About five years ago, Dr. C. Everett Koop saw his young grandson choking while eating. He quickly moved behind the child, put his arms around him and, with a quick thrust of his clasped fist into the boy's abdomen, dislodged a large chunk of meat that "shot about four feet across the room."
Yesterday, as the U.S. surgeon general, Koop endorsed the life-saving Heimlich Maneuver "as the only method that should be used for the treatment of choking from foreign body airway obstruction" and prodded the American Red Cross and American Heart Association to move more quickly in adopting it exclusively.
Noting that "more than 3,000 people die from choking in the United States each year," mostly while eating, Koop said that "the best rescue technique in any choking situation is the Heimlich Maneuver."
He urged that other methods be dropped immediately as "hazardous, even lethal," particularly the traditional use of sharp blows to the back that he said can drive a foreign object even deeper into the throat.
In doing so, Koop jumped into the middle of a long-running controversy in the public health community over the place of the Heimlich Maneuver in first aid procedures.
The technique is named after Dr. Henry J. Heimlich, a physician at Cincinnati's Xavier University who developed the life-saving "hug" in the early 1970s and has since widely promoted it as the best method of saving a choking victim.
But the health organizations who advise the public and the medical profession on first aid have been slower to adopt his stance and for the past decade have recommended that four sharp blows to the back be attempted first before the "abdominal thrust."
In July, after a national conference reviewing their guidelines, the American Red Cross and the American Heart Association made a joint announcement that the advisory panel had recommended "exclusive" use of the Heimlich abdominal thrust. Their press releases said that the change was being made to simplify teaching of first aid, but maintained that both back blows and the abdominal thrust are effective.
Yesterday, spokesmen for both groups repeated that view, saying that the recommendation on the Heimlich Maneuver is still under review and is not expected to be adopted officially until early next year.
"Dr. Koop and Dr. Heimlich are not giving the process quite the chance it deserves," responded Red Cross senior vice president Dr. Lewellys Barker.
Koop said in an interview that he felt the need to act more quickly after receiving letters from Heimlich and University of Cincinnati professor Edward A. Patrick, as well as his knowledge of the value of the procedure. "I felt that I couldn't stand around and wait."
Patrick, who has performed research showing that the back slap can drive a foreign object downward, complained to Koop that the "lives of many Americans are endangered as the result of Red Cross first aid instruction" and said "it is urgent that you inform the public through the media of the back slap danger."
Heimlich said by telephone that he was concerned not only by the slowness of the first aid groups' response, but by their "denial that the back slap is unsafe."
His procedure uses the large volume of air in a choking victim's lungs to help expel a foreign object if a rescuer presses sharply and repeatedly on the victim's abdomen with one balled fist wrapped in the opposite hand.
The blow is administered at a point just above the navel but below the rib cage and the diaphragm. It can be used on a standing or sitting victim who is conscious or unconscious as well as be self-administered. While it can be used on children, Koop said yesterday that "back slapping is still the recommended method for treating children under 1 year of age held in a head-down position."