Cliff Radel, The Cincinnati Enquirer

Choking is the fourth cause of accidental death in U.S.

Red Cross recommends five back slaps and then five abdominal thrusts

Red Cross is evaluating research behind its guidelines for first aid for choking victims

CINCINNATI -- Since inventing the Heimlich maneuver in 1974 with a team of Jewish Hospital researchers, Dr. Henry Heimlich claims the procedure and its abdominal thrusts -- into the stomach above the navel and up against the diaphragm to force air from the lungs and remove obstructions -- have saved the lives of 100,000 potential choking victims. And yet the American Red Cross' first-aid procedure recommends five back slaps and then five abdominal thrusts for someone who's choking.

Those recommendations "horrify" Heimlich. "There has never been any research saying the back slap saves lives," he said. "We know the Heimlich maneuver works. So it comes down to a matter of life or death."

Choking is deadly. The National Safety Council lists choking as America's No. 4 cause of accidental death behind poisoning (35,600 deaths annually), vehicles (35,500) and falls (28,000). In 2010, the most recent year for which statistics have been compiled, choking claimed 4,700 lives, a 4 percent increase over 2009.

Heimlich believes some of those lives could have been saved by his maneuver versus slapping someone on the back.

"I don't want to fight the Red Cross," he insisted. "But I don't want people dying needlessly."

Heimlich has asked the Red Cross to produce research showing the effectiveness of back slaps over his maneuver. If the nation's traditionally final word in first aid can't put up, he wants it to shut up. Stop telling people to slap choking victims on the back, he says. Tell them to use the Heimlich maneuver.

"There is no evidence whatsoever that hitting someone on the back helps a choking person," Heimlich said. "Many scientific studies" have proven "if a person is choking and the food is in the airway, if you hit them on the back, it causes the food to go deeper and tighter into the airway."

Heimlich has tussled with the Red Cross before. The Washington, D.C.-based first-aid and disaster relief organization has gone back and forth over the years on endorsing the Heimlich maneuver.

This waffling has vexed the Ohio thoracic surgeon, prompting him to ask the Red Cross to remove his name from any of its literature and training procedures on choking.

"When they started calling for back slaps first and then the Heimlich maneuver," he recalled, "I wouldn't let them use the Heimlich name. Why? Because patients were going to die."

Heimlich has also been at odds with the Red Cross over his claims that the maneuver could help drowning victims and someone suffering an asthma attack. Researchers have seriously questioned both of those claims.

Now, at the age of 92, writing his memoirs, the doctor plans to appeal to the Red Cross one last time.

Turns out, Heimlich's timing is impeccable. The Red Cross is conducting its semiannual evaluation of the scientific research behind its guidelines for providing first aid to choking victims. The report is due Saturday.

It also turns out, however, that the research Heimlich seeks doesn't exist.

"To the best of my knowledge, after doing a pretty thorough literature search, no controlled studies exist comparing back blows to abdominal thrusts or anything else," said Dr. Richard M. Bradley, a member of the Red Cross' Preparedness, Health and Safety Services advisory council and an associate professor of emergency medicine at the University of Texas Medical School at Houston.

An independent source concurs. "The literature says there is no one definitive treatment to relieve an obstructed airway on a conscious person," said William Terry Ray, director of the University of Cincinnati College of Nursing's Nurse Anesthesia program. He looked at 40 years of research. The reviews concluded "a person may have to use the back blows as well as abdominal thrusts to relieve the obstruction, depending on what caused the person to choke."

No definitive study exists to support Heimlich's theory that slapping someone on the back can push an obstruction further down the throat. "The literature on this is not conclusive either," Ray noted. Studies cited in a review of research projects "used animals, cadavers and anecdotal evidence." But not living human subjects.

Matt Huesman, who used the Heimlich maneuver in August on a choking victim at his restaurant, planned to continue using the Heimlich maneuver over slapping someone on the back. He questioned science's lack of progress.

"The Heimlich maneuver has been around for a long time," he said. "Maybe it's time somebody got on it and did that definitive study."

Bradley agrees. But he knows that's not where the grant money is. Choking happens outside of laboratory and research hospital settings, he noted. "Not enough dollars go to out-of-hospital research."

Nevertheless, choking remains a killer.

"Anytime something is in the top five," Bradley admitted, "it is a priority for research."