Some resort OC lifeguards use Heimlich while others shun it

(Aug. 14, 2009) There are two very different schools of thought regarding the use of the Heimlich maneuver on drowning victims, one calling for the procedure and one frowning upon it. Ocean City's two largest groups of lifeguards do not follow the same method; while one uses the Heimlich first, the other never uses it.

Developed by Dr. Henry Heimlich and a colleague in 1974 as a method to dislodge an object from the airway of a person who is choking, the Heimlich maneuver is one of the most well known medical procedures, and one of the most controversial.

The American Heart Association and American Red Cross recently updated their treatment protocols for choking victims, and the Heimlich maneuver was demoted. The groups now advocate giving a choking person five strong slaps on the back before resorting to the abdominal thrusts known as the Heimlich (even the name was removed in favor of the generic descriptive term).

Heimlich also promoted his technique as the first response for all drowning situations, because he said cardiopulmonary resuscitation, or CPR, is useless unless the water that has gotten into a person's lungs is expelled first.

The National Aquatic Safety Company, the third-largest lifeguard certification agency for water parks in the country, is based in Texas and operated by John Hunsucker. Hunsucker is a strong proponent of using the Heimlich maneuver on drowning victims, teaching it to his lifeguards and claiming it is more effective than CPR.

Hunsucker and those who follow his methods believe CPR cannot be done properly on drowning victims because of the water in their lungs and because the victims tend to vomit, which causes most people to shy away and stop the treatment.

But critics say this just delays the time until CPR begins and air is put back into the lungs, and also that there is no scientific proof that the Heimlich is useful to remove water from the lungs or airway. The American Heart Association and American Red Cross advocate for CPR, not the Heimlich, for drowning victims.

"All our guards get trained in CPR. We don't even teach abdominal thrusts for choking," Ocean City Beach Patrol Lt. Wes Smith, the training coordinator, said.

The Ocean City Beach Patrol's annual training follows the guidelines of the American Heart Association Healthcare Provider course and does not teach the Heimlich for any situation.

"There's not sufficient scientific evidence that shows it's beneficial. In fact, there's a greater risk of causing aspirated pneumonia," Smith said.

The training given to the 200 beach patrol lifeguards is the same received by hospital workers and it calls for CPR to be used immediately in potential drowning situations. Smith said doing the Heimlich can cause the patient to breathe in more water, leading to potential complications later on and delaying the time it takes for CPR to begin and air to be returned to the lungs.

"The chest compressions are going to help pump air in and out of the lungs anyway. The reality is I really can't see the benefit of doing abdominal thrusts on a drowning victim first. There's just not the clinical evidence to support it. The idea is more anecdotal than proven," he said.

On the other side of the issue, the approximately 60 lifeguards who work each summer at the Splash Mountain water park at Jolly Roger on 30th Street follow the training program of the National Aquatic Safety Company run by Hunsucker. They are taught to use abdominal thrusts first, then CPR.

"If we encounter an unconscious, nonbreathing person in the water, first we move them toward the deck and do five abdominal thrusts while moving them. Once they're on the deck, we start CPR," Splash Mountain Operations Manager Rick Korecky said.

Korecky said the technique is useful as the first procedure in pools because it takes time to move a victim to the deck where CPR can be performed, so there is time to use the Heimlich while the person is being moved.

"We use it in an attempt to clear any water that's in the airway. It's useful as a preliminary form of first aid, providing some care while we're moving the person," he said.

The objection to CPR about the victim vomiting is not an issue for the beach patrol, because of the technique its members use. Called the cricoid pressure technique, it requires three people to perform, which is why it is not commonly done. But three lifeguards respond to every situation in Ocean City, allowing this to become common practice.

The technique requires one person to press on a specific portion of the trachea to reduce the amount of air that enters the stomach while the other rescuers perform CPR, thus reducing the likelihood of vomiting. With that danger greatly reduced, local lifeguards have less reason to be squeamish about performing CPR quickly and effectively, Smith said.