The Masterful Marketing of the Heimlich Maneuver | Hacker News Reader

The Masterful Marketing of the Heimlich Maneuver

psmag.com

69 pointsThevet35 comments

This article hits home for me.

I just last week gave my pregnant wife the Heimlich after she started choking on food at home. She is about 6 months pregnant. I was present enough in the moment to press into her abdomen above where the baby is situated. The food released on the second or third thrust. The thrusts where rather light compared to what I would have done had she not been pregnant. I shudder to think what I would have had to do if the light thrusts had not worked, given that the only thing in my mind at the time was the Heimlich maneuver. Despite it all happening to so fast, I was aware of the fact that I was willing (as a last resort) press lower in her abdomen and harder and risk injuring the baby to save my wife.

It all turned out okay, but I wish I had known that back blows are a viable alternative and probably a first approach for pregnant women.

Interestingly enough I was all set to argue your point about back blows. When I became an NREMT-B back in the late 90s, we were told, in no uncertain terms, that back blows WERE NOT recommended as they could lodge the object fully.

After just now doing a bit of research, it appears that back blows are still "controversial" with the Red Cross recommending them as part of their '5 and 5 method' (first 5 back blows and then 5 abdominal thrusts) and the American Heart Association ONLY recommending abdominal thrusts.

I should refresh myself sometime soon but from memory of my training there is an element of "appropriate position" involved in the back blows technique. It can work in any position but there is a "safest" one that should be used if the situation allows for it. From memory the position involves leaning them forward as far as practicable. They still discuss the Heimlich manoeuvre, but advised us all that, like putting a dislocated shoulder back in its socket, it seems simple enough but there is much room for things to go wrong.

I find it interesting that the American Heart Association is taking any kind of stance. It's not directly a heart issue, is it?

They do CPR certification, and choking treatment dovetails with those courses.

I'm not sure you would have hurt the baby anyway. It's really well protected in there.

The mother on the other hand would be in pain.

Choking is really interesting in that it's one of the few life-threatening situations that, if treated properly, you can walk away from without any further medical care. One moment you're about to die, the next moment you're fine to carry on with your day.

I'm not sure how an effective study of choking treatments would be developed. How do you take into account all the successful treatments that go unreported?

There are many examples of this problem. SIDS [1] is similar: there's no way for experimenting, it's extremely difficult to find out the circumstances when something bad happens; and if you can somehow record them, then it's extremely difficult to find out what's relevant and what's not.

[1] http://en.wikipedia.org/wiki/Sudden_infant_death_syndrome

Back blows are the proper first-aid measure for dislodging an object that blocks the airway.

The problem with the Heimlich manoeuvre isn't so much that it's ineffective but that in order for it to be effective you have to exert an enormous amount of pressure on the abdomen, which in turn can cause severe injuries. That potential trade-off might still be worth it if the person otherwise would choke to death and there's no other help available but it makes it something of a measure of last resort.

> A little air has gone out of Dr. Henry Heimlich’s claims, but he still saved thousands of lives.

Except that you've just stated that it's entirely possible he's caused more harm than not.

Radiolab have an episode [1] that the history of the Heimlich manoeuvre, as well as it's inventors other dubious creations.

[1] http://www.radiolab.org/story/273532-heimlich/

I preferred to try to find written sources about "dubious creations."

http://abcnews.go.com/blogs/headlines/2007/07/heimlichs-son-...

"A recent 20/20 investigation detailed Dr. Heimlich’s attempts to promote the use of his maneuver on near drowning victims and cystic fibrosis patients, which leading medical experts say is either useless or potentially dangerous. Dr. Heimlich has also been criticized for supporting human studies into his theory that malaria can be used to treat AIDS patients. The application of so-called "malariatherapy" has been denounced by leading AIDS researchers as dangerous, scientifically unfounded and unethical. "The harm that he’s caused overwhelms the good he accomplished," Peter Heimlich told ABC News about his father."

"Every study in this shows that back slaps drive the food deeper and do not save lives, that only the Heimlich maneuver saves lives," eldest son Phil Heimlich told ABC News on behalf of his father.

Though Peter denies the charge, Phil also believes that Peter’s campaign has been motivated by personal issues."

Radiolab's episode was also edited later:

"We removed the audio of Peter Heimlich, Henry Heimlich’s son, from the version now on the site. When we approached Henry’s other son Phil to arrange an interview with his father, one of Phil’s conditions was that we not air audio of Peter. We thought he’d waived that provision in a subsequent conversation but he contends he did not. So we are honoring the original request."

In Poland nobody heard of this, everybody used back blows. Recently this changed because of movies and internet.

In Germany it's the same. Are there countries except the USA where this method is the normal one?

In France, the official method (taught in first aid classes) is the 5+5 approach from the red cross described in another thread.

I have been saved by the Heimlich maneuvre after choking on some bread, and recently saved the life of another family member choking on some meat using the same technique. If we had started with back blows, I think the family member would have been unconscious before we had the opportunity to resort to the Heimlich maneuvre, given that my family member didn't raise the alarm until quite a while after the choking started.

Personally, despite the potential for injury that people say the maneuvre has, neither of us were injured, and both were able to breathe after the blockage was removed (it took 2-3 thrusts). I am forever grateful that this technique is so well known. In our life threatening situations, the risk of injury or bruising was well worth it to be able to breathe again.

Why do you assume that back blows would not have been just as effective at removing the blockage? Obviously in your case it's great that the Heimlich worked, and natural that you appreciate it having been used. In some cases though, perhaps back blows are even more effective. And they are certainly easier to perform correctly.

Also, five back blows take less than five seconds to administer. Certainly it is beneficial to know the Heimlich as well, and be ready to administer it if the back blows fail, but I'm inclined to agree with the current medical opinion that they should be attempted first.

I guess that given the sense of urgency I felt, I wanted to get the person breathing as soon as possible, and I knew from my personal experience that the HM was very effective.

I've also read that back blows may further lodge the blockage in the throat, especially if you can't get the person to lean over, and this was a concern for me as well. Whether it's true or not is hard to know, but when your family member is choking and close to losing consciousness, you really don't care about breaking ribs! It's kinda the same with CPR - you don't care about breaking ribs, and it's pretty common for that to happen during compressions.

I'd be interested to know what the potential injuries are from the HM - is the main one breaking ribs?

Yes, it's unfortunate that it is really difficult to formally study something like this. You can't very well induce choking to test the options.

My completely uninformed guess is that the 'further lodge the blockage' thing might be a result of the marketing campaign ("death blows", etc.) rather than an established fact. In that case, although it would take a few extra seconds, I can see it making sense to try back blows before the HM. For one thing, you may actually dislodge the blockage more quickly. (Especially, one would think, in cases that make the HM difficult, such as with pregnant women, or even if it's just physically difficult to get into the correct position due to surroundings.) And while of course I agree with you that a few broken ribs is an easy trade for continued breathing, I expect in rare cases those abdominal injuries could have serious (or even fatal) consequences. Ah, yes; a quick search came up with this[1].

[1]: http://www.ncbi.nlm.nih.gov/pubmed/8576987

> You can't very well induce choking to test the options.

Why not?

Put some soft rubber on a string and place it in the airway then try to dislodge it. If you have any problems pull it out with the string.

It wouldn't hurt the person - you can hold your breath for a minute with no problem.

If it's uncomfortable you can spray some local anesthetic in the throat first.

Maybe you could try this, but I don't think this is something that any reputable institution's IRB would approve.

I would actually recommend trying what you suggest on cadavers. You'd have to inflate the lungs first though.

I do not mean to be rude but anecdotes are not data.

No, and I didn't pass it off as data. It's a personal anecdote, as I have stated.

Is the Heimlick really the most effective way to dislodge something caught in a person's throat, or is it just the most convenient? I ask because, thinking about the mechanism behind e.g. water-boarding torture, the first thing I'd want to do to someone who is trying to get something up that's trying to go down their throat, is to flip them over or incline them such that the gravitational force on the object will be aiding them rather than fighting them.

I mean, nobody would think of trying to perform CPR on a drowning victim with the person propped up instead of laying flat, right?

With babies, this is a recommended method (cradling them upside down, letting gravity work, while also giving minor back blows). However, this method would be entirely impossible with a fully grown adult. The problem is also that the object can get lodged wanting to neither move up OR down, so getting them upside down only, probably wouldn't dislodge it. That's why it becomes necessary to push it out with what little air is below the object.

The first aid for toddlers I learnt many uears ago recommended picking them up by the legs and whacking their backs.

This is impractical on adults.

I'd did the HM on a guy choking at a Backyard Burgers. The weird thing he was making these seal-like barks, which wouldn't seem possible with a blocked off airway. Anyway, it worked and it dislodged the hamburger.

I have heard of people's ribs being broken, and wouldn't be surprised if someone was sued after a HM. Fortunately I didn't hurt the guy, despite me being 6'5" and probably lifting the guy off the ground.

My so does ems.

The most important thing is, if you're choking, don't politely go off to the restroom. That's how you die. Make a scene and get help.

While I'm on the subject, drowning also doesn't look like the frantic splashy display shown on tv. If you go swimming, learn to recognize it [1]

[1] http://www.slate.com/articles/health_and_science/family/2013...

Most states have good samaritan laws that prevent such lawsuits from happening. The good samaritan laws do not cover professional EMS personnel however. As a professional, you can be sued for negligence if you render aid and you're found negligent.

Just as FYI / technical distinction, you can be sued for rendering first aid, the likelihood of that suit being successful is unlikely due to the protections under the good Samaritan laws. Lawyers can still be expensive. As a professional you should always have professional indemnity insurance on top of whatever the employer provides.

You can have an object lodged in your throat in such a way that it allows you to exhale but not inhale.

As a child, I remember choking on a bit of bread or pastry or something. I couldn’t breathe in, but I could wheeze and make noise. I was able to dislodge it by pointing my head downward and exhaling forcefully with my remaining air, effectively an internal version of the Heimlich.

Don't forget the famous Rex maneuver. https://m.facebook.com/photo.php?fbid=568822759849746&set=pb...

That actually brings to mind a very practical question - what do you do if you're choking alone? From the mayo clinic:

    First, if you're alone and choking, call 911 or your local emergency number immediately. Then, although you'll be unable to effectively deliver back blows to yourself, you can still perform abdominal thrusts to dislodge the item.

    - Place a fist slightly above your navel.
    - Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
    - Shove your fist inward and upward.

http://www.mayoclinic.org/first-aid/first-aid-choking/basics...

There's a lot of interesting backstory on the Heimlich family.

One son goes on to accuse him of fraud: http://medfraud.info/

Another becomes a Cincinnati religulous politician: http://philheimlich.com/

A perspective from a comedian: "The trouble is it's very difficult to say when you are choking to death". https://www.youtube.com/watch?v=itordNWNRM8

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