School cafeterias are often a land of chicken nuggets, pizza, and salads. Equally ubiquitous as the standard school lunch fare is the poster showing first aid for choking. In addition to back blows and chest compressions, these posters feature the classic image of a person choking and a second person standing behind them with their fists above the victim’s abdomen, thrusting downward. This move is known as the Heimlich Maneuver.
Unfortunately, this choking solution doesn’t work for every population–especially people with disabilities. According to a 2023 resource from the Virginia Department of Behavioral Health and Developmental Services, people with neurodevelopmental disabilities are at high risk for choking. Other contributing risk factors include structural abnormalities of the mouth or throat; difficulty moving the tongue around the mouth; face, mouth, or neck muscle weakness, and having a cleft lip, cleft palate, or high-arched palate.
For young people, there are additional risks. Between childhood and age 18, the esophagus can range from the size of a dime to the size of a nickel. That small size combined with disability-related risks and potential medicinal side effects can lead to a perfect storm for choking.
Toni L’Abbate, founder of Equal First Aid, is an advocate for alternative choking solutions beyond the Heimlich Maneuver. “How do you get your arms around a power chair to perform an abdominal thrust?” asked L’Abbate. She explained that many organizations don’t have recommendations for saving disabled people who are choking.
L’Abbate, a nurse, had previously been a hands-on caregiver in the disability community. She saw first-hand how important it was to have the correct tools to work with the disability population and noticed how few tools were available. Equal First Aid’s purpose is to advocate for inclusive choking solutions for the disabled community. They believe that having “no option is not an option.”
New York State Senator Joseph P. Addabbo Jr. is working to help bring a more accessible, inclusive choking solution to New York public schools. Senate Bill S7018 is currently before the Legislative Education Committee. It would amend an existing education law by clearly defining airway clearance devices to be used in schools as “a portable medical device that uses manually created suction to remove blockage from the airway during a choking emergency and has been registered as a Class II acute upper airway obstruction device with the United States Food and Drug Administration.”
Schools would have to develop policies and have device usage training for school nurses and staff including airway management and removal of any obstruction using an airway clearance device.
While there are already laws on the books that provide for equal access to healthcare and equal access in educational settings, this bill is essential to clearly ensure safety in an educational setting for all students. Visit equalfirstaid.org to learn more about you can support Equal First Aid in advocating for this legislation.
As an ambulatory wheelchair user, spouse and parent of two able-bodied children, I am constantly trouble-shooting situations before they happen. Being prepared is the only option. The value of acquiring and having these anti-choking devices in our first aid kit is three-fold. If I am the person choking, I may not be able to position myself to have abdominal thrusts performed. Additionally, I may be with my young children who would not be able to perform such a move on an adult. Alternatively, if one of my children, my husband, or a guest began to choke, logistics and strength might render abdominal thrusts or back blows improbable or ineffective.
The anti-choking device’s lightweight design and easy to understand instructions make it a much more accessible process to save someone who’s choking. As the primary caregiver in my family, the limited amount of strength required to build the manual pressure required to dislodge an object from an airway means I can take action in a choking situation in my home, whether it involves my ever-growing children, first-responder husband, or myriad guests, regardless of how my body is feeling that day. Having an anti-choking device empowers me, and it can empower so many people with and without disabilities.