A controversial method of using the famed Heimlich maneuver on near-drowning victims will no longer be an option for lifeguards at Lagoon’s water park.
Beginning this year, lifeguards at Lagoon-A-Beach will not use the lower abdominal thrusts as a resuscitation method, after the State of Utah determined the technique didn’t meet required standards.
Late last year, the Utah Department of Health denied an application from the National Aquatic Safety Company to continue to train and certify lifeguards at two Utah parks — Lagoon-A-Beach, in Farmington, and Cowabunga Bay, in Draper. After NASCO agreed to exclude abdominal thrust training for its Utah clients, the state again certified it. The Texas-based NASCO still teaches the Heimlich method in other states.
Utah’s ban on the thrusts is welcome news for Peter Heimlich, son of Henry Heimlich, the doctor who is credited with the invention of the maneuver named after him. The younger Heimlich, who lives in suburban Atlanta, has been on a crusade of sorts to stop his father’s technique from being used on near-drowning victims across the country. And he’s talking to anyone who will listen.
While the Heimlich maneuver is valuable for dislodging a piece of food or other solid obstruction from a choking person’s airway, Peter Heimlich says the only evidence that it works on drowning victims is a handful of anecdotal reports.
“I’m still shocked by his ‘Heimlich for drowning’ scam, which started in August 1974,” Heimlich said of his father in a recent email interview with the Standard-Examiner.
And he says he’s not the only one who’s shocked.
“Long before I entered the picture, the top medical and water safety organizations and drowning experts had thoroughly reviewed and dismissed my father’s claims,” Heimlich said. “They unanimously agreed that the treatment was unproven, has no merit, and was potentially harmful.”
Erin Sutton, Lagoon-A-Beach manager, is in charge of lifeguard training at the Farmington amusement park. Each January, she and a few other staff members attend a three- or four-day NASCO safety school, then return to Utah and teach the techniques to the park’s lifeguards in more than 20 hours of training.
Sutton attended her first NASCO safety school in January 2010, and they were teaching abdominal thrusts at that time. This past January, the Utah lifeguards were not taught that method.
“The State of Utah did some research and decided they didn’t like the abdominal thrusts, and so they said ‘We’re not going to approve you if you teach the abdominal thrust,’ ” Sutton said. “NASCO, because they’re willing to adapt their courses to facilities depending on what people need, said ‘If you’re not going to allow that, then they don’t need to teach that in Utah.’ It’s still in their curriculum, but that’s something we will not be teaching to our lifeguards.”
Sutton said the abdominal thrust technique has never been applied on a swimmer at Lagoon.
“Thankfully, we’ve never had to use it,” she said. “We’ve never had a drowning. Ninety-nine percent of what happens is kids wander in a little too deep and they go ‘Uh-oh,’ and then the lifeguard assists, puts them back on their feet, and takes them where they can touch bottom — and sometimes we’ll issue them a lifejacket. That’s kind of business as usual around here.”
Lagoon is a shallow-water facility, with no areas deeper than five feet, so the training isn’t the same as for, say, a diving pool.
“We don’t have to teach our lifeguards how to do deep-water rescue — they don’t need to dive down to nine feet of water to get a brick off the bottom of the pool,” Sutton said.
Dave Huish, general manager of Cowabunga Bay, the other NASCO-trained facility in Utah, said late last season the Utah Department of Health notified him that his park was no longer in compliance with Utah regulations. Huish says he spoke with NASCO, and the company worked it out with the state.
Like Lagoon-A-Beach, Cowabunga Bay is a shallow-water facility. It has no large bodies of water, such as wave pools, and Huish says the certification change hasn’t really affected them. The biggest body of water is the park’s “Lazy River,” and it’s only about 12 feet wide.
“We’ve never used (abdominal thrusts) in the past, and our goal now is to get that person out of the water as quickly as possible,” Huish said. “And because we’re so close, it would almost slow things down to do the abdominal thrusts, so we just get them out as quickly as possible.”
Huish says he understands NASCO’s theory behind abdominal thrusts.
“If you’re in the middle of a wave pool and somebody has drowned, (NASCO’s) concept is that it’s better to be doing something and try to clear out an airway while you’re getting the person to the edge of the pool,” he said. “With us, it’s more important to get them up on the deck and start working on them there, than us performing those abdominal thrusts.”
But Dr. Scott Youngquist — an emergency room doctor, associate professor of medicine at the University of Utah and the medical director for the Salt Lake City Fire Department — says it’s not necessarily better to be “doing something.” Using the Heimlich for a drowning victim is “contrary to current guidelines.”
“It’s not blessed by the medical establishment, that’s for sure,” he said.
A primary concern, according to Youngquist, is that using the Heimlich presents the possibility of delaying the vital care of mouth-to-mouth and chest compressions — two things that should be started as soon as possible on a drowning victim.
But the E.R. doctor says there are other potential problems as well. For example, if the victim dove into a shallow area and hit the bottom, he might have a broken neck.
“Administering thrusts may worsen those injuries,” Youngquist said.
Also, performing abdominal thrusts vigorously on younger patients can cause liver lacerations and bleeding, according to Youngquist.
“It can cause internal injury in some patients,” he said.
That’s not to say there isn’t a time and a place for the Heimlich maneuver.
“It’s certainly lifesaving for an airway obstruction with a solid object,” Youngquist said. “But there really is no evidence you are going to get (a liquid) up — maybe if you turned the patient upside-down and used gravity.”
With a solid object, Youngquist said the Heimlich can generate a pressure wave below the object to dislodge it. With water in the lungs, it requires more force to generate pressure below, and it’s unlikely you’ll be able to eliminate that water.
“I think it’s something that there’s no evidence of benefit, and clearly has the potential for harm,” Youngquist said, which goes against the Hippocratic Oath.
“I just think you want to avoid something that is unlikely to benefit the victim but has clear down sides,” he said.
Gretchen Burdekin, the American Red Cross’ territory aquatics specialist for Utah and Colorado, agrees that the science simply doesn’t support the claims.
“It’s not something the Red Cross uses,” Burdekin said of these abdominal thrusts. “Basically, it’s not safe or effective. It doesn’t work. There is no scientific study that shows that that water can be removed from a drowned person’s lungs using those abdominal thrusts.”
Besides, Burdekin said that when a person drowns, there’s usually not a lot of water in their lungs to be expelled anyway.
In a post on the company’s website titled “An Open Letter To Our Clients, The Public and The Press,” NASCO officials write:
“We are, and have always been, on the cutting edge of lifeguarding technology. We publish our work and are open about what we do. Because of this, we will be and have been attacked by others whose technology and protocols lag significantly behind ours and by some of the press whose desire is to create controversy where none should exist.”
The company offers four reasons why it teaches abdominal thrusts in its safety courses:
-- “It works and works well.”
-- “It does no additional harm to the victim.”
-- “It delays the initiation of on-deck CPR only a very small amount of time.”
-- “It initiates a respiration step early in the rescue sequence.”
Peter Heimlich commends the Utah Department of Health for cracking down on the practice, and he encourages people in other states to ask their government officials if lifeguards are using abdominal thrusts on drowning victims.
And, although it’s caused some friction in the Heimlich family, Peter Heimlich says it’s important to bring this issue to public attention.
“I wasn’t going to keep silent and hope nobody else got hurt,” he said. “Some things go beyond family loyalty.”