To Save A Life: The Heimlich Technique

[Daniel Rogov]

Foreword: This is probably the only article I have ever written that I implore my readers not only to read but to read in depth and perhaps to print for future quick reference. Although I have started the piece on several humorous notes, there is nothing at all funny about the potential that we all have for saving a human life, and that is precisely what this piece deals with. This article has appeared at various times in newspapers, magazines and internet sites. It is as urgent today as it has ever been.

The Heimlich Technique - Saving A Life


There is no love more sincere than the love of food
- G.B. Shaw


There are all sorts of things that can stick in one's throat during dinner. When Queen Victoria was celebrating her Golden Jubilee, one of her guests was Princess Liliuokalani of Hawaii. During dinner, the Polynesian princess told Victoria: "Your Majesty, I thought you would like to know that I am a blood relative of yours." The astonished Queen asked how that could be. "My grandfather ate your Captain Cook" was the reply.

Such dangers exist even at breakfast. When Winston Churchill was breakfasting at Blenheim Palace, he entered into an acrimonious argument with Nancy Astor. In a pique, Nancy snapped: "Winston, I were married to you, I'd put poison in your coffee." Churchill retorted: "Nancy, if I were married to you, I'd drink it". And then there was the Marquis of Blandford who looked forward eagerly to his daily breakfast of bacon and eggs. One can imagine his dismay when one morning he lifted the cover of the silver dish which usually contained them and found in their place a tiny baby doll, all dressed in pink. The doll had been placed there by his wife to let him know that she had discovered that he had just fathered a new addition to the family of their friend Lady Aylesford.

The anecdotes are amusing but Nancy Astor, Princess Liliuokalani and the Marquis of Blandford have something far more tragic in common. Each of them died by choking to death while eating.

Food is marvelous - of that there can be no question. But choking can kill. In fact, choking is the sixth major cause of accidental death in the world today. The saddest part of this story is that most of these deaths could have been prevented. In 1974, Dr. Henry Heimlich discovered a simple maneuver that could save the lives of choking people. Although the technique is taught in nearly all first aid courses in the United States and throughout Europe, there are still far too many of us who are not familiar with it.

The first important thing is to recognize the choking victim. The person who is choking can neither breathe nor speak. After a short time the victim's face starts to turn blue and a hand reflexively goes to the throat. When asked if they are choking, nearly all victims will nod affirmatively. From the time one starts to choke you have four minutes to avert unconsciousness, brain damage and death.

A pamphlet published by the United States Department of Public Health suggests that too many people waste time wondering if the person is having a heart attack. Nearly all doctors concur that in case of doubt you should try the Heimlich maneuver first, and only then go on to give the kiss of life. In a recent English survey of 56 restaurant deaths, 55 were found to have choked and only one had a heart attack.

To use the maneuver on a standing victim, get behind the person, put your arms around him, make a fist and put it on the victim's stomach, below the bottom of the rib cage and above the navel. Grasp your fist with the other hand and thrust it sharply upwards into the victim's abdomen. You may have to repeat this up to six times, but in most cases the obstruction will pop out of the mouth after one or two thrusts. Take care not to squeeze the ribs themselves, as this could actually fracture a bone.

Although most people who realize they are choking tend to stand up, some remain seated. The Heimlich technique can still be used, simply thrusting from behind the victim's chair. With children (or adults who have already lost consciousness), it is best to put the victim on his or her back, with the head straight (sideways might block the escape of the offending object). Kneel astride the victim, position your hands and thrust in an upward direction. Take care in such cases not to thrust from the side as this could harm the liver or spleen.

In the event that you are the person choking, there are two ways to use the technique. Try punching your own paunch or, if that does fails, stand alongside a table or the back of a chair and jab your abdomen against it.

There are several actions that are not only useless but also potentially harmful. Slapping a choking victim on the back or poking fingers in the victim's mouth can waste valuable time and can drive the object further in. Nor should you let anyone who might be choking leave the room alone, as they might lose consciousness and die in the lavatory.

None of this knowledge should put a damper on the love of good dining. Several years ago, Dr. Heimlich, who used to dine frequently at Frank's Trattoria in New York wrote that his own favorite meal consists of raviolis stuffed with mushrooms, minestrone soup, veal scallopini with fried peppers and biscuit tortoni.

[Karen/NoCA]

Thanks for this Daniel. Had my husband Gene not known this technique, I may not still be alive. Twice in our married life, once in my 40's and again in my 50's I choked on meat that I had not chewed properly and swallowed. I pointed to my throat, and yes, I stood up, like the article says. Gene came to my rescue using the Heimlich, and out it came. Not a pretty site when one has guests as we did on the first occasion. I am very careful to chew my food now, especially meats. In both cases it was a matter of having a bit too much fun, wine, and talking. I am more careful now.

[Paul Winalski]

This is one of the basic life-saving techniques that ought to be taught as commonly as mouth-to-mouth resuscitation. But inexplicably isn't. Thanks for posting this.

-Paul W.

[Ian Sutton]

On a humourous note, my first awareness of the Heimlich maneuvre came via Gary Larson's Far Side cartoon, a wonderful example of a joke leaving the lead-up to the situation entirely at the mercy of the reader's imagination.

[Jenise]

In both cases it was a matter of having a bit too much fun, wine, and talking. I am more careful now.

So, you don't talk?

Seriously, very glad Gene knew what to do. This place wouldn't be the same without you!

[Daniel Rogov]

I just received an important update from a well-informed source – Dr. Heimlich's son who refers me to the latest information as published by the American Red Cross. This information contradicts what was earlier said about giving blows to the back.

Indeed one of the recommended first treatments is to help the choking person lean forward and then, quoting from the site "using the heal of your hand, give five forceful back-blows between the shoulder blades. Each back-blow should be a separate attempt to get the object out. If the five back-blows do not get the object out, give five abdominal thrusts", that is to say the Heimlich technique. "Stand behind the person, use one hand to find the naval. Make a fist with your other hand and place the thumb side of your fist against the middle of the abdomen just above the navel. …Now that you have your fist in the right place, grab that fist with your other hand. This is the position you want to be in to give five abdominal thrusts. Pull upward, quickly, with each thrust. Each thrust should be a separate attempt to force the object out".

It is important that throughout the first aid encourage the person to continue coughing. "Continue giving five back-blows and five abdominal thrusts until that object is coughed up, until the person starts to breathe or cough forcefully on his own or until the person becomes unconscious. If the person loses consciousness, gently lower them to the ground, taking care to protect the head all the way down"

Also recommended is that as soon as you have realized that someone is choking, conscious or not, you should have someone immediately phone 911 or whatever the emergency service number is where you live. If the first-aid you give is successful, be sure to phone back and tell the emergency service that the situation has been resolved.
The full Red Cross page can be seen at http://www.redcross.org/flash/brr/Engli ... hoking.asp

[Daniel Rogov]

And tonight, too lazy and too tired to prepare anything at home, pizza at a local joint. Two white pizzas, one with mushrooms, what was said to be truffle oil and onions; the second with coarsely grated Parmesan and arugula; and a salad of romaine lettuce, croutons, finely grated Parmesan and with those the 2005 Special Reserve of Recanati.

And now reflecting that I have been gaining weight. The thought of a diet terrifies me!!!! I shall thus simply follow my own good advice for a month or two by eating only half of whatever is served me.

Best
Rogov