St John Ambulance experts believe that a shift in approach to choking incidents could significantly reduce the number of fatalities. By emphasising prevention strategies, such as promoting safe eating habits and educating people about potential choking hazards, they aim to minimise the occurrence of choking incidents in the first place.
Additionally, they advocate for widespread first aid training to equip individuals with the knowledge and skills to respond effectively to choking emergencies, potentially saving lives.
A safer alternative to the Heimlich manoeuvre
Instead of employing the abdominal thrusts used in the traditional Heimlich manoeuvre, paramedics and first responders can use back blows to dislodge objects stuck in a person’s airway.
Hitting someone on the back between the shoulder blades generates enough pressure to clear obstructions without causing damage to vital organs. This alternative method is considered less invasive than the Heimlich maneuver, which can lead to complications such as rib damage and even heart valve problems.
Senior Instructor Grace Lawson at St John Ambulance emphasised that new guidelines are needed for treating choking incidents when no one else is present.
Every second counts in choking emergencies
Emergency services stress that prompt action is crucial during choking emergencies, as brain cells can die within five minutes without oxygen. Delaying resuscitation efforts increases the risk of severe brain damage and death.
In a typical scenario, first responders would attempt to dislodge the obstruction by pulling up and in on the abdomen below the rib cage from behind.
According to St John Ambulance guidelines, it is recommended that first responders begin by administering a series of back blows prior to considering the use of abdominal thrusts as part of their treatment protocol for choking incidents.
Preventing choking-related deaths
According to recent data, an estimated 270 people lose their lives each year in the UK as a result of choking-related incidents, highlighting the potential benefits of adopting more effective methods for responding to such emergencies.
By implementing this safer alternative method, emergency responders have the potential to make a significant impact on reducing choking-related fatalities and alleviating the distress experienced by individuals who suffer from such incidents.
Every year, on the second Saturday of September, the world observes World First Aid Day to stress the life-saving importance of basic first aid skills. Established by the International Federation of Red Cross and Red Crescent Societies in 2001, this initiative focuses on raising awareness about the crucial need for first aid skills. Accidents and emergencies can happen at any time, and having the right skills can make a huge difference.
First aid isn’t just about knowing what to do—it’s about having the confidence to act when an emergency strikes. World First Aid Day helps prepare individuals to respond promptly and effectively by promoting first aid training. Basic skills like stopping heavy bleeding, performing CPR, and treating burns can be vital in emergencies. Additionally, knowing how to check breathing, apply ice packs, or use back blows for choking can make all the difference in saving lives.
Heroes and first aid initiatives
This day also recognises the importance of stepping up during emergencies. Many individuals have become heroes by providing life-saving first aid in critical moments. One notable example is actor Jackie Shroff, who recently highlighted the importance of CPR training in rural communities, helping spread the message of first aid awareness.
Immediate first aid can make a real difference.
Jackie Shroff
Moreover, World First Aid Day encourages others to step forward and gain the knowledge needed to assist during emergencies. By making these essential skills widely accessible, more people can contribute in times of need.
Promoting first aid accessibility
World First Aid Day emphasises the need to make first aid knowledge available to all. It reminds us that anyone can play a crucial role in saving lives with the right training.
Whether it’s treating burns, applying an ice pack, or checking breathing in an unconscious person, immediate action is often the difference between life and death. By spreading first aid education, we can build a culture of safety and preparedness for everyone.
In many countries, first aid courses are mandatory in order to obtain a driver’s license, or employers must train a certain number of employees as first aiders (company paramedics). However, these courses can also be attended independently at any time – this is also strongly recommended in order to be able to react correctly in an emergency situation. Likewise, it is recommended to refresh the knowledge again and again so that the first aider can make the right decisions with a high level of self-confidence.
Germany
Life-saving immediate measures
n this course, only life-saving immediate measures (LSM) from first aid were taught. The course lasted 4 lessons of 90 minutes each. Since April 1, 2015, the new first aid course (see below) has replaced the previous LSM training. After completing the LSM course, the participant should be able to act as an immediate / first aider at an accident site. In Germany, presentation of the certificate of attendance was a prerequisite for obtaining driver’s license classes AM, A1, A2, A, B, BE, L and T. Older LSM certificates were still valid for obtaining a driver’s license until October 21, 2017; since then, only first aid courses have been accepted. Attendance was also required for obtaining a private pilot’s license (PPL).
A legal obligation to repeat the course is not provided by the Driver’s License Ordinance (FeV § 19 FEV). The Road Traffic Act (§ 2 Para. 2 No. 6 StVG) stipulates that applicants for a driving license must be able to provide first aid. According to general recommendations, the knowledge should be refreshed every 2 to max. 3 years.
First aid course
In this course, the measures for the first aid of vital threatened persons are to be taught. The knowledge that can be acquired here is helpful and even life-saving in many emergencies that can occur in the private and professional environment. To a large extent, this involves respiratory and circulatory emergencies. The treatment of injuries, burns, shock and poisoning is also taught. The duration comprises 9 teaching units of 45 minutes each (before April 1, 2015: 8 teaching units of 90 minutes each).
The course is compulsory in Germany for all driver’s license classes, for the acquisition of the passenger transport license, the youth leader card and for admission to the physics examination. The employers‘ liability insurance associations require repetition every two years, with the repetition training for company first aiders comprising 9 teaching units of 45 minutes each (before April 1, 2015: 4 teaching units of 90 minutes each).
The training in a first aid course imparts, among other things, the following knowledge:
Behavior at the emergency scene
First link of the rescue chain: securing, self-protection, emergency call, immediate measures
Second link of the rescue chain: first aid/other measures in case of:
Shock as a life-threatening condition
Wounds and wound care, hemostasis
Poisoning (e.g., with alcohol, medications, carbon dioxide, carbon monoxide, pesticides, chemicals, or drugs)
seizure (epilepsy) and stroke (cerebral infarction)
thermal injuries (burns, frostbite and hypothermia)
chemical burns
insect bites (especially in the mouth and throat)
violent impact on the head (head injury), concussion
choking (swallowing of foreign bodies)
Abdominal injuries, acute abdominal illnesses with nausea and diarrhea or vomiting
Cardiovascular disorders (cardiac arrest, heart attack, stroke and arrhythmia)
Bone and joint injuries
Mental care of the casualty/patient
Third link in the rescue chain: rescue service
Fourth link in the rescue chain: hospital
Since 2005, the rescue chain has been specified in four links. The previous separation between the „immediate measures“ and the „emergency call“ has been abolished; the emergency call is made as far as possible in parallel with the other immediate measures.
There is no final examination of the acquired knowledge and the learned practical skills. Only the participation is certified. References to the possibly mental care of traumatized first responders after e.g. serious accidents are not given
Special first aid courses
Meanwhile, many aid organizations and other approved providers offer customized training courses, for example for members of special risk groups:
First aid in children’s emergencies (for parents, grandparents, educators and other supervisors of children up to approx. 10 years)
First aid in sports accidents (for sports teachers, exercise instructors, trainers)
First aid for seniors
First aid for the disabled
First aid for cardiovascular patients
First aid in outdoor areas, including specific courses for first aid in alpine areas
First aid for seafarers (extended courses that include, for example, placing infusions)
First aid courses delivered online and introduced during the COVID 19 pandemic
On the other hand, there are courses that are tailored to specific groups of first responders:
First aid for medical students
First aid for road traffic
First aid for company first aiders
First aid for private and domestic use
First aid for children, adolescents, mentally or physically handicapped persons
First aid for soldiers of the German Armed Forces
First aid for professional trainers of sports associations
Some of these courses are also held in cooperation with schools, kindergartens or facilities for the disabled.
New to the program are the courses „Life-saving immediate measures with self-protection content“ and also „First aid with self-protection content“, which correspond in content to a course in life-saving immediate measures or first aid and have been supplemented with topics from civil and population protection. These courses are only financed 100% by the federal government if the very narrow requirements are met (note: funding is limited). The requirements include a very narrow age range of participants (14 to 16 years) and a maximum of 15 participants per course.
Company first aider
In every company in Germany, a sufficient number of trained company first aiders must be „available“ according to § 10 ArbSchG and specified in § 26 of DGUV Regulation 1. These company first aiders must, as mentioned above, undergo training comprising 9 training units. A suitable refresher course of 9 units must be attended every two years at the latest. Depending on the type of company, between 5 and 10 % first aiders are given as a guideline. A first aider is required for as few as two employees. The use of the first aid kit must be documented in the first aid manual.
Paramedic courses
Paramedic courses are sometimes offered as general training or serve as training for civil protection (disaster control/civil defense).
For some occupational groups (personal and property protection, for all weapon carriers, for service dog handlers), paramedic training is mandatory. The paramedic training requires a basic training in first aid (usually with at least 9 teaching units). In addition, the employers‘ liability insurance associations stipulate that, depending on the size of the company, an appropriate number of first aiders must be present (from two members of staff). Only licensed physicians and dentists are considered first aiders without any special training. From a certain company size, training as a company paramedic is mandatory (from 1500 staff members present, on construction sites from 100). This training takes considerably longer than a normal first aid course (first aid = 9 teaching units. versus company paramedic training = (at least) 95 teaching units, whereby the latter builds on a first aid course) and also includes the basics of medical assistance. The training is divided into a basic and an advanced course (paramedic, paramedic, paramedic assistant as well as the training to become a nurse and a medical sergeant in the German Armed Forces are recognized as basic training). At least every three years, the company paramedic training must be refreshed by a 16-hour continuing education course. Training and continuing education may only be conducted by so-called authorized bodies. Equivalent to the company paramedics are the so-called remedial assistants according to the mountain ordinances. (Source: Accident Prevention Regulation – DGUV Regulation 1, Principles of Prevention, BGV A1 and Employer’s Liability Insurance Association Principles, BGG 949, published by the German Federation of Institutions for Statutory Accident Insurance and Prevention, as of January 1, 2004)
Advanced courses
Courses or vocational training that go far beyond imparting first aid knowledge for first aiders include, for example, courses for on-site helpers (D only), rescue assistants (D only), paramedics (D, Ö) and emergency paramedics (D, Ö). In 2014, the professional training for emergency paramedic replaced that of the paramedic, who could further qualify to this through further training. Information on these training courses can be found under the corresponding keywords. The paramedic and emergency paramedic is a vocational training in Germany. In Austria, this applies to training as a paramedic as well as an emergency paramedic.
Austria
Scope
The curriculum for the first aid course in Austria has the following structure:
Why should you give first aid?
First aid equipment
Basics of first aid:
Rescue chain: securing, providing first aid and making an emergency call (in parallel), rescue service, further care
Tasks of the first aider
Danger zones, securing, recognizing, requesting special forces
Emergency call: possibilities, which questions are asked, emergency numbers and other important telephone numbers
Helmet removal, pull away, rescue (formerly „salvage“) with the hash handle
Emergency check
turn over (from prone position to supine position), pull away, get someone onto a blanket
Acute emergencies – recognize each and initial measures
Heart attack
Stroke
Seizure
Diabetes
Asthma attack
Collapse
sunstroke
Ingestion
Poisoning
Allergic reaction
Severe bleeding (pressure bandage, finger pressure)
Wounds
Bandages
Head bandage, hand bandage, knee bandage with triangular cloth
Nosebleed
Animal bite
Foreign body in the wound
Burn
Chemical burn
Bone and joint injuries
Arm injury (arm sling)
Leg injury
Sprain
Duration and types
The following types of first aid courses are usually offered:
16 hours basic course – required for driver’s license D (bus)
4 hours refresher course
8 hours refresher course
Children’s emergency courses (4 to 16 hours)
6 hours driver’s license course (immediate measures at the scene of an accident) – is required for driver’s license B
Instruction for defibrillators and various special courses
Company first aider
According to the Workplace Ordinance (AStV), company first aiders must be trained in companies (§ 40 AStV).
In offices or workplaces with a comparable accident risk:
1 first aider for up to 29 regularly employed workers at the same time
2 first aiders for 30 to 49 employees regularly employed at the same time
one additional first aider for every 20 additional employees regularly employed at the same time.
in all other workplaces:
1 first aider for up to 19 regularly employed workers at the same time
2 first aiders for 20 to 29 employees regularly employed at the same time
one additional first aider for every 10 additional employees regularly employed at the same time.
for construction sites:
1 first aider for up to 19 workers employed by an employer on a construction site.
2 first aiders for 20 to 29 regularly employed workers
one additional first aider for every 10 additional workers regularly employed by an employer on a construction site
First responders must have at least 16 hours of training (eight hours in companies with fewer than five employees). An eight-hour refresher must be completed every four years, or alternatively a four-hour refresher every two years.
Switzerland
Providers and offers
In Switzerland, several Swiss Red Cross organizations, namely the Sameriter Schweiz, the Swiss Life Saving Society (SLRG) and the Swiss Military Medical Association offer first aid courses on a non-commercial basis. The second major provider, the Swiss Medical Corps – an association of doctors, paramedics and trainers – mostly works with commercial partners (mainly driving instructors, Migros Club School, TCS).
The Inter Association for Rescue (IVR) certifies and standardizes a large part of the training courses. As an example, an overview of the courses offered by the Samaritan Association:
Course
Content
Target group
Duration of the course (in hours)
Validity period of the ID card (in years)
Prerequisite
Emergency helper course
According to Art. 10 VZV: securing the accident site, alerting, preservation of vital bodily functions, positioning of the injured person, ventilation, severe bleeding, basics of cardiac massage.
Learner drivers (categories A, A1, B and B1) must have a valid ID card
10
6
none
First aider IVR 1
General first aid in everyday situations (traffic, household, workplace, leisure) and correct alerting. The first aider can implement instructions from the emergency call center according to the situation. Participants will also receive certificates for the emergency responder course and BLS-AED-SRC.
general
14
2(respectively 6 and 3)
none
First aider IVR 2
Formerly known as the „Samaritan Course.“ Deepens and expands first responder IVR 1, including: Assessing, providing initial care, and observing accidental bodily injury and acute illness until professional help arrives; assessing whether and what professional help needs to be called for; level-appropriate classification of hazardous situations.
z. e.g. youth group leaders, sports coaches, part-time company paramedics
14
2
IVR 1 or emergency responder + BLS-AED-SRC
First aider IVR 3
Link to professional rescue. Differentiated situation assessment, best possible care of the patient based on available resources. Assists emergency physician and paramedic.
z. e.g. part-time or full-time company paramedics
42
1
IVR 2
BLS-AED-SRC
Ventilation, cardiac massage and use of a defibrillator according to the guidelines of the Swiss Resuscitation Council.
in general, but especially relatives of heart patients, police officers, firefighters, fitness instructors
4
3
none
Emergencies in young children
Hazard recognition, patient assessment, ingestion of objects, resuscitation.
Parents, childcare workers
4
unlimited
none
First aid part of the CZV course
According to annex CZV, number 3.5: situation assessment, avoidance of secondary accidents, alerting, rescue and first aid, behavior/evacuation in case of fire, procedure in case of violence, preparation of accident reports.
Compulsory for persons who professionally drive vehicles in categories C, C1, D or D1.
2 X 8
5
none (de facto emergency helper course, due to previous learning license category B)
If repeat courses are attended within the period of validity, the validity is extended. There is no obligation to repeat courses, but employers (in the case of company paramedics), sports associations or youth organizations, for example, insist that first aiders have a valid card in each case.
Specialized first aid courses are offered by:
SLRG: Accidents during bathing, swimming and water sports
Swiss Alpine Club: Emergencies in mountain sports
History
The Military First Aid Association of Berne was founded in 1880 to provide first aid services at major civilian events (e.g. gymnastics and shooting festivals). In 1885, also in Bern, the first Samaritan Association was founded, and in 1888 the Swiss Samaritan Federation. Since 1965, Samaritan associations have offered emergency courses to the public, and since 1977, attendance at an emergency course has been compulsory for learner drivers. The Samaritan Association introduced resuscitation courses in 1993.
Operational Health
In Switzerland, there is no more precise legal regulation of industrial hygiene; the law stipulates that, depending on the operational hazards, location and size of the operation, the „necessary means“ must be available and that, if necessary, trained industrial paramedics and first-aid rooms must be available. For judicial practice (e.g. liability issues), the guidelines of the State Secretariat for Economic Affairs (SECO) and those of the various industry associations are binding.