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?

Heimlich reportedly lobbied Ellis, who tapped Hunsucker to independently investigate whether it made sense to perform the maneuver before CPR. Hunsucker traveled to Cincinnati several times to visit with Heimlich, who was then in his seventies.

Hunsucker insists he received no compensation from Heimlich. "Everybody would like to say John Hunsucker was paid by Henry Heimlich to take this position," he says. "That's bullshit."

Hunsucker also says he was not blinded by Heimlich's celebrity. "My job is to stop people from drowning," he says. "It wasn't one of these things where the persona persuaded me."

NASCO-trained lifeguards Jordan Crowder and Kaeley Scarborough demonstrate how the Heimlich maneuver can be performed in the water before CPR.
Photos by Daniel Kramer
NASCO-trained lifeguards Jordan Crowder and Kaeley Scarborough demonstrate how the Heimlich maneuver can be performed in the water before CPR.

In fact, Hunsucker describes the iconic doctor in largely unflattering terms. "Dr. Heimlich has a personality that is very, very difficult to get along with," he says. "If you don't agree with him, you're stupid. There's no compromise in him at all."

Hunsucker adds that the anecdotal evidence Heimlich used to promote his maneuver for drowning victims was unconvincing. "Nobody believed Dr. Heimlich's data," he says. "I didn't believe it. It was so biased and prejudicial."

But, he says, the arguments against the Heimlich maneuver for drowning made even less sense.

For instance, Hunsucker says, anecdotal evidence showed that the Heimlich maneuver expelled about a cup of water from most drowning victims. So while it's true that water is eventually absorbed into the bloodstream, the immediate removal of even a small amount of water seemed beneficial.

Hunsucker also rejected the argument that the Heimlich maneuver may cause internal injuries since the primary goal is simply to keep the victim alive. And he dismissed the claim that the maneuver may cause a drowning victim to vomit, making it harder for a rescue worker to perform CPR. "Either way they're going to vomit," he says, "so what's the difference?"

The sole argument against the maneuver that Hunsucker considered valid was that it delayed ventilation. So he conducted a study of 167 lifeguards across Texas and found that it takes a mere four to six seconds to perform five Heimlich maneuvers on a drowning victim. It's a worthwhile gamble, he says, especially since the Heimlich maneuver, unlike CPR, can more readily be performed while the victim is still in the water.

In many cases, drowning victims begin breathing on their own after a few Heimlich maneuvers and do not need CPR. This is extremely significant, Hunsucker says, since even rescue workers who are trained in CPR often refuse to perform the ­technique.

"Imagine the worst victim who ever came to your pool," he wrote in the Splash essay. "Give this victim whatever characteristics you find extremely unattractive. Make the person big. Now cover him with vomit and ask yourself, would you rather kiss him or hug him?"

He answers his own question at the end of the article, writing, "I'm a hugger and don't kiss unless I have to."

NASCO and E&A kept statistics based on actual rescues at their clients' water parks, which indicated a high success rate when the Heimlich maneuver was employed as a first response. During the 1995 summer season, E&A found that 21 of 26 nonbreathers were revived by the Heimlich maneuver alone. During the next five years, the company claimed the Heimlich maneuver saved 147 out of 152 unconscious drowning victims.

"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 E&A 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."

In 2000, freelance reporter Pamela Mills-Senn exposed the scientific evidence against the Heimlich maneuver for drowning in a special edition of the trade magazine Fun World, published by the International Association of Amusement Parks and Attractions. Mills-Senn cited several doctors who said that Henry Heimlich had intentionally distorted their studies to support his claims.

E&A abruptly stopped using the Heimlich maneuver just weeks after the article ran. "We stopped because the medical community doesn't recommend it," says Louise Priest, a spokeswoman for E&A.

Peter Wernicke, medical advisor to the United States Lifesaving Association, sent letters in 2004 to Heimlich requesting medical records regarding several allegedly dubious case studies. "...We have an ethical obligation to investigate and correct the record, if necessary," Wernicke wrote. But Heimlich declined to produce any additional documentation.

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So you can't experiment on animals because that is cruel, and you can't collect data from people because that is cruel, so it's best to stick your head in the sand and never experiment so that the Heimlich maneouvre can continue to be discredited as "it has never been proven". Hmm, how scientific - to discredit something without proof! For someone who has witnessed a person drown, I can tell you that blowing air into this poor man's mouth makes it all go into the stomach. First, bubbles came out of his mouth, then it started pouring out in a steady stream, then vomit came spurting out. His belly became bigger and bigger, and when the stomach could expand no more, its contents are forced to come back up with the air. He turned paler and paler and never regained consciousness. In retrospect, I can say for certain that his vocal cords were NOT constricted. If so, the rescue breath would not have gone past his mouth and his stomach would not have bloated up. It was his lungs that were full of water, and that's why none of the air went in there and it all went into the stomach instead. It's just a matter of common sense that you need to get the water out of the lungs first. So simple, and yet. It's a bloody disgrace that doctors with vested interests choose not to do what is best for the victims, for reasons that only they know. They keep insisting that Heimlich is wrong, without trying to PROVE him wrong. Why? Are they afraid to find out that he is right? Is this a battle of egos? Meanwhile, people continue to die - needlessly.

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