At the end of the long, stark white hall, walking from work after a long day, I saw three friends laughing as they left the cafeteria of the hospital. I couldn’t make out their faces, as they were brightly backlit by sun pouring in the large exit doors I was headed toward. Approaching closer, I could see the two ladies flanking their fellow nurse in the middle were slapping her on the back. I thought they were really having a fantastic time!
Then, at about five feet from the group, when I could truly see their faces, it was apparent the lady in the middle was not having as much fun as the two by her sides. While her two friends were still quite jovial – laughing as the kept hitting her, the one on the middle was clearly panicked.
She was choking.
It was 1998, a time when back slapping a choking victim was regaining prominence. Thankfully, years of military first aid Training kicked in….I asked if she could speak, and she shook her head violently, “N O !“
The nurse in the middle was a large lady, to put it lightly. I told her what I was going to do to help. Wrapping my arms around her, fists below her rib cage and “j-ing” up just wasn’t working. So, I picked her up with the same reverse bear hug and bounced her, using gravity to help. Out popped a peppermint, right into her hand.
After many thank-yous from her and the continuing guffaws from her friends, we all parted ways – her much happier for the encounter.
A few years before, our then five-year old was upstairs with her sister, yelling, “Momma, the baby! Momma, the baby!” My wife bounded up to our 6-Month old’s room to find our oldest and our infant both terrified. Our baby was gasping for air, and blood was coming from her mouth.
My wife’s first aid Training also kicked in (she was training to be a diagnostic medical sonographer at the time)….She looked inside our youngest’s mouth and could see nothing. She finger-swept the back of her throat, and felt something lodged there… (note: debate is still open on mouth sweep)
My kids’ super hero mom flipped her over, held her slightly down across her forearm, commenced back blows toward her chest….and out came nothing. She tried five more blows which only produced only more blood.
She called 911. Our six-month-old was gasping for air in distress. All three were terrified. I was at work. Thank God for their mom. I would have fallen apart.
You never want to see your littlest loved one loaded into an ambulance. My wife rode along, and a neighbor took our oldest. I got the call you never want: “LT Horel, this is EMT Smith. There is nothing you can do, so make sure you drive the speed limit and come to Sacred Heart Hospital. Your wife is here with your daughter. She is being given the best possible care; she is going into surgery to remove a foreign object blocking her airway. Your wife needs you to be here with her. Drive safely. That’s all you can do now.”
Luckily, the object was the disposable cover of an otoscope – that curious tool used to look into your ears and the back of your throat. Our neighbor was an ER doctor, and the neighborhood kids played with his all the time, evidently. My oldest thought it would be something fun for her and her sister to play with, too. A baby often sees something new and investigates by putting in their mouth, so pop it in she did.
Just enough air got through, and while things were touch and go then, that little lady has grown up to be an incredible teacher in the Bronx. I will never forget how she looked on this day; she was a pitiful little bundle of distressed and confused baby for whom the Heimlich failed. Not because mom didn’t do everything right; Instead, because of what was in her throat, and how it was lodged.
Today marks the 44th anniversary of the invention of the Heimlich maneuver —a method for saving a choking victim with a bear hug and abdominal thrusts to eject a throat obstruction. Given life in 1974, it has become a national safety icon, taught in schools, portrayed in movies, displayed on restaurant posters and endorsed by medical authorities.
It is the stuff of breathless, brink-of-death tales – like the two true stories above – and those told over the years by icons like Ronald Reagan, Edward I. Koch, Elizabeth Taylor, Goldie Hawn, Cher, Walter Matthau, Carrie Fisher, Jack Lemmon, the sportscaster Dick Vitale, the television newsman John Chancellor and many others. Dr. Henry J. Heimlich, the thoracic surgeon and medical maverick who developed and crusaded for the antichoking technique, has been credited with saving over 100,000 lives. He passed just two years ago.
The Heimlich maneuver, when he first proposed it, was suspect — an unscientific and possibly unsafe stunt that might be too difficult for laymen to perform and might even cause internal injuries or broken bones in a choking victim.
But the stakes were high. In the 1970s, choking on food or foreign objects – like toys, which my five-year-old thought the otoscope cap was – stood as the sixth-leading cause of accidental death in America. Choking resulted in some 4,000 fatalities annually, many of them children. A blocked windpipe often left a victim unable to breathe or talk, gesturing wildly to communicate distress that mimicked a heart attack. In four minutes, an oxygen-starved brain begins to suffer irreversible damage. Death follows shortly thereafter.
Standard first aid for choking victims, advocated then by the American Red Cross and the American Heart Association, consisted of a couple of hard slaps on the back or a finger down the throat. But Dr. Heimlich believed those pushed an obstruction farther down in the windpipe, wedging it more tightly. He knew there was a reserve of air in the lungs and reasoned that sharp upward thrusts on the diaphragm would compress the lungs, push air back up the windpipe and send the obstruction flying out, like that peppermint.
His solution — wrapping arms around a victim from behind, making a fist just above the victim’s navel and below the ribcage, then thrusting up sharply. Worked on dogs, so why not humans? His ideas, published in The Journal of Emergency Medicine in an informal article headlined “Pop Goes the Cafe Coronary,” were met with skepticism.
Anticipating resistance from his peers, Dr. Heimlich sent copies to major newspapers around the country. Days later, a Washington State man who had read about it used the maneuver to save a neighbor.
Other cases began to hit the headlines. A 5-year-old Massachusetts boy saved a playmate after seeing the maneuver he had seen demonstrated on television. Testimonials flooded in…. Dr. Heimlich was on his way to celebrity.
In a profession that then frowned on self-promotion, he was regarded as a publicity-seeking eccentric, if not a crackpot. But as saved lives accumulated into mounds of real evidence, skeptics were silenced, state and federal health authorities endorsed the technique, and its popularity spread. Today, it is known to millions from the internet, television, films, pamphlets, books, newspapers and magazines, talked up in families and taught in schools, often with videos provided by the Heimlich Institute.
According to WikiHow, there are four ways to perform the Heimlich. They all follow a similar format.
For a standing person
Determine if the person is truly choking.
A choking victim will often have their hands around their throat. If you notice someone making this gesture, look for other choking signals. You should only perform the Heimlich on a choking person. Look for the following
- Cannot breathe or experiencing loud, difficult breathing
- Cannot speak
- Inability to cough effectively
- Blue or gray color to lips and fingernail beds
- Loss of consciousness
Let the person know you’re going to perform the Heimlich or abdominal thrusts.
Tell the choking person you want to help them. Let them know you know the Heimlich Maneuver and are going to perform it on them.
Wrap your arms around the person’s waist.
Stand with your legs separated to best support your body. Gently wrap both arms around their waist. Lean them forward slightly.
Position your hands.
With one hand, make a fist. Which hand you use does not matter. Position your fist below the ribcage, but above the navel. Then, wrap your other hand around your fist.
Make a series of thrusts.
To make a thrust, press hard and quick into the abdomen. Pull inward and upward as you press. It should feel like you’re trying to lift the person off the ground.
- Make the thrusts quick and forceful.
- Perform five abdominal thrusts in quick succession. If the object is still not dislodged, repeat with five additional thrusts.
Perform back blows.
If the object is not dislodged with the Heimlich maneuver, do back blows. Deliver five blows to the person’s back with the heel of your hand. Aim for the area between the shoulder blades.
Press down hard, as you need to use enough force to dislodge the object. However, keep the force confined to your hands. Do not squeeze the area surrounding the person’s ribcage or abdomen.
Call emergency services.
Call emergency services if the object is not dislodged. Preferably, have someone else call emergency services after the Heimlich fails the first time and you are performing another round of back blows. When an emergency service worker arrives, they can get the object dislodged. At this point, stay away from the choking person
For an infant
Hold the infant face down.
To start, find a firm surface. Lay the infant on the firm surface with their face down. Make sure the infant’s head is turned so they can breathe. Kneel near the infant’s feet.
You can also place the infant on your lap face down.
Give the baby five quick blows to the back.
Use the heel of your hand. Deliver five quick blows to the area between the infant’s shoulder blades. Hopefully, an object will pop out quickly.
With an infant, be firm in the blows but do not use harsh force. You do not want to press too hard, as this could hurt an infant. Gravity combined with back blows can provide adequate force to dislodge the object.
Turn the infant over.
If no object pops out, turn the infant over. Support their head with your hand, keeping the head slightly lower than the feet.
Give the infant five chest thrusts.
Place your fingers on the lower half of the infant’s breastbone. Make sure to keep your hand in the middle of your infant’s breastbone and not to one side of another. Press down five times in a series of chest thrusts. If you see the object become dislodged, stop giving chest thrusts.
Call emergency services if the object fails to come out.
Immediately call 9-1-1 if the object does not become dislodged. As you wait, repeat the back blows and the chest thrusts. Repeating the steps may cause the object to become dislodged while you’re waiting.
There are also methods for a victim lying on the ground and for performing the lifesaving technique on yourself. You can find those here….
Back to the man and the history of the maneuver itself. Dr. Heimlich developed and held patents on a score of medical innovations and devices, including mechanical aids for chest surgery that were widely used in the Vietnam War, procedures for treating chronic lung disease and methods for helping stroke victims relearn to swallow. He also claimed to have invented a technique for replacing a damaged esophagus with stomach parts, but later acknowledged he learned a Romanian surgeon had been using it for four years prior to his published article. No one is sure if he really knew, but he was invited to Romania after he learned to meet the man and champion the procedure.
No one knows how many lives have been saved by this technique, although reported choking deaths declined after its popularization. The Heimlich Institute claims 50,000 lives saved in the United States alone. A 2009 Op-Ed article in The New York Times estimated that 100,000 people had been rescued from choking. The American Medical Association, which endorsed the technique in 1975 and gave it the name Heimlich maneuver, says it saves unknown thousands annually. Most likely go unreported these days, like the case of the jovial nurses above. Just a matter of a day in a hospital hallway.
In 1984, Dr. Heimlich, the recipient of many honors, won the Albert Lasker Public Service Award, one of the nation’s most prestigious medical science prizes, for a “simple, practical, cost-free solution to a life-threatening emergency, requiring neither great strength, special equipment or elaborate training.” A surgeon well regarded by many, while considered a crackpot self-promoter by some, used what would be considered social campaigning to get the word out, appearing on TV and publishing in every print piece who would honor the request. Omni magazine, in a 1983 article, quotes him saying, “I can do more toward saving lives in three minutes on television than I could do all my life in the operating room.”
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