
The Masterful Marketing of the Heimlich Maneuver - Thevet
http://www.psmag.com/navigation/health-and-behavior/masterful-marketing-heimlich-maneuver-94519/
======
throwaway5643b
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.

~~~
gregd
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.

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

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

------
japhyr
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?

~~~
sz4kerto
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](http://en.wikipedia.org/wiki/Sudden_infant_death_syndrome)

------
BjoernKW
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.

------
vertex-four
> 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.

------
douglasfshearer
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/](http://www.radiolab.org/story/273532-heimlich/)

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

[http://abcnews.go.com/blogs/headlines/2007/07/heimlichs-
son-...](http://abcnews.go.com/blogs/headlines/2007/07/heimlichs-son-p/)

"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."

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

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

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

------
blergh123
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.

~~~
tempestn
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.

~~~
blergh123
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?

~~~
tempestn
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](http://www.ncbi.nlm.nih.gov/pubmed/8576987)

~~~
ars
> 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.

~~~
cornellwright
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.

------
derefr
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?

~~~
gregd
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.

------
madengr
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.

~~~
gregd
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.

~~~
NolF
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.

------
dzdt
Don't forget the famous Rex maneuver.
[https://m.facebook.com/photo.php?fbid=568822759849746&set=pb...](https://m.facebook.com/photo.php?fbid=568822759849746&set=pb.113732812025412.-2207520000.1383499943.&type=3&theater)

~~~
japhyr
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...](http://www.mayoclinic.org/first-aid/first-aid-
choking/basics/art-20056637)

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

One son goes on to accuse him of fraud:
[http://medfraud.info/](http://medfraud.info/)

Another becomes a Cincinnati religulous politician:
[http://philheimlich.com/](http://philheimlich.com/)

------
dirtyaura
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](https://www.youtube.com/watch?v=itordNWNRM8)

