Updated June 2025
Key points:
- Providers should be alert to choking risks within your service
- Providers should ensure 24/7 onsite first aid capabilities
- All staff should understand how to manage a choking event
- When suction devices are present in the aged care service, they should be readily accessible to clinical staff and checked regularly to ensure they are functioning properly
- Clinical staff should also be regularly trained to operate suction equipment to remove food, liquid or any other foreign material from the mouth and throat when required
- All staff should be aware that an advance care directive NOT TO RESUSCITATE does not mean first aid shouldn’t be performed when needed - such as during a choking episode.
The Commission is advising you as a residential aged care provider to be alert to choking risks and to ensure 24/7 onsite first aid capabilities within your service.
You should ensure there is onsite first aid capability at your service and that all staff within your service know how to access this at any time.
Staff should be aware of the immediate measures required to manage a choking event, including how to call for assistance and commence first aid measures. When suction devices are present, clinical staff should know how to access and use them when required. There should also be processes in place to ensure suction devices are always functioning correctly.
You should ensure your staff are aware that an advance care directive NOT TO RESUSCITATE does not mean first aid shouldn’t be performed when required e.g. in the event of airway blockage or in the event of other injury.
In relation to choking, your staff need to be made aware of the following:
- choking can occur at any time, including in people with no known eating, drinking or swallowing difficulties.
- there is a higher risk of choking in people who have eating, drinking, and swallowing difficulties.
- a speech pathologist can assess eating, drinking and swallowing function and provide management strategies to support safe eating and drinking. This may include risk mitigation strategies as well as safe swallowing strategies such as assistance at mealtimes, direct supervision and textured modified foods and thickened fluids. Prompt referral and regular review is important to ensure recommendations are up to date.
- A multidisciplinary team assessment and discussion including the older person in the process, can identify risk mitigation strategies, and ensure the team is knowledgeable regarding support required for safer eating, drinking, and swallowing. For further information please see our fact sheet on supporting choice about food and drink.
- any discussions between an older person, speech pathologist, general practitioner and aged care staff members about eating, drinking and swallowing issues needs to be consumer-focused, individualised, and well documented.
- residents can decide to what extent they take the advice and accept known risks. This is known as Eating and Drinking with Acknowledged Risk (EDAR). Risks may include aspiration, chest infections, pneumonia, choking events and sometimes, death. Discussions around risk should include consideration of the level of risk; nutrition risks; quality of life and food enjoyment; discomfort; potential distress experienced by the person, their family or care providers or those who witness a negative outcome of the risk; and any other issues relevant to the individual. Eating, drinking, and swallowing risks can change over time and records of decisions and preferences must be kept up to date.
A choking event should be managed as a serious incident. This includes:
- open disclosure
- Immediately investigating and understanding the contributing factors to the choking event, across all aspects of care
- having a speech pathologist assess or reassess the resident and provide the person opportunity to update their food risk preferences and decisions.
- assessing the staff response to the incident
- planning to make any identified required changes
- ensuring sustained implementation of changes
- staff debriefing and support
You can find accredited first aid courses at various locations including through St John Ambulance Australia, the Royal Life Saving Society - Australia and the Australian Red Cross.
Please print and display this St John first aid fact sheet at your service.
Please share this alert with relevant management and staff within your service.
Dr Mandy Callary
Chief Clinical Advisor
