"(My father's promotion
of the Heimlich) maneuver for drowning (rescue) is a bizarre
30-year scam that had deadly consequences. His only evidence
was a handful of cases in which drowning victims were allegedly
saved by the maneuver. Our research uncovered that the cases
are dubious at best, fraud at worst. When doctors have asked
my father to provide details, he comes up empty," says Peter
Heimlich. Controversial
Maneuver
by Michael Riley, Asbury Park Press, August 14, 2007
My father
Dr. Henry Heimlich's claim that the Heimlich maneuver is effective
on near-drowning victims is entirely based on a string of anecdotal
case reports in which near-drowning victims were allegedly rescued
by bystanders who performed the maneuver. All the cases are problematic.
For example,
his two most important cases are the August 14, 1974 Rehoboth
Beach case and the June 22, 1980 Lima, Ohio case. In attempts
to change national first aid drowning guidelines, these cases
were presented by my father and Dr. Edward A. Patrick to committees
of the American Heart Association (1985) and the Institute of
Medicine (1993), and the cases were widely published, such as
this
September 1981 article by my father in the peer-reviewed
Annals of Emergency Medicine, this
May 11, 1999 New York Times article, and this
September 14, 1999 Baltimore Sun article (by Pulitzer Prize-winning
medical reporter Diana Sugg).
The alleged
rescuers in the two cases were, respectively, Drs. Victor H.
Esch (Potomac MD) and Edward A. Patrick (Union KY). As it happens,
both men had longstanding close relationships with my father
prior to the alleged rescues. Esch has stated to a reporter that
he was friends with my father since the late 1940s; Dr.
Patrick has been involved has been involved in every aspect of
the Heimlich maneuver since the early 1970s and even claims to
be the maneuver's uncredited co-developer. There's no evidence
any of the three men divulged their pre-existing relationships
at any time.
What are
the chances that two of my father's closest friends "happened"
to be the rescuers in the two primary cases which allegedly prove
that the maneuver should be used to rescue drowning victims?
Similar problems exist with all his case reports and none stand
up to even minimal scrutiny. When asked to provide full disclosure
by other doctors and reporters - that is, to provide bona fide
medical records - my father, Dr. Patrick, and Dr. Esch have failed
to comply.
To date, one alleged Heimlich
drowning rescue has been unequivocally proven as fraud
- the so-called Dallas Ambulance case. (My father and Patrick
published the case in two peer-reviewed journals - details below.)
Based on my original research, problems with the Dallas case
were reported
in this section of medical reporter Kevin Lamb's September
2006 ten-part Dayton Daily News series, Is
the Heimlich Maneuver Safe for Drowning Victims?; the
fraud was explicated in the award-winning
Detroit Metro Times cover story, Off
the Deep End by Curt Guyette, December 8, 2004:
(The) Metro Times has verified
that in 1981, a fraudulent letter was sent to a magazine for
emergency medical technicians falsely claiming that the Heimlich
maneuver was used to save a two-year-old drowning victim in the
small central Pennsylvania town of Dallas near Wilkes-Barre.
What we found is as nefarious as it is bizarre.
In July 1981, Heimlich wrote
an article promoting the use of his maneuver for use in near-drownings
for the magazine Emergency Medical Services. (Heimlich also served
on the magazine’s board of directors.) The next issue of
the magazine contained the following letter:
“Your article concerning
the ‘Heimlich maneuver: First Treatment for Drowning Victims,’
was the topic of discussion at our August crew meeting and the
next day was used on a two-year-old drowning victim. The child
had been submerged in a swimming pool for 10 minutes. Upon removal
from the water, he had no vital signs and his pupils were dilated
and fixed. The Heimlich maneuver was used immediately and approximately
two cups of water were expelled from his airway. CPR was initiated
and continued for 10 to 15 minutes before the child was resuscitated.
He has since fully recovered with no ill-effects. We would like
to compliment you on your excellent presentation as well as the
quality material presented in your magazine.
Dallas Ambulance Squad
Dallas, PA
Seven years later, in August
1998, Heimlich used the letter to help substantiate claims of
the maneuver’s effectiveness in an article he wrote for
the publication Postgraduate Medicine, and later referenced it
as supporting material in a report he provided to the Institute
of Medicine when it was conducting a comprehensive study to evaluate
the merit of the maneuver in drowning cases.
An August 1981 story in the
Dallas Post indeed describes the near drowning of a 2-year-old
boy in his family’s pool. The article makes no mention of
the Heimlich maneuver being used, but does name the emergency
medical technician, Robert Besecker, who saved the boy. It turns
out he was the child’s uncle. In a phone interview, he confirmed
the newspaper account of the event, and was adamant that the
Heimlich maneuver had not been used. “I didn’t even
know then that the Heimlich maneuver could be used in a drowning
case,” he said.
Asked if it was possible that
another 2-year-old had also nearly drowned that same month, he
said he was certain that could not be the case. Dallas is a very
small town, he explained, and he certainly would have been aware
of another such incident. Drownings are extremely rare, he said,
with the ambulance company responding to them only once every
five years or so.
Obviously, someone cared enough
about advancing the cause of the Heimlich maneuver to lie to
emergency personnel. The only question now is, who?
When asked by doctors or reporters to
provide details
about the Dallas case and his other cases, my father is silent.
In other words, "America's
most famous doctor" - as my father was praised by Jason
Zengerle in an April 23, 2007 article in The New Republic
- faked drowning cases to promote a bogus treatment that, when
put into practice by lifeguards and bystanders, has been associated
with numerous deaths, including many children.
Read on for detailed information
about the Dallas fraud and links to supporting documentation.
###
The July/August 1981 issue
of Emergency Medical Services (EMS) contained an article by Dr.
Henry J. Heimlich entitled, Heimlich
Maneuver: First Treatment for Drowning Victims. (In this
article, Heimlich cites the Patrick and Esch cases, among others.
Note that EMS is entirely unrelated to "Emergency"
magazine, although it, too, is not peer-reviewed.)
The November/December 1981
issue of EMS contained a letter
to the editor in response to Heimlich's article and described
a successful near-drowning rescue using the Heimlich maneuver:
Your article concerning the
"Heimlich Maneuver: First Response for Drowning Victims,"
July/August 1981, was the topic of discussion at our August crew
meeting and the next day was used on a two-year-old drowning
victim. The child had been submerged in a swimming pool for 10
minutes. Upon removal from the water, he had no vital signs and
his pupils were dilated and fixed. The Heimlich maneuver was
used immediately and approximately two cups of water were expelled
from his airway. CPR was initiated and continued for 10 to 15
minutes before the child was resuscitated. He has since fully
recovered with no ill effects. We would like to compliment you
on your excellent presentation as well as the quality of the
material presented in your magazine.
The letter was signed "Dallas
Ambulance Squad, Dallas PA."
Seven years later, Heimlich
& Patrick published a brief description of the case in a
1988 article in Postgraduate
Medicine (which is listed as a reference in the IOM committee
report). From that article:
At a routine crew meeting
one day in 1981, the Dallas Ambulance Squad discussed the
use of the Heimlich maneuver for near-drowning victims. The next
day, they were called to treat a two-year-old boy who had been
submerged in a swimming pool for ten minutes upon their arrival.
When removed from the water the boy had no vital signs and his
pupils were dilated and fixed. However, with the use of the Heimlich
maneuver, about two cups of water was expelled from his airway.
CPR was done for 10 to 15 minutes before the boy was resuscitated,
and he recovered fully.
The above paragraph leads
to a citation for
the original letter to the editor of EMS. (In much the same form,
a brief description of the case also appears in Heimlich's article,
"Heimlich Maneuver
for Near-Drowning" in "The Physician and Sportsmedicine,"
October 1991. Here, no citation is listed at all.)
When Heimlich & Patrick
describe and cite this case in the 1988 Postgraduate Medicine
and 1991 Physician & Sportsmedicine articles, they refer
to the locale only as "Dallas," which might lead readers
to assume the case happened in Dallas, Texas. The only way
to learn that the town was Dallas, PA, and not Dallas, TX
was to locate the original EMS letter to the editor in the 1981
issue, because letters to the editor of EMS are not indexed.
Adding to the difficulty of locating the original case, the Heimlich
& Patrick articles don't include dates or people's names.
Nevertheless, a persistent
search located the original drowning accident.
Dallas, Pennsylvania, is a small town outside of Wilkes-Barre.
The August 12, 1981 Dallas Post
newspaper of Dallas, Pennsylvania had a two-column front-page
story about the near-drowning of a two-year old boy in a swimming
pool. It is clearly the case in question.
The story includes thorough,
well-written details of the accident, but there is no mention
anywhere of the use of the Heimlich maneuver, no mention of the
boy's dilated pupils, and no mention of two cups of water
being expelled from his airway.
However, the article does
quote the rescuer, Robert Besecker, who was the boy's uncle and
a member of the Dallas Ambulance Company (not "Squad"):
All I did was to do some CPR
on the boy.
The successful use of CPR
in the case is mentioned six times in the article. In fact, the
entire incident as described in the article could be characterized
as a tribute to CPR. As Mr. Besecker says:
It seems like all the more
reason for people to support their local fire companies. I'm
going to suggest it (CPR) to everybody at work.
For over 20 years, Heimlich
has criticized the value of CPR. For example, there is an anti-CPR
article on the Heimlich Institute web site entitled "The
Kiss of Death", the title apparently being wordplay
on "The Kiss of Life."
Did Heimlich and/or Patrick
locate the Dallas near-drowning case in which a child was saved
by CPR, then alter the facts in an attempt to discourage using
CPR in favor of the Heimlich maneuver? If so, it is difficult
to imagine a more cynical and contemptible action by medical
doctors.
A close reading of the Dallas Post article reveals that the
rescue was not even performed by Dallas Ambulance personnel,
but by the Jackson Township Ambulance Company, because
the accident occurred in Jackson Township, not in neighboring
Dallas Township.
Heimlich & Patrick published
their brief anecdotes describing the case in two peer-reviewed
journals. Neither description contains names, dates, or any other
identifying information. Before they wrote and published the
information, whom did they interview? The rescuer, the EMTs,
the doctors, the family? Or no one at all?
And who wrote the EMS
letter from the Dallas Ambulance Squad and how did the letter
get published?
One person who might be able
to answer those questions would be one of EMS
Magazine's editorial advisory board members at that time,
Dr. Henry J. Heimlich.
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