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?

"You can't have good ideas all the time," Hunsucker says. "I'm sure da Vinci painted some pictures ugly as hell."

Some of John Hunsucker's arguments don't exactly hold water.

For instance, he frequently criticizes CPR as having a low success rate by citing a 1996 study published in the Annals of Emergency Medicine that found CPR works just 5 percent of the time. But opponents say that such a statistic is misleading since it encompasses all cases, including cardiac arrests.

"That's scientifically dishonest," says Rosen, the emergency medicine expert, adding that CPR is "very effective" in reviving drowning victims, particularly in controlled environments such as water parks where rescuers tend to get to the victims quickly.

Hunsucker has also warned for years that CPR puts rescuers at risk of contracting serious diseases such as AIDS, hepatitis and tuberculosis.

But no such cases have ever been reported, according to Nikki Kay, a spokeswoman for the Centers for Disease Control and Prevention. "To date, CDC does not have record of any cases in which HIV, hepatitis or TB were transmitted through CPR," she says.

When pressed, Hunsucker says he has no data to support his claim, saying, "It just makes sense."

And that pretty much sums up Hunsucker's positions, which he admits tend to rely more on practical experience and logical thought than on scientific theory and research.

According to the CDC, some 4,000 Amer­icans — including about 300 in Texas — die each year from drowning, which remains the second-leading cause of unintentional injury-related death for children under 14.

And, as Hunsucker rightly emphasizes, children are often the ones charged with rescuing them.

Teenagers comprise the vast majority of lifeguards, especially at water parks and swimming pools. But the crushing realities of the job — low wages, mind-­numbing boredom, fears of skin cancer and time-intensive certification requirements — have made lifeguard positions tough to fill. Virtually every summer season, newspapers across the country warn of a potential public-safety crisis due to a lifeguard shortage.

In response to the shortage, the American Red Cross in 1999 started a program to get 11-to-14-year-olds interested in becoming lifeguards. Today the United States is one of only a handful of countries that set the minimum age requirement for lifeguards at just 15 — a point of controversy for many in the aquatics safety industry, including Hunsucker, who says 16 should be the cut-off.

Recent neurological studies show that 15-year-olds may lack the cognitive development critical to working as lifeguards since the region of the brain responsible for judgment and decision-making is not fully developed, according to an essay titled "A Matter of Maturity," published last September in Aquatics International.

"How do we motivate the little brats to do the job?" Hunsucker wrote a decade earlier in Splash. Put another way, he asks, "What can we get a 16-year-old to do?"

Hunsucker also rightly points out that the medical establishment is not always correct.

For instance, late last year the American Red Cross once again revised its protocols for choking. Based on a 2005 report published in the American Heart Association journal Circulation, the organization wound the clock back 20 years by promoting back slaps as a first response for choking victims rather than the Heimlich ­maneuver.

Emergency medicine experts admit it remains unknown which method should be performed first, saying that back slaps, chest thrusts and Heimlich maneuvers should be applied in rapid sequence until the obstruction is relieved.

"It's a change that suggests that assisting a choking victim is a sort of frantic, try-anything proposition," Mills-Senn, the freelance reporter, wrote in an April 2007 essay published in Cincinnati Magazine.

And the same may be true for reviving drowning victims.

In Hunsucker's experience, the Heimlich maneuver works. It's a simple, non­invasive technique, unlike CPR, which relies on ratios that "are impossible to keep straight." Especially, he says, if you're a teenager suddenly thrust into the harrowing situation of having to perform mouth-to-mouth ventilation on what appears to be a dead body that is rapidly turning blue and covered in vomit.

"None of the training prepares you for it," he says.

Hunsucker does not hide his views. His company's 100-page lifeguard textbook, posted for free online, devotes an entire chapter to using the Heimlich maneuver as a first response for drowning victims.

He insists his decision is based on principle, not ego — and certainly not any allegiance to Henry Heimlich.

"Other companies are afraid of being sued," he says. "I'm afraid a child will be hurt because I didn't do the right thing."

todd.spivak@houstonpress.com

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