The (Confusing) Red Cross Response

A reader gently chided me for writing that the American Red Cross “inexplicably” abandoned abdominal thrusts (the Heimlich Maneuver) as its recommended first response to choking.

A reader gently chided me for writing that the American Red Cross “inexplicably” abandoned abdominal thrusts (the Heimlich Maneuver) as its recommended first response to choking.

"Inadequately explained why may be more accurate,” my reader wrote, saying the Red Cross issued a “pretty decent explanation . . . about seven years after the fact.”  That’s a gentle way of saying the Red Cross let Americans believe for years that abdominal thrusts still were the best first response to potentially deadly choking after it decided otherwise.

Before the Red Cross attempt at explanation/justification, local and national Red Cross offices were unresponsive to my attempts to sort out the return to back slaps and abandonment of the “Heimlich” name for abdominal thrusts.

What tickles me is that when the national Red Cross decided to explain anything, it was responding to a story about Henry Heimlich by the Cincinnati Enquirer’s Cliff Radel. Or put another way, Radel moved the American Red Cross closer to candor than anyone else since it adopted and dropped the Heimlich Maneuver as its recommended first response to choking.

I read Radel’s Jan. 21, 2013 story when it appeared. I saw the Red Cross’ response recently, tipped by my reader. So here is that official explanation from the Jan. 22, 2013 Red Cross Blog by Dr. Richard N. Bradley:

“ . . . (A)n article appeared in the Cincinnati Enquirer outlining some differences in opinion about how people should respond to choking emergencies. There are a few things you should know about our stance on how to treat choking emergencies.

“First, it’s important to know that all Red Cross training and related products are designed based on the most up-to-date science available on first aid, CPR, AED and emergency cardiovascular care.

“The Red Cross even has its own Scientific Advisory Council to help evaluate the best science available. This council is an independent body of experts that provides guidance, based on scientific and educational research, on content for Red Cross programs, products and messaging. I’m a member of the Scientific Advisory Council and chair of its CPR Sub-Council, and here are several other points about how we developed our choking recommendations:

“The Red Cross has recommended using multiple protocols for removing foreign body obstructions blocking airways including delivering back blows, administering abdominal thrusts — Heimlich Maneuver — and administering both black blows and abdominal thrusts.

“In 1974, Dr. Henry Heimlich came to the Red Cross advocating his maneuver. An ad hoc committee was formed in 1975. Based on the committee’s recommendation, performing abdominal thrusts was included in the 1976 edition of the Red Cross booklet First Aid for Foreign Body Obstruction of the Airway. The Red Cross uses the term ‘abdominal thrusts’ rather than the namesake ‘Heimlich Maneuver’ in training programs and materials in order to clearly describe exactly what the skill is.

“American Red Cross 2005 Guidelines for Emergency Care and Education recommend using cycles of 5 back blows and 5 abdominal thrusts to treat conscious, choking children and adults. A review of the scientific literature suggested that back blows, abdominal thrusts and chest compressions are equally effective.

“Additionally, the use of more than one method can be more effective to dislodge an object. These findings are consistent with those of international resuscitation societies. The Red Cross certainly isn’t discounting the use of abdominal thrusts. But we include back blows, abdominal thrusts and chest compressions in our training because there is no clear scientific evidence to say that one technique is more effective than the others when treating a choking victim.

“Related literature was reviewed during the 2010 Guidelines process and the recommendation remains the same. The... Scientific Advisory Council is currently conducting a triennial scientific review on techniques to treat first aid for conscious, choking victims.

“We produce similar periodic reviews for all lifesaving skills and, as always, we’ll take great care and effort to review the best science behind how we tell the public to respond to a choking emergency.”

What Dr. Bradley doesn’t reveal is when the Red Cross dropped the Heimlich name or what science initially persuaded advisors to embrace abdominal thrusts under the Heimlich Maneuver name. If there was more than anecdotal evidence, he doesn’t cite it. The same is true of the shift back to back blows as the first response. That’s because the science doesn’t exist, Bradley told Radel days earlier for the story that prompted his blog entry.

"To the best of my knowledge, after doing a pretty thorough literature search, no controlled studies exist comparing back blows to abdominal thrusts or anything else," Bradley said.

Bradley, also a member of the Red Cross' Preparedness, Health and Safety Services advisory council and an associate professor of emergency medicine at the University of Texas Medical School at Houston, isn’t alone in this.

"The literature says there is no one definitive treatment to relieve an obstructed airway on a conscious person," William Terry Ray, director of the University of Cincinnati College of Nursing's Nurse Anesthesia program, told Radel.

Ray said he looked at 40 years of research. The reviews concluded "a person may have to use the back blows as well as abdominal thrusts to relieve the obstruction, depending on what caused the person to choke." No definitive study exists to support Heimlich's theory that slapping someone on the back can push an obstruction further down the throat, Ray continued. "The literature on this is not conclusive either." Studies cited in a review of research projects "used animals, cadavers and anecdotal evidence." But not living human subjects.

Bradley told Radel that human research on this common killer is not where the grant money is. Choking happens outside of laboratory and research hospital settings, Bradley said. "Not enough dollars go to out-of-hospital research." Nevertheless, choking remains a killer, Bradley added. "Anytime something is in the top five, it is a priority for research."

Bradley did not respond to a CityBeat question about the evidence he referred to in his Red Cross blog.

CURMUDGEON NOTES:

The Enquirer’s glowing promo of new Whitfield Avenue apartments just north of Good Sam missed or ignored the zoning fight between developers and neighbors along Terrace Avenue.

Neighbors are pleased to see new apartments replacing aged buildings. Issues involve stabilization of Terrace Avenue hillside back yards adjacent to the new construction, privacy after years of trespass by former Gaslight Property tenants and plans to shift significant tenant parking to neighborhood streets already crowded with Good Sam and UC student vehicles. 


The dispute went to a formal 90-minute zoning hearing. We live on the affected Terrace Avenue block. I spoke at the hearing although our property is not directly involved in the soil stabilization issue. Parking and protecting children from tenant-trespassers were my issues. All of this is on the hearing record.

The Enquirer could also have reported Mayor John Cranley’s pro-developer intervention in the zoning decision after the comment deadline. 


Post-hearing conversations between the developer and neighbors may resolve the issues. Meanwhile, this week’s Enquirer story — on the cover of its More Local+Business section — is a classic of the paper’s growing “boost, don’t knock” news policy.


• Monday’s funeral for U.S. District Judge S. Arthur Spiegel reminded me of his role in my sole encounter with the U.S. Supreme Court. It reflected his decades on the bench: Insist on the rules but do it with as much grace and humor as possible.

My moment arose from the judge’s pioneering use of summary jury trials to resolve complex civil cases that threatened to tie up his court for months. Real jurors heard evidence presented by attorneys and brought in nonbinding advisory verdicts.

More often than not, a new, realistic appreciation of the dollar amounts in those advisory verdicts speeded settlements. The judge treated a summary jury trial as a settlement conference, as if it occurred in his chambers.

By then, our professional relationship had matured into “Art” and “Ben”; I’d flown in his Piper Clipper and our family had become friends with the judge and his wife, Louise.

In this one case, defense attorneys didn’t want me to know the verdict. They said a Cincinnati Enquirer story could influence new jurors if settlement proved elusive and the suit went to trial. Art warned me that I’d have to leave when jurors said they’d reached a verdict and defense attorneys formally asked him to close the court to reporters. He promised me a moment to request time to bring in an on-call Enquirer lawyer to challenge his decision. However, he’d deny my protest.

When I said we’d ask the Sixth Circuit Court of Appeals to overrule him, Art said, in effect, “Go for it.” The appellate court agreed that the summary jury trial was public and immediately allowed me back into court. Unhappy defense attorneys won an equally swift decision from a Supreme Court justice overturning the Sixth Circuit and affirming Art’s original ruling: summary jury trials were settlement conferences and he could close them to reporters and seal the verdicts.

It was all done with good humor; court security officers were in on the choreography. They smiled as they waited for me to stand and make my protest before escorting me out. Then back into the court room. And out again.

• Ferguson, MO, police suspended spokesman Tim Zoll after he called a spontaneous memorial for shooting victim Michael Brown “a pile of trash in the middle of the street.” At first, Zoll denied he said that to a Washington Post reporter and city officials believed him. Then officials said, “The officer admitted to department investigators that he did in fact make the remarks attributed to him, and that he misled his superiors when asked about the contents of the interview.”

• Here’s a University of Cincinnati Health screw up that I’m sure the Enquirer can spin as an upbeat advance: a new requirement for privacy reviews of proposed postcard patient notifications. This follows postcards in October telling recipients about “strategies for managing your Epilepsy.”

Great idea except that the postcard — personalized medical information on one side and recipient’s name and address on the other — offended federal medical privacy law.

The postcard should not have included the personal pronoun, “your.” Even without that pronoun, the message would suggest the recipient was epileptic and, at least, that could violate the intent of HIPPA rules. Why else receive that postcard?

Two months later, a “personal and confidential” letter warned postcard recipients of the UC Health privacy breach. Two revelations in that letter cry for news coverage.  First, UC Health said it sent the letter because it was “required to notify you of the possible disclosure.” That suggests UC Health would not have acted otherwise.

Second, UC Health apparently had no HIPPA privacy compliance review for postcard mailings but they said they’d start one now. Apparently, any previous postcards with names and addresses and indications of serious medical conditions didn’t prompt privacy considerations. Oh, and by the way, the Epilepsy postcard went to some people who don’t have that medical condition.

• The Enquirer couldn’t avoid reporting that UC Hospital was the only local health center to be docked 1% by Medicare for medical lapses. In an attempt to spin the bad news, UC said the problems were worse in previous years.

The Enquirer’s Cincinnati.com said Medicare based the penalty on “three measures: frequency of central-line bloodstream infections caused by tubes used to pump fluids or medicine into veins; infections from tubes placed in bladders to remove urine, and rates of eight kinds of serious complications that occurred in hospitals, including collapsed lungs, surgical cuts, tears and reopened wounds and broken hips.”

The Centers for Medicare and Medicaid Services websites indicate those Hospital Acquired Conditions at UC Hospital were significantly above the maximum permissible measures but Cincinnati.com didn’t tell us how bad the problems were.

• The Enquirer and WCPO.com provided intelligent coverage of a Warren County transgender teen’s suicide. Not long ago, the youngster’s suicide wouldn’t have been reported; barring a very public act, suicide was ignored by the news media as too shameful to report. There’s still anxiety whether a news story would prompt copy cat suicides.

Not long ago, same-sex anything was too shameful to report unless it involved arrests. It was the stuff of scandal, whisper and giggle. Coverage of LGBTQ life and issues — from identity to marriage — is now routine. In part, social media changed that. Once people read Josh/Leelah Acorn’s Tumblr blog suicide note, it couldn’t be ignored. Now it’s an international story, seemingly free of nudge, wink and giggle.

• Speaking of nudge, wink and giggle, TV showed Aaron Rodgers pulling a colleague’s long, red beard during a recent Green Bay Packers game. That inspired someone at the St. Paul Pioneer Press to tweet, “It’s red and 9 inches long, and #Packers quarterback Aaron Rodgers tugs it for good luck..."

NYTimes’ Science Tuesday section last week recounted how early responses to Ebola in West Africa went lethally awry. Experts got it wrong. The World Health Organization — perpetually corrupt and inept — undermined others’ efforts. Ever-sensitive African governments obstructed outside — read white — efforts to control the outbreak. Local traditions and suspicions kept people from cooperating with often-clueless medical teams. It’s a reminder of why we need financially stable news media willing to commit their resources to serious journalism. It’s also a reminder that “long form” reporting can be riveting in the hands of keen reporters, talented editors and a fine story-teller.

• When Weekly Standard’s Bill Kristol and the NYTimes’ Gail Collins agree at almost the same moment, I view it with the kind of dread that people have responded to comets for millennia.

As NASA.gov puts it, comets have been called “Harbinger of Doom’”or “the Menace of the Universe” because they’ve been regarded as omens of disaster and messengers of the gods. That’s comets, not Kristol and Collins. But the two commentators mined electoral history that streaks across our consciousness.

Kristol: “Since 1952, with the only exception being ‘Reagan’s third term’ in 1988, voters have ousted the incumbent party after eight years. Indeed, the candidate of the eight-year incumbent party always does considerably worse in his election than the incumbent running for reelection four years before.”

Collins: “(N)o Democrat has been elected to succeed another Democrat since James Buchanan in 1856.” (Truman was the incumbent in 1948; he succeeded FDR in 1945.)

• It was too good to check out, so editors’ credulity created a howler. I’ll let London’s Guardian tell the instructive tale involving Huffington Post, London’s Independent and others:

“Argentina’s President Cristina Fernández de Kirchner has not become godmother of a Jewish baby to stop him from becoming a werewolf — despite what you may have read...Like all good urban myths, the articles were based on a grain of truth: By tradition, the seventh son (or daughter) born to an Argentine family is eligible to become the godson (or daughter) of the president.

“Until this month, the honour had only been bestowed on Christian babies, but on Wednesday, Iair Tawil — not a baby, but the strapping 21-year-old son of a rabbi — became the country’s first Jewish presidential godson...But somehow, the story became entangled with the ancient legend of the lobizón (Argentina’s equivalent to the European werewolf).

“According to some versions of the myth, the seventh son of the seventh son is particularly prone to fall victim to the curse. Evidently, the chance meeting of a Latin American president with a colourful myth too good to fact-check proved irresistible

“...But according to Argentine historian Daniel Balmaceda, there is no link between the two traditions. ‘The local myth of the lobizón is not in any way connected to the custom that began over 100 years ago by which every seventh son (or seventh daughter) born in Argentina becomes godchild to the president,’ he said.

“That custom began in 1907, when Enrique Brost and Apolonia Holmann, Volga German emigrés from south-eastern Russia asked then-president José Figueroa Alcorta to become godfather to their seventh son, said the historian. ‘The couple wanted to maintain a custom from Czarist Russia, where the Tsar was said to become godfather to seventh sons, and Argentina’s president accepted.’”

The Guardian continued, saying the practice became tradition and was passed into law in 1974.

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