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As Sidebar readers know, medical authorities in New Zealand and Australia don't recommend the Heimlich maneuver (aka abdominal thrusts) for responding to a choking emergency.

Per Aviva Ziegler's 2009 documentary, in the Land Down Under my dad's namesake treatment is considered unproven and potentially harmful.

That opinion was echoed in the American Heart Association's 2005 guidelines which state, "Life-threatening complications have been associated with the use of abdominal thrusts."

Instead Kiwi and Oz first aid experts recommend back blows and chest thrusts.

The latter treatment was first proposed in a 1976 study by my friend Dr. Chuck Guildner of Everett, Washington. Click here for more about that and related information.

Yesterday, Radio Live New Zealand aired Do you know what to do when a child is choking? which included this clip of first aid instructor Billy Doyle explaining the back blows followed by chest thrusts protocol. To my knowledge it's the first time the chest thrusts treatment has been described in a video.



As it happens, "the Heimlich" has been credited with saving choking victims when, in fact, the rescuer performed -- yep -- back blows and chest thrusts.

For example, in January a dashcam video of a dramatic choking rescue in Rochester, NY, was picked up by numerous news outlets.

Via the original YouTube video, here's the description:

source

Here's the video:

Via The Right Way to Stop Choking by Daniela Ongaro, The Daily Telegraph (Australia), October 29, 2014:

Although popularised by Hollywood, the manoeuvre (invented by American physician, Dr Henry Heimlich in the 1970s and introduced in the US) has never been accepted practice in Australia.

The Australian Resuscitation Council in its June 2014 guidelines states: “Life-threatening complications associated with use of abdominal thrusts have been reported in 32 case reports.

“Therefore, the use of abdominal thrusts in the management of Foreign Body Airway Obstruction is not recommended. Instead back blows and chest thrusts should be used.”

St John’s Ambulance First Aid trainer Nick Allison says Australian resuscitation experts do not recommend the Heimlich, which has attracted significant controversy for the risks it poses and the lack of scientific evidence supporting its use.

“The Heimlich manoeuvre looks dramatic, which is why you see it in all the movies,” Allison says.

“It came out in the US but there were concerns because of the damage being caused (to victims) such as broken ribs and the difficulty involved in using it if the choking person was a larger person.

“It’s not a recommended technique because it can be dangerous.”

Via the Dallas-based American Heart Association's most recent Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science (2010), chair: Robert A. Berg MD, Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia (emphasis added):

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.

Simplicity in training?

What about science-based evidence?

Via CPR research: Increasing survival after cardiac arrest, Discovery's Edge (the Mayo Clinic's Online Research Magazine), November 2011:


Via A New Maneuver - the circular history of a lifesaving procedure by Pamela Mills-Senn, Cincinnati Magazine, April 2007:

Ladies and gentleman, welcome to an international first aid throwdown.

The prize? Determining the most effective method to rescue a choking victim.

In this corner, courtesy of the September 5, 2011 Sydney Morning Herald, Australia's largest first aid organization, St John Ambulance:



In the opposing corner, from the website of Cincinnati's Heimlich Institute, my father and the late Edward A Patrick:

Drs. Edward A. Patrick & Henry J. Heimlich

All that's missing is a referee. How about the medical profession? 

Or how about the media? Presumably the press wants to provide the public with the best available first aid information. Also, controversy sells newspapers and this one's got that base covered, plus two world-famous doctors are in the mix.

If anyone wants to ask the various players what they have to say to support their positions, click the names for their contact information: St John Ambulance Australia, the Heimlich Institute, and the Koop Institute at Dartmouth College.

* 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." (source)

From Stephen on mission to save lives by Judith Kerr, Bayside Bulletin/Redland Times (Australia), January 27, 2011

Birkdale's Stephen Dean has seen the face of death. As an officer with the Royal Australia Navy, his desperate attempts to resuscitate a man who had had a heart attack ended when the man died in his arms. But ever since that day, the 58-year-old father of two has made it his life's mission to save people.

For his dedication to that mission and his work in the field of resuscitation and first aid training, he was awarded a Medal of the Order of Australia (OAM) on Wednesday. As the assistant CEO of St John Ambulance Australia's Queensland branch, it has been Stephen's job to teach and train people across the resuscitation industry.

..."It is important for people in the business of saving lives to be taught to follow a set of common rules, regulations and procedures to stop confusion."

In the US, they still advocate the Heimlich Manoeuvre for choking but in Australia, we believe the evidence shows it is dangerous and so our guidelines don't promote it," Stephen said.

Click here for source