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Heimlich maneuver on unconscious persons causes controversy

The practice of using the Heimlich maneuver on unconscious persons has sparked a tremendous amount of mixed responses among medical professionals. The Heimlich maneuver, developed by Dr. Henry Heimlich in 1974, is used to treat persons who are choking on a foreign object become lodged in their airway.

Certain entities, such as the American Heart Association and the American Red Cross, do not recommend using the Heimlich maneuver on unconscious patients; however, the American College of Emergency Physicians (ACEP) and Henry Heimlich have advocated the practice.

Two different thought processes are circulating in the medical community on how to best treat unconscious choking victims. Should a choking a victim become unconscious while the Heimlich maneuver is being attempted, should rescuers begin CPR or continue to administer a modified Heimlich maneuver in an attempt to dislodge the foreign object?

ACEP advocates the use of the Heimlich maneuver on unconscious victims. In fact, a website sponsored by ACEP gives clear instructions on administering the modified Heimlich to unconscious persons; however, the American Red Cross and American Heart Association do not recommend the practice.

In an effort to uncover the scientific reasoning behind ACEP’s stance, this reporter contacted ACEP representatives and even visited their headquarters in Irving. Unfortunately, physicians refused to comment on the matter and referred this office to a media liaison in Washington D.C. who did not respond by press time. This reporter is left to wonder if this is a solid medical practice why no ACEP physician is willing to comment on the matter.

Happily, this reporter was able to speak to Cherl J. Phillips, an American Heart Association Instructor and Manager of the Baylor Medical Center at Irving Education Department, who discussed the practice taught to Baylor nurses, patient care technicians and radar technicians in reference to the Heimlich maneuver.

“Looking at the American Heart Basic Life System Book [for Healthcare Providers Student Manual], [a] choking victim may be responsive and then may become unresponsive. In this circumstance, you know that choking caused the victim’s symptoms and you know to look for a foreign object in the throat,” Phillips said. “Basically, if someone is conscious and they become unconscious while you are trying relieving their choking, the first thing you’re going to do is look in their throat because [the obstruction] may become dislodged. If you see it, go in after it. You do what we call a ‘finger sweep’. You never do blind finger sweeps.

“If they become [unconscious], then you activate EMS right away, then you begin CPR starting with compressions, so you’re no longer doing abdominal thrusts [Heimlich] in that case. If you come up on somebody who is unresponsive, you don’t know what happened, so you’re going to start with calling 911 and chest compressions. You don’t want to start doing abdominal thrusts on somebody [who needs CPR],” she said.

The ACEP sponsored website states to only begin CPR after the obstruction is removed; whereas, the American Heart Association BLS Handbook states to begin CPR immediately following a person losing consciousness.

Peter Heimlich, son of Henry Heimlich, has also made several attempts to contact ACEP. He has also met the ACEP’s reluctance to comment on a medical practice the College openly advocates. Due to the lack of response, Peter reached out to Dr. David Lakey, Commissioner of the Texas Department of State Health Services. Peter listed a copy of the letter on his blog, and he is currently waiting for a response.

Heimlich Heroes, a Cincinnati-based first aid program developed partly by Henry Heimlich, is teaching students to perform the Heimlich maneuver on unconscious choking victims. This means that school children are being taught a medical practice that is not recommended by the American Heart Association or Red Cross, two highly credible public health organizations.

With medical professionals citing different opinions on the use of the Heimlich maneuver on unconscious victims, it may be difficult to decide which instruction to follow during a medical emergency. The consensus says that if a choking victim is conscious and breathing independently, do not administer the Heimlich until the person fails to breathe on their own or advanced medical care arrives.

For more information about the uses of the Heimlich maneuver, visit these websites: www.acep.org, www.heimlichheroes.com and www.emergencycareforyour.org. To view Peter Heimlich’s letter to Dr. Lakey, visit Peter’s blog at http://www.the-sidebar.com/2014/11/against-recommendations-of-heart.html.