United States Lifesaving Association PO Box 366 Huntington Beach, California 92648 Tel: 866-FOR-USLA www.usla.org B. Chris Brewster President March 31, 2004 Jerry Gavin Vice-President David Shotwell Secretary Greg Farry Treasurer Duke Brown Recurrent Representative Eric Bauer Liaison Officer Tim Gallagher Advisor Dr. Peter Wernicki Medical Advisor John Chip More Legal Advisor Henry J. Heimlich, MD, ScD, President The Heimlich Institute 311 Straight St. Cincinnati, OH 45219-9957 Dear Dr. Heimlich, In 1995, American Lifeguard Magazine, which is published by the United States Lifesaving Association, carried an article which you authored, The Heimlich Maneuver First Step for Resuscitating a Drowning Victim. In the article, you recommended to our readers, who are professional lifeguards, For unconscious, nonbreathing drowning victims, perform up to five Heimlich Maneuvers, stopping when water no longer flows from the mouth. Almost all victims recover immediately, unless submersion was prolonged. Follow with CPR when necessary. It was thus your recommendation that lifeguards perform the Heimlich maneuver on drowning victims prior to initiating CPR and your assertion that almost all drowning victims will recover immediately, except in cases of prolonged submersion. Your article went on to state, Some lifeguards may be concerned as to whether they are obligated to follow American Red Cross recommendations Based on the evidence in this paper, I stand ready to testify that if a drowning victim dies and the Heimlich Maneuver was not the first treatment, that the treatment was inadequate. You thus encouraged lifeguards trained under CPR protocols maintained by the American Red Cross to ignore those protocols in favor of the protocols you advocated. You further stated that, Finally, all first aid, rescue and lifeguard training organizations agree that the Heimlich Maneuver should be used to save drowning victims. Your article credited discovery of the usefulness of the Heimlich maneuver in treating drowning victims to Victor Esch, MD, of Potomac, Maryland. You stated, In 1974 he watched as a lifeguard pulled a man from the water at Rehoboth Beach, Delaware, and declared the victim dead. Dr. Esch stepped forward and performed the Heimlich Maneuver on the man. Water gushed from the victim s lungs and he immediately recovered. According to an August 28, 1974 article in the Washington Star-News, this rescue purportedly took place on August 14, 1974. The victim, Donald Urquhart
of Columbia, Maryland, was taken to Milford Memorial Hospital [Delaware] where he was treated for two days and then released. Your article in American Lifeguard Magazine included a footnote to a journal article authored by you which described this case (JAMA, 1975, 234:398-401). Your article in American Lifeguard Magazine included footnotes to three other articles authored by you, one of which was coauthored by Dr. Edward Patrick. All three articles describe a case in which Dr. Patrick purportedly used the Heimlich maneuver to revive a two year old drowning victim (Annals of Emergency Medicine, 1981, 10:476-480; Emergency Medical Services, 1981, 10(4):58, 60-61; Postgraduate Medicine, 1988, 84(2); 62-73). Although the name of the victim and other details were not included in your articles, it has been suggested to us that you and Dr. Patrick were referring to the case of Erin Snow, a two year old girl who was treated at Lima Memorial Hospital in Lima, Ohio, after a drowning accident on June 22, 1980. Recent information provided to us has raised questions regarding the factual basis of the Donald Urquhart and Erin Snow cases you have cited that purport to show the efficacy of the Heimlich maneuver for drowning. We have an ethical obligation to investigate and to correct the record, if necessary. We presume that you have personally reviewed corroborating evidence regarding these cases that validate your use of them as anecdotal evidence of efficacy of the Heimlich maneuver in drowning cases. In that regard, can you please: 1. Provide the names of the physicians and hospital staff who treated Donald Urquhart at Milford Memorial Hospital, and who treated Erin Snow at Lima Memorial Hospital. 2. Provide hospital reports from both cases. 3. Provide the names of lifeguards and EMTs who participated in the Urquhart rescue. 4. Provide the names of ambulance personnel who participated in the Snow case and who will corroborate Dr. Patrick s version of events. 5. Provide copies of EMT run sheets in both cases and a lifeguard report from the Urquhart rescue. 6. Provide a list of the people you interviewed in both cases to validate the facts you have cited. 7. Provide any clinical and anecdotal evidence beyond these two cases that supports your claim that when the Heimlich maneuver is used as a first step in drowning resuscitation, Almost all victims recover immediately, unless submersion was prolonged. 8. Provide any evidence you may have to demonstrate that, as you stated, all first aid, rescue and lifeguard training organizations agree [or agreed at the time of your article s appearance] that the Heimlich maneuver should be used to save 2
encl: American Lifeguard Magazine article Washington Star-News article cc: Bryan Burklow, President, Deaconess Associations E. Anthony Woods, Chairman of the Board, Deaconess Associations Harvey V. Fineberg, MD, President, Institute of Medicine Augustus O. Grant, MD, PhD, President, American Heart Association Marsha J. Evans, President, American Red Cross Tracy Napper, Managing Editor, Annals of Emergency Medicine Peter A. Setness, MD, Editor in Chief, Postgraduate Medicine Carol Summer, Executive Editor, Emergency Medical Services Victor H. Esch, MD Edward A. Patrick, MD 4