Assistant Managing Editor
Inside Edition
555 W. 57th St.
New York, NY 10019
Dear Ms. Malley,
Based on the following information, this is to respectfully request a published correction re: the November 24, 2021 Inside Edition report, Wisconsin Bartender Saves Choking Coworker With Imperfect Heimlich Maneuver by correspondent Ann Mercogliano. In my opinion, Inside Edition also owes an apology to Joseph Reinhart, the bartender featured in the story.
A young man was eating a chicken sandwich in the kitchen of a Wisconsin restaurant, when it went down the wrong way and he started choking. But the man who saved his life is getting backlash for the way he came to the rescue.
When 20-year-old Ashton Hoffhein put his hands around his throat, making the universal sign for choking, bartender Joseph Reinhart sprung into action.“I noticed that he kind of had his hands by his throat for international sign for choking and just kind of without thought, I started performing what I knew as the Heimlich maneuver,” Reinhart said.But his heroism is also making him the target of criticism, because he didn't use the perfect technique to execute the maneuver.Reinhart wrapped his arms around Hoffein’s [sic] chest, much higher than they were supposed to be and lifted him off the ground while squeezing. Bad technique or not, it still worked, and the piece of chicken flew out....“His technique wasn’t perfect, but it did contribute to saving his life,” expert Shane Woodall of Frontline Health told Inside Edition.Woodall showed us the correct way to do the Heimlich maneuver.
A review of the scientific literature suggested that back blows, abdominal thrusts and chest compressions are equally effective (at relieving an airway obstruction). Additionally, the use of more than one method can be more effective to dislodge an object. These findings are consistent with those of international resuscitation societies.
The Red Cross certainly isn’t discounting the use of abdominal thrusts. But we include back blows, abdominal thrusts and chest compressions in our training...
From ILCOR's 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations published on October 21, 2020 in Circulation, the AHA's journal:
The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 as an international council of councils and currently includes representatives from the American Heart Association (AHA), the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian and New Zealand Committee on Resuscitation, the Resuscitation Council of Southern Africa, the InterAmerican Heart Foundation, and the Resuscitation Council of Asia.1 The ILCOR mission is to promote, disseminate, and advocate international implementation of evidence-informed resuscitation and first aid by using transparent evaluation and consensus summary of scientific data.
...The topic of foreign body airway obstruction (FBAO) was last reviewed by ILCOR in 2010, and at that time, the principal treatment recommendation was that “chest thrusts, back blows, or abdominal thrusts are effective for relieving FBAO in conscious adults and children older than 1 year.
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 (Class IIb, LOE B). If abdominal thrusts are not effective, the rescuer may consider chest thrusts (Class IIb, LOE B). It is important to note that abdominal thrusts are not recommended for infants <1 year of age because thrusts may cause injuries.
Trainer: A question that often comes up in our courses is to why we don't do the Heimlich manoeuvre in Australia. So are you all aware of that where they get that sort of a bear hug squeeze from behind? OK, the reason it's not taught is the simple fact that research conducted here in Australia and also overseas has proven that it can be dangerous because there's a risk of damaging internal organs such as the spleen, the liver, pancreas etc. We follow the policy statements as laid down by the Australian Resuscitation Council, they are saying that if there was any clinical evidence to prove that it was effective they'd put a policy on it and we would have it in our book. Any other questions?
A Foreign Body Airway Obstruction (FBAO) is a life-threatening emergency. Chest thrusts or back blows are effective for relieving FBAO in conscious adults and children with low risk of harm (only 4 observational studies report harm from back blows and 5 observational studies report harm from chest thrusts). Life-threatening complications associated with use of abdominal thrusts (including the Heimlich Manoeuvre) have been reported in 52 observational studies. [Click here for a compilation of study citations.] Therefore, the use of abdominal thrusts in the management of FBAO is not recommended and, instead back blows and chest thrusts should be used. [Good practice statement] These techniques should be applied in rapid sequence until the obstruction is relieved. More than one technique may be needed: there is insufficient evidence to determine which should be used first.
(It) is clear the Heimlich maneuver was recommended by Henry Heimlich for general usage without any human clinical studies to support its safety and efficacy. With (Dr.) Heimlich’s aggressive promoting of the technique it became the recommended way to treat choking conscious individuals despite experimental evidence showing it inferior to chest thrusts and no controlled human trials to support its safety and effectiveness.
Australia and New Zealand, countries free of Heimlich’s influence, do not recommend the Heimlich maneuver for choking victims.
It is entirely possible that chest thrusts are a safer and more effective maneuver for removing foreign bodies from choking victims. Since Dr. Heimlich died in December, 2016 perhaps the organizations that teach CPR can reevaluate their recommendations in this area without fear of public shaming or retribution.
Given the uncertainty in the treatment of choking victims and the number of deaths, a national trial comparing chest thrusts versus abdominal thrusts as the initial procedure should be initiated as soon as possible.
In other words, by using chest thrusts to respond to Mr. Hoffhein's predicament, Mr. Reinhard may have pointed to the future of first aid in our country and elsewhere. That's worthy of commendation, not the ill-informed criticism he received in Ms. Mercogliano's story.
Peter M. Heimlich
Peachtree Corners, GA 30096 USA
ph: (678)322-7984
e-mail: peter.heimlich@gmail.com
website: http://medfraud.info
blog: http://the-sidebar.com
Twitter: https://twitter.com/medfraud_
bio: http://tinyurl.com/ych7o7dr
Chris Mertes, Managing Editor/Sun Prairie Star
Chris Ender, Leslie Ryan/CBS Communications
Frontline Health LLC is a Proud Provider of American Red Cross First Aid CPR AED certification training classes and an American Heart Association BLS Provider certification training site.