Anyone who has ever waited on tables or worked in a kitchen likely knows about first aid for choking victims.

Posters illustrating the steps to be taken have graced the kitchen walls of restaurants and diners for decades. But this year the advice changed.

For more than 20 years, the American Red Cross had recommended the Heimlich maneuver as the first response in assisting a choking victim.

The maneuver named for Dr. Henry Heimlich uses abdominal thrusts to clear an obstructed airway.

New standards from the Red Cross released in 2006 say five back blows should be the first step in assisting someone with a blocked airway, followed by abdominal thrusts if the back blows fail to dislodge the object blocking the airway.

“The American Red Cross 2005 Guidelines for Emergency Care and Education” lists choking as a common breathing emergency.

“When a person shows signs that he or she is choking, responders must act quickly to relieve the obstruction,” the guidelines state.

The Red Cross says the sequence of skills recommended to assist conscious choking victims is based on the current “science on care and education and the expert input of Red Cross volunteers and professional staff.”

The American Heart Association, which also offers and promotes first-aid training, continues to recommend abdominal thrusts as the first response in assisting a choking victim.

“As a nurse, I can’t think of any compelling reason why to not use abdominal thrusts,” said Julie Hilsinger. “The Heimlich maneuver works.”

Hilsinger works at Blue Hill Memorial Hospital and is the school nurse at George Stevens Academy in Blue Hill. She is the emergency medical services chief for the Brooklin Fire Department and also leads first aid and CPR training sessions in area schools and businesses.

She said she follows American Heart Association guidelines in all her training sessions.

She said the latest training videos and manuals available from the AHA mention nothing about back blows for giving first aid to choking victims, except when treating infants.

Although the two organizations disagree on which first-aid skill should be employed initially when coming to the aid of a choking victim, both still teach the Heimlich maneuver as an effective tool in helping conscious choking victims.

(Both organizations are replacing the phrase “Heimlich maneuver” with “abdominal thrusts” in their first aid and CPR courses, primarily because the term is more descriptive of the action to be taken.)

“Research shows that the use of more than one method to dislodge an object can be more effective,” said Lynn Duswald, a health and safety program specialist with the Pine Tree Chapter of the Red Cross.

She said she doesn’t know why the Red Cross is recommending that back blows come first when treating choking victims, adding that all three methods employed — back blows, abdominal thrusts and chest compressions — are equally effective in dislodging objects from a blocked airway.

(Chest compressions are commonly employed when trying to dislodge an object from victims who have become unconscious.)

Duswald said that if nothing moves, if no air is moving after five back blows, you should position yourself directly behind the victim and administer five abdominal thrusts. If the airway remains blocked, go back to five back blows.

“It’s a repeating cycle,” she said.

The Red Cross and the Heart Association agree on what constitutes choking, and both organizations teach that unless someone is actually choking, first aid should not proceed to the level of back blows or abdominal thrusts.

Hilsinger said when someone appears to be choking, the first step in helping the person is to determine whether he or she is actually choking.

  She said if the person exhibits any sign of air exchange, do not proceed to abdominal thrusts. Instead, you should try to calm the person, which could lead to coughing that would dislodge the object.

When people are choking, she said, they cannot speak or cough.

“If you are even able to cough a little bit, it’s a sign you are getting air,” she said. “Choking is like a cork in a bottle; you’re totally blocked.

“If you detect any kind of air exchange, give them a moment, and they’ll cough it up. That’s always best.”

Red Cross guidelines echo that advice.

“If a person can cough forcefully, encourage the person to do so,” the guidelines state. “If a person cannot cough forcefully, speak or breathe, the person may be choking.”

The difference in advice comes at the next step.

Convinced that a person’s airway is totally blocked, Hilsinger would employ abdominal thrusts, based on education guidelines from the American Heart Association.

“There are several techniques for clearing an obstruction: back blows, abdominal thrusts and chest throws,” according to the Red Cross guidelines. Because there is no evidence which technique is better and there is clear evidence that in many victims if one method does not work another method sometimes does, the technique for conscious choking is a series of back blows followed by abdominal thrusts.

“In addition when you approach a victim from the front, as taught, you are in a natural position to deliver back blows first.”

The first-aid instructions posted at restaurants and other workplaces may be helpful but are not substitutes for first aid and CPR training, which is highly recommended by the Red Cross and the Heart Association.

“Our goal is to have one member in every household trained in CPR and first aid,” said Duswald.