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?

After the AHA conference, Dr. Jerome Modell planned to conduct an experiment on animals to decide once and for all if the Heimlich maneuver worked on drowning victims. But Henry Heimlich incited protests from animal-rights activists — which is ironic given that he had conducted experiments on dogs just a decade earlier — according to Modell, a professor emeritus at the University of Florida's Department of Anesthesiology, who scrapped the project after receiving multiple death threats.

Modell says he hired a sheriff's deputy to stay at his family's farm 24 hours a day for a week as protection. "They threatened to cut the tails out of our horses and kill them," he says (while acknowledging this was a somewhat strange position for ­animal-rights activists to take).

Henry Heimlich wrote to officials at Modell's university, complaining of medical improprieties — a tactic he employed several times against his critics.

A lifeguard keeps a lookout one September afternoon at Schlitterbahn Galveston Island.
Todd Spivak
A lifeguard keeps a lookout one September afternoon at Schlitterbahn Galveston Island.
Hunsucker and Heimlich pose together in an undated photograph likely taken about ten years ago.
Courtesy Peter Heimlich
Hunsucker and Heimlich pose together in an undated photograph likely taken about ten years ago.

In 1987, Orlowski published a case study in the Journal of the American Medical Association of a ten-year-old boy who was retrieved from an indoor pool but vomited after the Heimlich maneuver was performed, interfering with the lifeguard's ability to provide mouth-to-mouth ­ventilation.

He wrote that CPR would have given the boy a 90 percent chance of recovery. Instead, the boy fell into a coma and died seven years later.

Orlowski dismisses Heimlich's arguments as "worthless anecdotal evidence," though he admits his own report in JAMA was also "based on loose science." He condemns Heimlich for obstructing controlled laboratory experiments that could resolve the issue: "Dr. Heimlich has played politics and never really studied any of this scientifically."

In 1994, Heimlich presented his case to the National Academy of Sciences' Institute of Medicine, but was again shot down. The next year, drowning expert Peter Rosen, who chaired a committee at the conference, wrote a special report in the Journal of Emergency Medicine strongly opposing the maneuver for drowning ­victims.

"...The available evidence does not support routine use of the Heimlich maneuver in the care of near-drowning victims," concluded Rosen, a former professor at University of California at San Diego's Department of Surgery.

Heimlich was undeterred, increasing his public appearances and even urging lifeguards to ignore American Red Cross and American Heart Association protocols as a matter of conscience.

And he wrote to officials at Rosen's university, once again complaining of medical improprieties.

"Superstitious beliefs without scientific evidence can lead you to do some very strange things, and I think that unfortunately Dr. Heimlich is guilty of the same kind of reasoning," says Rosen, who has authored two dozen books on emergency medicine. "Anytime he sees somebody who survives near-drowning who has had a Heimlich performed on him, he says the Heimlich caused the success. But chances are, if you had dipped that patient in feces, he would have survived."

Coincidentally, John Hunsucker founded NASCO in 1974 — the same year Henry Heimlich pioneered the maneuver that made him famous. But it took another two decades before they crossed paths.

Raised in Port Neches, Hunsucker's family roots in East Texas date back to the 1830s. He became a certified lifeguard as a teenager, beginning a decades-long devotion to the American Red Cross, to which he claims he contributed 25,000 volunteer hours over 30 years as lifeguard, aquatic instructor, committee member and chairman at various local chapters, including in Houston and Galveston.

By the 1970s, Hunsucker had become dissatisfied with the American Red Cross, which was then embroiled in several financial scandals. "They lost sight of their mission," he says, calling it an increasingly vast bureaucracy.

So he struck out on his own. But Hunsucker's company didn't take off until water parks such as Six Flags and Water World first opened in the early 1980s.

NASCO, he says, helped fill a void by establishing lifeguard techniques designed specifically for water parks at a time when the new combination of attractions and moving water were causing a spike in drownings and litigation.

At that time, the Houston area spawned what are now the two largest private companies in the country devoted to lifeguard safety for water parks: Dickinson-based NASCO and Kingwood-based Jeff Ellis & Associates, or E&A, an industry giant which today trains 55,000 lifeguards a year for more than 150 water parks and nearly 1,000 flat-water pools.

Hunsucker and Ellis are friendly rivals with a long history. Hunsucker trained Ellis at the American Red Cross's national aquatic school in the late '60s. Ellis, a former head of the water safety program at the organization's Houston chapter, refers to Hunsucker as his mentor.

NASCO and E&A have earned praise for developing new innovations in water safety. But they have also been condemned as profit-driven and controversial — critics say they are overly zealous in their attempts to distinguish themselves from the American Red Cross by adopting untested protocols and marketing them as cutting-edge.

In 1995, just months after the Institute of Medicine signaled its opposition, both companies began teaching the Heimlich maneuver as a first response for drowning victims. The decision was considered a coup for Henry Heimlich.

"Instead of facing up to his critics, Heimlich went directly to the lifeguard companies," Orlowski says. "He has always sidestepped conventional medicine."

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