QUSTIONABLE MANEUVER

In 1995, the legendary Dr. Henry Heimlich-namesake of the Heimlich maneuver-stood before the United States Lifesaving Association (USLA) board of directors and presented a radical idea: Not only was the Heimlich maneuver the cure for choking victims, it was the cure for near-drowning victims. As USLA president Chris Brewster listened, he found Heimlich's idea intriguing yet problematic.

“What struck me immediately was that a key in training people is teaching them that they can't adjust treatment in accordance to what they think is appropriate,” says Brewster, who lives in Mission Beach and is still USLA president. “Lifesavers are given very specific protocols to follow. For example, a paramedic who happened to have read some medical magazine on some procedure can't just use that in the field. It'd be a serious violation of not only the law, but of ethics.”

Raising his hand, Brewster-who at that time had more than a decade of experience and was the San Diego lifeguard chief-told the esteemed doctor that it didn't seem right to advise medical personnel to ignore the protocols they had been taught. Heimlich was quick to respond to Brewster's comment.

“He told me that if I wanted to let people die because I didn't want to do his procedure, the only effective procedure, that was my choice,” says Brewster. “Then he said that this is just what the Nazis said at Nuremberg, that they were just following orders. This is a classic example of how Heimlich tries to browbeat people, to basically intimidate people.”

Heimlich's statements seem confrontational, but, after all, this is a man who spent years battling with the medical establishment to get his now-famous maneuver approved-a procedure that is now recognized the world over as the best thing to do to save someone from choking to death.

But after a lifetime of developing treatments that range from notoriously simple-like his famed maneuver-to wildly radical-like combating AIDS by infecting patients with malaria-84-year-old Dr. Heimlich has become a controversial figure. Heimlich sites 50,000 cases where the maneuver he pioneered saved lives-including, according to the doctor's website (www.heimlichinstitute.org), the lives of Cher, Carrie Fisher and both halves of Odd Couple Walter Matthau and Jack Lemmon. But Heimlich wants to do more. It's here that his crusade to have the maneuver replace CPR as the first treatment for near-drowning victims begins.

What makes the Heimlich so appealing as a treatment for near-drowning is the layperson's logic behind it: someone who has water in their lungs can't breath; the Heimlich clears water. But the doctor's reasoning is a matter of much debate.

“Heimlich believes that his maneuver gets water out of the lungs, which is what you need to do before you can effectively start CPR,” says Bob Kraft a spokesman for the Heimlich Institute who said Heimlich's hearing problems make phone interviews too difficult for the doctor. “There are people that disagree, and that's the extent of debate as I see it.”

While Heimlich sites anecdotes that bolster his claim, many in the medical community disagree. Some have gone so far as to say that the maneuver is not just ineffective-it can do serious damage and even result in death.

“The first thing we learn in medicine is ‘do no harm.' This may do harm,” says Dr. Alan Steinman, who was on an American Heart Association/American Red Cross panel in 1986 at which Heimlich presented his theory. “We didn't buy [it] then, and not much has changed in the past 20 years.”

Steinman points to a San Diego Medical Center study from the '90s that says “the available evidence does not support routine use of the Heimlich maneuver in the care of near-drowning victims.” The study goes on to say that it is likely the maneuver would do considerable damage by delaying ventilation.

“We tend to be very gentlemanly in the medical community, but the wording of this study is harsh,” he says. “I would not like to be on the other side of this study.”

Steinman says there are no clinical or epidemiological human or animal studies that show the Heimlich maneuver is effective in the resuscitation of near-drowning victims. The entire premise of the use of the Heimlich on near-drowning victims is false because the lungs and airways are not filled with water in drowning victims, he adds. No drowning or emergency medicine expert the doctor knows recommends the maneuver for the resuscitation of near-drowning victims.

While Heimlich has continued to lobby major medical groups such as the American Heart Association, the doctor also has taken his campaign directly to the people. Heimlich has been a guest on NBC Nightly News, The Today Show and Live With Regis and Kathie Lee. He also enjoys constant free publicity from newspapers across the country. Everyday headlines like “11-year-old saves 4-year-old with Heimlich maneuver” and “Boy honored for saving granddad's life” banner the tops of papers.

Yet Heimlich's crusade seems to be stalling. In 1995, Ellis & Associates-one of the biggest private lifeguard training companies in the world-instituted the use of the Heimlich maneuver as the initial care step for near-drowning victims. But based on an analysis of data collected over a five-year period, Ellis wasn't able to draw a definitive conclusion about the maneuver's efficacy. Ellis' data, coupled with recommendations from the American Heart Association, led the company to reverse its endorsement of the maneuver.

“Because of the debate, the American Heart Association brought up some liability issues,” says the Heimlich Institute's Kraft. “Without saying it did the wrong thing, without backing off, Ellis changed its protocol in favor of CPR. But they never said the Heimlich wasn't effective.”

For Brewster, Heimlich's crusade can't wane fast enough. The San Diego lifeguard chief says he still sees emergency medical personal championing the Heimlich maneuver.

“I was at an EMT refresher course and one of the students asked the instructor what he thought about the Heimlich for drowning, and the instructor said, ‘I don't know, but it makes some sense to me,'” says Brewster. A discussion ensued and Brewster got a little nervous. The last thing he wanted was lifeguards under his watch using the move.

“I stood up and said, ‘This is a problem,'” he says. “The instructor backed down very quickly, realizing the variance of protocol that this involved, but one of the students in the class said, ‘Well, that's fine, but I think the Heimlich is the best thing to do and I'm going to do it regardless of the protocol.'”

What upsets Brewster so much is this breaking of protocol. The reason the protocol is so rigid is because it is backed by science and protects people from liability, he says.

Dr. Steinman agrees.

“The medical community works hard to set an accepted standard of care,” says the doctor. “Dr. Heimlich can say what he wants, but for emergency medical personal to deviate from these standards, that's a problem. It's a problem for their patients, it's a problem for them and it's a problem for emergency medicine.”