In a major holiday feature, The Cincinnati Enquirer offered this potentially lethal pool safety advice: Use the Heimlich maneuver as the first response to someone who is pulled from the water and apparently is not breathing.
Wrong, say the American Heart Association (AHA), the American Red Cross (ARC), Centers for Disease Control and Prevention (CDC), the Coast Guard's expert on drowning and resuscitation, the International Life Saving Federation and its American affiliate and others.
CPR — alternating pressure on the chest and mouth-to-mouth breathing — is the appropriate first response, they agree. It appears doubtful whether the Heimlich maneuver ever should be a response to near-drowning; using it for choking is not the issue here.
Critics say that using it first dangerously delays oxygen to the lungs and brain and can cause the victim to inhale vomited stomach contents with dangerous if not deadly results.
The Enquirer screw-up could have been avoided if it had reported what it long has known about iconic Dr. Henry Heimlich's unflinching advocacy in the face of expert opposition and doubts about his evidence of success.
A clarification came two days later. It should have been a correction. In it, the paper acknowledges the controversy, says CPR is the preferred first response but suggests the Heimlich maneuver is an alternative. Also, the note directing readers to the correct version misleadingly says the original graphic included "procedures not universally accepted."
Almost "universally condemned" is more accurate.
That equivocation provoked outrage from Hamilton County Commissioner Todd Portune, who already had excoriated the Enquirer for its initial instructions. This wasn't politicking; Portune knows his stuff. More on that later, but reacting to the clarification, Portune's damning email says:
"I do not understand the need for the Enquirer to still encourage people to employ a discredited technique in near-drowning events. ... (T)his may have made things even more dangerous because the reader is left to their own devices to figure out what to do instead of being given clear direction. From a public safety perspective, the only thing to do is to give clear, unequivocal direction - not to muddy the waters."
The furor began Saturday of Memorial Day weekend. When someone is pulled from the water, the Enquirer said, call 911 and "while waiting for emergency officials," use the maneuver. "If the victim has not recovered after trying the Heimlich maneuver, proceed with CPR." The paper shows how to apply the maneuver to a person lying down or standing.
That evoked scorn from a U.S. Coast Guard expert on drowning, Rear Admiral Alan Steinman: "One completely stupid aspect of the Enquirer's recommendations, aside from using the Heimlich maneuver itself, is the section on how to administer the maneuver for a victim who is standing. It doesn't take an expert on drowning to know that an unconscious victim of drowning is not going to be standing!"
Sources cited for the paper's initial pool safety advice were the CDC, ARC, AHA, Heimlich Institute Foundation, Gannett News Service, and "Enquirer research." That misrepresents CDC, ARC and AHA. The exception might be if something solid blocks the windpipe and must be cleared for CPR.
The Enquirer can't claim ignorance. It has known about the controversy for years. For months the maneuver has been a focus of The Dean of Cincinnati, a blogger who is no stranger to the paper's editor, on cincinnatibeacon.com. The Dean sometimes is aided by Heimlich's younger son, Peter, who also communicates with local journalists in his national campaign to discredit the maneuver as a near-drowning response.
Ironically, the cock-up opens the long-closed Enquirer door to Peter Heimlich and his allies. The question is not whether Enquirer artists, who produced the "info-graphic," will be scapegoats but whether the Enquirer will publish a savvy story about Henry Heimlich's persistent promotion of his maneuver as the appropriate first response to near-drownings.
Locally, Portune's critique demonstrates the power of controlled anger and sound memory. His initial email to the paper, says, in part: "This is an urgent life and death message. ... To use the Heimlich maneuver first has been rejected by every credible medical body that has considered the issue. ... The critical issue in drowning is to force air (oxygen) into the lungs as quickly as possible and to do so first. Seconds count, and anything that delays bringing oxygen into the lungs is considered life threatening. ... Under ARC guidelines, and consistent with the practice and recommendations of all credible emergency medical agencies and most national (and local) life-guarding services, using CPR first is the only acceptable first response."
Then Portune turned to hearings the paper covered and "Enquirer research" should have found.
"In 1993 Dr. Heimlich approached Cincinnati City Council and urged that we shift away from CPR as the first response in the city's pools. I, as the chair of council's Law and Public Safety Committee, oversaw the debate and conducted hearings on the matter. We had evidence presented by the foremost emergency medical authorities on the subject."
Heimlich was rebuffed, Portune adds.
"Our decision has proven correct," he writes.
In addition to local responses, the Enquirer provoked these incredulous emails:
· B. Chris Brewster, a commissioner of the International Life Saving Federation and president of its U.S. affiliate, says, "The Heimlich maneuver for drowning is an internationally discredited and denounced procedure. It has never been accepted or adopted by the CDC, ARC, AHA or any reputable medical authorities. Internationally accepted standards on drowning resuscitation ... state: 'Attempts to remove water from the breathing passages by any means other than suction (e.g. abdominal thrusts or the Heimlich maneuver) are unnecessary and potentially dangerous. The routine use of abdominal thrusts or the Heimlich maneuver for drowning victims is not recommended.' "
· Robert S. Baratz, who identifies himself as an emergency physician and president of the National Council Against Health Fraud, in Peabody, Mass., says, "Henry Heimlich, who has never apparently treated a drowning victim, who was not an emergency physician ... is now proclaimed by The Cincinnati Enquirer as an expert in drowning. ... Health fraud is the promotion of the unproven without a disclaimer. The Enquirer piece continues to fit that definition."
Responding to my questions, Steinman, former director of health and safety — equivalent to the Surgeon General — of the Coast Guard, says the Enquirer's original advice "will no doubt put lives at risk."
Steinman is a physician and expert on drowning, sea survival and hypothermia. He says, "No expert on drowning advocates using the Heimlich maneuver as a first response, if at all, in drowning resuscitation. Furthermore, the Institute of Medicine of the National Academy of Sciences thoroughly evaluated the issue and recommended, in no uncertain terms, NOT to use the Heimlich maneuver as a first response in drowning."
Steinman adds, "The Heimlich maneuver is almost certain to cause the victim to aspirate (vomit and inhale) stomach contents, which can gain entry into the lungs and cause severe damage, perhaps making subsequent resuscitation impossible. In a fresh water drowning, very little water gains entry into the lungs, and what does is rapidly absorbed. Thus, contrary to what Heimlich claims, the victim's airway is not filled with water."
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The Cincinnati Post's Memorial Day weekend headline, "Tributes to human sacrifices," is the new Little Gem News Service (LGNS) challenge. Send a very brief news story that plays off that headline to [email protected]. I will publish the winner next month. See April's column for LGNS history.
Ben L. Kaufman teaches journalism ethics at Northern Kentucky University.