Heimlich's Maneuver

Usually, when a case study is biased -- or shown to be fabricated -- the motive is profit. A pharmaceutical company, for example, wants to demonstrate that its drugs work, and it's willing to cheat to do so.

In the Erin Snow case, profit wasn't a factor, but as the man behind the technique, Heimlich had much to gain.

Says Dr. James Orlowski, a drowning expert who spent 19 years at the Cleveland Clinic before moving to Tampa: "He has a personal investment in this whole thing, and he's taken a rather disingenuous approach to it."

Still, the medical field did not initially suspect fraud. It just dismissed Patrick's article as error-ridden and Heimlich's endorsement of it as foolhardy.

"The science behind it was totally bogus," says Orlowski. He and other national experts contend that Heimlich operates on a fundamentally false premise: that water fills the lungs and blocks the airway of drowning victims.

Instead, studies show that the moment water threatens to surge into the lungs, the vocal cords shut, a response called laryngospasm. A person has about two minutes before laryngospasm expires, after which water may flow into the lungs. But research has shown the water doesn't stay there to block the airway. Rather, it is absorbed by tissue and passes into the bloodstream.

Hence, revival depends on ventilation, not on removing water. A near-drowning victim who received the Heimlich maneuver would almost certainly vomit, but experts say that does little to aid breathing. Worse, the sheer mess of a vomit-covered face might discourage rescuers from performing mouth-to-mouth resuscitation. And in drowning rescue, mere seconds of delay could make the difference between full recovery and brain damage or death.

The other concern is that vomit may come up, only to go back down into the victim's lungs. "The stomach contents are acid," says Orlowski, "so it's like pouring acid into your lungs. Acid doesn't belong there . . . It essentially eats the lungs."

Finally, since some drownings occur after a head or neck injury, performing the Heimlich maneuver might compound spinal damage.

With science stacked against it, and with only a single flimsy study to support it, the nation's experts considered the Heimlich maneuver dead on arrival.

But his opponents underestimated Heimlich's power of persuasion as well as his persistence.

"In my experience," says Peter Heimlich, "he cannot hear the word 'no.' Sometimes it's good to be resolute, but this is something different."

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Once every six years, the American Heart Association convenes leading researchers to consider how advances in science can serve the many health concerns under its purview.

By 1985, Heimlich had enough influence to land a seat on the association's Special Situations Committee. The stakes were high. If Heimlich succeeded in convincing the panel that his maneuver worked for drownings, lifeguards the world around would adopt his technique at beaches and pools. At his side was Dr. Patrick.

The pair cited Patrick's Lima case, as well as a case involving Dr. Victor Esch, another friend of Heimlich's who claimed that he, too, had saved a drowning victim by using the Heimlich maneuver in 1974.

But since Esch's case was never reported in a medical journal, it had even less credibility than Patrick's.

What he lacked in scientific evidence, Heimlich made up for in hubris. Transcripts from the meetings show Heimlich battling with University of Florida researcher Dr. Jerome Modell, one of the world's foremost authorities on drowning. Modell was backed by thorough, objective research; Heimlich by Patrick's case and little else. Nonetheless, Modell acquiesced, conceding that the Heimlich maneuver could be performed second -- if CPR failed.

Still, Heimlich insisted that his maneuver should be the first response. The final decision rested with the committee chair, Dr. Joseph Ornato. In letters Ornato wrote to Heimlich, he says that the night before he was to pass judgment, Heimlich confronted him, threatening that if he didn't get his way, he would "go to the media."

Ornato struck what looked to be a compromise. He kept CPR as the first response, but mentioned the Heimlich maneuver's use in those cases where a solid object, like food or sand, obstructs the airway, or if CPR fails.

Heimlich was furious. In one letter he told Ornato that "your recommendation of August 5 condemns the drowning victim to die due to water in the lungs rather than performing the Heimlich maneuver to expel water."

In his next letter, Heimlich drifted into conspiracy theory. "It is now clear there has been a secret conference." He charged that the decision was a "furtive process" between Ornato and his "collaborators" on the committee. He even scolded Ornato for using the term "subdiaphragmatic thrust" instead of "Heimlich maneuver."

Admiral Alan Steinman, the U.S. Coast Guard's water-safety specialist and a committee member, doesn't remember collaborating. "There were no secret meetings. We didn't say, 'We've got to get Heimlich.' That's crazy. It was simply a matter of 'Here's what science shows, and Heimlich is advocating something that isn't supported by studies.'"