Friday, December 3, 2021

Inside Edition ran an error-ridden choking rescue story - today I asked for a published correction and an apology to a Minnesota bartender [1/2/22 UPDATE]


Inside Edition Owes An Apology to Sun Prairie Bartender by Peter M. Heimlich, Sun Prairie Star, January 2, 2022 (Link leads to Twitter thread with related added information)

Choking incident that spawned viral video takes bizarre turn by Chris Mertes, Sun Prairie Star, December 28, 2021


December 3, 2021

Lee Malley
Assistant Managing Editor
Inside Edition
555 W. 57th St.
New York, NY 10019

Dear Ms. Malley,

This is me:

Based on the following information, this is to respectfully request 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.

From Ms. Mercogliano's 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. 

First, my father's namesake anti-choking maneuver is an abdominal thrust in which a rescuer's hands are placed below the rib cage and above the naval. A chest thrust (or chest compression) is, naturally, performed on the chest. 

Per this joint statement by the American Heart Association (AHA) and the American Red Cross (ARC), since at least 2007 both organizations have recommended chest thrusts as an effective treatment response in a choking emergency.

More from resuscitation expert Richard N. Bradley MD in a January 22, 2013 post on the ARC's blog entitled Choking 101:

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 Circulationthe 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.

Long story short, the entire framing of Ms. Mercagliano's is misguided because the choking rescue at Daly's Bar and Grill in Sun Prairie, MN, had nothing to do with the Heimlich maneuver. 

Further, as I've shown, Mr. Reinhart's response to Mr. Hoffhein's distress was in compliance with approved guidelines and recommendations.* 

Here's another twist from The Heimlich manoeuvre by Aviva Ziegler, an Australian Broadcasting Corporation audio documentary dated January 18, 2010:

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.

Here's more from a 2018-19 two-part article, A Call to Reconsider the Heimlich Experiment, by Dr. Anthony Pearson of St. Louis, MO (aka The Skeptical Cardiologist):

(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.

Moving right along, presumably everyone can agree that the public is entitled to the best available medical care. And the topic is clearly newsworthy - a search of the word choking on Inside Edition's website turned up countless storiesNevertheless, based on my experience, most people - including medical professionals - are unaware of the chest thrust vs. abdominal thrust debateWith that in mind, I'd encourage Inside Edition or another CBS news program to further explore the topic. 

Finally, on was unable to locate instructions on how to submit a corrections request to your program. Prior to being provided your contact information by CBS's publicity department, I sent multiple emails and left voice messages for a number of your program's executives in which I simply asked their guidance on how to submit a corrections request to your program. None responded. 

Per this Washington Post column by Erik Wemple, I'm dogged when it comes to obtaining published corrections, but in the interests of providing accurate information to your audience, why not make it easier? Would you please raise this concern with the appropriate editors and let me know their response?   

Thanks much for your time/consideration and I look forward to your reply. Questions for me? Just ask.


Peter M. Heimlich
Peachtree Corners, GA 30096 USA
ph: (678)322-7984‬

cc: Joseph Reinhart/Daly's Bar and Grill
      Chris MertesManaging Editor/Sun Prairie Star
      Anthony Pearson, MD/The Skeptical Cardiologist
      Chris Ender, Leslie Ryan/CBS Communications
      Erik Wemple/Washington Post
      Esther Pessin, Co-Executive Producer/Inside Edition      

encl: 2007 April 25 Joint AHA-ARC media statement re chest thrusts.pdf; Compilation of journal citations re complications associated with Heimlich maneuver.pdf

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.

Presumably Mr. Woodall is aware of the above information. Did he share it with Ms. Mercogliano? Last week via tweets to both of them and an email and voice message to Mr. Woodall, I attempted to contact them in order to discuss my concerns. I didn't receive a reply.