"Red Cross Deviates from Heimlich Maneuver," Journal Inquirer, April 10, 2007

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"Red Cross Deviates from Heimlich Maneuver" by Anne Pallivathuckal, CT
Journal Inquirer, April 10, 2007

Look at any poster depicting how to save a person who is choking and
you will most likely see an illustration of the Heimlich maneuver.

Soon, those posters may be replaced.

For many years, the American Red Cross had recommended the Heimlich
maneuver as the preferred method for clearing an obstructed airway.

The Heimlich maneuver involves abdominal thrusts to dislodge an
obstructed airway. But that changed last year when the organization
released new guidelines for saving choking victims.

The Red Cross now recommends a series of five back blows and then five
abdominal thrusts to aid a conscious choking victim.

Paul Shipman, senior director of marketing and external relations at
the Red Cross' Farmington-based Charter Oak chapter, says, "We teach a
choking rescue that conforms to the latest science. What we teach is
an overall cycle of choking care."Back blows mean you should bend the
individual forward slightly, cradle them around the shoulder with the
left arm, and use the heel of the other hand to give five blows
between the shoulder blades, Shipman says.

If the object is not forced out, Shipman says the Red Cross suggests
the rescuer use five abdominal thrusts by standing behind the
individual, holding the hands together below the sternum, and giving
upward abdominal thrusts."The thrusting motion is similar to the
thrust used in the Heimlich maneuver, but the overall regimen is
different," Shipman says.

Shipman says referring to the motion as abdominal thrust, and not the
Heimlich maneuver, helps people to get an actual picture of what you
are tying to do for a victim in terms people can visualize and
understand.

The American Heart Association, which still recommends using the
Heimlich maneuver for choking victims more than a year old, describes
the maneuver as "a series of under-the-diaphragm abdominal thrusts."
It lifts the diaphragm and forces enough air from the lungs to create
an artificial cough. The cough is intended to move and expel an
obstructing foreign body in an airway.

Henry Heimlich published the results of his studies on the maneuver in
1974, which generated a lot of media coverage and hype, according to
his son, Peter Heimlich, who lives in suburban Atlanta, Ga.

"My father branded choking," he says. "It brought a lot of focus on an
area of first aid that had generally been overlooked."Within the first
week of publication of a news story on the Heimlich maneuver by a
syndicated columnist, a victim in Washington, D.C. was reportedly
rescued by the method, Peter says.

Peter is currently doing research for a book he is writing along with
his wife, Karen Shulman, titled "Outmaneuvered." He says it is a
biography of his father and includes the history of the Heimlich
maneuver.

He says that the Heimlich maneuver works, but "the question is whether
it is the best method."

Peter contends that the maneuver gained widespread prominence because
of his father's media blitz, even while other methods were found to be
more effective.

Peter cites the work of Charles Guildner, a doctor who studied chest
thrusts as a method for rescuing choking victims in the mid-1970s.
Guildner did a series of tests to compare the effectiveness of using
abdominal thrusts versus chest thrusts by measuring airflow. His
findings showed that chest thrusts were more effective.

A more recent study in Norway that tested the effectiveness of chest
thrusts using cadavers replicated Guildner's findings, Peter says.

The AHA in its journal, "Circulation", cites this study, in which
randomized trial maneuvers to open the airway in cadavers was tested.
The AHA journal also mentions other studies that show that higher
sustained airway pressures can be generated using the chest thrust
rather than the abdominal thrust.

The AHA has said that studies have shown that when treating choking
victims, "the likelihood of success was increased when combination of
back blows or slaps, abdominal thrusts, and chest thrusts were used.

"However, it says, "for simplicity in training we recommend that the
abdominal thrust be applied in rapid sequence until the obstruction is
relieved." The AHA also cautions that abdominal thrusts can cause
injuries.

If this method is ineffective, the rescuer then may consider chest
thrusts, the AHA says.

The Red Cross' revised guidelines are similar to what is followed in
many other countries, Peter says."In Europe, they've been teaching
back blows followed by abdominal thrusts for 25 years," Peter says. In
Australia, the recommended method is back blows followed by chest
thrusts, he adds.

The Red Cross recommends a treatment similar to CPR, which includes
chest compressions, if the victim is unconscious, according to
Shipman.

With the changes in the Red Cross guidelines, Shipman says the
organization is now rolling out new posters illustrating the revised
procedures to save a choking victim.

©Journal Inquirer 2007

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