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Jan. 21, 2013

Heimlich Outlines History of Red Cross Dangerous Backslaps to Treat Choking Victims
Dr. Henry J. Heimlich, the award-winning physician who invented the Heimlich maneuver in 1974, relates the history behind the American Red Cross (ARC) and its dangerous recommendation to use backslaps as treatment for choking victims. Despite overwhelming medical evidence that the Heimlich maneuver is the safest and most effective method to save a choking victims life, the Red Cross has persisted in recommending backslaps, then the use of abdominal thrusts. Heimlich states that the choking misinformation the ARC disseminates today dates back to1933. According to an excerpt from Heimlichs unpublished memoir of his medical life, from 1933 to 1970 the ARC recommended backslaps to treat choking victims. In 1969, the medical journal Transactions of the American Bronchoesophagological Association warned the ARC that backslaps were killing people. (There is no known scientific report that backslaps ever saved a choking victim..)

By 1970, the ARC manual read: Do not allow anyone to slap you on your back if you are choking and do not try to dislodge an object from another persons throat by this means except as a last desperate measure to save his life. Heimlich became interested in the problem of saving choking victims in 1972. He was a thoracic surgeon, associate clinical professor at University of Cincinnati and director of surgery at The Jewish Hospital in Cincinnati. He conducted research on an anaesthetized beagle and did studies on himself and 10 other doctors, measuring the huge flow of air coming out of the mouth. He proved that pressing the diaphragm upward , compressing the lungs, could carry a piece of food out of airway and out of the mouth. Hitting the back or squeezing the rigid chest does not produce any air flow. By 1974, his treatment had developed into what became known as the Heimlich maneuver. The June 1974 edition of medical journal Emergency Medicine published Heimlichs scientific report of his methodology to save choking victims. The story was picked up by Arthur Snider, a prominent medical writer for the Chicago Daily News, and distributed to newspapers throughout the country. A week after the article appeared, the Seattle Times reported that Isaac Piha, a retired restaurateur, was the first to successfully perform Heimlichs method on a woman choking on a piece of chicken, saving her life. Two months after the Emergency Medicine article appeared, so many reports of the Heimlich method saving choking victims were documented that the editors of the Journal of the American Medical Assn. (JAMA) named the procedure the Heimlich maneuver in its Aug. 12, 1974 edition. Also in August of 1974, Heimlich was asked to write an article for JAMA on how he developed the Heimlich maneuver. He said he submitted the article within a few months, but there was a long delay before publication. When he asked editors for an update, JAMA responded that a Red Cross senior advisor on choking had completed his own researchwhich

involved backslaps. The Red Cross article, however, was rejected by JAMA. In August of 1975, Heimlichs article was printed, along with an editorial stating that the Heimlich maneuver was officially endorsed by the American Medical Associations Commission on Emergency Medical Services, setting it on the path toward widespread, worldwide use. In 1976, the Red Cross brought out its new recommendations for treating choking victims, promoting backslaps first, then the Heimlich maneuver. The Heimlich maneuver was already well established and saving lives around the world, Heimlich said in the manuscript. Yet to our astonishment, the new (ARC) manual now suggested four backslaps before doing the Heimlich maneuver. Dr. Heimlich knew that backslaps could cause deaths, so he informed the ARC that it could not use his name if they recommended backslaps. Death occurs four minutes after the onset of choking. A lack of oxygen for less than that time can cause brain damage, with paralysis and coma. In response, Red Cross recommendations changed to the words abdominal thrusts instead of the Heimlich maneuver. The term abdominal thrusts suggests pressing the fist anywhere on the abdomen. It is not a Heimlich maneuver and does not expel the air that carries the choking object out of the mouth, said Heimlich. It can surely cause injury to organs inside the abdomen. He said he attended an ARC meeting in 1976 which addressed the issue. The chairman of the Red Cross at that meeting was a leading advisor on choking to the Red Cross, the American Heart Association (AHA), and the National Academy of Sciences (NAS) as well as the medical director of a private film company that produced films on first aid. The chairman of that Red Cross meeting described two unpublished scientific studies that led to the conclusion that backslaps were an effective treatment method. One of the studies involved four anaesthetized baboons. In that study, the medical director of a private film company that produced films on first aid reported a piece of meat was placed down the baboons throats and they were hit on the back. The meat was loosened, but not expelled.

The same doctor (who conducted the baboon study) also anaesthetized six human volunteers and placed pieces of meat in their throats, Heimlich said in his manuscript. He tied a string to the meat so it could be pulled out in an emergency. Once again, he tried backslaps and claimed to get the same results. These two unpublished studies were a basis, at that time, for the Red Crosss recommendation that backslaps should be the first aid for choking. In 1978, Heimlich said he received a phone call from Dr. Milton Uhley, a Los Angeles physician and cardiologist. Uhley had reviewed every medical article he could find back to the 17th century and discovered that they all warned people not to slap a choking victim on the back or bend his or her head downward because it would cause certain death. The two men collaborated on a pair of articles about the Heimlich maneuver, describing the historical and technical aspects of the maneuver, which appeared in a 1979 issue of Clinical Symposia. In the issue, Uhley and Heimlich reported the first 1,134 documented cases of choking in which the Heimlich maneuver was applied. In 174 instances, backslaps were tried first, without success, said Heimlich. More important, in 35 cases, the choking victim fell unconscious due to lack of oxygen while backslaps were being attempted. These persons were seconds from brain damage or death. Only when the Heimlich maneuver was finally applied were their lives saved. Heimlichs research on back slaps and the Heimlich maneuver were validated in 1985 by Dr. C. Everett Koop, the nations most well-known and respected U.S. Surgeon General ever, in Public Health Reports, the official journal of the of the U.S. Public Health Service. Millions of Americans have been taught to treat persons whose airways are obstructed by a foreign body by administering back blows, chest thrusts and abdominal thrusts, said Koop in the November- December issue in1985. Now they must be advised that these methods are hazardous, even lethal. A back slap can drive a foreign object even deeper in the throat. Chest and abdominal thrusts, because they refer to blows to unspecified locations on the body, have

resulted in cracked ribs and damaged spleens and livers, among other injuries. In that document, Koop reported that at a national medical conference held in July, 1985 participants established first aid standards for the ARC and AHA and concluded that methods other than the Heimlich maneuver can be dangerous and only the Heimlich maneuver should be used to treat a choking victim. In that issue of Public Health Reports, Koop also urged the ARC and AHA to teach only the Heimlich maneuver in their first aid classes, and to withdraw from circulation manuals, posters, materials that recommend treating choking victims with back slaps and blows to the chest. The

ARC did not comply. Today, its website recommends five backslaps, then five abdominal thrusts to treat choking victims. We in the medical community and its supporting education associations have a responsibility to save peoples lives by giving people the correct information, said Heimlich. With the advent of the internet, it becomes even more imperative to provide and distribute the correct information. When people use the backslap, they kill choking victims.