LECTURE AT CoNFERENCE ON EMERGENCY AIFMAY MANAGEMENT

NATIONAL ACADEMY OF ScIENCES, HASHINGTON, D. C.

JUNE 21, 1976

HEIr'1JCH

M1\NElIVER:

ANALYSIS (f

HENRY

J.

nr FIRST

BY
HEIMLICH,

50J DOCU~NTED LIVES SAVED

M,D.,

*
F.A.C.S.

INTRODUCTla~
~RE

n-tAN 50) OOCUMENTED REPORTS OF CHOKING VICTIMS

WHOSE LIVES HAVE

BEEN SAVED BY TI-lE HEIMLICH MANEtNER HAVE BEEN RECEIVED SINCE THE TECHNIOUE
WAS INTRODUCED 00

YEARS AGO.

P-N INDIVIDUAL CHJKING ON FOOD OR ANOniER OBJECT

HAS LESS ll-IAN FOUR MINUTES TO LIVE.

ANy

PERFORM THE HEIMLICH MANElNER INSTANTLY.

VICTIM HAS BECOME UNCONSCIOUS,

PERSON ON TI-lE SCENE MUST BE ABLE TO

THIS

IS PARTICULARLY TRUE WHEN mE

AT Y-n-HCHTIME THERE ARE ONLY SECONDS BEFORE

BRA I N DWiAGE OR DEATH OCCU~S

THE VALUE OF TI-lE HE IMLI CH ~NElNER

LI ES I N -ITS S I MPLI CITY,

GENERAL PUBLIC TO IMvlEDIATELY UNDERSTAND TI-lE CONCEPT.

SAVED LIVES OF CHOKING VICTIMS

ENABLI NG TI1E

MANY PERSONS HAVE

AFTER HAVING READ A BRIEF DESCRIPTION

HEIMLICH MANEUVER OR MERELY Hl\VING HEARD IT DESCRIBED ON THE RADIO.

OF THE
~E

OF

THE tv'nST DRJVv\l\TIC EX/lMPLES IS AN 8-YEAR OLD IN ViENATCHEE, HASHINGTON, WHO

LEARNED TI1E HEIMLICH MANEUVER IN SCf--IOOLAND SAVED HIS 6-YEAR OLD BROTHER.
IN ANOTI1ER INSTANCE,

A 10-YEAR

OLD, IN J'It.1ARILLO, TEXAS, WHOSE 2-YEAR OLD

BROTI-lER WAS CHJKING,

WAS GIVEN HEIMLICH r1A.NEUVER INSTRUCTIONS

APPLIED TI1E f''1ANEUVER AND A M.ARBLE WAS EXPELLED.

BY PHONE.

HE

BLIND ATIORNEY IN SIOUX CITY,

IOWA, SAVED HIS WI FE AT A BANQUET AFTER OTI-lERS SCREN1ED TI-l.l\ T SHE WAS CHOKI NG

HE

HAD LEARNED TI1E HEIMLICH MANEUVER FRa'1 A TALKING BOOK.

tl_EVEN PEOPLE HAVE

USED TI1E HEIMLICH MANEUVER TO SAVE TI-lEMSELVES, INCLUDING AN 85-YEAR OLD WCl'Ll\N
LIVING ALONE.

HEIMlicH

- 2IN VI E'w OF THE

'LlJ),)

DEArus

1W\ T

OCCUR EACH YEAR IN TH I S COUNTRY,

CHOKING IS A PUBLIC HEALTH, RATHER TI1AN A FIRST AID, RESPONSIBILITY.

HEIMLICH MANEUVER CAN ONLY BE FULLY EFFECTIVE
POPULATION.

THE

IF DISSEMINATED TO THE ENTIRE

THE MOST SUCCESSFUL AND WIDESPREAD PROGRflJv\S ARE BEING CARRIED

OUT BY LOCAL AND STATE PUBLIC HEALTH AUTHORITIES

INDIVIDUALS CONDUCTING THIS MEETING.

hH)

SHOULD BE AMJNG THE

~ANY OF TH5"1 ARE ACTING UNDER STATE

LAWS THAT REQUIRE TEACHING THE HEIMLICH MANEUVER IN SCHOOLS, RESTAURANTS, AND
PUBLIC INSTIlUTIONS,

THE ARMED FORCES CONDUCT AN EXTENSIVE PROGRAM AS. DO

MANY INDUSTRIAL MEDICAL DIRECTORS.

PERSONNEL
AIRPLANES.

FOR EXN1PLE,

10

IN THE FIRST FIVE MONTHS OF TEACHING AIRLINE

PERSONS WERE SAVED BY Tl-IE HEI~1LICH ~'\.\NElNER IN

HE HAVE BEEN. ADVISED THAT DURING THE SAME PERIOD THREE DEATHS

FRC1-1FOOD CHOKING OCCURRED ON PLANES \'lHERE THE PERSONNEL HAD NOT YET RECEIVED
HEIMLI CH MANEUVER TRA I NI NG
BASED ON THE FIVE REPORTS OF D~lNG

VICTIMS SAVED BY RESCUERS

USING THE HEIMLICH MANEUVER AFTER USUAL RESUSCITATIVE

WE CONTINUE TO BE ENCOURAGED BY THIS POSSIBILITY
THE LUNGS AS AN INITIAL
CASE REPORT:

STEP,

MEASURES HAD FAILED,

OF EXPELLING WATER FROM

PRIOR TO ATTEMPTING TO GET AIR INTO THE LUNGS.

VICTOR ESCH,

M.D.,

WASHINGTON,

SURGEON AND ADVISER ON WATER SAFETY TO THE

RED

D,C"

CRoss,

FIRE DEPARTMENT

STATED:

HEIMLICH Ml\NEUVER) MAY OPEN UP A NEW VISTA OF RESUSCITATION.

GOOD TO DO THE STANDARD fIOUTH-TO~

IT (THE
IT DOES NO

BREATHING IF THERE IS WATER IN THE

WNGS OR DEBRIS IN -mE TRACHEA FROf'1 VQ\1ITING.

THE AIR ~/T

GET THROUGH.

HE Ir1..ICH

- 3-

I HAPPENED TO BE ON THE BEACH ~EN A VICTIM

GUARD. I USED THE HE 1M...ICH TEe...., I QUE THE
HE BEGAN BREATHING.

WAS BROUGHT ASI-mE BY A LIFEWATER GUSHED OUT OF HI S M:lUTH AND

HE HAD TO BE TREATED FOR PNElMJNIAI

HE HAD WATER IN THE LUNGS.

(O-UCAGO DAILY NEWS, AuG.

WHICH PROVED

24, 1974.)

* HENRY J. HEIMLICH, M,D" F,A.C,S.,

DIRECTOR OF SURGERY & PHYSICIAN-IN-CHIEF
OF l1-IEESOPHAGUS CENTER , THE JEW ISH Hasp ITAL OF
CINCINNATI, AND ASSOCIATE CLINICAL PROFESSOR OF
SURGERY, UNIVERSITY OF CINCINNATI CollEGE OF ~1EDICINE,

HEI~1LICH

HISTORY

(f

THE HEIf1LICH ryWJEUVER f\s REU\Tf]) TO THE RED CROSS AND THE HEART ASs(xIATIOO
197tl, DR,

IN JANUARY
TO THE AMERICAN

HEH1LICH

Nt...TIONAL RED

FIRST

"T1-lE HEIMLICH

PRESENTED

CROSS FOR EVALUATION,

FOR TWO YEARS THE

CROSS MADE NO DEC I S ION REGARD I NG THE HE I MLI CH ~1ANELNER

TInS

PERIOD,

INITIATED
LIVES

TEACHING

SAVED.

RED

fv1ANY DEDICATED

CROSS WORKERS AND

OF THE HEIMLICH

OrrlERS,

!-Dr/EVER,

f14NELNER

FORTUNATELY,

INSTRUCTORS

THEMSELVES

RED

FOLLO't1ED NATIONAL

~\t\NE\NER

RED
OUR I NG

IN LOCAL CHAPTERS

AND, SUBSEQUENTLY,

CROSS DIRECTIVES

REPORTED

TI-lAT DID

NOT RECOM"1END TrlE HE I MLI CH ~t\NELNER.

A MEJIORIAL

WAS HELD ON

r~W 6, 1976,

OLD yffi CHOKED TO DEATH ON SPAGHETTI

MEDICAL TECHNICIAN
MA.NElNER,

TRIED

THE DIRECTOR

OF

TRAINED

IN

ALL niE

TRADITIONAL

HEALn~,

SALT

THE CI-()KING DEAll-l OF A 2-YEAR

TI-lESE LIVES

RED

IN BRO!'i'N CoUNTY,

AS HIS I8-YEAR

RED

CROSS,

UTAH,

REPORTED

Sc IENCES

FOR A DEC I S ION CONCERN I NG USE OF THE r~NElNER

THIRTEEN

SCIENTISTS.

BACK BLOWS,

THAT THEY DEPENDED UPON THE NATIONAL

STATED THEY ylERE "FRUSTRATED

ACTION BY THE AcMJt}1Y,"

TO l1~E RED CROSS

AND, SUBS EOUENTLY , THE

THE MAJORITY

MIGHT

lWO YEAR DELAY I N ACCEPT I NG THE

~~NElNER,

CROSS OFFICIALS

VENTILATICl4.

f1e..NEUVER?

HEIM..ICH

RED

ADVISED

AN EMERGENCY

t4QUTH-TO-MJUTH

OLD CHI LD WHILE RECEIVING

DlJR I NG mE

FOR A 15-YEAR

BUT NOT IN TI-lE HEIMLICH

INCLUDING

U\KE CrTY~CoUNTY,

HAVE BEEN SAVED BY TI-lE HEIMLICH

THE NATIONAL

OLD BRamER,

CROSS TECH~IQUES,
METI{)DS

(luo,

EVENTUALLY,

AND IMPATIENT

RED

OF 11-K)SE PRESENT

kADEMY OF
HASH I NGTON

OVER THE LACK OF

CROSS CALLED A MEETING OF

WERE PAST OR PRESENT

RED

CROSS,

HEIMLICH

- 5 -

NATIONAL AcMJOO
WI-OSE OPINIONS

OF ScIENCES,

21 MEETING.

JUNE

HAD RESULTED

AND ACTIONS

TI-iE HE I MLI CH ~1ANEU'VER

OR IlMERICAN HEART I~SSOCIATION

RED CROSS

ADOPTED BY A MAJORIlY

YEAR DELAY IN TEACHING

THE SAl"1E I ND I V I DUALS ()CCUPY KEY POS IT IONS AT TI-lE

THE CONTROVERSIAL

NOW I NCLUDED I N A

IN THE n10

CONSULTANTS

ASPECTS

BOOKLET,

REPORTED

FRrn

mAT

MEETING,

WERE, ACCORDI NG TO TI-lE RED CRoss,

OF THE THIRTEEN

PARTICIPANTS,

AND NOT BY UNANItvUUS

DECISION.

THE REPORT mAT

1975,

CONTAINED THE HEIMLICH

IkTOBER
lW)

27, 1975,

YEAR DELAY.

AND DEATH.
USED DIRECTLY
I N mAT

FROM THE RED CRoss

r'~NEINER

ALSO INCLUDED 'tJERE I\DDITIONS

ARE MEDICALLY

TI-lEREFORE,

ADVISED

OR INDIRECTLY

CONFERENCE

RESULT SHOUll)

CONFERENCE

IN TOTAL AS

R.ED

IN RELATION

J{If<v\,

LED TO THE

TO AND VARIATIONS

OF TI1E

IN INJURY

CROSS TI1AT MY NN~E t-1AY NOT BE

TO THEIR

ARE NOT ONLY RES PONS IBlE

IT IN

mAT

UNSOUND A~ID CAN RESULT

THE

REPORT.

PA.RTICIPANTS

FOR THE r1ED 1C!\L PROBLEMS iliA.T

THAT REPORT BE WIDELY DISTRIBUTED,

mIT ARE SlJB.JECT TO

TREMENDOUS F I NANC I AL L I AB I L I TY SHOULD MY MED I CAL OP I N I ON PROVE CORRECT

IN FEBRUARY
OF TRUSTEES

1976,

DID NOT APPROVE

IT.

OTHERS,

HILL

SERIOUSLY

MANElNER ,tl.S IS BEING

THROUGHOlff

ASSOCIATION

IT IS SINCERELY

AND ACADF.J1Y CONSULTANTS

TI-lE HEIMLICH

TI1AT RED CROSS REPORT WAS SUBMITIED

OF THE AMERICAN r1EoICAL

THE COUNTRY.

27,

OF CtToBER

DESCRIBED

JUDGMENT

RA I SING A QUEST I ON AS TO THE

I BELI8!E

MANEUVER THAT

RESULTED

DONE BY PUBLIC

TO THE FoARD

FOR APPROVAL AND THE TRUSTEES

HOPED THE RED CROSS,

RECONSIDER

THEIR

HEART ASSOCIATION,
POSITION

HEALTI-l OFFICIALS,

AND TEACH
AND w\NY

HEIMLICH

- 6-

FEBRUARY

18, 1975,

TI1E h1ERICAN HEART ASSOCIATION

WHICH INCLUDED, 'TIR. HENRY J.

ISSUED A STATEMENT

HEIMLICH IS TO BE COMPLIMENTED FOR HIS ANIMAL

RESEARCH WORK ON BEAGLE DOGS RELATED TO AIRWAY OBSTRUCTIONS.

HOWEVER, TIiERE

I S NO EVIDENCE AT TH I S TI ME THAT \AlECAN EXTRAPOLATE FROM THE ANI MAL STUD I ES

TO UPPER AIRWAY OBSTRUCTION IN MAN."

THAT WAS ONE IVONTH AFTER WE HAD RE-

PORTED, AT A NATIONAL MEDICAL HEETING,

~\t\NElNER.

LIVES SAVED BY THE

To MY KNOWLEDGE, THAT .STATEMENT HAS NOT BEEN RESCINDED.

THE NATIONAL
THE JUNE

96

THE FIRST

21

kADf:Mf

OF ScIENCES

MEETING (SPONSORED BY THE

HAS DISSEMINATED

RED

RED CROSS

OF

CROSS AND THE HEART ASSOCIATION)

THE UNPUBLISHED PAPERS OF 1'\10 INVITED SPEAKERS,

PRESENTED AT THE

TO PARTICIPANTS

WHICH Ml\TERIAL WAS ALSO

CONFERENCE OF Ck:TOBER

2J, 1975.

THOSE PAPERS

DESCRIBE HUMAN EXPERIMENTATION ON VOLUNTEERS SUBJECTED TO THE RISKS OF

ANESTHESIA.

ALTHOUGH UNIVERSITY

APPOINTMENTS ARE LISTED

IN THE "TWO PAPERS,

IT IS NOTED THAT THE EXPERIMENTS WERE CARRIED .OUT IN CDr"MUNITY HOSPITALS.

HERE TIiE EXPERIMENTS APPROVED OR REJECTED BY TI-lE UNIVERSITY

HUMA."lEXPERI~1ENTATION

CQM\1ITTEES?

I WISH

TO BE CERTAIN lW\T MY WORK IS TOTALLY DISASSOCIATED

HJMAN EXPERIMENTS.

THE DEPARTMENT OF HEALTI-I, EooCATION

FROM THOSE

AND WELFARE'S POLICY

REGARDING HUMAN EXPERIMENTATION REQUIRES THAT ''THE RISKS TO AN INDIVIDUAL

ARE OlITWEIGHED BY THE POTENTIAL BENEFITS
KNOWLEDGE TO BE GAINED.

II

I HAVE AIJtJAYS

TO HIM OR BY TI-lE IMPORTANCE OF TI-lE

BELIEVED AND STATED IN

PUBLISHED

HEIMLICH

- 7WORK THAT SUBJECTING

HUMANS TO THE RISKS OF ANESTI-IESIA IN ORDER TO S11JDY

CHOKING ON FOREIGN OBJECTS WAS NOT WARRANTED.

THE CLINICAL

SUCCESS OF TI-lE

HEIMLICH MANEWER HW ALREADY BEEN PROVEN PRIOR TO THOSE HUMA.N EXPERIrv'ENTS.

IN

ADDITION,

IT HAD ALREADY BEEN DEmNSTRATED

IN ANIMAL S11JDIES lli\T

CAUSED RElAXATION OF TIiE DIAPHRAGM AND INTERCOSTAL mSCLES,

ANESTI-IESIA

THEREBY INVALIDATING

STUDIES OF PRESSURE AND yJUUME MEASUREMENTS WHEN PERFORMING THE HEIMLICH

~EUVER.

HEIMLICH

- 8-

DEFINITION Cf HEIMLICH r1L'lNEUVER

IN ORDER TO. ADDRESS OURSELVES TO THE HEIMLICH MANEUVER WE MUST DEFINE
IT.

SoME CONFUS ION t<1A Y RESULT FROM THE STATEMENTS OF OTHER SPEAKERS.

THE PRECED I NG SPEAKER SENT ME THE RESULTS OF HIS EXPER I MENTS ON JANUARY

1975,

WHEN

5,

HE INDICATED THAT HE HAD PERFORMED THE HEIMLICH MANElNER ON THE UPPER

ABOO'1EN, MID-CHEST AND UPPER CHEST.

HE NOW RELEGATES THE HEIMLICH r1o.NBNER

TO THE ABOOMEN ALONE.

THE UNPUBLISHED PAPER SUBMITTED BY THE SPEAKER WHO FOLLOtIS ME, EQUATES
THE HEIMLICH MANEUVER WITH A PROCEDURE WHEREBY THE RESCUER USES ONE HAND
TO PINCH THE VICTIM'S
ffilffii

,THEN
:

NOSTRILS,

GOES ffilITH-TO-MJUTH

KERCHIEF ~MILE

THEN PLACES A HANDKERCHIEF OVER THE VICTIM'S

WITH THE VICTIM AND SUCKS AGAINST THE HAND-

AT THE SAME TIME, puMPING

INTO THE VICTIM'S

ABOO'1EN WITH

HIS OTHER HAND.

rtf DEFINITION

OF THE HEIMLICH MA.NEUVER, AS PRESENTED AT THE

CONFERENCE OF Ck:TOBER

2J, 1975

HAS ALWAYS BEEN :

RED CRoss

THE HE I MLI CH MANEUVER IS

A TECHNIQUE FOR SAVING THE LIFE OF A PERSON CHOKING ON FOOD OR ANOTHER OBJECT.
IT CONSISTS OF EXTERNAL COMPRESSION OF THE AIR IN THE LUNGS IN ORDER TO
PROVIDE A FLOW OF AIR FROM THE LARYNX SUFFICIENT
OBJECT.

TO EXPEL THE OBSTRUCTING

HEIMLICH

-9lECHNlOOE FOR PERFO~ING TIf HEIr'lICH rw~BJVER

(SITTING

AND STANDING POSITIONS)

Haw DID WE ARRIVE AT THE PROPER METHOD FOR PERFORMING THE MANEUVER
AS IT IS BEING SOCCESSFULLY TAUGHT TO MILLIONS OF PEOPLE BY PUBLIC HEALTH
OFFICIALS

AND OTHERS?

I N EMERGENCY

r-tn I CINE,

MY

FIRST DESCRIPTION

IN JUNE

197Ll,

OF THE ~ll\NEUVER, PUBLISHED

BASED ON ANItv1AL sruo I ES, SUGGESTED

THAT THE RESCUER STAND BEHIND THE VICTIM AND WRAP HIS ARMS AROUND THE
VICTIM'S

WAIST.

THEN, GRASPING HIS OWN WRIST,

STRONGLY PRESSES

INTO THE VI CTI MiS ABOOMENI

I STATED

IN THl\T PAPER

THAT WE COULD NOT BE CERTAIN THt\T THE EXPERn1ENTAL

RESULTS WQULD BE DUPLI CATED IN HlJt;1ANS

ARTICLE BY

PR.

ARlHlR SNIDER,

ScIENCE

WHO RECOGNIZED FROM THE SCIENTIFIC

AND IN JUNE

,L\t.1ERIcAN
TO ~~.

1974,

r1:DlcAL

THE RESCUER RAPIDLY AND

THE SAMt: All-"ON IT ION APPEARED I N AN

EDITOR OF- THE u-nCA(,,o DAILY NEWS,

ARTICLE THE POTENTIAL OF THE TEC~IQUE

WIDELY DISSEMINATED

THE INFORMl\TlON IN THE PRESS.

ASSOCIATI-cii--f,J\MA)-LATER-AWARDED

THE 1975

JOUR~LisM

(THE
AWARD

SNIDER BECAUSE OF THE NUMBER OF LIVES SAVED AS A RESULT OF HIS REPORTS

00 TI-lE HE I MLI CH ri4NEUVER.)

IN THE FIRST

tIONTHS, REPORTS WERE RECEIVED OF LIVES SAVED, BUT IN

SEVERAL INSTANCES RIBS WERE FRACTURED.

PLACED HIS ARMS AROUND TI-lE VICTIM'S
PROUJCED UM CHEST COMPRESSION.

IT WAS APPARENT THAT WHEN THE RESCUER

WAIST,

GRASPED HIS rlRIST AND SQUEEZED, HE

ALTHOUGH, AS LATER REPORTED IN JN14,

WE KNEW

THl\T THE HEIMLICH r1t\NEUVER PERFORMED BY CHEST COMPRESSICN WOULD SUCCESSFULLY

EXPEL A BOLUS FROM THE AIRWAY, THAT POSITION

WAS ELIMINATED FOR SEVERAL REASONS.

HEIMLICH

- 10 DISADVANTAGES (f PERFO~1ING 1HE HEIrlJCH ~8JVER

1.

BY CHEST CCWRESSlOO

THE UNNECESSARY DANGER OF FRACTIJRI NG RIBS:

RED CRoss

HAUGEN, AT mE

VICTIMS HE HAD AUTOPS I ED

CONFERENCE, STATED mAT fv'OST FOOD Cf-K)KING

\'/ERE ELDERL.Y IND IVIDlW.S

hH)

HAD FRAGI LE

RIB CAGES AND WOULD SUFFER t-ULTI PLE FRACTIJRES I F CHEST C<11PRESS ION WERE
USED.

How

Ml\NY CHESTS WERE, AND STILL ARE BEING CRUSHED BY EXTERNAL

CARDIAC CO'1PRESSION AS TAUGHT BY mE

2.

UJ.1PRESSION

RED

CROSS AND HEART AsSOCIATION?

FRACTURE OF THE RIBS RESULTS IN RUPTURE OF THE SPLEEN,

LIVER AND STOMACH.

fVbSELY, IN HIS TEXTBOOK, AcCIDENT SuRGERY,
FRACTIJRES OF'RIBS
O::TOBER

27, 1975,

9-l2

SHCMS THAT CC1-1PRESSION

RESULT IN INTRAABOOVlINAL INJURY.

ISSUE OF

IN\l\,

IN THE

WHICH CONTAINED MY PAPER, ANOTHER

REPORT DESCRIBED A CHOKING VICTIM WHOSE LIFE. WAS SAVED BUT HIS STOMACH
WAS RUPTIJRED.

(SuRGERY SAVED HIS LIFE A SECOND TIME).

THE ALffi10RS

ADVISED ME THAT THE EPISODE TOOK PLACE AT A CLUB WHERE ALCOI'nLIC

IS HIGH AND THEY COULD NOT LOCATE THE RESCUER.

INTAKE

THE INJURY IS ONE t1)ST

LIKELY TO OCCUR DUE TO AN ENCIRCLING CC1-1PRESSION "BEAR HUG. II

. 3.

U:M>RESSION OF THE CHEST REGlJIRES AN UNPREDICTABLE AND SUBSTANTIAL

FORCE AND CAN NOT BE ACCOMPLI SHED BY A SMA.LL OR WEAK PERSON.

4.

CHoKING VICTIMS CAN NOT SAVE THEMSELVES USING CHEST C<l"1PRESSION.

DESCRIPTION

OF THE CORRECT, INFRADIAPHRAGMA.TIC, METHOD IS, THEREFORE,

ALSO REQUIRED.

5.

CoNTRACTION OF THE INTERCOSTAL M.JSCLES CONTRIBUTES LITTLE TO TIDAL VOUM:,

WHEREAS ~
TIDAL VOWME.

OF THE DIAPHRAGM ACCOONTS FOR

(BEST AND TAYLOR, PHvSIOUXjICAL

525

CC OF THE

500-700

cc

BASIS OF r-\:nICAL PRACTICE).

HEIMLICH

-11THE PREVIOUS SPEAKER,

IN HIS UNPUBLISHED PAPER, DESCRIBES,

HCM HE PERFORMED HIS HUrwI EXPER I MENTS :

HAS TI-iE RESCUER POSITIONING

''THE HE I MLI CH OR 'ABDOMI NAL' POS IT ION

HIMSELF BEHIND TI-fE SUBJECT,

AT TI-iE LEVEL OF TI-iE SUBJECT'S

AND TOWARD THE DIAPHRAGM."

WAIST,

GRASPING TI-fE WRIST

AND APPLYING A QUICK TI-iRUST UPWARD

HE WAS, THEREFORE, ACTIJALLY TEST I NG A LCM

CHEST C(X>1PRESSION
AND NEVER EVALUATED TI-iE PROPER TECHNIQUE,
------~.RESCUER'S

USING THE

E.I.SI: AT A LATER DATE HE ADDED A DESCR IPTJ ON OF lHE CORRECT

INFRADIAGPHRAGMATIC POSITION

AS FOLLOWS,

ctTOBER

2J, 1975,

IN THE INTRODOCTION TO HIS PAPER.

TI-iE flMERlCAN r-BJlCAL ASSOCIATION

ISSUED TI-fE

FOLLCMI NG RELEASE:

"CI-DKItlG ~1L\N8JVERENOORSrn BY (lfi1L\Clli'lISSH1J

CHlCAC,o -- THE HEIMLICH MANEUVER -- A LIFE-SAVING
TO RESCUE INDIVIDUALS

TECHNIQUE

CHOKING ON FOOD -- RECEIVES THE OFFICIAL

OF THE IV1ERICAN ~'EDICAL ASSOCIATION'S

SERV ICES 1N TI-iE

FIRST-AID

Orr. 27

ENDORSEMENT

COM'1ISSION ON EMERGENCY MEDICAL

I SSUE OF THE ..JOURNAL OF THE fV.1ERICAN

r1:n ICAL

AsSOCIATION
''THE Cot1'1ISSION

BELIEVES n1E f-1ANEUVERTO BE A fvOST mPORTANT ADDITION

TO THE EMERGENCY CARE PROCEDURES FOR THE PERSON CHOKING ON FOOD OR

OTHER OBJECTS THAT SHlff OFF mE AIRWAY," SAYS TI-iE STATEMENT.
IN THE SAME ISSUE OF
HEIMLICH,

M.D"

JN1l\,

CINCINNATI

WHOM IT IS NNv1ED

"

mE TECHNIQUE IS DESCRIBED BY HENRY ..J.

SURGEON

\',H()

DEVELOPED THE ~NELNER

AND FOR

HEIMLICH

-]2-

VICTIM STANDING OR SITTING

--

HEIt1..ICH

MANEtNER AS OFFICIALLY

ENDORSED:

RESCUER STAr'IDING -- VICTIM STANDING OR SITfING

STAND BEHIND THE VICTIM ANn WRAP YOUR ARMS AROUND HIS WAIST
PLACE YOUR FIST THUMB SIDE AGAINST THE VICTIM'S

ABDOMEN,

SLIGl-ITLY ABOVE THE NAYEL AND BELOt'I THE RIB CAGE.

GRASP YOUR FIST \,11TH YOUR OTHER HAND AND PRESS I NTO THE
VICTm'S

ABDOMEN WITH A QUICK UPt/ARD lliRUST

REPEAT SEVERAL TIMES IF NECESSARY

\'IHEN THE VICTIM

VICTIM'S

IS SITTING,

THE RESCUER STANDS BEHIND THE

CHAIR AND PERFORMS THE MANEUVER IN THE SAME MANNER.

FOR AllilST ThO YEARS THIS SIr1'l.E AM) CLEAR tflIDD HAS BEEN TAlkJHT TO
MIL1IOOS (f PE(J>LE AND HAS BEEN PR(MI) EFFECTIVE NID SAFE.
PRESSING UPWARDrn THE DIAPHfW11 tffTS LI1ll RESISTANCE. THE bUICK
UPt4ARDTHruST WITH THE Cl..ASFfD FIST CAN BE PEffOMD GENTLY WITH EXCEllENT
RE9JLTS. ~EEZING ANDrnCIRCLIMJ awRESSI(J~ IS TOTAll.Y AVOIDED.
THE ~

TECItJIQlJE HAS BEEN USB) BY COOKING VICTIf'E TO SM THEMSELVES.

HEIMLICH

- 13THE ANATOMICAL BASIS FOR mE FUNCTION OF mE HEIMLICH ~t.\NEUVER

Hl\S BEEN ESTABLISHED BY mE FOLLOtIlNG OBSERVATION.

HrfH A PATIENT IN THE

LATERAL POSITION DURING THORACOTOMY. PRESSURE APPLIED BY THE SURGEON'S FIST

UPWARD INTO mE ABOOMENBELOtI THE RIB CAGE IS SEEN TO CAUSE THE DIAPHRAGM
TO RISE SEVERAL INCHES INTO THE PLEURAL CAVITY.

S11JDIES ON HEALTI-fYCONSCIOUS

ADULTS DOONSTRATED THt\T THE HEItvlLICH Ml\NElNER, PERFORf1ED IN THE APPROVED

fAANNER, CAUSES AN AVERAGE Fla1
rtOUTH IN

114

OF

940

SECOND AT A PRESSURE OF

CC OF AIR TO BE EXPELLED FROM THE

31

f1v1

It.

THIS AIR IS PRIMARILY FROM

THE EXP IRATORY RESERVE PLUS WHAT REMl\I NS OF TI-lE TIDAL VOLUML

HEIMlICH

-14 IS TIfRE /W( VALUE TO THE TRADITIrnAL rrHODS (f TREATING

CrnKlNG VICTIMS, SUCH AS PACK SLAPPING, REACHING INTO TIlE xum HITH (JJE/S
FINGERS, OR ruJTH-TQ-MlITH RESUSCITATHlr.
FOR YEARS TI-lE
SLAPPING,

INSERTING

RED

CROSS AND TI-lE HEART AsSOCIATION

FINGERS IN THE MOUTH, AND MOUTH-TO-MOUTH RESUSCITATION

TO SAVE A Cf-OKING VICTIM,

TI-lAT TI-K:>SETRADITIONAL

HE HAVE FOlMD NO PUBLISHED SCIENTIFIC

METI-K:>DSHAVE VALIDITY

INDICATION AS TO ~

IN FACT, THERE IS NO

THEY \'JERE ORIGINALLY ADOPTED,

THERE ARE, PERHAPS ANECOOTAL HISTORIES

THESE PROCEDURES HAS, ON OCCASION,
EX#1PLE,

EVIDENCE

IN TI-lE TREATMENT OF FOOD CHOKING,

NOR IS THERE A RECORD OF LIVES SAVED BY THEIR USE.

SCIENTIFIC

HAVE TAUGf-ff BACK

TI-lAT A CHILD PLACED FACE

THAT INDICATE ONE OF THE FIRST 1WO OF

BEEN SUCCESSFUL.
[)()'y'i'N

IS CONCEIVABLE,

FOR

WITH HIS ABJn.1EN OVER THE RESCUER'S

ARM OR KNEE HAS BEEN HELPED BY BACK SLAPS.

THE HEIMLICH MANEUVER WITH 11-IE RESCUER

IT

IS

THIS IS ESSENTIAllY
KNEE OR ARM.

PERFORMING

THE HEIMLICH r1\NELNER

CAN JUST AS WELL BE CARRIED OlIT IN THE USUAL APPROVED MA.NNER, HOWEVER, \~ITHOUT
CONFUSING RESCUERS BY ADDING ADDITIONAL

INSTRUCTIONS.

IN fv'ORE 1l-IAN SIXTY OF OUR FIVE HUNDRED DOCUMENTED CASES,

ONE OR ALL

OF THOSE METHODS WERE TR I ED UNSUCCESSFULLY AND OFTEN REPEATEDLY,

WHICH THE HEIMlICH

~tA.NELNER WAS USED AND SAVED THE VICTIM'S

LIFE.

FOLLOvlI NG

HEIMLICH

- 15FAILURE OF ALTERNATE r'1rnioDS

BEFORE HEIMLICH MANElNER SAVED CHOKING VICTIM

TOTAL CASES

1. BAcK BLows ,
2. FINGER PROBES .
3. f'buTH- TO-tIOUTH

4.
* <15 OF

,. 69 *

45

UPSIDE DOWN
TI-lE

69 ARE

20
7

COMBINATIONS OF

1 - 4)

IN 34 CASES (50%), THE COOKING PERSOO WAS APPROACHING LOSS OF

C~SCIOUSNESS
OR HAD BECCJA.E CCJIIATOSE, A FEW SECONDS FRa1 BRAIN DAMAGE OR
DEATH, DUE TO THE DELAY CAUSED BY TRYING OOE OR MJRE OF nSE ALTERNATE
METHODS, BEFORE BEING SAVED BY lHE HEH1 ..ICH MANBJVER.

HAVE BEEN ASKED ~ER

BACK BUMS

IN THE

45

CASES MIGHT NOT HAVE

LOOSENED THE BOLUS AND IMPROVED THE EFFECT OF THE HEIMLICH ~ElNER.
LOGICAL ANSWER IS ''WHAT LOOSENED THE BOLUS IN THE

455

THE

PERSONS hOOSE LIVES

WERE SAVED BY THE HEH1 ..ICH MANEUVER, WI-D WERE NOT SLAPPED ON "THE BACK?/I

BACK SlAPS
I N A REPORT BY THE MEn ICAL Assoc I AT I ON OF THE STATE

CASE REPORT:
OF ~,

3-1/2

YEAR OLD

MICHELLE

STRANGLI NG ON A PIECE OF CANDY.

HER UPSIDE 00r.tJ AND

sroo

CONSCIOUS ~1EN A NEIGHBOR,

~1ANElNER ON TELEVISION

TERRY OF rvbNTGOMERY, ALABAMA, WAS

HER tIOTHER BEAT HER ON THE BACK AND HELD

HER WITH NO SUCCESS.

r1ICHELLE WAS NEARLY UN-

WHO HAD SEEN A PHYSICIAN

PRESENT THE HEIMLICH

l1-iE DAY BEFORE, ANSWERED THE fv'OTI-fER'S CALLS AND

APPLIED THE HEIMLICH r1;NELNER.

THE CANDY, STILL

It1'1EDIATELY POPPED OUT OF MICHELLE'S

ENCASED IN TI-lE ".IRAPPER,

rouTH AND HER LIFE WAS SAVED.

HEIMLICH

- :1.6-

r~, WARREN

CASE REPORT:
INDIANA

RESTAURANT

HEIMLICH

MANElNER

SPANGLE,

ASSOCIATION,

OF THE

SOMEONE SLAPPED

ON TI1E PACK PRODUCES

THE

USED TO CLEAR THE BLOCKAGE AND BRING

HIM ON ill: BACK JUST

AIRWAY WAS CLEAR AND THE FOOD WENT BACK mIN

"POUNDING

VICE PRESIDENT

WAS CHOKING. ON FOOD AND STATES

WAS SUCCESSFULLY

. THE FOOD INTO HIS ttOUTH:

ExECUTIVE

NO

EFFECT

f'R.

AGAIN.

IN DISLODGING

AS HIS

SPANGLE

FOOD.

STATES,
(EMPHASIS

/I

IS

HIS.)

THERE ARE SEVERAL REPORTED DEATHS WHERE BACK SLAPS WERE USED BY
PERSONS

NOT AWARE OF THE HEIt1..ICH

CASE REPORT:
T IM1Y,

fiRS.

Mt\NEUVER. Two REPRESENTATIVE

C. AnNER \'lROTE TIiA T HER FIFTEEN

WAS CAMP I NG WITH HIS EIGHTEEN

EMERGENCY MEDICAL TECI-f'HCIAN

NOT IN THE HEIMLICH
INCLUDING
Sfi)\fl)

WHO WAS TRAINED

IN

RED

RESUSCITATION,

YEAR OLD SON,

BRADLEY,

CRoss

RED

BRADLEY USED ALL THE

Nt\NEUVER.

i"OUTI1-TO-M)lffif

YEAR OLD BROTHER,

CASES FOLLOW.

AN

TECH'JIQUES
CRoss

BUT

MEASURES,

BUT HIS BROTHER DIED.

MOPSY

THAT T IM'1Y HAD Cf-KlKED TO DEATI-l ON SPAGHETTI.

CASE REPORT:

CITY-CouNTY,
~EUVER,

DR.

HARRY

L.

GIBBONS,

DIRECTOR

CONDUCTS a-~E OF THE FOROOST

ATIRIBUTED

OF HEALTH,

TEACHING

\,IITH SAVING MANY LIVES.

AS WE

FIRST

NEW REPORT,

THE NATIONAL

OF Mt\NY CavlPLICATED

THEY STATE WAT

FIGURE

WAS SELECTED

IS DEVOTED TO HOW ONE DELIVERS

RESCUER.

STEPS

BUMS

RED

HE REPORTS

CRoss

THE DEATH OF

BACK.

RECOMv1ENDS FOUR BACK SLAPS

TO SAVE A CHOKING VICTIM.

ARBITRARILY.

LAKE

PROGRAMS OF THE HEIMLICH

A SMALL CHILD WHILE THE PARENTS POUNDED THE CHILD'S

IN THEIR

SALT

WHY

FOUR?

FULL PAGE IN THAT REPORT

TO THE BACK fURTHER

CONFUSING

THE POTENTIAL

HEIMLICH

-v HHY WERE BACK BLOWS NOT ONLY INCLUDED IN TI-lE

GIVEN HIGHEST PRIORITY?

RED

CROSS REPORT, BUT

THE DECISION WAS BASED, TO A LARGE EXTENT, ON THE

UNPUBLISHED PAPER, DISTRIBUTED

BY TI-lE SPEAKER, A

FOLLOWS MY PRESENTATION AT TI-lE JUNE

21 NATIONAL

RED

CROSS CoNSULTANT, WrlO

AcAnoo

OF ScIENCES

THAT PAPER STATES THAT ELEVATED AIR PRESSURES WERE OBTAINED ON

I-lIfWlS AND

ANESTI-lETIZED BABOONS WITI-l BACK BLOWS.

Z1.

HJWEVER, TI-lE SPEAKER WHO PRECEDES ME AT TI-lE JUNE

CONFERENCE, ON COMPLETION OF DUPLICATE EXPERIMENTS,

PAPER, liTHE TECl-fH QUE OF DELI VER I NG A
WAS ALSO APPLIED SEVERAL TIMES.

So

ANOJHER

CONFERENCE.

ANESTI-lETIZED

RED CRoss

CONSULTANT,

NATIONAL kADEMY OF &IENCES

STATES,

IN HIS UNPUBLISHED

SHARP BLOW BETWEEN TI-lE SI-()ULDER BLADES I

INEFFECTIVE

WAS TI-lIS PROCEDURE IN CREATING

AIRFLOW OR INCREASED PRESSURE WITHIN TI-lE CHEST, THAT IT WAS ABANOONED."

MN CASE,

IT HAS BEEN SHOr;'N BY

ELECTRICAL ENGINEERING,
UNIVERSITY,

DR.

ErMARD PATRICK,

PH.D., M.D.,

IN

PROFESSOR OF

PuRDUE UNIVERSITY AND PROFESSOR OF r1EDICINE,

INDIANA

THAT IT IS THE AIR FLCM THAT PROVIDES TI-lE KINETIC ENERGY WHICH

r-DVES A BOLUS AND CAUSES IT TO FLY OUT OF TI-lE AIFMAY, NOT THE PRESSURE.

THE FIRST MENTIONED RED CROSS CONSULTANT ALSO PUT A PIECE OF MEAT IN
TI-lE THROATS OF SEDATED DOGS AND Forn
BLOWS LOOSENED THE BOLUS.
ME OF Q:TOBER

I DO

Brr.

ANESTHETIZED BABOONS AND SUGGESTED THAT BACK

AS STATED BY DR. PETER SAFAR IN HIS LmER

30, 1974, '1~lEWOULD LIKE

TO

TO SEE YOUR MANELNER STUDIED IN PRIMATES ...

NOT KNOtI HOW ONE CAN DO TI-lIS IN UNANESTI-lETlZED f'IONKEYS.

ANESTI-lESIA OR

SEDATION \,-/OULD REDUCE SPASM, h'HICH IS AN IMPORTANT FACTOR IN ASPHYXIA FROM FOREIGN
BODY INHALATION.

II

HEIMLICH

- 18 27, 1975, I

AT THE RED CROSS CONFERENCE OF ctToBER

PRESENT KNEW OF A LIFE BEING SAVED BY BACK BLOfIS.

CONSULTANT (THE NEXT SPEAKER ON THE JUNE

No

OTHER PARTICIPANT

THE SAME

21 NAS PROGRAM)

HIMSELF HAD SAVED THE LIVES OF THREE INDIVIDUALS

BY USING BACK BU~S,

ASKED I F ANYONE

RED

CROSS

STATED THAT HE

CHOKING ON FOREIGN BODIES

OR OBSERVER KNEW OF A LIFE

BEING SAVED BY BACK BLCMS.

FINGER IN THE MJJrn TO REKNE FOOD

fWN

CASE REPORT:

PHYSICIANS

HAVE SAVED CHOKING VICTIMS USING mE

HEIMLICH MANElNER, AND WE KNCM OF TWO WHJ WERE THEMSELVES SAVED,

(ME

DOCTOR, AT J\ COUNTRY CLUB, REALIZED HE WAS STRANGLING ON A PIECE OF BEEF.

/\NOTHER PHYSICIAN
ONLY SQ\1E ICE

PUT HIS FINGER INTO 111E VICTI1'S

mAT WAS IN \,/ATER THE VICTIM

I-W)

MJU111, GmING
TRIB)

TO DRINK TO

OUT
II

WASH

mE MEAT DOWN. II

THE VI CT I M DESCk IBB) HIS I<NOtJLEDGE OF HIS I MPENDI NG

DEATH IN DETAIL,

111EN STATB) THAT A WOMAN (NOT A PHYSICIAN)

CAME UP BEHIND

HIr1, APPLIED THE HEIMLICH f'lANEUVER AND SAVED HIM,

ff

CASE REPORT:

TONS I L WAS LACERATED BY A RESCUER'S

F I NGERNAI LIN

UNSUCCESSFUL A1TEMPT TO REMOVE FOOD FROM A CHOKING VICTIM'S

IN SEVERE BLEEDING.
MANEUVER.

MOUTH, RESULTING

THE RESCUER THEN SUCCESSFULLY USED THE HEIMLICH

fNE MEDICAL EXAMINER HAS REPORTED EXTENSIVE ntROAT LACERATIONS

FROM THIS CAUSE IN VICTIMS WHO DIED OF FOREIGN BODY ASPHYXIATION,

CHILDREN.

AN

PARTICULARLY

HEIMLICH

-19 THE RED CROSS REPORT GIVES HIGH PRIORITY

TO THE RESCUER PROBING

THE THROAT WITH FINGERS TO REMOVE A FOREIGN BODY,

PROFEssoR
CHILDREN'S

OF OrOLARYNGOL<XJY, NORlli'IESTERN
ME.MJRIAL HOSPITAL,

GABRIEL

UNIVERSITY

F,

TUCKER, M.D.,

AND HEAD OF OrOLARYNOLOGY,

CHICAGO, A LEADING AUTHORITY ON FOREIGN BODY

CHOKING, HAS DESCRIBED IN SEVERAL TEXTBOOKS THE t-WlNER IN \'n-lICH PARTIAL

RESPIRATORY BLOCKAGE HAS BEEN CONVERTED TO COMPLfE OBSTRUCTION AND DEATH
BY INSERTING

FINGERS INTO THE CHOKING VICTIM'S

HE HAS DEfVONSTRATED BY AUTOPSY FINDINGS,

FINGERS DEEPER INTO THE WINDPIPE
THE WINDPIPE,

ttOOl1-l,

ESPECIALLY

THAT OBJECTS ARE PUSHED BY THE

OR INTO THE ESOPHAGUS, WHERE THEY COMPRESS

ASPHYXIATING THE VICTIM.

IT IS ADVISABLE TO DESCRIBE THE

MANNER IN WHICH FINGER PROBES MIGHT BE USED, WITH APPROPRIATE

BUT NOT, AS IS STATED IN THE

RED

IN CHILDREN.

PRECAUTIONS,

CROSS REPORT, AS A PRIt-1ARY PROCEDURE TO BE

USED ON THE UNCONSCIOUS VICTIM WITH SUSPECTED FOREIGN BODY OBSTRUCTION.

DR. HIl.LIAM
ON

50

AUTOPSIES

J, BRADy,

CHIEF MEDICAL ExAMINER,

00 FOOD CHOKING VICTIMS,

OF THE PHARYNX THROtx;H THE MJUTH '"

THE BOLUS,

I F PRESENT,

STATE OF OiEGON,

REPORTING

STATED IIExAMINATION BY VISUALIZATION

WILL PROVIDE A COMPLETELY UNRELIABLE RESULT,

CHARACTER ISTI CALLY, I S NOT VI SIBLE lliROUGH THE MJUTH.

HE HAS ALSO SHOWN THAT MOUTH-TO~

RESUSCITATION

II

HAS BEEN RESPONSIBLE

FOR DRIVING A PARTIALLY OBSTRUCTING OBJECT DEEPER INTO THE AIRWAY AND CAUSING
DEATH.

HEIMLICH

- 20 HEIMLICH MAN8JVER 1ECHNHlJE

(LYING

IN

DawN

THE JOURNAL OF ll-IE ftMERI CAN

I ORIGINALLY

CtTOBER

2J, 1975,

FOR PERFORMING THE

ONE hHEN THE VICTIM IS STANDING OR SITTING:

WHEN THE VICTIM IS SUPINE --

M:n I CAL Assoc IATI ON,

DESCRIBED ll-IE 'TWO SIMPLE POSITIONS

HEIMLICH f1A.NEWER --

HHEN

POSITION)

ll-IE SECOND

LYING ON THE FLOOR.

ORIGINATED THE SUPINE POSITION,

EMPHASIZED ITS NEED

IN lWO CIRCUMSTANCES:
!\)

THF: RESCUER

IS TOO Srv\LL

TO REACH AROUnD TljE VICTI~1 OR TOO I/EI\K

TO ADEOUATELY PEnFOf\t111IE

III

POSITION.
STRF.JJGTH,
B)

FRon

i'\t\NEUVE!I ItJ TIlE STNmIr~G

TIlE SUPIrIE

POSITIOtI,

TI-IE GrJSET OF FOOD CHOKING TO DEAI1I IS i\PFP.OXU;I\TELY

H(I\'/[vER,

IS JUST A ML\TIER OF SECOUDS.

RESCUE TECHtH()IJE

I:)()'rlN -

HElr1.ICH

r1UST BE INSTAfHLY

U;/COi/SCIO'JS),

THE OUICKESL

,'(lST

APPLl ED,

M4NEUVER AS OFFICIALLY

1. VI CT I MIS LY I w; on HIS BAC K

2. FACING VICTH-i, ~Jj[[L ASTRIDE

ENOORSED:

HIS HIPS

\'III1~ otlE OF YOUR IINlDS ON TOP OF TI-1E OlHER,

YOUR DOTIOn

FOUR ,W/ljfE).

fjl\S ALf<F.ADY COLLAPSED 10 Tl-lE FLOOR (FALLUJ

SUFNIVI\L

EFFECTIVE

VICTIM LYING

nor

RESCUER USES HIS I'JEIGHL

TO PRESS UP'I'IARD ON THE D I APHRAGr,1.

\,IHEU TIlE VICTJ~l

3,

njE

OR SITIlilG

PLACE THE IIEEL OF

HN m orl TI If. AlJIX)r"[N SLI Gl-fTLY MOVE TIlE NAVEL N III f)ELOI'I

I1jE RID CAGE

IL

PR[SS

5.

P[PEA T SEVERAL T I~i[S

!tHO 111E VI CT Jr',' S APrX)f-i[N

\';f

11-1 A GJ1JJ~J(__J!Ll'![IRlLIJJDllc;J-.

I F NECESSARY.

THIS ~T1-IOD HAS BrnJ PRaVEN TO SAVE TIf LIVES OF (HOKING VTr:TTM~_

HEIMLICH

-21THE

RED

CROSS CONSULTANTS ADDED AN ADDITIONAL POSITION

DESCRIBED BY DR, HEIMLICH IN

rlHEN THE VICTIM

IS LYING OOWN.

SIDE OF THE VICTIM,

SLAPPING,

JAJ"lL\

TO l'HAT

FOR PERFORMING THE HEIMLICH r1ANELNER

THEY WISH TO DO THE MANEUVER FROM mE

SuPPOSEDLY,

THIS EXTRA POSITION

ENABLES BACK

PUTTING FINGERS IN THE MOUTH AND GIVING MOUTH-TO~

RESUSCITATION,

ALL TECI-I'lIQUES THAT t-1AYFATALLY DELAY THE ONE PROCEDURE

1<NC1r'JN TO BE SUCCESSFUL -- THE HE I fv1L I CH f1\NEUVER,

ITIS

OF GREATER

CONCERN l'HAT THERE IS NO EVIDENCE THE HEIMLICH r1o.NEUVER CAN BE PERFORMED

FRQ'v1 THIS NEW POSITION

--

RED

EXCEPT PRESSURE STUDIES MADE BY THE

CROSS

CONSULTANT ON THE FOUR PABOONS AND SIMILAR EXPERIMENTS OONE ON SIX

..uMANS SUBJECTED TO n~E RISKS

DR,

It,\RRY

OF ANESTHESIA FOR THESE TESTS,

L. Grr_mor~s, DIf~ECTOR

OF f!EALl1-1,

SALT LAKEC lTY-CoUiIT{,

IS THE

PUBU C HEALTH OFF I C I AL hHO HAS BEEN CONDUCTI NG Of ~f:: OF TIlE "'(lST C<TE' IS IVE
TEJ\GlJriG

PROGRN"S

THE IIEIf'lLICH
UTAII.

/'IBDa'lErJ

I-{,,\S ADVISED

RUPTUP-E OF THE LIVER

TIl~IR

INSTRUCTIONS

DIRECTLY

AND IS CREDITED

TIlE

Pm

CROSS THilT

TO USE l1-1E 'iETlIOiJ TI!EY RECOI!.'Hm

OR THE OTHER,

OR SPLEEn.

BY SAYIfl(:;,

PRESS TO EITH[R

SIDE."

LAY RESCUER IN nlE

r1' S

TI!E

IT IS

FE\'I stcoms

r.or

~1ll1-10UT PRESSlilG

rVIIl'

NJD PRESS

ml

OrlE SIDE OF THE

If LJURY --

1111 S DM IGER J ~I

TO',JARD THE D I APHRAGr1.

EXTRA INSTRUCTIONS
OF LIFE

rUST

HI

PfNSICAlLl'

I NTEf~N.l\l

CROSS ACIJ IO\'/lmGES

LIVES

"POCK FOR\'IARD SO THAT YOUR SHOUU)[JIS

MDonEN

TI!CSE

RED

STAFF H),S Tf\.lY;HT

\-IITH ;_:r\VItlG

SUCH PF<ESSURE tvW CAUSE SER rois

OVER THE VI CTI

lhs

rf~OELEt-1S IN THE COUfJTRY,

f'~~VjEUVER TO 1110USNlDS

DR. GIBBONS

POSSIELE

ON (fDKIf'lG

!IRF.
I

BE COf~SID[].(W

LEFT TO THE UfiCOflSCIOUS VIeTH1.

DO t ;OT
BY THE

HEIMLICH

-22SINCE

THE ADD IT I OiJl\l

RED

TI-lE

BY HIE [(ED (noss

RESCUER TO USE HIS BODY I--IEIGHT Iii APPLYING

EnABLE H1E SI''ALl

f'A~jEUVER,

POS IT I ON SUGGESTED

(ROSS

DOES NOT
THE HElr-~LlCf!

ADV I SES f-W,l TO USE THE ASTR I DE POS IT I Oil --

THE SN'iE onE DESCR I BED BY jJr<.

HE If'lLl

CH I N

jNl~,

TIV\ TIS,

Till S ADDS TO THE f<ESCUEf< IS

COIJFUS ION,
THE POSITION
ItI

JNV'I,

IS SU IT MLE

NW tors

Nl OUTSTNloHlG
ItHERNAL

RED

HGSPIT/\L,

FIFTY-SiX
FIFTY-FIVE
APPflPErlT

ON TI-lE OTIIER ffAfID,

TI-lE HEIr'lLICH

AS PUBLISHED

H,\rIEUVER,

ACCORD JrJS TO

CNJ CAUSE S[RIOI)S

TI-lAT T U1E nE TAKEU TO USE ~iJun 1- ro-rouru

VICTI~lS

R. 1<.

III\UGUI,

FLcmIfll\,
HI TIlE

AS TJ-IEY ~v\Y BE HI\VIrIG A HE/\RT (lTTI\CI~,

(SF)) COtlSECUTIVE

DEPARn1ENT

l'nlO PRESENTED

rlo'l

OF rI\TIIOLOGY.,

TO TIiE RED (POSS

l:.NGLI\UD JOURfti\L

I ES or ~ ALL PER sot ~s DY Ir~G SUDDEnLY

COrTllnEE

OF f,1[DIClilE,

I rl RESTAURNHS

J rJ

110LY CROSS

OF THE RESULTS

TJ-1A T CITY,

CASF:S OF SUDIIErJ DFATI1 IN PtSTAURflNTS,

HE F0urm

(~8+%) OIFJ) OF FOOD CHOKInG AND (lf1LY orlE (IF A COROW\f\Y,

TIlI\T lJNLESS'TI1E

IS BREATHING,

CONFUS I NG, NJD,

Li\UOERDALE,

()C))

TO S{\VC LI VES,

THE I\DD IT I ot Jl\L RED

S I DE OF TIlE ArDOr,lEN,

IS UtlPROVEtl,

CROSS REPORT HEcory.nlJ)S

FT,

oESCRIl3ED

HAS BEEr~ U~ED SUCCESSFULLY

ON EITHER

TIlE "IORK OF fiR.

HIS 'FIrIDIr'IGS,
OF urors

FOR [ILL RESCUERS,

ON &J~,UNCONSCIOUS

Ic:tIORES

AS ORIGIW\LLY

AUTI-lORITY orJ TEJ\CrHNG

r NJURY

VE~jTlLATrot~
THIS

THE VICTII'1,

NOT CAUSE PRESSURE

CROSS POS IT ION,

THE

ASTRIDE

IrIDIVlDUAL

THE LOGICAL TREATr'1[NT

FOUW) UNCONSCIOUS

HI I\r~ E/\TJrJG

Ifl
THAT
IT IS

ESTI\PUSlli1GIT

IS TO PERFORi1 TH[ HEIt'1L1CH ['1,r,:i[U\Tf: "/ITll!)'JT

DEl/'ll',