UPDATE, June 3: After publication of this story, the Northern Virginia Regional Parks Authority announced Friday they would be eliminating the Heimlich maneuver in the protocols for the lifeguards at their five water parks.
ORIGINAL POST: The Heimlich maneuver became famous as a way for people to dislodge a foreign object from a choking person’s airway. But it’s been utterly discredited as a way of rescuing a person who is drowning, and can actually do serious harm to someone who has just been pulled from the water, numerous experts say.
Still, one aquatics company, National Aquatic Safety Company of Houston, is training lifeguards to use the Heimlich maneuver. And the Northern Virginia Regional Parks Authority enthusiastically continues to use NASCO to train lifeguards at its five waterparks: Cameron Run in Alexandria, Upton Hill in Arlington, and Bull Run and Pohick Bay in Fairfax County and Algonkian in Loudoun County.
Asked why Northern Virginia still uses Heimlich, the parks authority released a statement by Derric Bolton, the authority’s risk manager: “The NASCO lifeguard training program has been a valuable tool for helping NVRPA manage the safety of swimmers who enjoy our fun and exciting aquatic facilities. NVRPA embraces NASCO’s mission to ‘reduce the loss of life due to drowning.’”
In a subsequent interview, Bolton said NASCO’s founder had “written articles for peer-reviewed journals about the protocols, why they’re used, the statistics behind them.” Articles by NASCO’s founder, John Hunsucker, have been roundly criticized for using faulty methods and data.
Last year, Bolton also wrote a two-page letter on NVRPA letterhead extolling the virtues of NASCO. Bolton did not disclose, either in the letter or in his statement to The Post, that he is on NASCO’s tactical advisory board, according to his own LinkedIn profile.
Bolton said he wrote the letter as a standard testimonial from a customer, and that he is merely a lifeguard instructor and parks authority liaison for NASCO and has no financial or voting interest in the company. More than 200 lifeguards at NVRPA’s five waterparks are now prepared to use the Heimlich maneuver as their first response, though the American Red Cross calls that ”unnecessary and potentially dangerous.”
The list of experts who reject the Heimlich maneuver is lengthy: The American Red Cross; the United States Lifesaving Association; the American Heart Association; the Institute of Medicine; the International Life Saving Federation and many experienced doctors and academics have strongly inveighed against doing “abdominal thrusts” for drowning victims.
The experts correct a widely held misconception that drowning occurs when a person inhales water into the lungs. Science has shown that the larynx actually closes and prevents water from going into the lungs during submersion, and water is absorbed into the blood stream, causing drowning, many knowledgable sources have concluded.
In an extensive review of scientific studies, the Advisory Council on First Aid and Safety for the American Red Cross wrote in 2006:
“Subdiaphragmatic abdominal thrusts [the Heimlich maneuver] are neither effective nor safe methods for attempting water removal from the airway or lungs of drowned people. No scientific literature supports the idea that aspirated water obstructs these patients’ airways thus hindering ventilations. Since no scientific study has shown water can be removed from drowned people's airways or lungs through subdiaphragmatic abdominal thrusts, the 2005 [Consensus on CPR and ECC Science and Treatment Recommendations] guidelines remain the CPR treatment standard for drowned people.”
The international medical community has “resoundingly condemned” the Heimlich maneuver in drowning situations, according to Peter Wernicki, an orthopedic doctor and longtime medical advisor to the U.S. Lifesaving Association. When someone has been underwater for too long, they have been deprived of oxygen, Wernicki noted. They need to be given oxygen, not squeezed from behind to push oxygen out.
Wernicki said, as numerous scientific studies do, that even if water has reached the lungs, “by blowing air in through CPR, you would still get oxygen in.”
Wernicki added, “We thought we had this all put to bed, only to find that NASCO is somehow still on the [Heimlich] track.”
NASCO was founded and is still operated by John Hunsucker, a Ph.D. mathematician and engineer from Houston. NASCO trains lifeguards at dozens of water parks around the country. Their training manual, publicly available, advises that for unconscious or passive victims, “the basic procedures is [sic] to administer five and only five abdominal thrusts in the water ane while moving to the extrication point. This will help to insure a clear airway and work as a crude form of respiration.”
Hunsucker did not respond to phone and e-mail messages seeking comment, and after being profiled in various news media, he reportedly does not speak to reporters any more. But in 2007, he told the Houston Press that his common sense and his experience in water parks told him the Heimlich maneuver worked, even if there were no scientific studies to back it up.
“These so-called medical experts,” Hunsucker told reporter Todd Spivak. “Screw ‘em. What do you want me to do, walk in lockstep?”
Henry Heimlich, now 91, is alive and well in Cincinnati. He is certain that his maneuver is correct, regardless of the medical establishment’s view, and he cites anecdotes of lives saved to support his opinion.
“It has been proven,” Heimlich said in a telephone interview, “that in the area of 90 percent of drowning victims, the lungs filled with water. That is well-documented. To not get the water out of the lungs is to let people die needlessly.” He said the medical establishment’s claim that water doesn’t enter the lungs is “absolutely ridiculous.”
Heimlich noted that the Red Cross and the American Heart Association had recently reversed themselves on treatment of heart attack victims. Asked why those associations were so opposed to using the Heimlich maneuver on drowning victims, he said, “Perhaps because it was not conceived of until I came along.”
The Northern Virginia Regional Parks Authority oversees park land and more than two dozen recreational facilities in Fairfax, Loudoun and Arlington counties, and in the cities of Fairfax, Falls Church and Alexandria. It is a separate entity from the county and city park authorities in each of those jurisdictions.
Both the Fairfax County and Prince William County Park Authorities use a different training company for lifeguards, Jeff Ellis & Associates of Ocoee, Fla. Richard A. Carroll, the company’s chief operating officer, said it had discarded the Heimlich maneuver more than a decade ago, though he said his company found it as effective as CPR. Loudoun parks officials said they do their own training and stick to Red Cross protocols that call for CPR, not Heimlich.
In Tampa, which has one of the highest drowning rates in the country, Dr. James Orlowski said he has documented nearly 40 cases where rescuers performing the Heimlich maneuver have caused complications for the victim. Orlowski is chief of pediatrics and pediatric intensive care at University Community Hospital in Tampa.
“You’ve got one man and a few small supporters,” Orlowski said, ”that continue to push this in the face of overwhelming evidence to the contrary.”
The medical director for the Fairfax County Fire and Rescue Department, Dr. Scott Weir, said, “The Heimlich maneuver really doesn’t fit into drowning victims’ care.” He said even if water did enter the lungs, the maneuver doesn’t necessarily remove it, and that CPR has been the protocol in Fairfax for many years.
One of the most vehement critics of the Heimlich maneuver for drowning victims is Peter Heimlich, Henry Heimlich’s son. He has created a website which extensively documents his father’s supposed missteps, including allegedly taking false credit for creating the Heimlich maneuver, and calls the use of the maneuver for drowning “a 30-year medical atrocity.”
Heimlich said that the media “have incorrectly written that there’s a ‘controversy’ associated with the treatment. In fact, in the medical community, it’s my father vs. everyone else. That’s not a controversy, that’s one celebrity doctor -- someone who hasn’t worked in a hospital since 1976 and has no background in drowning except for his claims promoting the Heimlich maneuver -- making unsupported claims.”
Here is Henry Heimlich discussing the use of the maneuver at a U.S. Conference of Mayors meeting in 2005: