When your child is gagging
on a piece of chicken, what should you do? This time line summarizes
what US first aid organizations have recommended over the past
three decades:
US CHOKING RESCUE GUIDELINES FOR
ADULTS AND CHILDREN, 1975-PRESENT
|
Pre-1975: Perform a series of backblows. |
|
1976-1985: Perform a series of backblows. If backblows fail
to remove the obstruction, proceed with the Heimlich maneuver
(aka abdominal thrusts). |
|
1986-2005: Perform only the Heimlich maneuver. (Backblows
eliminated.) |
|
December 2005: It is unclear which method of removal
of FBAO (Foreign Body Airway Obstruction) should be used first.
For conscious victims, case reports showed success in relieving
FBAO with back blows/slaps, abdominal thrusts, and chest thrusts.
Frequently more than one technique was needed to achieve relief
of the obstruction. Life-threatening complications have been
associated with the use of abdominal thrusts. (American
Heart Association) |
|
March 2006: The American Red Cross (ARC) institutes new FBAO
guidelines which they call the "five and five." Rescuers
should first do a series of five backblows; if the backblows
failed to remove the obstruction, rescuers should proceed with
five abdominal thrusts. (The term "Heimlich maneuver"
is no longer officially used.) |
Perhaps the most obvious question
presented by the time line is this: Why were backblows removed
from the guidelines in 1986 - at which time they were considered
the primary treatment response - and then reinstated 20 years
later? Along the same lines, why do some
people believe that backblows are dangerous?
Meanwhile, the December 2005
American
Heart Association (AHA) guidelines (the most recent) raise
more questions than they answer. Should the mother with the choking
child do backblows, abdominal thrusts (aka the Heimlich maneuver),
chest thrusts, or a combination of methods? And what do chest
thrusts - typically associated with CPR - have to do with choking
rescue? (More on that later.)
If that's not confusing enough,
the Red Cross and Heart Association now teach conflicting rescue
methods:
The heart association favors
the no-back-blow argument, saying that it's easier to simply
teach one method. But under new rules taught in rescue courses
this summer, the American Red Cross officially says yes to the
back blow debate. The group says a rescuer should first use back
blows, and then move to the Heimlich maneuver to help a choking
person. (source)
Given such a relatively simple
medical issue, what accounts for so much muddle?
The answer may be found in
the intriguing 30-year history of duplicity by my father and
subsequent bureaucratic capitulation by the medical profession.
It also sheds light on why the Heimlich maneuver became universally
known, thereby earning my father the reputation of "America's
most famous doctor" (The New Republic, April 23,
2007).
Perhaps that sobriquet should
be modified to "America's most infamous doctor"
given that facts prove my father, in collusion with other medical
professionals, successfully defrauded the AHA, the American Red
Cross, the National Academy of Sciences, and other organizations
in order to promote the Heimlich maneuver over all other methods
and to eliminate backblows from national first aid guidelines.
In addition to attacking the
first aid organizations in a media campaign my father called
"backblows
are death blows," he engaged in a variety of dirty tricks
such as using
his secretary to send threat letters under an alias and clandestinely
funding a Yale research study which allegedly proved backblows
were dangerous.
Astoundingly, the country's
leading medical organizations and most prominent physicians were
terrified of my father and gave him everything he wanted. From
Outmaneuvered by
Thomas Francis, Radar Magazine, November 2005:
(In) the late '70s and early
'80s he attracted widespread coverage of the Heimlich maneuver,
while accusing the Red Cross of risking lives by refusing to
recommend it over the application of back blows, which was then
the standard intervention for choking victims. His point was
neatly driven home by slogans such as "back blows are death
blows."
"He was able to tailor
his message to what reporters wanted to hear," says Peter
(Heimlich). "The image of the underdog, the maverick, the
David vs. Goliath of medical bureaucracy, was a compelling story."
At the same time Heimlich
was gearing up for a showdown at the 1985 American Heart Association
conference, at which a panel of experts in each safety field
would decide whether new evidence warranted new recommendations
for approved actions in emergencies. The chairman of that conference,
Dr. Bill Montgomery, knew that Heimlich was prepared to do battle
with the committee on the topic of choking.
"It was this huge publicity
campaign. He was something to be reckoned with," Montgomery
recalls. "He threatened to sue us all and write to the presidents
of our universities. It was brazen, terrible, unusual."
Different studies reached
different conclusions about the most effective method for choking
intervention: the Heimlich maneuver, back blows, or chest thrusts,
which consist of pushing down on the victim's sternum, as with
CPR. There was a dearth of data. As one panel member, Dr. James
Atkins, summarizes the situation, the committee could "adopt
something that has no evidence, something that has very poor
evidence, or something that has mediocre evidence."
Heimlich's evidence might
have been even less persuasive, however, had he informed the
panelists that his own foundation had financed the one study
demonstrating the superiority of the Heimlich maneuver. In fact,
they didn't learn this until 20 years later when I told them.
When informed of these facts,
Roger White MD of the Mayo Clinic, who chaired the 1985 AHA committee
that recommended removing backblows from the guidelines, wrote:
There was never any evidence
here. Heimlich overpowered science all along the way with his
slick tactics and intimidation, and everyone, including us at
the AHA caved in. (Source)
A few months after the AHA
conference, US Surgeon General C. Everett Koop stepped in with
a widely-reported public statement endorsing the Heimlich maneuver
and condemning all other treatments as "hazardous, even
lethal." A short time later, backblows were removed from
US first aid guidelines.
What neither Dr. Koop nor
my father revealed was that they are longtime friends. Facts
indicate Dr. Koop used the office of the Surgeon General to help
manipulate US first aid guidelines, not based on scientific evidence,
but as a buddy favor. (Details
here.)
Then in March 2006 and with
no fanfare, the American Red Cross reinstated backblows as the
first treatment response. This might seem like big news in the
world of first aid since it means retraining the American public
and medical professionals, new posters in restaurants, revising
various statutes, etc. Yet more than two years since the update,
few people are aware of the information, including most medical
and media professionals. Why? One reasonable explanation is that
the Red Cross has sent out only three press releases, all of
which bury the information.
Nevertheless, over the past
two years a few dozen TV and print stories have reported the
news that "backblows are back." In fact, the Red Cross
isn't responsible for generating these stories - I am.
As part of our research, when I see an interesting choking story,
I contact the reporter and ask if they're aware of the Red Cross
update. Out of dozens of such inquiries over two years, only
one reporter was aware of the information. As it happens, she'd
taken a Red Cross class a couple weeks before I contacted her.
CLICK HERE FOR A LIST OF RED CROSS
PRESS RELEASES AND RELATED NEWS ARTICLES.
A good question is, why has
it fallen to me to be doing the job of the Red Cross's media
office? Why is the Red Cross failing to inform the press about
the best way to rescue choking victims so that the media may
then inform the public and, as a result, perhaps save lives?
Here's a straightforward example.
Cincinnati is a market where a major story about a new choking
rescue would be a natural. After all, my father introduced the
maneuver there in 1974 and still lives in the Queen City where
he's
a local celebrity. In the past 30 years, Cincinnati media
has reported hundreds of stories about him and the Heimlich maneuver.
Yet not one daily paper or TV news station there has reported
the Red Cross choking update story. Has Cincinnati's Red Cross
affiliate informed local media? Ask their CEO, Sara
Peller.
Meanwhile, what going on at
the Red Cross's media department? Awards, for one thing. News
items about the Red Cross handing out lifesaving awards and all
sorts of other awards appear almost daily all around the
country. Such stories generate positive PR and donations as well
as providing free advertising for Red Cross first aid training
classes.
Does the failure to inform
the public simply amount to bureaucratic incompetence? From a
January
16, 2008 New York Times report:
Facing a $200 million operating
deficit, the American Red Cross is preparing to cut as much as
one-third of its headquarters staff, up to 1,000 employees, and
pare regional management. The cutbacks will not diminish the
relief operations and other services provided by the organization,
said Suzy C. DeFrancis, the Red Cross’s chief public affairs
officer. “We’ve just come to the conclusion that we’ve
gotten too top heavy,” Ms. DeFrancis said...Since 2002,
the Red Cross has had five leaders, including its last president
and CEO, Mark W. Everson, who was dismissed in November after
only six months on the job because of an affair with a female
subordinate.
A November
29, 2007 Times article described the Everson firing:
A senior executive at the
Red Cross who had been hired by Mr. Everson told board members
about Mr. Everson’s relationship - with a married woman
who is head of a Red Cross chapter on the Gulf Coast. Mr. Everson
met the woman on trips that were part of efforts to restore the
Red Cross’s reputation there. She is pregnant, two Red Cross
executives said.
In contrast to Mr. Everson's
urgent personal interests, perhaps his successor Mary
S. Elcano - who wears the multiple hats of "Acting President
and CEO, General Counsel and Corporate Secretary" - will
be more attentive to the public interest.