Fighting for Air: Drowning and the Heimlich Maneuver

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?

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.

University of Houston professor emeritus John Hunsucker owns the third-largest lifeguard certification agency for water parks in the country.
Todd Spivak
University of Houston professor emeritus John Hunsucker owns the third-largest lifeguard certification agency for water parks in the country.

"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?"

Methods used to revive drowning victims once included burying them up to their necks in horse dung, placing burning coals on their bodies and blowing tobacco smoke into their rectums. They were violently shaken and back-slapped, rolled back and forth over a barrel and hung by their feet and beaten with sticks.

But even as far back as the late 1700s, doctors were also advocating chest compressions and mouth-to-mouth ventilation — the precursors of CPR, which became standard practice in hospitals in the early 1960s and prompted what some consider the largest public health initiative of the modern era.

Then Henry Heimlich invented his anti-choking maneuver and challenged all that.

In the early 1970s, national statistics showed that choking on food had become a leading cause of accidental death, killing nearly 4,000 people a year. Doctors scrambled to respond with patented innovations such as the ChokeSaver, essentially a pair of giant plastic tweezers, and the Throat-E-Vac, a device designed to literally suck foreign objects from the airway.

Heimlich, then a thoracic surgeon at Jewish Hospital in Cincinnati, took a different approach, seeking a way to harness the air in the lungs to expel the object lodged in the throat. He experimented on an anesthetized beagle by inserting a tube into its larynx and pressing on its chest, and eventually discovered that several sharp thrusts under the diaphragm ejected it like a cork from a champagne bottle.

He unveiled his findings in a June 1974 article titled "Pop Goes the Café Coronary" in the journal Emergency Medicine, in which he asked people to share their experiences using the technique. Hundreds wrote letters, including a handful who incidentally claimed it also proved effective at reviving drowning victims.

The scientific community, which for decades had advocated back slaps for choking, was slow to approve the maneuver. So Heimlich, who has never subjected any of his medical theories to peer review, took his invention directly to the public, appearing on television, embarking on speaking tours and even manufacturing posters and T-shirts. He condemned back slaps as "death blows" that may actually force the obstruction deeper into the throat, citing a study he helped fund.

Heimlich's tactics earned him a wide­spread reputation as a sometimes-­ruthless master of self-promotion. His efforts finally paid off in 1985 when then-U.S. Surgeon General C. Everett Koop endorsed the Heimlich maneuver as "the only method" to treat choking victims, leading the American Heart Association and the American Red Cross to change their protocols.

That same year, Heimlich stepped up efforts promoting his maneuver as a first response for drowning victims. He cited two case studies at an American Heart Asso­ciation conference in Dallas, but the panel of drowning experts dismissed the evidence as anecdotal and voted him down.

Heimlich has maintained for years that water fills the lungs and blocks the airway of drowning victims. CPR is useless, he contends, unless his maneuver is performed first since "you can't get air into the lungs until you get the water out" — an argument that "seems to be rather solid," John Hunsucker wrote in his article for Splash.

But medical doctors such as Orlowski disagree, arguing that hardly any water ends up in the lungs of most drowning victims. When water threatens to surge into the lungs, they say, the vocal cords constrict almost immediately, closing off the airway. It's the same involuntary response, known as laryngospasm, as when a drink "goes down the wrong pipe." And, unlike, say, a wad of steak, water does not obstruct the airway but rather gets absorbed by tissue and passes into the bloodstream.

The focus, according to Orlowski and other drowning experts, should be on ventilating victims as fast as possible since most people can survive without oxygen for only four to six minutes without suffering permanent brain damage or death.

They also warn that the Heimlich maneuver will likely cause the victim to vomit, discouraging rescuers from performing mouth-to-mouth resuscitation. And that it may rupture organs, compound spinal injuries or cause the victim to take stomach contents into the lungs — which can also cause severe brain damage or death.

According to doctors who presided over the AHA conference, Heimlich threatened to "go to the media." The doctors cratered, conceding that the maneuver could be used in drowning cases if CPR proved ineffective.

"Heimlich overpowered science all along the way with his slick tactics and intimidation and everyone, including us at the AHA, caved in," Dr. Roger White, a professor of anesthesiology at the Mayo Clinic who chaired a panel discussion at the '85 conference, admitted in a revealing 2004 e-mail to Peter Heimlich (who corresponded with White using a ­pseudonym).

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