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UPDATED: See my May 29, 2017 Sidebar item, UK crowdfunding effort to install anti-choking devices in Yorkshire schools derailed by government-initiated medical review.


Should schools implement a medical treatment unapproved by mainstream medical authorities? 

According to one school in northeast England, the answer is yes.

Should parents be informed and provided the opportunity to consent?

According to the same school, the answer is no.


This is a tangent to my item a few weeks ago about a crowdfunding campaign that raised "raised £2,218 to install (the LifeVac anti-choking device) into as many schools in the Hull & East Riding area as possible."

One area school has confirmed that they've incorporated the LifeVac into their first aid treatment protocol for choking emergencies.

Per this March 8 tweet:


It was posted by called Time to Train, which describes itself as "a family run business in Hull, East Yorkshire. In addition to providing professional first aid training, we also offer several health and safety courses."

I was interested in learning more, so I filed a FOIA request with Victoria Dock, a primary school in Hull.

I received a prompt reply from the school's business manager, Debbi Truran, who informed me that although there were no written records:

I can confirm that the school has been gifted a LifeVac by the company TimeToTrainHull. Part of the 'gift' was two training sessions to show staff how to use the LifeVac. One training session was for the support staff and the second training session was for the teaching staff. 18 members of support staff and 17 members of teaching staff took part in the training. The trainer used a LifeVac and Torso dummy to train the staff members. No charge was made for the training.

In response to one of my questions, Ms. Truran stated that parents of Victoria Dock students had not been asked whether or not they consented to the LifeVac being used on their children.


Third, for the same reason, the school may have violated the National Health Service's Consent To Treatment standards:


When I asked Ms. Truran on what basis Victoria Dock had agreed to include the LifeVac in medical treatments being provided to students, she made it clear the school had relied on the professional expertise of Time to Train.

source

Since then I've sent a few e-mails with straightforward questions to Shaun Sykes at Time To Train Hull, the guy who arranged the gift and conducted the free training sessions, and copied Ms. Truran.

I haven't received a reply from him.

Last April I blogged UK stupid press tricks? Three separate "dogs rescue their masters from choking" stories in the past four months about articles in the Daily Mirror, the Carmarthen Journal, and the Daily Star.

According to today's Daily Mirror and Daily Mail -- see the video above and the following screen shots -- the four-legged lifesaving spree continues!

source: Daily Mirror

source: Daily Mail

To my knowledge, the first recorded "dog rescues choking master" case was in 2007, when Debbie Parkhurst of Calvert, Maryland, claimed her pooch "Toby leapt up and down on her chest, dislodging the chunk of apple that had lodged in her throat."

The story was widely reported and even landed her and Toby an appearance on the Letterman show.

source

I have no reason to doubt the veracity of any of these stories. Plus they provide me with fun, bloggable material.

On the other hand, it's not so difficult to fake a choking rescue to gin up media attention.

For example, my father and country music star Luke Bryant apparently did.

Which leads me to this April Fool's Day challenge to merry pranksters out there.

Make up a story that your pet saved you from choking and get it reported by a mainstream news outlet.

Share the results with me and I'll likely blog it. (Click here for my contact info.)

So don't just stand there wagging your tail. Unleash your wits and see if any reporters roll over.


4/2/15 UPDATE:  As two eagle-eyed Sidebar readers (both of whom are journalists) wrote me, contrary to the headlines and text of the Mirror and Mail stories, Lexi the lab did not "Heimlich" his master.

The "Heimlich manoeuvre" (UK spelling) is an abdominal thrust -- a squeeze below the rib cage. Mr. Spencer's precocious pooch reportedly jumped on his back.

As it happens, Lexi's actions were in compliance with the first aid guidelines of St John Ambulance UK which, like the American Red Cross, recommends back blows as the first treatment response to a choking emergency.

One of the sharp-eyed readers also suggested that Lexi be presented with a lifesaving award, so I'm sending a nomination to St John Ambulance UK and will report the results.

Also on Lexi's behalf, yesterday I submitted corrections requests to the Mirror and the Mail. More about that later....

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:

Erienne Lette (source)

Via Step up and save a life: why you need to do a Basic Emergency Life Support course by reporter Erienne Lette, published May 12, 2014 by PerthNow, a newspaper owned by News Corp Australia, "Australia’s number one media company" according to the company's website.














Sound like a story worth looking into by U.S. reporters?

It does to me, but, to my knowledge, it's never been reported anywhere except in the Land Down Under and here at The Sidebar.

FYI, "St John" in the article refers to St John Ambulance, "Australia’s leading provider of first aid services," according to their web site.

Click here for the organization's "non-Heimlich" recommendations for responding to a choking emergency.

source

Want to learn more?

I'd suggest starting with The Heimlich manoeuvre, a half-hour Australian Broadcasting audio documentary by Aviva Ziegler that first aired on July 27, 2009 and includes interviews with these notables and yours truly:


Another news hook for interested journos?

Happy anniversary!

source

Per my previous item, last night Cincinnati Reds baseball team representative Rob Butcher accused me of being "on some kind of mission to prevent people from helping others."

What did I do to elicit such opprobrium?

I asked him for information about ballplayer Todd Frazier's apparent endorsement of "Heimlich Heroes," a first aid training program in Ohio schools that includes performing the Heimlich maneuver on unconscious choking victims.

Here's a clip from one of the program's training videos:



As I reported last month, representatives of the American Red Cross and the American Red Cross told me they don't recommend the treatment.

And, per my previous item, "Heimlich Heroes" program manager Terri Huntington has refused to answer a number of reasonable questions I've submitted.

For example, would she please direct me to any published research studies, to any medical organizations, and/or to any licensed medical professionals that recommend performing "the Heimlich" on unconscious choking victims?

Because I can't find any.

source

Despite the Rodney Dangerfield treatment I've gotten from the two Cincinnati organizations, my self-esteem just got a boost from the other side of the globe.

Via Lifesaving spaniel earns pat on the head from Heimlich by reporter Guto Llewellyn published this morning in the Carmarthen Journal:

Lifesaving spaniel Mollypops has been praised by none other than the son of the inventor of the Heimlich manoeuvre.

Owner Rachel Hayes, 40, from Drefach Felindre, had been choking on a chew sweet for several minutes and believed she was about to die until her pet jumped on her back, dislodging the sweet.

Since the Carmarthen Journal reported the story last week news of Mollypops's heroism has spread across the world, even drawing the attention of Peter Heimlich, whose father Henry invented the Heimlich manoeuvre.

The Heimlich manoeuvre involves using a series of abdominal thrusts on a choking victim in a bid to dislodge the item. However, the technique has been called into question, and by now it is advised that people follow St John Ambulance advice instead of the Heimlich manoeuvre. This involves using hard blows on the upper back of the victim.

Peter Heimlich said: "I give big props to Mollypops. Based on what I've read in the Journal, she's strictly up to date on St John Ambulance's first aid recommendations, plus she kept her cool in a stressful situation.

"I'd urge all creatures great and small to follow her example and learn how to respond to choking and other medical emergencies."

...Mollypops only needed one blow to save her owner's life, and Rachel says she is delighted with the recognition her dog is receiving.

She said: "It's really good. I have just been overwhelmed by the attention her story has received, and it's amazing to hear Mr Heimlich say that she did the right thing."

Based on my recent experiences with Rob Butcher and Terri Huntington, to get some pointers on how to deal with the media, their masters might wish to consult Mollypops.

WGN radio host Jonathon Brandmeier (source)

My father's never gotten proper credit as a master media manipulator who for decades used his charm to spin uninformed journalists.

As I told reporter Paul Teetor of the LA Weekly:

"My father is such a brilliant promoter, he could teach P.T. Barnum a few tricks."

But as a result of the dozens of media reports that exposed him as a career scammer -- for example, check out Chuck Goudie's tough ABC7 Chicago expose that aired over seven years ago -- presumably it's gotten more difficult for my father to find marks.

Also, who would consider my father -- a 94-year-old with a history of making delusional claims, who hasn't held a medical license since 2002, and who lives in a retirement community -- to be a medical authority?

Enter WGN Chicago talk show host Jonathon Brandmeier.*

Check out these clips I stitched together from Are you choking?! Dr. Heimlich is here, a March 12, 2014 interview Brandmeier and his second banana conducted with my father (with my brother Phil Heimlich on hand). In keeping with the show's yuckfest approach, I added clown horns where I spliced the clips.  




Briefly, after falling for my father's long-discredited hokum that rescuers should never use back blows to revive a choking victim, Brandmeier then imprudently advises WGN listeners to "forget the Red Cross" recommendations on how to respond to a choking emergency.

While you're at it, forget liability as well.

By the way, my father's claim that the American Red Cross is the only organization to recommend back blows is false. On the contrary, virtually every major first aid organization, including the Canadian Red Cross and the UK's St John Ambulance recommends performing back blows as the first response to choking.

In other words, Dr. Maneuver is clueless about his own claimed field of expertise.

And just after the 2:00 mark, my father recommends performing "the Heimlich maneuver" on choking infants. That treatment has never been recommended by any legitimate first aid agency because it may result in serious harm.

What if a WGN listener follows his advice and hurts a baby?

That's one of the questions I'll be asking the Tribune Company -- they own WGN.

They also own the Chicago Tribune which a few weeks ago published a well-researched first-person article by Ian Mitchell that included:

In a conscious choking emergency, where a person can't cough, speak or breathe, the Red Cross procedure is to ask the person if he or she is choking and get consent to give aid.

Then administer five strong back blows between the shoulder blades with the heel of your hand, "as forceful as you deem necessary to save that person's life," (Red Cross instructor Gabriele) Romanucci said.

The back blows are a less-invasive technique that might help clear the airway, so the Red Cross advises trying them first, he said.

"If that technique is not successful, then we would go to the abdominal thrust (aka Heimlich maneuver)," he said.

"Less-invasive" = Less potentially harmful.

What sort of potential harm?

See Case reports of complications from “the Heimlich maneuver,” a list I compiled of about 40 medical journal articles.

Finally, there's this clip in which Brandmeier & his sidekick guffaw about the hilarious concept:

What if the great Dr. Heimlich himself actually performed "the Heimlich" on a choking victim? Wouldn't that be a hoot?

When Brandmeier asks if that ever happened, my father replied, "I have not been in that position."




Punk'd by a nonagenarian!

Click here for the full article and other news outlets that ran with the story (BBC, New Yorker, etc.)

* CORRECTION (4/18/14): The audio of the interview is posted on the website of WGN-FM, so I assumed it aired on that station. After posting my item, I was informed by Tribune Radio Vice President Todd Manley that, in fact, the show aired on sister station WGWG-LP, 87.7FM. As of today, there's no indication of that on the website, hence my error.

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)

(Based on some quick Googling, I think this a scoop. But if you know of a previous media report, e-mail it to me and I'll give credit where it's due.) 

After years of lagging behind the rest of the world, the Canadian Red Cross (CRC) is finally updating their choking rescue guidelines.

Hey, I didn't say it - they did:

In many countries, the combination of back blows and abdominal thrusts has been used since the 2005 guidelines. In North America, using only abdominal thrusts was decided upon as it was easier for the lay rescuer to remember, not due to supporting evidence. Evidence now supports the combination of techniques as more successful than using only one method.

More from a CRC statement published last October:

Airway obstruction – for adults and children (one year or older), if the person shows signs of mild airway obstruction, encourage continued coughing but do nothing else. If he or she shows signs of severe airway obstruction and is conscious, apply up to five back blows. If this fails, give up to five abdominal thrusts. If the obstruction is still not relieved, continue alternating five back blows with five abdominal thrusts.

So why is Canada late to the dance? I don't know, but for decades, most of the world's first aid organizations have recommended backblows as the first treatment response.

Here's another question. Why did the CRC decide to continue to teach abdominal thrusts (a/k/a the Heimlich maneuver) rather than chest thrusts, the preferred treatment in Australia and New Zealand?

The Aussies have a straightforward explanation for their position:

Stephen Dean, Assistant CEO, St John Ambulance Australia's Queensland branch: "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."

That argument certainly seems to be backed up this information: 

For conscious (choking) victims, case reports have shown success in relieving FBAO (Foreign Body Airway Obstruction) with any one of several techniques, including back blows/slaps, abdominal thrusts and chest thrusts. Frequently, more than one technique is needed to relieve the obstruction. However, there have been reported life-threatening complications associated with the use of abdominal thrusts.

...Severe complications from the use of this technique have been cited in the medical literature. Desaiet al. reported a case of traumatic dissection and rupture of the abdominal aorta after a forceful Heimlich maneuver. In addition to this complication, these authors cite reports of other complications occurring with the use of the Heimlich maneuver. These injuries include retinal detachment, rib fractures, and ruptures of abdominal organs. Additional injuries included rupture of the diaphragm, jejunum, liver, esophagus and stomach. Other reported injuries of vascular structures consisted of aortic stent graft displacement, rupture of the aortic valve, acute aortic regurgitation, laceration of a mesenteric vessel, and acute aortic thrombosis in both an aneurysmal and non-aneurysmal aorta.

The above is from the 2011 international first aid and resuscitation guidelines of the International Federation of Red Cross and Red Crescent Societies.

Now take another look at this sentence from the CRC statement posted at the top of this item:

In North America, using only abdominal thrusts was decided upon as it was easier for the lay rescuer to remember, not due to supporting evidence.

Am I missing something or is this a rationale for continuing to teach a potentially life-threatening procedure simply because they don't want to take on the job of re-training the population? 

An enterprising reporter could certainly ask the CRC to provide the supporting evidence that persuaded them to continue recommending abdominal thrusts rather than switching to chest thrusts.