Fighting for Air: Drowning and the Heimlich Maneuver

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The first time John Hunsucker performed CPR was on some poor schmuck who dropped dead in his driveway.

The young college professor was driving home from work late one evening back in the early 1970s when he spotted a ­middle-aged man lying motionless beneath a bicycle. He hopped out of his car, tossed the bike aside and spent the next hour performing chest compressions and mouth-to-mouth ventilation.

The guy vomited profusely, but never regained consciousness.


Heimlich maneuver

"There are foods I don't eat today because of that," says Hunsucker, pausing for effect before biting into a patty melt inside a Denny's near Baybrook Mall. "Cooked tomatoes is one of them."

Today Hunsucker is a professor emeritus at the University of Houston, where he taught mathematics and engineering for three decades. A longtime American Red Cross volunteer, he also owns and serves as president of the National Aquatic Safety Company, or NASCO, the third-largest lifeguard certification agency for water parks in the country, which he runs out of his house in Dickinson.

Hunsucker has never appeared in any Houston-area media, though he is internationally known as a pioneer and expert in the field of water safety. He helped create water-rescue techniques now commonly employed by many first responders, including the Houston police and fire departments. He also developed scanning procedures and ways to identify drowning victims for lifeguards in water parks.

His risk-management company boasts clients in almost every state, as well as foreign countries as far away as Dubai. He provides services locally for Schlitterbahn in Galveston, Water World in Spring and the city-owned pool in Deer Park.

He has won awards from the National Water Safety Congress and the Council for National Cooperation in Aquatics. In 2000, he was elected to the World Waterpark Association Hall of Fame, and, in 2005, he was recognized by Aquatics International magazine as among the industry's most influential people.

Although there's no award for it, Hunsucker is also widely considered among the most controversial.

NASCO is the largest and perhaps only lifeguard-certification agency in the country that teaches the Heimlich maneuver rather than cardiopulmonary resuscitation as a first response for drowning victims — a protocol shunned for years by the American Red Cross and the American Heart Association and warned against as potentially deadly by several leading drowning experts.

"The science is against it," says Dr. James Orlowski, chief of pediatrics at University Community Hospital in Tampa, Florida, who claims he has studied 30 cases where he says the Heimlich maneuver caused serious harm to drowning victims.

This year marks the ten-year anniversary of when Hunsucker first made his case in the trade magazine Splash, arguing that most lifeguards are teenagers who lack the maturity to perform CPR — a technique he calls confusing and far less effective than widely believed.

He also warned that CPR puts the rescuer at risk of AIDS, hepatitis and tuberculosis, as well as profound psychological scars. "Having performed mouth-to-mouth on a victim, I can assure you that the mental involvement of the rescuer is quite large," he wrote. "The experience was quite traumatic to my mental health."

Hunsucker even went so far as to encourage lifeguards to make up their own minds rather than "blindly follow" established medical protocols. "God gave you a brain, or else you would not be a lifeguard," he admonished. "I am not a physician. But on the other hand, I'm not stupid, either."

The essay remains a flash point for many leaders in emergency medicine and water safety.

"It's classic Hunsucker hubris," says B. Chris Brewster, president of the ­California-based nonprofit United States Life­saving Association. "Essentially what Hunsucker is doing is human experimentation on an untested medical theory. It's reckless and negligent, and just unbelievably ­unethical."

Hunsucker's critics love to point out that he has no background in medicine. And that he has aligned himself with Dr. Henry Heimlich, the iconic inventor and namesake of the anti-choking maneuver, whose reputation has been under siege in recent years.

In a twisted family drama, 53-year-old former punk-rock musician Peter Heimlich of Atlanta, Georgia, has spent years working to discredit his world-famous father, alleging he conducted illicit human experiments on AIDS patients, and falsely claimed credit for several medical ­innovations.

Henry Heimlich, who is now 87 and resides in a suburb of Cincinnati, Ohio, denies the allegations. "Dr. Heimlich has some unorthodox medical ideas that are out of the mainstream, and he's the first to admit they're unorthodox," says Bob Kraft, his spokesman. "But Peter wants to paint him as the great fraud of the 20th century when Dr. Heimlich has a long career of real achievement."

Henry Heimlich spent much of his career locking horns with the medical community, advocating his maneuver not only for choking but also as a first response for treating asthma attacks, heart attacks, cystic fibrosis and drowning.

"It makes no sense logically or medically or physiologically, and every expert in drowning has said that," says Dr. Robert Baratz, a Boston, Massachusetts-based primary care internist who serves as president of the National Council Against Health Fraud, a nonprofit agency that investigates and evaluates claims made for health products and services.

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.

"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).

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.

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."

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."

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.

Even after E&A dropped the Heimlich maneuver from its rescue protocols, Hunsucker dug in his heels. It was an unpopular decision that cost his company several clients, he says.

And why did he continue to promote it?

"Because we never had it not work," he says.

It's a response that drives the medical community bonkers.

"We don't do medical research that way," Baratz says. "That's called 'It-is-because-I-say-it-is.' It violates the basic rules of medical ethics."

Today Hunsucker insists there is no controversy, calling it a dead issue. "Everybody in the industry knows we do this," he says.

Still, he becomes prickly when asked about his critics. "I'm not an MD; congratulations; so what?" he says. "I'm a PhD; I am trained in logical thought. I'm not stupid; I'm not hidebound; I can change. Come up with a logical argument."

He adds: "All the agencies that say, 'Don't do it,' have never asked me for our data." When the Press requested to see any and all unpublished data, Hunsucker said there was none.

A black-and-white photograph shows Henry Heimlich with his arm around John Hunsucker. It's a fitting picture: Heimlich is smiling and relaxed, seemingly gleeful to have found a follower, while Hunsucker wears the sober, circumspect expression of a proudly independent thinker who resists the notion that he is anyone's lapdog.

The undated snapshot appears on the voluminous Web site medfraud.info, maintained by Henry Heimlich's estranged son Peter Heimlich, who writes above it:

"Every major first aid and water safety organization considers the use of the Heimlich maneuver for treating near-drowning as useless and potentially deadly. It's [sic] use has been associated with dozens of serious injuries and the loss of life, including children. So why is Prof. John Hunsucker's Houston-area company NASCO Aquatics teaching lifeguards to perform the Heimlich maneuver on drowning victims?"

Peter Heimlich devotes just a portion of the Web site to Hunsucker and drowning issues. He employs a mix of primary documents, scientific studies, news reports and original writing to create a laundry list of allegations against his father, whom he grandly denounces on the site as a "quack," "crackpot," "humbug" and "one of history's most prolific — and destructive — medical charlatans."

For instance, Peter Heimlich claims that his father financed and organized "illegal offshore human experiments on both American and Third World patients, deliberately infecting them with malaria. Medical experts have compared this un­supervised, exploitative 'research' to Nazi concentration camp atrocities."

It's true that Henry Heimlich has long advocated the use of malariotherapy to treat AIDS victims, in which high fevers are induced to stimulate the patient's immune system. It's also true that many AIDS researchers and medical ethicists have condemned the practice, warning that deliberately giving patients malaria risks killing them.

But Henry Heimlich did nothing illegal, insists his spokesman, Bob Kraft. "There are no secret African experiments going on," Kraft says. "The experiments that were done in China were completely legal; they were done under Chinese government auspices; there was no need for U.S. governmental or regulatory approval."

Peter Heimlich also claims that his father was fired from his last hospital job in 1976, and that he falsely took credit for inventing several medical innovations, including the maneuver that made him famous.

Kraft denies these ­allegations.

(A disclosure: The Cleveland Scene, a sister paper of the Houston Press, published a story in 2004 regarding a former Heimlich associate. The associate sued the Scene, alleging libel; the case is pending.)

Like his father, Peter Heimlich has aggressively used the media to promote his research. Much of the original and most illuminating work on the subject has appeared in the alternative press, though reports have also run in national outlets such as The New Republic and ABC News.

"We didn't want anyone else to be hurt or killed by this quackery, so we brought the information to a number of oversight agencies," Peter Heimlich writes on his site. "Most failed to take action, so we went to the media."

Peter Heimlich plugs a book on the Web site that he is currently writing with his wife Karen, and claims that Hollywood agents have shown interest in developing his story into a movie. He is unapologetic about taking on his own dad, whom he has not seen for five years. "I enjoy my work," he says. "I'm proud of my work."

Henry Heimlich has declined all interview requests regarding his son Peter. "As far as he's concerned, it's a tragic personal matter," Kraft says.

Peter Heimlich also uses his Web site to slam his two siblings: Phil Heimlich, a career politician who served as a city council member and county commissioner in Cincinnati and is now running for U.S. Congress, and Janet Heimlich, an Austin-based freelance writer whose work last year was honored by the Houston Press Club.

Among other things, Peter Heimlich charges his brother and sister with lying to the media about his mental health.

"We don't fully understand Peter's motivation," Janet Heimlich says. "We've all accepted that this is what he's chosen to do."

Hunsucker, meanwhile, says he is aware of the Web site but dismisses it, saying many of the issues are outside his area of expertise. Still, he admits that some of Henry Heimlich's theories seem ­misguided.

"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."


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