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Scenario — Choking — partial airway obstruction in a child
Patient Information
Dispatch
You are called to the canteen area at the school carnival. A parent is waving you down — an 8-year-old boy appears to be choking on food.
Incident History
Pt was eating a sausage sizzle when he began coughing forcefully. Parent states he is still coughing and can speak but is very distressed.
Emergency Contact
Minh Nguyen (Father) 0412 374 891
Initial Rapid Assessment
Response
Alert
Airway
Partial obstruction. Pt coughing forcefully, able to speak in short sentences. Nil stridor at rest. No drooling.
Breathing
Increased work of breathing. Accessory muscle use visible. Coughing is effective. RR elevated.
Circulation
Radial pulse present, strong. Skin pink, warm. Mildly distressed appearance. Nil cyanosis.
Disability
GCS 15 (E4V5M6). Alert and orientated to time, place and person. Anxious but cooperative.
Exposure
No visible injuries. No rashes. Food visible around mouth. No neck swelling.
Vitals
Time SpO2 Resp Dist RR Pulse BP CRT GCS PERL Temp BGL Pain
Initial 95% (RA) Mild 26 112 106/68 <2s 15 4 4 ++ 36.8 – 3
10 mins 99% (O2 simple mask 6L/min) Nil 18 96 104/66 <2s 15 4 4 ++ 36.8 – 0
History Taking
Signs/Symptoms
Coughing, throat discomfort, mild shortness of breath. Able to speak in short sentences. States 'something is stuck in my throat'.
Onset
Sudden onset approximately 3 minutes ago while eating.
Pain
Discomfort in throat rated 3/10. No chest pain.
Quality
Sensation of obstruction in throat. Intermittent coughing spasms.
Radiates
Nil
Severity
3/10 throat discomfort
Allergies
Nil known drug or food allergies.
Medications
Nil regular medications.
Pertinent History
No previous choking episodes. No history of dysphagia. No known respiratory conditions.
Last Oral Intake
Sausage sizzle approximately 5 minutes ago.
Treatment
Father performed two back blows before EHS arrival. No improvement noted.
Events Leading
Pt was running around with friends, came to the canteen, ate a sausage sizzle quickly and began choking shortly after.
Scenario Progression and Treatment Objectives

((If the trainee does not reassess cough effectiveness within the first 2 minutes, advise the facilitator to inform them that Liam's coughing is becoming weaker and less effective — transition to severe/complete obstruction presentation.))

((If the trainee attempts a finger sweep, remind them this is contraindicated and can worsen the obstruction and cause local trauma.))

((If the trainee attempts abdominal thrusts, remind them these are not recommended per CPG due to potential life-threatening complications.))

((If oxygen is not considered after obstruction resolves, prompt with 'Liam is still looking a little pale — what else might you consider?'))

((If the trainee does not continuously reassure the patient and parent, the facilitator should note the parent is becoming increasingly distressed and demanding action.))

This patient is suffering from a mild/partial foreign body airway obstruction secondary to food bolus ingestion.

  • Ensure scene safety and don appropriate PPE.
  • Perform Primary Survey — confirm partial airway obstruction with effective cough and ability to speak.
  • Continuously reassure Liam and his father throughout the scenario.
  • Encourage Liam to cough — do NOT interfere with an effective cough.
  • Do NOT perform finger sweep — this is contraindicated in FBAO.
  • Do NOT perform abdominal thrusts — not recommended per CPG.
  • Position Liam to allow gravity to assist if cough becomes ineffective.
  • Maintain constant observation for any sudden deterioration from partial to complete obstruction.
  • Assess Liam's cough effectiveness every 1–2 minutes — rate, strength, ability to speak.
  • Consider oxygen therapy if SpO2 remains below 94% or patient shows signs of distress — apply simple face mask at 5–8 L/min targeting SpO2 94–98%.
  • If obstruction resolves: perform full vital sign survey, perform secondary survey, auscultate lung fields bilaterally to confirm air entry.
  • If obstruction progresses to severe/complete (ineffective cough, unable to speak, cyanosis): immediately transition to FBAO severe protocol — position patient with gravity assistance, deliver up to 5 back blows between the scapulae at 90° angle, check for dislodgement between each blow, if still obstructed perform up to 5 chest thrusts, continue alternating until obstruction dislodges.
  • If patient becomes unconscious at any point: commence CPR as per Cardiac Arrest Guidelines and call for Priority 1 transport with pre-notification of receiving facility.
  • Arrange transport with paramedic backup given paediatric choking presentation — any paediatric choking event warrants medical review.
  • 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 · Cardiac Arrest - Paediatric