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Heimlich, Dangerous?

Experts discredit maneuver


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The name Heimlich has brand recognition when it comes to medical techniques. In the case of choking victims, the maneuver, named after Dr. Henry Heimlich, has been credited with saving the lives of countless unlucky diners worldwide, so it would seem logical that the same maneuver could help to save drowning victims with waterlogged lungs. However, many in the emergency-medicine community point out that there’s an important difference between somebody choking on a dinner roll and a drowning victim. The drowning victim needs all the oxygen he or she can get, not to have air forced out of the body through the Heimlich maneuver. The technique unfortunately also forces the victim to vomit, further complicating the rescue.

Despite medical experts and emergency-care organizations lining up to speak against the Heimlich maneuver for drowning victims, two water parks in Utah—Lagoon in Farmington and Cowabunga Bay in Draper—still certify their lifeguards from a company that teaches the Heimlich maneuver as a lifesaving technique for drowning, in opposition to a mountain of medical research.

Heimlich’s “subdiaphragmatic abdominal thrust” maneuver for clearing obstructed airways gained traction as a means of clearing water from the lungs of drowning victims when the maneuver was first promoted in the 1970s along with the maneuver’s application for choking victims. But today, numerous organizations dedicated to emergency-care policy, such as the Red Cross and the U.S. Lifesaving Association—a national lifeguard nonprofit group— have rejected the maneuver. So have doctors and health-policy organizations such as the Institute of Medicine.

Andre Meacham, the director of safety and security at Lagoon, says he has never heard of concerns about the procedure. Meacham has been employed by the amusement park for decades, even before it opened the Lagoon-a-Beach water park 22 years ago. He says the park defers to the National Aquatic Safety Co., based out of Texas, for certifying its lifeguard staff.

“We rely on the experience of NASCO to provide us with the most cutting-edge, recent technology and techniques when it comes to lifesaving skills,” Meacham says. “This is the first I’ve heard that it may be questionable to use abdominal thrusts with drowning victims.”

It’s not just medical professionals who warn against the maneuver’s use on drowning victims, however. Peter Heimlich, son of Dr. Henry Heimlich, is another voice calling into question the legacy of his father’s work when it comes to applying the technique to drowning victims.

Peter, who is actually working on a book about his father’s legacy, says that because of the success of the Heimlich maneuver for choking, his father gained media access to circulate "a string of crackpot medical claims, one of which was as the use of the maneuver to revive drowning victims." [see Editor's Note below]

“Drowning experts debunked the idea from the start, but the media gave my father a platform because of the success of the Heimlich maneuver for choking,” Peter writes via e-mail.
The crux of the debate has been the long-held assertion by Heimlich senior that oxygen cannot get to the victim through water-filled lungs. Henry Heimlich, now 91, sticks by a number of newspaper reports and anecdotal success stories of the application of the Heimlich for drowning victims. He challenges the organizations who advance CPR as a superior technique to the Heimlich, noting a 2010 change in the CPR protocol for heart-attack sufferers that now recommends only doing chest compressions and not doing breaths.

“[The Heimlich] has been well accepted for years, with all these papers saying it saves lives,” Henry Heimlich says from his Cincinnati home. “But as you can see now, CPR has essentially been given up by the American Heart Association and the Red Cross last year after using it for 50 years. Doesn’t that give you some say-so as to what value it has in drowning?”

However, some doctors, like James Orlowski, chief of pediatrics and pediatric intensive care at the University Community Hospital in Tampa, Fla., say the Heimlich maneuver can actually clog the lungs with fluid, rather than pump it out.

“There’s no question that when there’s a drowning accident, an individual swallows 10 to 30 times as much water as actually gets in their lungs,” Orlowski says, adding that while that water is quickly passed out of the lung, which is a very permeable organ, when doing the Heimlich “you’re almost certainly going to induce vomiting.” The vomit on its way out of the system will actually seep into the lungs and can complicate other rescue measures, like CPR.

“As you can imagine, that makes the aesthetics of doing CPR pretty bad,” Orlowski says. “It sets the patient up to aspirate their stomach contents and stomach acid into the lungs, and that can have devastating consequences.”

In Tampa, a city known for high rates of drowning, Orlowski has tracked 40 cases where lifeguards have used the Heimlich maneuver on drowning victims that ended up with further complications. Fortunately, none of the complications were fatal. However, Orlowski notes an incident in Cleveland in 1982, documented in the Journal of the American Medical Association, where a drowning victim was administered the Heimlich maneuver only to die from complications related to vomiting.

“Because of the Heimlich maneuver the lifeguard applied, [the victim] ended up developing pneumonia of the lungs and dying from complications,” Orlowski says.

Henry Heimlich argues, however, that that incident was the only confirmed death. He also points out a 1988 study of Australian lifeguard rescues that found vomiting was a major issue in CPR rescues also. That study, however, did not examine the Heimlich maneuver for drowning victims. Its main conclusion was that rescuers need to begin to resuscitate victims earlier.

The debate lingers because of the maneuver’s application by the National Aquatic Safety Co. Its founder, Dr. John Hunsucker, who holds a Ph.D. in math and engineering, recently co-authored an article in the International Journal of Aquatic Research and Education promoting the Heimlich maneuver as one that rescuers can use while still in the water. The rebuttal to that study, authored by more than half a dozen scholars of the medical community, however, pointed out that Hunsucker’s article did little rigorous analysis and did not compare the technique to a control or comparison group. (NASCO declined to comment for this story.)

In Utah, Lagoon’s Meacham says his staff undergoes rigorous lifesaving training that includes CPR and other techniques. As to the efficacy of the Heimlich maneuver, he says it’s thankfully never had to be tested in the park.

Jennifer Harker, a lifeguard at Cowabunga Bay, likewise says that while her park receives training from NASCO, training there includes a number of lifesaving techniques. “The training is very meticulous,” Harker says, adding that she, too, had never heard any concerns about the Heimlich maneuver.

That the concerns involved are news to those in the lifesaving business is still shocking to experts like Orlowski.

“That’s amazing,” he says, listing at length the medical organizations that have opposed the maneuver’s use and warned of its harmful effects. “People saying they are unaware just aren’t keeping up with what’s going on out there.”

[Editor's note: The online version of this story includes a new seventh paragraph. It replaces the following struck-out version that appeared in print: Peter, who is actually working on a book about his father’s legacy, says that as applied to drowning, the maneuver was accepted by many water parks and pools because of good promotion on his father’s part—not good medicine.]