while leaning forward.

You must act immediately if:
• The person cannot make a sound.
• They are making the universal choking sign (clutching their throat).
• Their face is turning blue and their eyes are bulging from the strain of trying to breathe.

If they can only respond to your questions with gestures, not their voice, act immediately.

Step 2: Administer Firm Back Blows

The victim should lean forward sharply (ideally, their head should be lower than their chest—gravity will help, not hinder).

1. Stand slightly to the side and behind them.
2. Using the heel of your hand, deliver 5 sharp, forceful blows between their shoulder blades, directed towards the mouth.
3. The blows need to be strong—you are trying to create vibration and pressure to pop the object out
4. Important for the Trail: If the person is wearing a thick down jacket or multiple layers of clothing, the force of your blows will be absorbed. Don't be afraid to use significant force. Check their mouth to see if the object has been dislodged.

Step 3: The Heimlich Maneuver (Abdominal Thrusts)

If the back blows don't work (the person hasn't coughed or started breathing), move immediately to the primary technique: the classic Heimlich maneuver.

1. Stand behind the victim and wrap your arms around their waist.
2. Bend them forward forcefully (their torso should be parallel to the ground or lower).
3. Make a fist with one hand. Place the thumb side of your fist against the victim's abdomen, on the midline, just above the navel and well below the breastbone (in the solar plexus area).
4. Grasp your fist with your other hand.
5. Perform 5 quick, inward and upward thrusts. The motion should be like you're trying to lift the person, using the air in their lungs to force the object out.
6. Check the victim's mouth again.

Step 4: Cycling and Backcountry Tactics

If the object hasn't come out, repeat the cycles: 5 back blows → 5 abdominal thrusts. Usually, up to three cycles are needed.

Crucial for Remote Locations: In the city, you would call an ambulance. On a hike, you are the ambulance. If you have communication (satellite phone/radio), call for rescue services (like local emergency services) while you are providing aid, sending one person from the group to make the call. If there's no signal, your only option is to continue the attempts until the object is expelled or the victim loses consciousness.

What to Do If the Victim Becomes Unconscious?

If the person stops responding (loses consciousness):
1. Carefully lay them on their back on a firm, flat surface.
2. Tilt the head back, open the mouth, and try to sweep the visible object out with your index finger (wrapped in cloth if available).
3. If you don't see anything, immediately begin Cardiopulmonary Resuscitation (CPR).
4. The ratio is 30 chest compressions (depth 5-6 cm / 2-2.5 inches) followed by 2 rescue breaths. As you give breaths, watch to see if the chest rises. If it doesn't, the blockage might still be there, and your breaths aren't effective.

Prepare for the Trail—Practice at Home

Performing good CPR is difficult without training. However, the Heimlich maneuver is a technique you can and should practice in advance.

• Practice with a Partner: Rehearse the hand placement and the "grab" (without actually squeezing) while you're still at home. This builds muscle memory.

• An Updated Tip: Even if you've taken a first aid course (ideally with organizations like the Red Cross or wilderness medicine institutes), refresh your knowledge before every major trip. Include a 15-minute briefing on emergency situations in your pre-trip preparations. Check where the first aid kit is and who in the group is responsible for medical response.

• For Beginners: If you can't find a course nearby, just remember the name "Heimlich maneuver" and watch an instructional video before you hit the trail. Visualizing the steps is incredibly helpful in a real crisis.

Remember: in the wilderness, your ability to help each other is your only guarantee of safety.

Next guide: First Aid for Wounds on a Hike: A Survival Guide

Previous guide: Wilderness First Aid: How to Handle Fainting and Rescue Breathing

You can view the full list here: Survival Guides for the Mountains

First Aid for Choking: The Heimlich Maneuver on a Hike