the performance of the Heimlich, only victims who lost spontaneous respiration are covered here. Also included is an age frequency chart for the victims.

As an aside, all of these victims survived. Care should be taken to not read too much into the results. Maybe the victims would have survived without the Heimlich.

So the data shows that the Heimlich is enough about two-thirds of the time. The real answer is perhaps a bit higher since there is a tendency to administer follow-up O2 as a standard procedure. If this was done, then the rescue would be included in the 29 requiring follow up O2 and would not be included in the 83.

The age frequency data is a bit disturbing in that it shows a large percentage of the victims as being six years old or younger. One would expect a large percentage of younger victims since they constitute the largest number of users of most facilities. However, one would also expect the supervision of this age group by parents or other responsible adults to be more intense.

Comments
Some of the comments that were included in the data are worth commenting on. Following is a sample.

"Ten Heimlichs in water expelled fluid, 10 on land and spontaneous respiration occurred"

"Three Heimlichs in the water and the victim responded"

"Returned to normal activities after hospital release."

"Heimlich on land cleared airway and spontaneous respiration occurred"

"Heimlichs in water caused spontaneous respiration."

"Began to cough and breath spontaneously after Heimlichs"

The primary impression gained from reading all of the comments is that water gushes out and spontaneous respiration occurs. Since a common symptom of drowning is a distended stomach, the water gushing out may allow the diaphragm to drop and breathing to occur spontaneously.

There is an impression that is gained from reading the comments that the hospital stay is shortened by the use of the Heimlich. This supposition is difficult to support because of the sparse data on this subject. However, the concept makes sense. In doing the Heimlich, there is some chance that some amount of water is evacuated from the lungs. At the least, the water that is in the airway leading to the lungs is not blown into the lungs during ventilation. So, in most cases it is reasonable to assume that using the Heimlich first reduces the water in the lungs. This should damage the victim less and therefore result in a shortened hospital stay.

Conclusions
We do not know whether the victims discussed above would have survived without the Heimlich. However, there are some things that we do know. One is that they did survive with the Heimlich. Another is that in those cases where spontaneous respiration occurred, the risk of passing a disease either from the rescuer to the victim or from the victim to the rescuer was less.

We do know that two-thirds of the time, the Heimlich was all that was required. We do know that the Heimlich is easy to learn and to use. We do know that simpler is better. All of this leads me to my original conclusion. Every rescuer has to make their own decision, but as for me, I'm going to hug with the Heimlich before I attempt to ventilate.

J.L. HUNSUCKER, Ph.D., PE.
is the president of the National Aquatic Safety Company, a company whose sole role is to reduce the loss of life or injury, due to aquatic accident.

What's Your Opinion?
Do you side with Heimlich first, ventilate second? Or, ventilate first and Heimlich second?
Write to Illinois Parks & Recreation magazine with your view:
Letter to the Editor
Illinois Parks & Recreation
Illinois Association of Park Districts
211 E. Montroe Street
Springfield, IL 62701-1186
217.523.4273 (fax)
iapd@eosinc.com