First Responder EMS Curriculum for Training Centers in Eurasia

one per second, each with the intention of creating enough of an "artificial cough" todislodge the foreign body.6. If the airway remains obstructed, repeat the sequence of up to five back blows and upto five chest thrusts until the object is removed or the victim becomes unresponsive.b. Abdominal thrusts (Heimlich maneuver) in the responsive child1. Stand or kneel behind the victim, arms directly under the victim's armpits, encirclingthe victim's torso.2. Place the flat, thumb side of one fist against the victim's abdomen in the midlineslightly above the navel and well below the tip of the xiphoid process.3. Grasp the fist with the other hand and exert a series of up to five quick inward andupward thrusts. Do not touch the xiphoid process or the lower margins of the ribcage, because force applied to these structures may damage internal organs.4. Each thrust should be a separate, distinct movement, delivered with the intent torelieve the obstruction. Continue the series of up to five thrusts until the foreign bodyis expelled or the victim becomes unresponsive.c. Unresponsive infant1. Open the victim's airway using a tongue-jaw lift and look for an object in thepharynx. If an object is visible, remove it with a finger sweep. Do not perform ablind finger sweep.2. Open the airway with a head tilt-chin lift and attempt to provide rescue breaths. If thebreaths are not effective, reposition the head and reattempt ventilation.3. If the breaths are still not effective, perform the sequence of up to five back blowsand up to five chest thrusts.4. Repeat steps 1 through 3 until the object is dislodged and the airway is patent or forapproximately 1 minute. If the infant remains unresponsive after approximately 1minute, activate the EMS system.5. If breaths are effective, check for signs of circulation and continue CPR as needed, orplace the infant in a recovery position if the infant demonstrates adequate breathingand signs of circulation.d. Unresponsive child1. Open the victim's airway using a tongue-jaw lift and look for an object in thepharynx. If an object is visible, remove it with a finger sweep. However, do notperform a blind finger sweep.2. Open the airway with a head tilt-chin lift, and attempt to provide rescue breaths. Ifbreaths are not effective, reposition the head and reattempt ventilation.3. If the breaths are still not effective, kneel beside the victim or straddle the victim'ships and prepare to perform the Heimlich maneuver abdominal thrusts as follows:• Place the heel of one hand on the child's abdomen in the midline slightly abovethe navel and well below the rib cage and xiphoid process. Place the other handon top of the first.• Press both hands onto the abdomen with a quick inward and upward thrust. Directeach thrust upward in the midline and not to either side of the abdomen. Ifnecessary, perform a series of up to five thrusts. Each thrust should be a separateand distinct movement of sufficient force to attempt to dislodge the airwayobstruction.4. Repeat steps 1 through 3 until the object is retrieved or rescuer breaths are effective.272 First Responder EMS Curriculum/AIHA, July 2002