The Heimlich maneuver, used to save the lives of people choking on food, can be dangerous if tried on near-drowning victims, a doctor said last week.

The maneuver, named for Dr. Henry Heimlich of Cincinnati, involves grasping a choking victim from behind and applying an upward thrust with the fist below the rib cage, causing the diaphragm to pump air out through the throat and dislodge the obstruction. Since it was introduced in 1974 it has saved the lives of at least 10,000 choking victims in the United States, Heimlich has said.

But Dr. James Orlowski of the Cleveland Clinic, in a paper published in the Journal of the American Medical Association, said using the maneuver in near drownings may cause the victim to vomit, further blocking the air passages and posing the risk of brain damage. He cited the case of 10-year-old boy who died as a result.

The American Heart Association and the American Red Cross both recommend the Heimlich maneuver as the treatment for foreign body obstruction in children and adults -- a recommendation not affected by Orlowski's concern about its use in drowning.

"It appears the Heimlich maneuver should not be the first step in rescuing a submersion accident victim," Orlowski wrote. "Not only does it unnecessarily delay the critically important step of ventilating . . . but it may predispose to vomiting and complication of gastric aspiration pneumonitis."