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Updated November 26, 2011

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NASCO  founder/president John Hunsucker PhD traning lifeguards


"These so-called medical experts. Screw 'em."

Why does NASCO teach lifeguards to perform abdominal thrusts (the Heimlich maneuver) on drowning victims?
by Peter M. Heimlich

CLICK HERE TO GO TO MEDIA REPORTS

 

SUMMARY: Drowning experts and every major first aid organization unanimously agree that performing abdominal thrusts (the Heimlich maneuver) on near-drowning victims has no proven value and its use may result in serious injury or death. Nevertheless, a Texas company called the National Aquatic Safety Company (NASCO) is training lifeguards at private waterparks and municipal pools around the country to perform the procedure.

Use of the Heimlich Maneuver First in Near-drowning Victims, American Red Cross, August 2005

Despite consensus, Henry J. Heimlich MD, who developed the maneuver to relieve choking victims, contends that in cases of near-drowning the Heimlich maneuver should be the first procedure attempted, before CPR. Dr. Heimlich contends that water gets into and obstructs the airway of near-drowning victims and that his maneuver will relieve this obstruction.

American Red Cross position: The American Red Cross follows the the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) guidelines which state that if a victim is not breathing, the rescuer should initiate CPR immediately...These AHA CPR/ECC guidelines are supported by the American Academy of Pediatrics, the American College of Cardiology, the American College of Emergency Physicians and the Institute of Medicine of the National Academy of Sciences. For more information reference the full Advisory Council on First Aid and Safety statement.

Adult Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, December 2010

Pediatric Submersion Injuries: New Definitions and Protocols by Charles Stewart, MD, FAAEM, FACEP, Pediatric Emergency Medicine Practice, April 2006

There is no evidence that water acts as an obstructive foreign body. Maneuvers to relieve foreign-body airway obstruction (FBAO) are not recommended for drowning victims because such maneuvers are not necessary and they can cause injury, vomiting, aspiration, and delay of CPR.

Dr. Heimlich, who advocates the use of the “Heimlich” maneuver to express water out of the lungs, expounds a notable exception to the policy of no “chest drainage maneuvers”. There are no data to support the use of a Heimlich maneuver in a drowning victim who does not have a particulate matter foreign body obstruction, and recently, the case reports that served as the basis for recommendations for the use of the Heimlich maneuver, have been debunked.


Care must be taken to prevent aspiration of gastric contents since vomiting is very common with this maneuver. It is imperative that no time be wasted with this or other maneuvers.

Further, the use of abdominal thrusts on near-drowning victims has reportedly been associated with dozens of such poor outcome cases, including children. For examples, see my web page, Some of the victims - casualties of the Heimlich maneuver for drowning rescue.

Despite this body of evidence, lifeguards at "some of the largest waterparks in the country" are being trained to perform abdominal thrusts (the Heimlich maneuver) on near-drowning victims by the Houston-area National Aquatic Safety Company (NASCO), "the third largest lifeguard certification agency for waterparks in the U.S." according to the company's website

According to a 2007 Houston Press cover story, here's how NASCO founder/president John Hunsucker addressed the matter:

"These so-called medical experts. Screw 'em."

From An Open Letter To Our Clients, The Public and The Press on NASCO's website (accessed 11/26/11):

The reasons that abdominal thrusts are embedded in our rescue protocol can be simply stated as:
  • 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, and
  • It initiates a respiration step early in the rescue sequence.
...During the rescue process, we do five and only five abdominal thrusts while the victim is still in the water.

In May 2010, the International Journal of Aquatic Research and Education (IJARE) published a research study by Hunsucker and Scott Davison, another NASCO employee. Their paper touted the advantages of performing abdominal thrusts on drowning vicitims.

In February 2011, IJARE published a stinging analysis/rebuttal by seven leading medical & water safety experts:




From the rebuttal (AT = Abdominal Thrust):

The use of ATs/Heimlich maneuver for drowned victims has been extensively reviewed, twice by the Institute of Medicine (Rosen & Harley, 1995), multiple times by the Emergency Cardiovascular Care Committee of the American Heart Association (Quan, 1993), by the International Liaison Committee on Resuscitation and twice (in 2000 and 2006) by the Advisory Council on First Aid, Aquatics, Safety, and Preparedness (ACFASP) committee of the American Red Cross (Pia, Fielding, Wernicki, & Markenson, 2010). At each review, each body recommended against its use for drowning resuscitation, noted that ATs may be harmful, and limited its use only to airway obstruction caused by a solid foreign object. The International Lifesaving Federation condemned its use in a published medical position statement (International Life Saving Federation, 1996). No resuscitation guideline that we are aware of anywhere in the world supports its use in drowning.

...The most disturbing aspect of this study is that Hunsucker and Davison ignored the ethical principles governing the conduct of human subject research. The study failed to adhere to all three recognized principles of human subject research—autonomy, beneficence, and justice as outlined in the Belmont Report National Commission (1979) and codified in all current regulations regarding human subject research. It appears that experimentation was conducted on unknowing human subjects (failure to adhere to autonomy). It involved the use of a disproved and potentially dangerous procedure that ignored the international standard of care - CPR (failure to recognize beneficence). To make matters even worse, the majority of the victims treated in the study were children (failure to adhere to justice). Apparently, no institutional review board was involved, consent was not obtained, and procedures for the conduct of human research in the absence of prospective informed consent were not followed. The authors seemed to justify and conduct the experiment on their own without any oversight or outside review. There was no informed consent given by the victims/patrons, but it is also unclear if the lifeguards, instructors, facilities, or their insurers were aware that they were participants in an unsanctioned study. By failing to employ appropriate methodology, statistical analysis, and conduct of the study as previously described, the study cannot be of benefit and thus fails even the minimal required test of human subject research - that a study has social value and scientific validity.

Both IJARE papers are behind a subscription paywall. Contact me for more information.


MEDIA REPORTS

6/3/11: NoVa parks authority teaches lifeguards discredited Heimlich maneuver (UPDATE: Authority discards Heimlich) by Tom Jackman, The Washington Post

The Heimlich maneuver became famous as a way for people to dislodge a foreign object from a choking person’s airway. But it’s been utterly discredited as a way of rescuing a person who is drowning, and can actually do serious harm to someone who has just been pulled from the water, numerous experts say.

Still, one aquatics company, National Aquatic Safety Company of Houston, is training lifeguards to use the Heimlich maneuver.

Dr. James Orlowski said he has documented nearly 40 cases where rescuers performing the Heimlich maneuver have caused complications for the victim. Orlowski is chief of pediatrics and pediatric intensive care at University Community Hospital in Tampa.

...One of the most vehement critics of the Heimlich maneuver for drowning victims is Peter Heimlich, Henry Heimlich’s son. He has created a website which extensively documents his father’s supposed missteps, including allegedly taking false credit for creating the Heimlich maneuver, and calls the use of the maneuver for drowning “a 30-year medical atrocity.”

Heimlich said that the media “have incorrectly written that there’s a ‘controversy’ associated with the treatment. In fact, in the medical community, it’s my father vs. everyone else. That’s not a controversy, that’s one celebrity doctor -- someone who hasn’t worked in a hospital since 1976 and has no background in drowning except for his claims promoting the Heimlich maneuver -- making unsupported claims.”

7/27/09: Local Lifeguards Trained In Dangerous Techniques (text version) by Bennett Cunningham, CBS-TV News, Dallas


10/11/07:
Fighting for Air: Drowning and the Heimlich Maneuver
by Todd Spivak (cover story), Houston Press
 
8/24/09: Questions Continue To Rise About Houston-Based Lifeguard Program by Mike Giglio, Houston Press

1/23/09: Swimming in Controversy - The Heimlich Maneuvers by Laurel Chesky, Austin Chronicle

8/22/11: Paso Robles water park lifeguards use discredited Heimlich maneuver by Karlee Prazak, CalCoast News

6/22/11: Heimlich, Dangerous? Experts discredit maneuver by Eric S. Peterson, Salt Lake City Weekly


July/August 2007: Letter to the Editor from B. Chris Brewster, President, International Life Saving Federation, Aquatics International magazine



NASCO materials

From An Open Letter To Our Clients, The Public and The Press, NASCO's website (unsigned, undated):

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.

In truth, most of the criticism centers on the use of abdominal thrusts in our rescue protocol. 

...We neither support nor do not support the application of abdominal thrusts as a method of treatment for drowning by the general public. We are neutral on this issue.

...A fact which is often reported in the press, and seems to have little bearing on the issues at hand, but perhaps should be addressed is this: John Hunsucker, NASCO’s president, has four college degrees and none of them are in medicine. Hunsucker’s degrees are in math, physics and engineering.

 
8/12/09 NASCO press release re: "misleading and prejudicial (media) statements'




Norm Matzl

Per this article, NASCO employee Norm Matzl (formerly of Ellis & Associates) has been hyping the Heimlich for drowning since at least 1995:




"Supervisors Leadership Training with NASCO Instructors Karlee Darby and Brian Cole"
(Century Pool Management)