"These
so-called medical experts. Screw 'em":
Why does NASCO teach lifeguards to perform abdominal thrusts
on drowning victims?
by Peter
M. Heimlich
SUMMARY:
Drowning experts
and major first aid organizations (including the American
Red Cross and the American
Heart Association) unanimously agree that performing abdominal
thursts ("the Heimlich maneuver") on near-drowning
victims has no proven value and is potentially dangerous. The
treatment delays ventilation and may cause a victim to vomit
and aspirate which may result in serious injury or death. The
use of abdominal thrusts on near-drowning victims has reportedly
been associated with dozens
of such poor outcome cases.
Nevertheless,
lifeguards at "some
of the largest waterparks in the country" are being trained
to perform abdominal thrusts on near-drowning victims by the
National Aquatic Safety Company (NASCO), a Houston-area company.
According to a 2007
Houston Press cover story, here's how NASCO founder/president
John Hunsucker's addressed the issue: "These so-called medical experts.
Screw 'em."
In 2009, drownings occured
at NASCO client waterparks in Denver, El Paso, and Sandusky Ohio.
In at least one case (Denver's Water World), reportedly
abdominal thrusts were applied to the victim.
ADDENDA:
A. The University of Houston's promotion
of Prof. John Hunsucker's unpublished study on drowning &
the Heimlich maneuver.
B. Northern Virginia Regional Parks Authority
(Fairfax Station, VA) presents award to lifeguard for performing
the Heimlich maneuver on a drowning victim.
C. From NASCO's 2008 lifeguard textbook:
(A) black male with
a well-developed body may sink faster and be more difficult to
bring to the surface than someone with a different ethnic background.
D. Contact info for NASCO principals
E. The
Standard of Care in Lifeguarding by Gerald M. Dworkin, Lifesaving
Resources Inc.
7/27/09: Local
Lifeguards Trained In Dangerous Techniques by Bennett
Cunningham, CBS-TV News, Dallas: It has been described as reckless, negligent, unethical
and useless. CBS 11 News has learned that some local lifeguards
may be trained to use the Heimlich Maneuver before using CPR
on an unconscious drowning victim. The result could be fatal,
and has the local medical community very concerned. Cities like
Rowlett and Dallas hired a Houston-based company called NASCO
(National Aquatic Safety Company), which instructs lifeguards
to use the maneuver as a first-response to a drowning victim.
NASCO runs one of the country's largest water safety certification
programs.
10/11/07: Fighting
for Air: Drowning and the Heimlich Maneuver by Todd Spivak (cover
story), Houston Press
Most
doctors say the Heimlich maneuver should not be used to save
drowning victims. So why does UH professor John Hunsucker continue
to teach it to lifeguards?..."Nobody knows more about water
parks than me," (Hunsucker) says. "Eventually I'll
wear them down and everybody will be doing it." In the meantime,
Hunsucker plans to continue thumbing his nose at opponents. "These so-called
medical experts," he says in a gruff, laconic voice through
tobacco-stained teeth. "Screw 'em. What do you want me to
do, walk in lockstep?"
8/24/09: Questions
Continue To Rise About Houston-Based Lifeguard Program
by Mike Giglio, Houston Press
Since
mid-May, there have been three drownings at NASCO-client parks.
In at least one, the Heimlich was used as the first step in resuscitation. "For somebody to continue to do
this and to teach it is foolish and borders on the insane,"
(says) Dr. James Orlowski, the chief of pediatrics at University
Community Hospital in Tampa, Fla. and an expert on drowning.
"You've got the International Liaison Committee on Resuscitation,
the American Heart Association, the American Red Cross and the
Institute of Medicine all coming out to say the Heimlich has
no role in resuscitating drowning victims."
9/11/09: July
drowning at Water World stirs controversy over Heimlich by
Steve Haigh, INDenver Times
Coroner Jim Hibbard’s
report says Valov’s accidental death was caused by “asphyxia
due to drowning,” and nothing in the toxicology results
sheds light on what might have happened in the pool. Another
aspect that’s troubling is the use of a rescue technique
that has been called at best inappropriate and at worst dangerous
by authorities on drowning and resuscitation. Before starting cardiopulmonary
resuscitation on Valov, a Water World lifeguard performed the
Heimlich maneuver.
8/11/09: Doubts
Raised About Kalahari Lifeguard Trainers by Shawn Foucher, Sandusky
Register: When
3-year-old Hassan Itani died a week ago at Kalahari Resort --
drowning in a shallow, outdoor children's pool while surrounded
by dozens of other children -- there were plenty of questions
to field...While it may have been an unavoidable tragedy, there
are other aspects of Kalahari's operations that raise questions.
And they're questions that have been asked by newspapers and
television stations in Texas. Texas media outlets focused not
on Kalahari but on a company that's central to Kalahari's lifeguard
training and safety: the National Aquatic Safety Co., or NASCO.
8/14/09: Some
resort Ocean City (New Jersey) lifeguards use Heimlich while
others shun it by Christine Cullen, Ocean City (NJ) Today
(The)
approximately 60 lifeguards who work each summer at the Splash
Mountain water park at Jolly Roger on 30th Street follow the
training program of the National Aquatic Safety Company run by
(John) Hunsucker. They are taught to use abdominal thrusts first, then CPR. "If we encounter an unconscious,
nonbreathing person in the water, first we move them toward the
deck and do five abdominal thrusts while moving them. Once they're
on the deck, we start CPR," Splash Mountain Operations Manager
Rick Korecky said. Korecky said the technique is useful as the
first procedure in pools because it takes time to move a victim
to the deck where CPR can be performed, so there is time to use
the Heimlich while the person is being moved. "We use it
in an attempt to clear any water that's in the airway. It's useful
as a preliminary form of first aid, providing some care while
we're moving the person," he said.
1/23/09: Swimming
in Controversy - The Heimlich Maneuvers by Laurel Chesky, Austin Chronicle
Dr.
John Hunsucker isn't a medical doctor – he's a professor
emeritus of engineering and math at the University of Houston,
where he's taught for three decades. Nevertheless, he's made
saving lives his business. He won't even talk to reporters anymore
unless they can offer proof of their own death-defying capabilities.
"I'll talk to you if you can tell me how it's going to save
a life," he repeated to this reporter no less than half
a dozen times when he was in Austin earlier this month. Hunsucker's
company, National Aquatic Safety Co., held its annual international
conference and training school at the University of Texas Jan.
7-10. NASCO, which Hunsucker runs out of his home in Dickinson,
is a risk-management company that consults with water parks on
matters of safety and runs the third-largest lifeguard-certification
program for water parks in the US. Hunsucker does have a specific
reason to dislike reporters. Last October, a Houston Press cover
story by Todd Spivak recounted a bitter controversy in lifeguarding
circles, with Hunsucker treading water in the center of it. NASCO's
lifeguard-training program teaches the use of the Heimlich maneuver
– or abdominal thrusts – on drowning victims. The logic
is that the thrusts force water out of the lungs, clearing the
way for air. Sounds reasonable, but a host of experts condemn
the technique, arguing that, among other things, abdominal thrusts
increase the risk of vomiting leading to aspiration of that vomit.
Administering CPR immediately, they insist, remains the best
way to save a life.
Lifeguards also have a legal
responsibility to act in the proper and prescribed manner. If
a lifeguard chooses not to act or acts in a way that could be
harmful to another person then there is the possibility of legal
action being taken against the guard - NASCO's Lifeguard
Textbook (2008 edition, p.4)
As widely reported, the use of the Heimlich maneuver (a/k/a
abdominal or subdiaphragmatic thrusts) to treat near-drowning
has been universally discredited as useless and potentially deadly
by the American Red Cross (source),
the American Heart Association (source),
the National Academy of Sciences (source),
an international association of lifeguards (source),
and every other legitimate drowning and water safety expert.
Also
widely reported, its use has been associated
with dozens of serious injuries including the deaths of kids.
Here's the conclusion from
the American Red Cross's 2006 position paper, Sub
diaphragmatic Thrusts and Drowning Victims:
Subdiaphragmatic abdominal
thrusts are neither effective nor safe methods for attempting
water removal from the airway or lungs of drowned people. No
scientific literature supports the idea that aspirated water
obstructs these patient’s airways thus hindering ventilations.
Since no scientific study has shown water can be removed from
drowned people’s airways or lungs through subdiaphragmatic
abdominal thrusts the 2005 COSTR Guidelines remain the CPR treatment
standard for drowned people...(Experts) contended performing
subdiaphragmatic abdominal thrusts prolonged establishment of
an airway, delayed ventilations of a patient’s lungs, might
induce regurgitation, and could lead to aspiration of stomach
contents. The only exceptions to these treatment priorities were
the articles written by Dr. (Henry) Heimlich.
The conclusions in my father's
articles were based entirely on anecdotal case reports in which
drowning victims were allegedly revived by the use of the Heimlich
maneuver. As has been widely reported, those cases have been
proven to be dubious at best. One case which he repeatedly published
in peer-reviewed journals, the so-called "Dallas
ambulance case," has been proven to be fraudulent.
Nevertheless, a Houston-area
company called NASCO (website)
has been training lifeguards to perform the treatment on drowning
victims. According
to NASCO,
"the number of facilities
reached with NASCO programs and services exceeds 150 different
facilities including some of the largest waterparks in the country."
From the blog
of Paul Gilbert, Executive Director of the Northern Virginia
Regional Park Authority (NVRPA), June 3, 2008. (Click
here for related 2007 Alexandria news report):
NASCO also provides the life
guard training, and regular auditing of our water safety staff.
This company was set up to offer the higher level of safety training
that is needed for busy water parks. Their client list is a who's
who of major water parks across the nation.
NASCO's current training manual includes detailed instructions on performing "abdominal
thrusts" (the Heimlich maneuver) on drowning victims. From
p.65, here's an example:
Abdominal
Thrusts In Deep and Shallow Water
OBJECTIVE:
To begin the resuscitation process as quickly as possible and
to remove water or any other obstruction that is preventing air
from getting to the lungs, while moving the victim as rapidly
as possible to the extrication point.
FUNDAMENTAL PRINCIPLES: Get the victim's nose up and exert inward
and upward pressure on the diaphragm. This will increase the
pressure in the chest and lower abdomen with the intent of expelling
the matter that is preventing breathing. Keep the victim's head
out of the water with the face vertical or leaning slightly forward.
Move the victim quickly to the extrication point while doing
no more then five abdominal thrusts. This is done to begin the
resuscitation process and to expel the water prior to performing
rescue breaths.
From Fighting
for Air: Drowning and the Heimlich Maneuver, the Houston
Press's October 2007 cover story by Todd Spivak:
John Hunsucker,
a plainspoken, pipe-smoking 66-year-old, believes firmly nonetheless
that the Heimlich maneuver will one day gain mainstream acceptance
for drowning victims. "Nobody knows more about water parks
than me," he says. "Eventually I'll wear them down
and everybody will be doing it." In the meantime, Hunsucker
plans to continue thumbing his nose at opponents. "These
so-called medical experts," he says in a gruff, laconic
voice through tobacco-stained teeth. "Screw 'em. What do
you want me to do, walk in lockstep?"
And NASCO
proudly takes credit for this achievement:
1993 - Introduction of the
abdominal maneuver into aquatic rescue.
A University
of Houston associate professor of industrial engineering,
Hunsucker
has no medical training and NASCO apparently has no medical professionals
on its corporate board. NASCO's lifeguard
training manual
("Written By The Staff Of The National Aquatics Safety Company,
LLC") includes no indication that it was reviewed by any
medical professionals. To my knowledge, NASCO is not obligated
to adhere to first aid standards established by other organizations.
Meanwhile,
what do Hunsucker's colleagues in the field of water safety think
about the issue? Here's what the president of the world's largest
association representing the interests of lifeguards had to say:
My greatest
concern, however, is that while Hunsucker's article addresses
the ineffectiveness of resuscitation, he and his company, National
Aquatic Safety Co. (NASCO), continue to advocate use of the Heimlich
maneuver for drowning. In this, they appear to stand alone because
it has long been rejected by international consensus of the national
resuscitation councils of the world. In one article on the matter,
while he acknowledged that his Ph.D. is in engineering he medically
deconstructed arguments on the maneuver and ultimately endorsed
it quipping, "I'm a hugger and don't kiss unless I have
to." Hunsucker appropriately worries over the psychological
impact on guards who unsuccessfully attempt resuscitation, but
what if that failure is the result of following his and his company's
improper guidelines? - B.
Chris Brewster,
President, International Life Saving Federation in Aquatics
International, July/August 2007
ADDENDA
A. The University of Houston's
promotion of Prof. John Hunsucker's unpublished study on drowning
& the Heimlich maneuver
From Fighting
for Air: Drowning and the Heimlich Maneuver by Todd Spivak,
Houston Press (cover story), October 9, 2007
"As a result of Hunsucker's
work, the Heimlich Maneuver has been widely endorsed by the medical
community, as well as by many lifeguard training organizations,
for use first in cases of drowning," according to an April
1996 University of Houston news release. Heimlich was quoted
in the release, saying, "Dr. Hunsucker's definitive study
establishes the Heimlich Maneuver as the primary treatment for
drowning." The release, written on UH letterhead, grossly
overstated the impact of Hunsucker's work, which was largely
dismissed by the medical community as more worthless anecdotal
information. Some even alleged NASCO and (Jeff Ellis & Associates)
had turned water parks into giant laboratories. "It's human
experimentation if they're collecting data from it," says
Baratz, president of the National Council Against Health Fraud.
"If you don't tell people that this is not proven and, in
fact, there is evidence to show it's wrong, then you are not
being honest with them." When asked about the news release,
UH Director of Communications Eric Gerber wrote the Houston Press
in an e-mail: "The University of Houston does not provide
oversight or specific scientific review on any researcher's project."
...Today Hunsucker insists
there is no controversy, calling it a dead issue. "Everybody
in the industry knows we do this," he says. Still, he becomes
prickly when asked about his critics. "I'm not an MD; congratulations;
so what?" he says. "I'm a PhD; I am trained in logical
thought. I'm not stupid; I'm not hidebound; I can change. Come
up with a logical argument." He adds: "All the agencies
that say, 'Don't do it,' have never asked me for our data."
When the Press requested to see any and all unpublished data,
Hunsucker said there was none.
From Heimlich
Controversy by Douglas Page, Ocean Navigator, Sept/Oct
1997, Ocean Navigator
The Heimlich was embraced
in the spring of 1996 by the University of Houston, whose research
concluded that two to four Heimlich Maneuvers clear the lungs
of water the most important step in resuscitation while other
techniques may either force water deeper into the lungs or do
not allow the water to be expunged quickly enough...The Houston
study was commissioned by Jeff Ellis and Associates, an organization
of international aquatic safety consultants, which announced
in 1995 that all of its lifeguard instructors would be trained
to use the Heimlich maneuver, not CPR, as the initial treatment
for non-breathing drowning victims. Ellis is the second largest
trainer of lifeguards in the world. In 1995, National Pool and
Waterpark personnel trained by Ellis' organization performed
lifeguarding services for 43 million people.
From Off
the Deep End - Dr. Heimlich’s Dangerous Maneuvers
by Curt Guyette, Detroit Metro Times (cover story), December
8, 2004
Hunsucker was an interesting
choice to compile and analyze the data. Identified by Ellis as
his “mentor,” Hunsucker was not a medical doctor, but
rather a mathematician who taught industrial engineering at the
University of Houston. Moreover, he, too, has a company that
trains lifeguards. Hunsucker’s company also adopted using
the Heimlich method as the first response. Apparently, the comprehensive
report promised by Ellis never appeared - at least never in any
peer-reviewed scientific literature. Neither Ellis & Associates
nor Hunsucker would provide the data to Metro Times....(Ellis
& Associates) abruptly changed course in 2000, returning
to its previous practice of having its lifeguards provide CPR
first instead of abdominal thrusts. Asked why, Carroll replies,
“We don’t feel that straying away from the scientific
community and the processes that have been recommended by them
is providing any increased level of care.”
And what about Heimlich’s
claim, posted on his institute’s Web site, citing statistics
collected from 1995 to 2000 - apparently from Ellis - claiming
that “152 unconscious, non-breathing drowning victims were
resuscitated using the Heimlich Maneuver,” with a mortality
rate of only about 3 percent? Carroll couldn’t confirm the
exact numbers, but says the company has come to the conclusion
that it’s not necessarily the Heimlich maneuver that contributes
to the extraordinary success rate. “We don’t think
the data can say the Heimlich maneuver is unequivocally the reason,”
Carroll says. “We could never draw that conclusion.”
More likely, he says, is the speed with which an Ellis lifeguard
is usually able to get to a victim - often within 30 seconds.