Lifesavers Debate First-Aid Methods

The doctor and the lifeguard are each convinced the other is spouting life-threatening nonsense.

At issue is how best to save the life of someone pulled unconscious from the water. For 40 years the preferred protocol has been cardiopulmonary resuscitation, including mouth-to-mouth breathing and chest compressions.

The doctor is Henry J. Heimlich, 80, the Cincinnati thoracic surgeon who developed a much-acclaimed method for saving choking victims. For nearly two decades he has been trying to convince a skeptical medical establishment that the Heimlich maneuver should be used not just for choking victims but also as a first response for people in danger of drowning.

People who oppose him on the drowning issue, Heimlich says, are just as ill-informed as those who refused for years to believe him about the choking issue.

“I lecture all the time about creativity,” Heimlich said. “What I tell people is that if all of your peers understand what you’ve done, you haven’t been very creative.”

The lifeguard is B. Chris Brewster, 44, chief of the San Diego lifeguard service and president of the Americas region of the International Lifesaving Federation.

Brewster is not the only person who thinks Heimlich is dead wrong. But unlike other critics, Brewster is just as outspoken as the doctor in making his case.

“In my view, what Dr. Heimlich is suggesting that lifeguards do is both reckless and unethical,” Brewster said. “He’s encouraging lifeguards to experiment with his unproven method on helpless human subjects.”

In recent years, Heimlich has been making slow but steady progress in bypassing the medical establishment and lifeguard groups and convincing lifeguards at private theme parks to use his method. But this spring he suffered a major reversal--owing, in part, to the dedicated opposition of Brewster.

The stakes are enormous. Despite increased awareness about water safety, drowning continues to be a leading cause of accidental death, particularly for children.

About 4,000 people drown every year in the United States, including some who were underwater only briefly and received vigorous CPR almost immediately. California has the most drowning deaths in the nation.

Heimlich has campaigned tirelessly for the proposition that untold lives could be saved if only his Heimlich maneuver were employed as a first response instead of CPR, which, he says, only wastes precious time.

Heimlich’s contrarian view and his cocksure demeanor have earned him plenty of criticism, from the American Red Cross, the American Heart Assn., medical researchers and others who have studied the physiology of drowning.

That criticism has tended to be polite and understated.

The Heimlich maneuver is “contraindicated” as a first response, says the Red Cross. Heimlich has not submitted his suggestions for peer review, say the researchers.

“If you delay CPR to do a series of Heimlich maneuvers, you might be putting that victim past the time at which the brain can no longer recover from lack of oxygen,” said Dr. Jerome Modell, an anesthesiology professor at the University of Florida medical school and expert on drownings and near-drownings.

The International Lifesaving Federation, meeting in San Diego in 1998, condemned the Heimlich maneuver as a first response in drowning cases because it takes time, could force vomiting and aspiration, and lacks a “clear medical rationale for its use.”

Heimlich is accustomed to opposition. The Red Cross and other organizations for years resisted his Heimlich maneuver as a way to prevent choking.

“When something new comes out, it exposes the dangers and lethal nature of what was being done in the past,” Heimlich said.

Only when then-Surgeon General Dr. C. Everett Koop gave the maneuver a ringing endorsement in 1985 did it gain acceptance from the Red Cross. For decades the Red Cross suggested the “back-slapping” method for dislodging something caught in the throat--despite Heimlich’s insistence that back slaps cause the object to become even more tightly wedged.

More recently, Heimlich has supported the idea that the suffering of AIDS patients can be alleviated by injections of live malaria virus. Heimlich has persisted despite almost universal opposition from major AIDS researchers.

Much the same has been true in his latest cause. A 1995 study by four professors, published in the Journal of Emergency Medicine, opposed the Heimlich maneuver as a first response in drowning cases.

About the same time, Heimlich made an important inroad by bypassing the medical establishment and appealing directly to the theme park industry, where aquatic parks are increasingly popular.

For five years a Houston-based aquatic safety consulting firm that trains lifeguards for parks from coast to coast taught that the Heimlich maneuver should precede CPR.

This despite the views of the Red Cross, the heart association and the lifesaving federation that the maneuver should be used only as a last-ditch effort and only when it is apparent that the victim is suffering a blockage in the throat.

Ellis & Associates licenses about 35,000 lifeguards annually, and Ellis-trained lifeguards work at parks, pools and waterfronts that see more than 50 million visitor-days a year. In Heimlich’s bid for approval of his maneuver, having Ellis on his side was a coup.

This spring, however, the firm abruptly changed course and dropped its endorsement of the Heimlich for drowning cases.

One reason given by Ellis consultant Larry Newell was the refusal of the heart association, at an international meeting held in January, to change its negative recommendation on the Heimlich maneuver.

In addition, by switching back to CPR, Newell said, Ellis will be able to gather comparative data about which method as a first response works better.

“We still don’t know whether it [Heimlich] is better than anything else because we have no data to compare it to,” said Newell.

Another factor in the change by Ellis may have been a story written for FunWorld, a publication of the International Assn. of Amusement Parks and Attractions. Like most trade journals, FunWorld specializes in upbeat feature stories.

The editor who assigned the story to Pamela Mills-Senn, a freelance writer from Signal Hill, envisioned it as a cheery look at how aquatic parks are on the cutting edge of safety by employing Ellis-trained lifeguards who use the Heimlich maneuver.

Instead, Mills-Senn quoted both critics and supporters of Heimlich and found critics to doubt the assertions of Ellis & Associates that parks using the Heimlich maneuver suffer a lower drowning mortality rate than those using CPR.

Mills-Senn also checked with researchers whose work Heimlich has quoted as supporting his thesis that most drowning victims die because water in their lungs blocks mouth-to-mouth resuscitation. Several of the researchers told Mills-Senn that Heimlich is distorting their findings and that they do not support his views.

“As we got deeper and deeper into the story, it suddenly seemed like it [using the Heimlich] was not a very good idea,” said editor Mike Moran. “It turned out out we had a tiger by the tail.”

The FunWorld publisher opted not to run the story but ordered it distributed immediately to the trade group’s 1,500 members, many of whom are Ellis clients.

“We wanted to give the issue a quick and high profile for our members,” said Joel Clift, spokesman for the association.

Moran, who had supported the story even when it took on a more critical tone, resigned to take another job. The Heimlich story, he said, “was a factor but not a deciding factor” in his move.

For Heimlich, the decision by Ellis to disavow its earlier support was a major setback. He responded with a point-by-point critique of the unpublished article, which was given to him by the editor for comment.

Although he has endured a good deal of criticism in his life as a medical maverick, Heimlich is particularly upset at Brewster’s comments in the Mills-Senn story: that Heimlich is being unethical by asking lifeguards to ignore their training and their orders.

“What he is saying is that you should obey the Red Cross just like Germans had to obey Hitler and we shouldn’t follow our own conscience and knowledge,” Heimlich said.

Brewster, who supervises 240 lifeguard service employees, said Heimlich used the same analogy about Nazi Germany five years ago when he and the doctor met in Florida during a meeting of the U.S. Lifesaving Assn. (Brewster is chairman of the national certification committee.)

“Dr. Heimlich is a legend, somebody who’s responsible for saving thousands of lives,” Brewster said. “He’s a real hero. I just wish that was enough for him.”