Paso Robles water park lifeguards use discredited Heimlich maneuver

August 22, 2011

By KARLEE PRAZAK

The Heimlich maneuver is most commonly associated with saving choking victims as a way to dislodge whatever foreign object is obstructing the airway. But, the use of the maneuver on drowning victims has been widely discredited and experts say it can actually do harm.

Nevertheless, the lifeguards at the Ravine Water Park in Paso Robles continue to be trained to use a technique called dangerous by numerous experts, and water park owner Jay Walsh said he doesn’t plan changing the lifeguard protocol any time soon.

“We subscribe to that protocol, and we like the way it has worked in the past,” Walsh said. “We’re comfortable with the procedure for now.”

The failed analysis with the abdominal thrusting for drowning is that the victim is choking on water. This was disproved by studies which found that the victim experiences a laryngospasm, during which the larynx closes to prevent water from entering the lungs of a drowning victim.

Cardiopulmonary resuscitation (CPR), therefore, is more effective because the drowning victim is experiencing a lack of oxygen — not choking. CPR forces the needed oxygen into the lungs, as opposed to forcing what little oxygen remains in the lungs out with abdominal thrusts.

The protocol Walsh referred to comes for the water park’s lifeguard certification company — National Aquatic Safety Company (NASCO). Walsh said his lifeguards have been certified by NASCO for the past five years, and although he said he has “heard discussion in the industry regarding various procedures,” he isn’t ready to part with NASCO procedures.

“To tell you the truth we are just following the NASCO protocol right now,” he said. “Until it changes from the NASCO guys, we will continue to use their system.”

Other organizations, such as The American Red Cross and the International Life Saving Federation, discredit the Heimlich as a way to rescue drowning victims. The American Red Cross even calls it “unnecessary and potentially dangerous.”

When asked about the use of the Heimlich on drowning victims, Walsh said they refer to it as more of an abdominal thrust that the lifeguard chooses to use, as opposed to a “chest thrust,” which is more reminiscent of CPR.

“I’ve seen and heard of it working multiple times over the past few years,” Walsh said. “It’s worked so many times, that’s why we keep using it.”

The American Red Cross would disagree though. The Advisory Council on first aid and safety for the American Red Cross concluded from scientific studies in 2006 that the Heimlich maneuver is neither effective nor a safe method for attempting water removal from the airway or lungs of drowned people.

NASCO founder and President John Hunsucker, who holds a Ph.D. in mathematics and engineering, stands behind his teaching of the Heimlich maneuver. After numerous media outlets reported unfavorably on his methods, he has refused to talk with the media.

In 2007 Hunsucker told the Huston Press, “Nobody knows more about water parks than me. Eventually I’ll wear them down and everybody will be doing it. These so-called medical experts … Screw ’em. What do you want me to do, walk in lockstep?’”

Walking “in lockstep” might prove to be the most effective way to save lives, based on the numerous findings of the American Red Cross and other scientific studies.

One last critic of the Heimlich maneuver who would agree with eliminating the abdominal thrusts from lifeguarding is Peter Heimlich, the son of Heimlich maneuver-founder Henry Heimlich.

Peter Heimlich created a website that criticizes the Heimlich and his father for the effectiveness of the maneuver.

“Facts indicate that in 1974 my father, who knew nothing about the physiology of drowning, simply dreamed it up,” Peter Heimlich says on the website. “My research uncovered that from 1974-2003 my father and a physician from Potomac MD used cronies to fabricate a string of cases in which drowning victims were allegedly rescued by the use of the maneuver.

“To encourage the public to perform the procedure, the cases were planted in the media and then my father published them in medical journals.”


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eddesuss

“NASCO founder and President John Hunsucker”


Here’s his picture. I sure wouldn’t want to have to pull this stout fella out of the drink!

http://short.as/ckq


mountainman

There are 5 stages commonly associated with drowning in normal water temperatures. Times included are for example and not exact.


Surprise (30-60 seconds)

Involuntary Breath Holding – laryngospasm (60-180 seconds)

Unconsciousness (180-240 seconds)

Hypoxic Convulsions (240-300 seconds)

Clinical Death


No one that I am aware of disputes the fact that the quicker you are able to “break the chain” of the drowning process and introduce oxygen back into the lungs, the better chance of resuscitation and survival.


For this to happen successfully, a lifeguard must recognize and respond ideally within the first stage of “surprise”. If lifeguard intervention occurs in a later stage, every second is critical. Typically, a lifeguard has to recognize, respond, contact, retrieve, and extricate a swimmer before even beginning the evaluation and resuscitation. If a lifeguard can perform a simple maneuver of a few abdominal thrusts, in the water upon first contact, precious seconds are gained.


The abdominal thrusts will open the airway (laryngospasm) and draw oxygen into the lungs with the compression and expansion of the abdominal cavity. The abdominal thrust is prescribed by all water safety agencies that I am aware of, for the proper treatment of a person suffering from laryngospasms.


Mugwump

“The abdominal thrust is prescribed by all water safety agencies that I am aware of, for the proper treatment of a person suffering from laryngospasms.”


Name those water safety agencies.


zaphod

Spit or swallow


mountainman

If anyone would like more information, there are tons of articles posted about these changes in CPR guidelines. There is a direct correlation between these changes and water rescue techniques that I described in my earlier post.


American Heart Association Endorses Chest-Compression-Only CPR


The 2010 AHA Guidelines for CPR and ECC recommend a change in the BLS sequence of steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, Airway, Breathing) for adults, children, and infants (excluding the newly born; see Neonatal Resuscitation section). This fundamental

change in CPR sequence will require reeducation of everyone who has ever learned CPR, but the consensus of the authors and experts involved in the creation of the 2010 AHA Guidelines for CPR and ECC is that the benefit will justify the effort.


http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf


Chest-Compression-Only CPR Saves More Lives


Researchers found that adults who experienced cardiac arrest in a non-hospital setting, such as a restaurant or mall, were 60% more likely to survive if they received compression-only CPR than if they received traditional CPR or no CPR until an emergency medical services (EMS) crew arrived at the scene.


http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives


Mugwump

“There is a direct correlation between these changes and water rescue techniques that I described in my earlier post.”


Because you say so. Wow, *that’s* a persuasive argument.


We’re all still waiting for your answer to my previous question:


“Since you portray yourself as authoritative on this subject, can you provide the name of a single emergency medicine MD or any first aid or water safety organizations that recommends performing the Heimlich to resuscitate near-drowning victims?”


My guess is no. My other guess is you’re unwilling to admit that you can’t produce a single legitimate source to back up your claim.


So exactly why is anyone supposed to take you seriously?


r0y

You don’t integrate into social settings well, do you?


Mugwump

I prefer “doesn’t suffer fools gladly.”


Typoqueen

r0y, I knew we could agree on something.


R.Hodin

The point is valid, nonetheless. Mountainman hasn’t supported his assertion of correlation (CPR revisions to abdominal thrusts), neither has he provided a link to the professional water rescue org recommendations.


But it’s always sporting to go after the messenger.


zaphod

scroll down `’Ziggy”


Typoqueen

I was just too curious so I did a bit of reading about this and now I’m not sure what to think. One website said that all lifeguards are certified through NASCO (not saying that all water parks use thier guidelines though) but this article and the link provided by one poster seems to indicate something else, so I’m not sure about that.


At first I thought that the Heimlich was all wrong. I took CPR through the Red Cross and they taught us not to use the Heimlich on near drowning victims. But when I looked it up I saw that there are several good arguments by many experts on both sides of this issue. I tend to agree with the argument that if water is blocking the airway that perhaps a thrush will initially push that water out faster and perhaps make CPR more efficient after the initial thrushes. But I’m not a lifeguard or a doc so I can only go by what seems to makes sense to me.


Mr. Whipple

“I saw that there are several good arguments by many experts on both sides of this issue.”


False. No drowning experts recommend performing the Heimlich on drowning victims. If you disagree, provide the details, but prepare to have your wings clipped.


“I tend to agree with the argument that if water is blocking the airway that perhaps a thrush (sic) will initially push that water out faster…”


You don’t have a clue what you’re talking about.


http://goo.gl/PYbCm

Adult Basic Life Support: 2010 American Heart Association Guidelines:

“There is no evidence that water acts as an obstructive foreign body. Maneuvers to relieve foreign-body airway obstruction (FBAO) are not recommended for drowning victims because such maneuvers are not necessary and they can cause injury, vomiting, aspiration, and delay of CPR.’


Typoqueen

This isn’t a political issue, it’s not worth debating. As I said, I’m not an expert, I was just going by a few websites that I read. If this were a political argument then I would discuss it with you but seeing that I’m not a lifeguard or a doc then I see no point, although I’ve taken CPR this simply isn’t my forte. If you don’t believe that there are reputable sources that feel that the Heimlich can be an effective addition to CPR then you are the one that’s clueless. I’m not saying they’re right or wrong, you’re the expert lifeguard and grammar cop so I’ll leave the rest to you.


Mr. Whipple

“If you don’t believe that there are reputable sources that feel that the Heimlich can be an effective addition to CPR then you are the one that’s clueless.”


What a childish rejoinder. I asked you to provide those sources (which you claimed to have located) and obviously you’re unable to do so.


Typoqueen

As I said, I’m not going to waste my time on Googling this topic or on you again. One source that I don’t have to waste time looking up would be NASCO, they agree and to some are a reputable source. They might be crazy, I don’t really care.


r0y

No, what you shouldn’t get (and what I don’t get) is why NASCO seems fine with the Heimlich still. The park picked their certification company, perhaps the problem lies in the certification process?


I’d like to know what NASCO’s replies to the Red Cross are (or any other org. that no longer uses Heimlich for drowning).


mountainman

What an interesting piece of slash journalism. No investigation and all sensationalism.


Abdominal thrusts are not used as a substitute to CPR … only in conjunction. It is a rescue technique that can be performed easily and effectively in the water while swimming with a victim. CPR can only be performed effectively on the pool deck on a firm/hard surface.


The abdominal thrusts accomplish three important steps in resuscitation efforts.


1. Open the airway. When the epiglottis is exposed to water, it seals shut. This is an involuntary response and is designed to keep water out of your lungs. This is actually and endorsed maneuver by the Red Cross and other agencies for what is defined as a “dry drowning”.


2. Once the airway is open, the compression and then expansion of the abdominal cavity will draw in fresh air into the lungs. This air actually has more oxygen content that exhaling your breath into the victim via “mouth-to-mouth”. It also keeps the rescuer and/or victim from passing pathogens without a proper barrier mask.


3. Lastly as stated before, this maneuver can be accomplished in the water with minimal effort and/or skill. This SPEEDS the introduction into a drowning victim. Without the delay of swimming a victim to the side of the pool and extracting them to the deck which takes a considerable amount of time.


This is really no different than several emergency agencies advocating for chest compression only CPR for first responders. It is only the water that makes the difference here and the necessity for TIMELY action.


Mugwump

mountainman, I’m all for investigation, especially when it comes to life or death issues.


Since you portray yourself as authoritative on this subject, can you provide the name of a single emergency medicine MD or any first aid or water safety organizations that recommends performing the Heimlich to resuscitate near-drowning victims?


If not, people may get the impression that you’re just another doofus with an internet connection.


Mugwump

Typo, sorry. Make that “recommend.”


sloslo

This article brings up some interesting points, but the way it is structured makes it seem like the author has an axe to grind with the Ravine water park and intends to damage their business rather than focus on the real story here, which is NASCO’s endorsement of the Heimlich maneuver.


Nowhere in the article is it mentioned what other pools and water parks in the area also subscribe to the NASCO guidelines, or any other statistics that would indicate how common this is in the industry. I doubt the Ravine is the only one, and if they are, this article should mention other parks they talked to. To solely focus on the Ravine without investigating any other swimming pools or water parks seems myopic and irresponsible journalism.


Also, it doesn’t sound like the reporter investigated the Ravine’s safety record to discover if there have been any injuries related to using the Heimlich or otherwise. From what I understand, the Ravine has a good safety record, but I would be interested in hear if that is not the case.


I hope that future articles delve more deeply into what they are covering and not try to merely publish sensational headlines to grab people’s attention.


Typoqueen

Great point, I would like to know if other local lifeguards use NASCO guidelines. There was a day when reporters would have automatically called each local rec facility to find out what they use. If other’s use this same protocol then it sounds as if they’re just picking on this particular place. If others do use the Heimlich then people need to know so they can be informed when taking their kids to these places.


ubell

NASCO client list dated 2004-08: http://scr.bi/hNMwF0


Typoqueen

@ubell, thanks for the link. Well as of 08 thier client list is pretty small,,,no wonder. They only have two clients in Ca. Was the Ravine Water Park not open back then, they’re not on the list? BTW, shouldn’t ‘ravine be spelled raveen or ‘ravean’, when I look at that word it looks like it should be pronounced rah and then ‘vine’ as in wine. Nothing to do with the story, sorry.


sloslo

Only two clients in CA?? I count at least six clients on that list in California:


Bonfante Gardens – Gilroy, CA

Dry Town Water Park – City of Palmdale, California

Morgan Hills Aquatic Center – Morgan Hills, CA

Paramount Waterparks/Great America – Santa Clara, California

The Wave Waterpark – Vista, California

Six Flags Hurricane Harbor – Valencia, California


Lifeguard

Dry Town Water Park – City of Palmdale, California

http://www.cityofpalmdale.org/drytown/policies.html

“All lifeguards are NASCO certified”


Typoqueen

My bad sloslo. I have no idea what I was doing when I posted that, probably rushing around as usual but when I just went back to the link I realized that I only looked at the first page. I stand (embarrassedly) corrected.


xappebum

Washington Post, 6/3/11: http://tinyurl.com/5r5cab8


‘The list of experts who reject the Heimlich maneuver is lengthy: The American Red Cross; the United States Lifesaving Association; the American Heart Association; the Institute of Medicine; the International Life Saving Federation and many experienced doctors and academics have strongly inveighed against doing “abdominal thrusts” for drowning victims…Dr. James Orlowski said he has documented nearly 40 cases where rescuers performing the Heimlich maneuver have caused complications for the victim. Orlowski is chief of pediatrics and pediatric intensive care at University Community Hospital in Tampa.’


sloslo

I’m not disputing that the Heimlich maneuver is rejected by a long list of experts. I believe it. I just think that in the interested of presenting a fair and balanced article, they shouldn’t have just focused on the Ravine water park, but also have investigated other public swimming pools and water parks to determine how widespread the use of the Heimlich maneuver is in this county/state. Other articles and websites are quoted in the article, but the only swimming pool or water park owner that the article mentions talking to is the owner of the Ravine.


Cindy

What’s interesting here is that when a person has drowned it is from lack of oxygen, not from choking on something that is lodged in our throat. What there is, is “maybe water in the lungs” but we have lost consciousness from a lack of oxygen. So it makes perfect sense that CPR would express the water from the lungs while displacing it with needed oxygen. Isn’t that just common sense?


From what I have read (after reading this article) and looking to other resources, expelling any remaining oxygen in the lungs of a drowning victim is dangerous and in a serious drowning, more people die than are actually saved (in a serious drowning) when the Heimlich maneuver is performed! The New York Post wrote an article a few years ago and during the subsequent week most water parks stopped using the Heimlich maneuver and went back to CPR. After all, water isn’t something that lodges in our throat and chokes us.


I recall years ago while living in S Cal, I developed an allergy to Chinese hot mustard and my throat closed up in a restaurant. I suddenly could get no oxygen, none, it was horrible, it was as if my throat had just completely closed itself off! It so happened a paramedic friend of mine was at the bar with friends and heard my friend yelling for help. He tried a quick Heimlich maneuver and then asked me if I was choking on food, all I could do was shake my head no and keep fighting for a breath. He ran out to his car and came back with an injection for anaphylactic shock, it worked. BUT, before he got back from the parking lot, another guy ran over and started with the Heimlich maneuver, he kept doing it harder and harder because it wasn’t working, he broke/cracked three of my ribs and I woke up in a whole lot of pain for several weeks.


Don’t use that maneuver unless someone is actually choking on something that needs to be dislodged!


Cindy

Look at this, 8 thumbs down and not a single person say’s why. I wonder if they know that only two water parks or beaches use the Heimlich maneuver for drowning victims in this state and one of them is Paso Robles. Perhaps the nay -sayers think it should be used for people who aren’t choking, well good luck, but not on me.


sloslo

Only two water parks and beaches in this state use the Heimlich maneuver? Care to enlighten us where you got this information, because it’s not mentioned in the article. Another poster linked to a 2008 list that listed at least six California water parks that are clients of NASCO :


Bonfante Gardens – Gilroy, CA

Dry Town Water Park – City of Palmdale, California

Morgan Hills Aquatic Center – Morgan Hills, CA

Paramount Waterparks/Great America – Santa Clara, California

The Wave Waterpark – Vista, California

Six Flags Hurricane Harbor – Valencia, California


And it is possible that other places use the Heimlich maneuver as well. Unless you are claiming you have surveyed the water parks and beaches in California, you can’t state that as fact.


falecow

http://to.ly/aZVt

‘As the assistant CEO of St John Ambulance Australia’s Queensland branch, it has been Stephen’s job to teach and train people across the resuscitation industry…”In the US, they still advocate the Heimlich Manoeuvre for choking but in Australia, we believe the evidence shows it is dangerous and so our guidelines don’t promote it,” Stephen said.’


danika

A few years ago I was fine dining at Carl’s Jr. in Paso. I witnessed a young man stressfuly trying to clear his throat. Realizing he had food lodged, blocking his airway, I quickly went over and applied the Heimlich maneuver and out popped the food. It was reaction on my part, having been medically trained. I can see how applying this maneuver would cause question and should be carefully reconsidered.


I offer this thought to Mr. Walsh: when someone brings forth litigation for the loss of their loved ones because you insisted on maintaining this controversial technique, this very article will show you were aware of the risk and opted to continue your routine practice, despite the opportunity to change your protocol. Good luck getting your insurance company to pay out when this happens.