Opinion: To Heimlich First or Not?

Three seasons ago in its National Pool and Waterpark Lifeguard Course, Ellis & Associates (E&A), a nationally known lifeguard training organization, introduced the use of the Heimlich maneuver at the front of its protocol for the treatment of a drowning victim.

For background, the widely known Heimlich maneuver is a procedure used to clear the airway of a foreign object and is taught in virtually all courses dealing with respiratory emergency. Named after U.S. surgeon H.J. Heimlich, the basic procedure consists of manually thrusting the diaphragm up into the chest cavity, which produces a high pressure in the chest that expels air up through the airway, thereby clearing it of foreign matter.

There are two basic camps on this issue. One position, held by organizations such as the American Heart Association and the American Red Cross, says you should attempt to ventilate first and then use the Heimlich only if needed. The other position held by E&A as well as the National Aquatic Safety Company, says you should do the Heimlich first and then ventilate only if needed.

The arguments for and against are covered in detail by my article "The Heimlich Maneuver and Drowning" in Splash magazine (vol.XVI, no.5, 1996). So they are not presented here. The important point is that the major arguments against doing the Heimlich first are that it delays the first breath and that there was no documented case studies supporting the work. The intention of this article is to discuss the data that the last three seasons have generated on the use of the Heimlich in the treatment of drowning.

Perhaps the reader should be reminded of some important points. There has never been an issue over whether the Heimlich clears the airway. The only issue is over where and how the Heimlich should be placed in the sequence. Basically, the two different positions can be described as Heimlich first, ventilate second or ventilate first and Heimlich second.

E&A Rescue Data Results
As mentioned earlier, this data represents a compilation of the B&A rescue data over the 1995, 1996 and 1997 seasons. This is data collected from a very large database. In it, the term "victim" refers to a non-breathing victim. There were, of course, many other rescues made, but since we are concerned with