Heimlich's Maneuvers

  There is debate as to just how much water or fluid enters the lungs of drowning victims, however, I believe that the Heimlich Maneuver should be used to remove whatever fluid exists, after which CPR can be applied. My idea is that rescuers should get the water out, at which point CPR would be most effective. Rescuers trying to revive a drowning victim have very little time to act. If a drowning victim is unconscious and has water in the lungs, administering CPR rather than the Heimlich Maneuver as a first response can waste valuable time.

  Is this idea controversial? Absolutely. But a number of people who have used the maneuver to treat a drowning victim agree.

  Using the Heimlich Maneuver as a first response for drowning victims “may open up a new vista of resuscitation,” Dr. Victor Esch told the media after he had saved the life of the drowning victim in Delaware Bay in 1974. “It does no good to do standard mouth-to-mouth breathing if there is water in the lungs or debris in the trachea from vomiting. The air won’t get through.”12

  Using the Heimlich Maneuver to treat drowning victims is worth examining, especially when you consider how it has worked, according to individual reports. One example occurred in 1986 in Destin, Florida. Four-year-old Shawn Alexander and his friend, five-year-old Michael Odom, were jumping off a public boat dock into the bayou below. The fun turned to fear when Shawn’s feet stuck in the muddy bottom, trapping him under the water. Young Michael pulled the boy out of the water, but by the time he got Shawn to safety, he was unconscious. A bystander gave Shawn mouth-to-mouth resuscitation, but the boy did not respond.

  At that time, Terry Watkins, Destin’s fire chief and an emergency medical technician, was pulling his fishing boat ashore when he saw the man trying to revive Shawn. Chief Watkins had recently read an article about the Heimlich Maneuver used for drowning victims and performed it three times on Shawn. Each time, a cupful of water was ejected from the boy’s lungs. After the third attempt, Shawn coughed up white foam and started to cry. He was taken to the hospital and released the next day in good health.13

  When I learned about this case, I was struck by the bravery exhibited by both Chief Watkins and Michael Odom. So, in 1989, I presented each of them with a Save-A-Life Award on the television show Rescue 911, hosted by actor William Shatner.

  Today, Mr. Watkins is a sixty-nine-year-old retiree but still works both as an EMT and part-time in the local sheriff’s office. “I’m an advocate for the Heimlich Maneuver for drowning,” he said, when contacted at his home in Destin on July 18, 2013. “I saw it work.”

  Another incident took place on August 13, 1995, in Jacksonville, Florida. Several police officers and Ron Watson, vice president of the US Lifesaving Association (USLA), raced to save two-year-old Deshun Richardson, who was drowning in the lake at Hanna Park. By the time Mr. Watson got to Deshun, he was lying lifeless on the lake bank, not breathing and without a pulse. The team first tried CPR, which yielded no immediate results.

  “Nothing was happening,” said Mr. Watson, who was contacted at his home in Harrison County, West Virginia, on July 15, 2013. At the age of sixty-eight, he is president of the Harrison County Commission in West Virginia, and he is still a USLA advisor.

  Mr. Watson remembered that, before the incident involving Deshun, he had met me at a convention in Washington, where I was talking to audiences about the Heimlich Maneuver. When Ron and I spoke, I had told him that it was necessary to get the water out of the lungs of drowning victims before air could come in.

  “So I did an upward thrust,” said Mr. Watson, recalling his rescue of Deshun, “and water gushed out of the boy’s mouth. He started gasping for air. We did CPR again, then more ‘Heimlichs.’ The boy began to breathe again.” Deshun stayed overnight in the hospital and was released the next day.

  One aquatics-safety organization has researched various rescue methods for drowning and trains its lifeguards to use the Heimlich Maneuver (called “abdominal thrusts”) while the victim is still in the water. The National Aquatic Safety Company (NASCO) was founded in 1974 and is based in Dickenson, Texas. NASCO stresses the need for rescuers to act quickly when a person is found unconscious in the water. It tells its lifeguards to administer five abdominal thrusts while the victim is in the water and is being moved to an extrication point. Once the victim is out of the water, NASCO trains lifeguards to administer CPR.14

  According to NASCO’s website, it believes in administering the abdominal thrust because it works well, does not do additional harm to the victim, delays the initiation of CPR for a very short time, and initiates “a respiration step early in the rescue sequence.” NASCO adds, “The time between when a victim is in the water and non-breathing and when they are placed on the deck and conventional CPR is initiated is typically between two and four minutes. The step of this sequence that often takes the longest is the extrication from the water.”15

  The NASCO lifeguard manual states that performing the abdominal thrusts takes only four to six seconds. “There is strong evidence that abdominal thrusts can help in the process of ventilating a drowning victim who has experienced a loss of spontaneous ventilation,” reads the manual.16

  NASCO has documented cases in which abdominal thrusts were successful. The organization states that from 1999 to 2009, of the millions of swimmers who were guarded, twenty-eight lost respiration. Of those, fourteen were revived by using only abdominal thrusts; eight required rescue breathing after the abdominal thrusts; and two required CPR after receiving rescue breaths and abdominal thrusts. Four of the victims did not survive, however, “other factors precluded the abdominal thrusts from being a significant factor,” according to a NASCO press release.17

  The main criticism against using the maneuver as a first response to revive drowning victims is that vomitus, or regurgitation matter, could be inhaled. It is true that drowning victims sometimes vomit.18 However, the worry that the maneuver would lead to aspiration of vomit has not been proven. In fact, the claim is based on only a single case from 1987,19 and in that case, the maneuver was applied much too late. NASCO points out in its press release that many people receiving artificial respiration or CPR will vomit while those procedures are being performed. Fortunately, NASCO lifeguards perform the maneuver as soon as they get to the victims while they are still in the water. “Our lifeguards are trained to position the drowning victim to reduce the chance of vomit being aspirated,” says the NASCO press release.20

  Too many adults and children drown every year in the United States. I believe that a large number of these deaths occur because rescuers are failing to remove water from the lungs because they are not using the Heimlich Maneuver before applying CPR.

  USING THE HEIMLICH MANEUVER FOR ASTHMA

  Twenty-five million people in the United States suffer from asthma. That’s about one in twelve people, and the numbers grow each year, especially among African-American children. Many individuals try to prevent attacks by avoiding contact with asthma triggers, such as allergens. Patients treat asthma attacks by using prescription medicines, such as inhaled corticosteroids. Long-acting beta-agonists, also known as “blockbuster” drugs, treat airway constriction but have been linked to serious side effects, including death.21

  The Heimlich Maneuver should be researched as a possible, natural, viable treatment for asthma.

  As in my research into using the Heimlich Maneuver for drowning, I began looking at it as a treatment for asthma after people contacted me and let me know they had used it on people who were having asthma attacks. What’s more, after the maneuver was applied, the asthma sufferer began breathing normally.

  For example, in the early 1990s, I gave a talk at the International Platform Association in Washington, DC. After I finished my speech, I recall a woman raising her hand. “My sister is an asthmatic,” she said. “One day when I was visiting her, she suddenly had an attack. She couldn’t breathe and was turning blue. I was sure she would die. The only emergency measure I knew was the Heimlich Maneuver, so I did it. She immediately took a dee
p breath and recovered.”

  On November 15, 1995, I received a letter from a man from Utah whom I had met at a training program in Salt Lake City. He wrote that his four-year-old granddaughter had asthma, and the child’s mother thought that the maneuver might be of help in the event of another attack. One night, the child had the worst asthmatic attack of her young life. Her mother performed the maneuver and, within a minute, the girl was breathing normally again. About four hours later, the girl experienced another episode and, again, her mother gave her the maneuver and the child’s breathing returned to normal.

  Three years later, I received a letter from the girl’s mother, Stephanie Hagen. She wrote that she had continued to use the Heimlich Maneuver on her daughter because it had worked so well to curb her asthma attacks. She said she used “mini-Heimlichs” as part of the family’s regular routine, and it helped with her child’s breathing long before it reached the “panicked stage.” Ms. Hagen noted that her daughter was receptive to the procedure, even asking, “Mommy, can you help me breathe?” when she felt an attack coming on. “She has probably had the healthiest winter in her life this year,” noted Ms. Hagen, who added that her daughter still used asthma medication after receiving the maneuver, and they believed it helped the medication “work more effectively.”22

  I received a letter from Ms. Hagen dated January 19, 2009, when her daughter was eighteen years old. Her mother informed me that her daughter had grown out of her asthma when she was in her early teens. When contacted in the summer of 2013, Ms. Hagen reiterated that the maneuver had been very helpful at curbing her daughter’s asthma. “When I heard years later that it was controversial, it made me sad because the Heimlich Maneuver had been so helpful to us. Doing the Heimlich Maneuver took away her fear a little. It would force the air out, she would gasp, and we would count until she could settle down and breathe again. It made us very happy.”

  After receiving numerous reports of this kind, I began to investigate the physiological basis for the Heimlich Maneuver as a lifesaving technique when used for an asthma attack. By looking at what happens when someone is suffering an asthma attack, it’s quite easy to see how the maneuver could help.

  Asthma attacks occur when muscles surrounding the airway contract. This narrows the smaller air passages, the linings of which are chronically swollen and inflamed, as is common in many asthma sufferers. Mucus that fills the airway acts as a valve; that is, when the asthmatic person breathes in, the airway opens slowly and air slides around mucous globs in the small air pockets, called alveoli, of the lungs. On exhaling, those mucous globs, known as plugs, clog the narrowed airways and act like a closed valve, so air cannot escape. Trapped air distends the lungs, making both inhalation and exhalation difficult or impossible. If this condition goes untreated for too long, the asthmatic cannot even inhale medication and can die.

  Remember that the Heimlich Maneuver pushes up on the diaphragm, compressing the lungs and expelling air left in the lungs. When the maneuver is applied, it has the potential to provide airflow that can carry away mucous plugs, thus clearing the airway. The maneuver also evacuates the thin layer of fluid that coats the lungs, called alveolar fluid, allowing asthmatics to breathe more easily. This evacuation of mucus and alveolar fluid allows airflow in and out of the lungs, ending the asthma attack. When performed on asthmatics, the maneuver need only be done gently and smoothly because you are expelling air and mucus, not a solid object.

  A 2005 study published in the West Indian Medical Journal provides evidence that the Heimlich Maneuver is effective for treating asthma. From August 2002 to July 2003, sixty-seven asthmatics aged six to sixteen years old were studied in Barbados regarding the efficacy of using the Heimlich Maneuver to treat asthma. Thirty-three patients received three Heimlich Maneuvers once a week whether or not they were having an asthma attack. Thirty-four acted as controls, and a researcher’s hands were merely placed on each these patients’ upper abdomen one day a week—no force was applied. For the entire group, respiratory-function tests were carried out at regular intervals, as were exercise-tolerance determinations and quality-of-life assessment. The tests showed “progressive improvement” in the study group compared to the control group, and no adverse effects were reported.23

  Because of the way the maneuver assists asthma sufferers, it makes sense that it can be used in other situations in which people are having breathing problems. In an episode on the PBS television program NOVA, titled “Everest: The Death Zone,” mountain climber David Carter was determined to reach the summit of Mount Everest in 1996. He suffered from chest congestion for a day or so prior to the summit attempt, but he felt the problem wasn’t severe enough to nix the planned attempt. The group reached the 29,000-foot summit, but on the way down, Carter’s breathing got worse. Fellow teammate Ed Viesturs called down the mountain for medical help. A medical expert in wilderness medicine on duty at the medical post below recommended the Heimlich Maneuver. Viesturs performed the maneuver on Carter multiple times, and Carter eventually breathed more easily and was able to continue down the mountain.24

  One of the most memorable moments of my life was calling in to an Indiana radio show featuring Carter after the mountain-climbing event. The first words Carter said to me were, “You saved my life.”

  Asthma patients should first consult their doctors well before trying the Heimlich Maneuver as a remedy. Still, based on what patients have told me, the technique holds a lot of promise. It is in our best interests to continue researching the possible effectiveness of the Heimlich Maneuver to treat asthma, especially when it occurs in children.

  TEACHING PATIENTS HOW TO SWALLOW

  I am forever grateful for the time I spent with Mohammed Ben Driss Hayani-Mechkouri, the teenage boy who came from Morocco to undergo the reversed gastric tube operation. Never will I forget him taking a lick of ice cream that smoothly traveled down his throat and through his newly made esophagus.

  But this could not have happened had I not first taught Hayani how to swallow—or, rather, how to relearn swallowing. Since he had gone so many years without swallowing, he had forgotten how to perform this simple act. The method I used, which I learned from a nurse who taught premature infants how to swallow, involved sucking Hayani’s finger so that he could know what successful swallowing felt like. Then he sucked his own finger, trying to produce that same feeling until he was able to master it.

  After using the technique with Hayani, I came across other patients who also suffered from disabilities that prevented them from being able to swallow. Take, for example, Orville Reiser, a forty-five-year-old teacher from Ohio who came to see me in 1972. In 1943, when Mr. Reiser was sixteen years old, he contracted bulbar polio, which left him with respiratory paralysis. When he was stricken with the disease, his throat closed and he was unable to swallow, so doctors passed a tube down through his nose and into his esophagus. Using an acepto syringe, the hospital staff fed him liquid food through the tube. During this time, Mr. Reiser was unable to swallow. He used handkerchiefs to catch his saliva. After six weeks, the tube was removed, and Mr. Reiser learned how to use a tube to feed himself. Three times a day, he passed the tube through his nose and down his esophagus, through which he passed warmed liquid meals consisting of different combinations of strained oatmeal, eggs, corn syrup, baby food, and milk.

  Understandably, having to eat this way greatly impacted Mr. Reiser’s life. “At sixteen years old, I had the world in a jug and a cork in my hand, and it kind of jerked the rug out from under me,” he said when contacted at his home outside Portsmouth, Ohio, on November 10, 2013. But he finished high school and went to college at Ohio University. There, the dean permitted him to fix his meals in his room. For twenty-nine years, Mr. Reiser continued to feed himself using the tube. Then a man he knew saw an article about my work with Hayani and suggested he contact me.

  By that point, Mr. Reiser had all but given up on finding a treatment for his swallowing problems. Doctors had told him that he would nev
er swallow again due to his paralyzed pharynx. When he came to see me, we measured the length of his esophagus by putting a tube down his throat. I was able to determine that not only did the muscles in his mouth work fine, but his esophageal muscles were also functioning, although erratically. To investigate further, I decided to do what no other doctor had done: I would operate on Mr. Reiser to understand just what was preventing him from swallowing.

  On March 23, 1972, I made an incision in the neck, exposing his upper esophagus. It was immediately obvious what had been causing the difficulty. A two-inch length of the esophageal wall was scarred and thickened, apparently due to irritation caused by the tube that had been initially left in his esophagus for six weeks. I set about removing the scar tissue. It was a delicate operation because I had to remove the scar tissue without perforating the lining of the esophagus. Once the scar tissue was gone, the walls of the esophagus could expand to at least normal size. Pleased, I announced to the operating room staff, “I could drive a truck through there!” In an operation that took less than twenty-nine minutes, the cause of Mr. Reiser’s inability to swallow food for twenty-nine years seemed to have been corrected.

  But Mr. Reiser’s problems were not over. A few days later, he was still unable to swallow fluids and soft foods. He would start choking, and the food would spill upward out of his mouth. I passed a tube through his mouth and throat and then down into his esophagus. There was no blockage. As I continued to be troubled by Mr. Reiser’s inability to swallow, I remembered my work with Hayani. I realized that, in all likelihood, Mr. Reiser, like Hayani, had also forgotten how to swallow. And so I decided I would try with him the same finger-sucking exercises I had done with Hayani.

  Mr. Reiser and I performed the finger-sucking exercises several times a day. After a couple of weeks of this therapy, Mr. Reiser returned home, where he continued to use his tube to feed himself but conducted exercises to train his esophagus to swallow. It took a great deal of patience. Five or six times a day, he stood in front of the mirror and put a four-inch-long tube the width of his finger down his throat and tried to swallow. By that time, he knew how to emulate the sucking action needed for swallowing from the finger-sucking exercises we had done in the hospital. Then he would try to sip milk with soda. Each time, he spit up the liquid, but he could get it down a little farther.