If someone near you can’t breathe, call 911 immediately and try to identify the cause. The right response depends on what’s happening: choking, an allergic reaction, a drug overdose, or cardiac arrest each require different actions. While you wait for help, there are specific things you can do that genuinely save lives.
First 30 Seconds: Assess the Situation
Before doing anything physical, take a quick read of what you’re dealing with. Ask the person what’s wrong if they can respond at all. Look for clues: Are they clutching their throat? Is there food nearby? Did they recently take medication or drugs? Are they wearing a medical alert bracelet? These details help you act correctly and help the 911 dispatcher send the right resources.
Check three things fast. Is the person conscious? Are they breathing at all, even weakly? Can they cough, speak, or cry? Your answers to these questions determine your next move. A person who can still cough forcefully is getting some air. A person who is silent, turning blue, or unconscious needs you to act now.
When you call 911, the dispatcher will ask whether the person is conscious and breathing normally. Answering “no” to either of those questions triggers the highest-priority emergency response, the same level as a cardiac arrest call.
If the Person Is Choking
A choking person will often grab at their throat and be unable to speak or cough effectively. The Red Cross recommends alternating between back blows and abdominal thrusts in sets of five.
Start with back blows. Bend the person forward at the waist so their upper body is roughly parallel to the ground. Using the heel of your hand, strike firmly between their shoulder blades five times. Make each blow a distinct, forceful hit rather than a rapid series of taps.
If the object doesn’t come out, switch to abdominal thrusts. Have the person stand up straight. Move behind them and place one foot between their feet for balance, bending your knees slightly. Find their navel, make a fist just above it, grab your fist with your other hand, and pull sharply inward and upward. Do this five times. Continue cycling between five back blows and five abdominal thrusts until the person can cough, speak, or cry, or until they become unresponsive.
If the person goes unconscious, lower them to the ground and begin CPR. Each time you open their airway to give breaths, look in the mouth for a visible object you can remove.
If the Person Is Unconscious and Not Breathing
When someone is unresponsive and not breathing, or only making occasional gasping sounds, they need CPR. Those gasping breaths (called agonal gasps) are not real breathing. They’re a sign of cardiac arrest.
Place the person on their back on a firm surface. Put the heel of one hand on the center of their chest, place your other hand on top, and push hard and fast. Current American Heart Association guidelines call for a compression depth of at least 5 cm (about 2 inches) but no more than 6 cm. Aim for a rate of 100 to 120 compressions per minute, roughly the tempo of the song “Stayin’ Alive.” Research on over 13,700 patients found the best survival rates at that range.
If you’re trained in CPR, give 30 compressions followed by 2 rescue breaths, then repeat. If you haven’t been trained or aren’t comfortable giving breaths, hands-only CPR (just compressions) is still effective and far better than doing nothing. Keep going until paramedics arrive or the person starts breathing on their own.
Drowning Is Different
For someone pulled from water, the priority shifts slightly because drowning is fundamentally a breathing problem. Trained rescuers should start with two rescue breaths before beginning chest compressions, then continue the standard 30-compression, 2-breath cycle. If you’re not trained in rescue breathing, chest compressions alone are still reasonable until help arrives.
If It’s an Allergic Reaction
Anaphylaxis can close the airway within minutes. Signs include swelling of the face, lips, or throat, hives or flushed skin, wheezing, and a sudden drop in blood pressure that may cause dizziness or collapse. If the person carries an epinephrine auto-injector, help them use it right away.
To use an auto-injector, press the orange (needle) end firmly against the outer thigh. You can inject through clothing. Hold it in place until you hear or feel a click, then remove it. Have the person lie down with their legs elevated unless that makes breathing harder, in which case let them sit upright. Call 911 even if symptoms improve, because anaphylaxis can return after the medication wears off.
If You Suspect an Opioid Overdose
Opioid overdoses shut down the brain’s drive to breathe. The classic signs are very slow or stopped breathing, extreme sleepiness where the person won’t wake up even when you rub your knuckles hard on their breastbone, and tiny “pinpoint” pupils. You may also notice a slow heart rate and bluish lips or fingertips.
Naloxone nasal spray is available without a prescription at most pharmacies. To use it, lay the person on their back. Tilt their head back slightly and support the neck with one hand. Insert the nozzle into one nostril until your fingers rest against the bottom of their nose, then press the plunger firmly. Don’t test or prime the device first. One spray is one dose.
After giving the spray, turn the person onto their side and call 911 immediately. If they don’t respond within 2 to 3 minutes, give a second dose in the other nostril using a new device. Continue alternating nostrils every 2 to 3 minutes if needed until paramedics arrive. Even if the person wakes up, they still need emergency care because naloxone wears off faster than most opioids, and breathing can stop again.
If the Person Is Breathing but Unconscious
Someone who is unconscious but still breathing on their own needs to be placed in the recovery position to keep their airway open and prevent choking on vomit or saliva. With the person on their back, kneel beside them. Extend the arm closest to you out at a right angle, palm facing up. Take their far arm and fold it across their body so the back of that hand rests against the cheek nearest you. Hold it there. With your free hand, bend their far knee up to a right angle, then use that knee as a lever to gently roll them toward you onto their side.
Once they’re on their side, tilt their head back slightly and lift the chin to open the airway. Check that nothing is blocking their mouth. Stay with them and keep watching their breathing until help arrives. If their breathing stops, roll them onto their back and begin CPR.
If the Cause Isn’t Obvious
Sometimes breathing difficulty comes on without a clear trigger. Asthma attacks, heart problems, blood clots in the lungs, and panic attacks can all make someone feel like they can’t breathe, and telling them apart in the moment isn’t always straightforward.
If the person has a known condition like asthma and carries an inhaler, help them use it. Have them sit upright, as this position makes breathing easier than lying down. Loosen any tight clothing around their neck and chest. Don’t give them food or water, because if their airway is compromised, they could choke.
Panic attacks and hyperventilation can mimic serious breathing emergencies. About half of people with hyperventilation syndrome also have panic disorder, and the overlap makes self-diagnosis unreliable. A person hyperventilating from anxiety will typically have normal oxygen levels and a clear-sounding chest, but these same symptoms can also appear with blood clots in the lungs or heart problems. Hyperventilation syndrome is a diagnosis of exclusion, meaning it can only be confirmed after ruling out dangerous causes. If there’s any doubt, treat it as a medical emergency and call for help. It’s always better to have paramedics arrive for a panic attack than to assume the worst isn’t happening.
What to Do While Waiting for Help
Keep the person as calm as possible. Anxiety makes breathing harder regardless of the cause. Speak in a steady, reassuring voice. If they’re conscious, let them find the position that feels easiest for breathing, whether that’s sitting upright, leaning forward, or lying propped up on pillows.
Monitor their breathing continuously. Count their breaths for 15 seconds and multiply by four to get a rate per minute. Normal is 12 to 20 breaths per minute in adults. Watch their lips and fingernails for a bluish tint, which signals dangerously low oxygen. If they stop breathing or lose consciousness, be ready to start CPR immediately. The transition from breathing emergency to cardiac arrest can happen fast, and the minutes before paramedics arrive are when bystander action matters most.