((If trainee attempts a finger sweep — advise the patient winces and coughs more forcefully; remind trainee that finger sweeps are contraindicated as they can worsen the obstruction and cause local trauma))

((If trainee does not encourage coughing as the first intervention — patient's cough becomes less effective over the next 60 seconds and she begins to look more distressed; prompt trainee to reassess whether obstruction is worsening))

((If trainee fails to continuously reassess for deterioration to severe/complete obstruction — after 2 minutes the patient suddenly becomes unable to speak and her cough becomes silent; facilitator prompts trainee: 'Sarah grabs your arm and cannot make any sound'))

((If trainee does not apply oxygen therapy — SpO2 remains at 93–94% and patient reports increasing breathlessness; prompt trainee to consider oxygen delivery))

This patient is suffering from a mild/partial foreign body airway obstruction secondary to food bolus ingestion, presenting with an effective cough and partial ability to speak.

• Ensure scene safety and don appropriate PPE including gloves
• Perform Primary Survey — confirm mild/partial obstruction: patient is alert, able to cough forcefully, able to speak in short phrases
• Reassure patient continuously throughout management
• Encourage patient to continue coughing — do NOT perform back blows or chest thrusts while cough remains effective
• Do NOT perform finger sweep — this is contraindicated and can worsen the obstruction
• Apply oxygen therapy via simple face mask at 5–8 L/min titrated to SpO2 target 94–98%
• Position patient in a position of comfort — allow patient to choose their own position; do not force supine
• Continuously monitor for deterioration to severe/complete obstruction: silent or ineffective cough, inability to speak, cyanosis, decreasing conscious state
• Obtain vital signs including SpO2, RR, pulse, BP and GCS
• Take IMISTAMBO history: SAMPLE — allergies nil, medications OCP, no prior swallowing conditions, last oral intake chicken skewer 10 mins ago, events leading as above
• Perform Secondary Survey including auscultation of lung fields bilaterally to assess air entry
• Assess whether obstruction has cleared: patient able to speak in full sentences, effective cough, improving SpO2, improving RR
• If obstruction resolves: continue monitoring observations every 5–10 minutes, advise patient to seek further medical review if symptoms recur or she develops ongoing throat discomfort or difficulty swallowing
• If obstruction deteriorates to severe/complete (patient unable to speak, silent cough, cyanosis): transition immediately to severe obstruction management — follow Foreign Body Airway Obstruction skill: up to 5 back blows between scapulae at 90° angle, check for dislodgement between each; if not dislodged, up to 5 chest thrusts; alternate 5 back blows and 5 chest thrusts until dislodged; request Priority 1 backup and pre-notify receiving facility
• If patient loses consciousness: commence CPR as per Cardiac Arrest CPG and call for Priority 1 backup immediately
• Document all observations, interventions and patient responses on ePCR
• Scenario ends on arrival of ambulance and IMISTAMBO handover
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Choking (Foreign Body Airway Obstruction) · Foreign Body Airway Obstruction · Oxygen Delivery · Primary Survey · Auscultation