Choking and Anaphylaxis: Vital First Aid in UK & Ireland

First aid provision for sudden medical emergencies like choking and anaphylaxis is a critical component of public health and workplace safety across the UK and Ireland. While both present immediate life-threatening risks, their underlying causes and, crucially, their emergency treatments differ significantly. Understanding these distinctions and adhering to established guidelines from regulatory bodies such as the Health and Safety Executive (HSE) in the UK and the Health and Safety Authority (HSA) in Ireland, alongside clinical guidance from the Resuscitation Council UK (RCUK), is paramount for effective response.

The Silent Threat of Choking: Statistics and Prevention

Choking occurs when an obstruction blocks the airway, preventing effective breathing. It can affect anyone, but young children and the elderly are particularly vulnerable. Between 2018 and 2022, there were 1399 choking-related deaths in the UK, with food substances accounting for 1097 of these. The elderly are identified as the most at-risk demographic due to factors such as eating too quickly, difficulty swallowing, and dental issues. In children, choking remains a significant concern. The National Child Mortality Database revealed that 17 children died as a result of choking in the three years leading up to March 2022 in the UK, with nine of these deaths attributed to food items like grapes, sausages, and strawberries. In Ireland, choking or suffocation is among the top six most common causes of death in children.

Workplace Choking Incidents

In workplace settings, particularly those involving vulnerable adults, choking incidents are also a serious concern. HSE (Ireland) data from 2020-2024 reported over 3,000 choking incidents or near misses in HSE and HSE-funded services. Over 70% of these occurred in non-acute services, primarily in care of the older person, mental health services, and disability services. Food and drink were implicated in over 80% of these incidents, with medication accounting for approximately 3%. Tragically, 20 incidents resulted in death. Risk factors often include dysphagia (difficulty swallowing) associated with neurological disorders, mental health difficulties, or intellectual disabilities.

Immediate Action for Choking

Prompt and correct first aid is crucial for choking. For adults and children, the recommended approach involves encouraging the casualty to cough. If ineffective, five sharp back blows should be administered. If choking persists, five abdominal thrusts (Heimlich manoeuvre) should be performed. For infants, a combination of back blows and chest thrusts is advised. It is vital to call for emergency medical help if the obstruction is not cleared. Sadly, research indicates that only 44% of people know how to administer basic back blows for choking.

Anaphylaxis: A Severe Allergic Reaction Requiring Rapid Intervention

Anaphylaxis is a severe, life-threatening allergic reaction that is rapid in onset and can cause death. It is characterised by rapidly developing airway, breathing, and/or circulation problems. While anaphylaxis is considered rare, its incidence, particularly food-induced anaphylaxis, is increasing worldwide. In the UK, approximately 20 million people live with an allergy, with around 10 million experiencing allergic symptoms annually. Around 10 people die each year in the UK from food-induced anaphylaxis, a figure that has remained relatively stable over the past two decades, largely due to improved emergency management and wider access to adrenaline auto-injectors. Between 1998 and 2018, there were 101,891 hospital admissions for anaphylaxis in the UK, with 152 deaths attributed to food allergy as the likely trigger. The most common single cause of fatal anaphylaxis in children in the UK is cow's milk. In Ireland, deaths due to anaphylaxis are also rare, estimated to occur in 1 in 1-3 million people per year.

Recognising and Treating Anaphylaxis

Early recognition and prompt treatment with intramuscular (IM) adrenaline are critical for managing anaphylaxis. The Resuscitation Council UK (RCUK) published updated guidelines in 2021, emphasising the importance of IM adrenaline and providing an algorithm for treatment. Key changes in the guidelines include a greater emphasis on IM adrenaline, changes to the role of antihistamines and corticosteroids (which are no longer advised for routine emergency treatment), and refined observation durations. If an individual does not respond to two appropriate doses of IM adrenaline, it is classified as refractory anaphylaxis, requiring further medical intervention.

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The RCUK recommends that individuals at risk of anaphylaxis carry two adrenaline auto-injectors at all times. Training in their use is essential, as techniques can vary between devices. Despite the clear guidance, low rates of adrenaline auto-injector prescription have been observed, even in those with a history of anaphylaxis.

Workplace First Aid Regulations in the UK and Ireland

Employers in both the UK and Ireland have a legal obligation to provide adequate and appropriate first aid provisions for their employees. This includes equipment, facilities, and trained personnel.

United Kingdom (Great Britain)

The Health and Safety (First-Aid) Regulations 1981 mandate that employers in Great Britain assess workplace risks to determine their first aid needs. This assessment dictates the number of trained first aiders or appointed persons required, and the contents of first aid kits. For instance, in low-hazard workplaces with fewer than 25 employees, an appointed person may suffice. For 25-50 employees, at least one Emergency First Aid at Work (EFAW) trained first aider is needed, and for over 50 employees, one First Aid at Work (FAW) trained first aider per 100 people is required. In higher-hazard environments, more first aiders are necessary. Employers must also inform employees of first aid arrangements.

Republic of Ireland

In Ireland, the Safety, Health and Welfare at Work (General Application) Regulations 2007 outline the legal requirements for first aid in the workplace. Similar to the UK, employers must conduct a risk assessment to determine the appropriate first aid measures, considering factors such as the number of employees, the nature of work, and specific hazards. The HSA provides guidelines for the recommended number of occupational first aiders, with, for example, one occupational first aider recommended for workplaces with up to 99 employees. First aid kits should be easily accessible, clearly marked, and regularly checked and replenished. Occupational first aid certification is valid for two years and requires refresher training.

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