Wednesday, February 22, 2012

Six years after the American Heart Association recommends chest thrusts for choking rescue, the story gets reported...sort of

From Life Saving Skills: A New Way to do the Heimlich Maneuver by Maddie Garrett, KATC-TV News, Lafayette, Louisiana, February 8, 2011:
(The) rules on what to do if someone is choking have changed, and there's a new way to do the Heimlich Maneuver...(If) the person choking becomes unconscious, the rules have changed. Instead of pushing up in the abdomen, (Registered Nurse Ella Beth) Goetschius said it's better to perform more like CPR, minus the breaths of air. She said to lay the person on the floor, do 30 chest compressions, then open the mouth and check to for the object.
First, contrary to the report, this information ain't new.

From the 2005 Adult Basic Life Support guidelines published in Circulation, the journal of the American Heart Association (AHA):
Treatment Recommendation
Chest thrusts, back blows/slaps, or abdominal thrusts are effective for relieving FBAO (Foreign Body Airway Obstruction) in conscious adults and children >1 year of age, although injuries have been reported with the abdominal thrust. There is insufficient evidence to determine which should be used first. These techniques should be applied in rapid sequence until the obstruction is relieved; more than one technique may be needed. Unconscious victims should receive CPR. The finger sweep should be used in the unconscious patient with an obstructed airway only if solid material is visible in the airway. There is insufficient evidence for a treatment recommendation for an obese or pregnant patient with FBAO.
Five years later in 2010, the most recent AHA guidelines were near-identical:
Although chest thrusts, back slaps, and abdominal thrusts are feasible and effective for relieving severe FBAO in conscious (responsive) adults and children ≥1 year of age, for simplicity in training it is recommended that abdominal thrusts be applied in rapid sequence until the obstruction is relieved.  If abdominal thrusts are not effective, the rescuer may consider chest thrusts. It is important to note that abdominal thrusts are not recommended for infants <1 year of age because thrusts may cause injuries. 
Second, the guidelines say chest thrusts are recommended as effective for conscious choking victims. For some reason, the TV story only reported that the treatment should be done on unconscious victims.

Confused? Yeah, me too.

But there's one thing I'm reasonably sure of.

Over six years after the AHA began recommending chest trusts as an alternative choking rescue treatment, to my knowledge this is the first TV news story to report the information. 

On the bright side, in Cajun country, KATC viewers have been informed about this potentially lifesaving skill.

At this rate, it's only a matter of decades before the rest of the country gets the news!

Charles W. Guildner MD, July 2011; click here for contact info

Incidentally, the idea that chest thrusts could be effective for choking rescue was introduced in a 1976 published study by Charles W. Guildner MD of Everett, Washington.

Per this 2007 Seattle Public Radio report by Patricia Murphy, Dr. Guildner explained how my father tried to derail his work:
By the time the chest thrust study was published in 1976, Dr. Heimlich had filed complaints against Dr. Guildner with 6 different medical groups. Eventually Guildner was cleared of all charges, but by then the Heimlich maneuver had become firmly entrenched as the primary method for choking response in the US....

GUILDNER: "It's so repugnant to me the way Dr. Heimlich has bullied. He's a bully and he has bullied people into submission."

In his quest for what reporter Thomas Francis called the "choking rescue crown," my father also called in some medical muscle in the form of US Surgeon General C. Everett Koop who used his federal government pulpit to stomp the competition and put the debate on ice.

From Koop's Declaration regarding the Heimlich Maneuver, Public Health Report, US Department of Health and Human Services, September 30, 1985:
(Dr. Koop) urged the American Red Cross and the American Heart Association to teach only the Heimlich Manuever (sic) in their first aid classes. Dr. Koop urged both organizations to withdraw from circulation manuals, posters and other materials that recommend treating choking victims with back slaps and blows to the chest...these methods are hazardous, even lethal."
The result? From a 2007 Creators Syndicate column by Lenore Skenazy:
After that, only the Heimlich Maneuver was considered kosher.
The fix?
What most people don't realize, Dr. Heimlich's son, Peter Heimlich, said, is that "Koop was an old friend of my father's, and he did it as a buddy favor."